title: Lobar distribution of changes in gray matter and white matter in memory clinic patients: detected using magnetization transfer imaging.
abstract: OBJECTIVE
  Previous studies have shown involvement of both gray matter (GM) and white matter (WM) in mild cognitive impairment (MCI) and Alzheimer disease (AD). In this study, we assessed the lobar distribution of the GM and WM pathology over the brain and the association of lobar distribution with global cognitive decline.
  
  
  METHODS
  Fifty-five patients with AD, 19 patients with MCI, and 43 subjects with normal cognitive function participated in this study. GM and WM were segmented on dual fast spin-echo and fluid-attenuated inversion recovery MR images. A custom template representing anatomic areas was applied. Magnetization transfer imaging (MTI) peak height and mean magnetization transfer ratio (MTR) provided measures for structural brain damage.
  
  
  RESULTS
  Both mean MTR and MTI peak height showed that patients with AD had more structural brain damage in the GM of all lobes compared with controls. Patients with MCI had lower GM peak height compared with controls for the temporal and frontal lobe. WM peak height was lower for all lobes investigated for patients with both AD and MCI. WM mean MTR was lower in the frontal, parietal, and temporal lobes for patients with AD compared with controls. Age and both temporal GM peak height and mean MTR were the only parameters that predicted cognition.
  
  
  CONCLUSIONS
  This study shows that in addition to more focal GM MTI changes in the temporal and frontal lobes, widespread WM changes are present in the earliest stages of AD. This might point to an important role for WM pathology in the earliest stage of AD.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. A.C.G.M.van_Es@LUMC.nl
authors.forename: A C G M
authors.initials: AC
authors.lastname: van Es
authors.forename: W M
authors.initials: WM
authors.lastname: van der Flier
authors.forename: F
authors.initials: F
authors.lastname: Admiraal-Behloul
authors.forename: H
authors.initials: H
authors.lastname: Olofsen
authors.forename: E L E M
authors.initials: EL
authors.lastname: Bollen
authors.forename: H A M
authors.initials: HA
authors.lastname: Middelkoop
authors.forename: A W E
authors.initials: AW
authors.lastname: Weverling-Rijnsburger
authors.forename: J
authors.initials: J
authors.lastname: van der Grond
authors.forename: R G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology* / Q000523:psychology; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000473:pathology* / Q000523:psychology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D009778:Occipital Lobe / Q000473:pathology; D010296:Parietal Lobe / Q000473:pathology; D013702:Temporal Lobe / Q000473:pathology