title: Regional atrophy is associated with impairment in distinct cognitive domains in Alzheimer's disease.
abstract: BACKGROUND
  In Alzheimer's disease (AD), some patients present with cognitive impairment other than episodic memory disturbances. We evaluated whether occurrence of posterior atrophy (PA) and medial temporal lobe atrophy (MTA) could account for differences in cognitive domains affected.
  
  
  METHODS
  In 329 patients with AD, we assessed five cognitive domains: memory, language, visuospatial functioning, executive functioning, and attention. Magnetic resonance imaging (MRI) was rated visually for the presence of MTA and PA. Two-way analyses of variance were performed with MTA and PA as independent variables, and cognitive domains as dependent variables. Gender, age, and education were covariates. As PA is often encountered in younger patients, analyses were repeated after stratification for age of onset (early onset, ≤65 years).
  
  
  RESULTS
  The mean age of the participants was 67 years, 175 (53%) were female, and the mean Mini-Mental State Examination (score±standard deviation) was 20±5 points. Based on dichotomized magnetic resonance imaging ratings, 84 patients (26%) had MTA and PA, 98 (30%) had MTA, 57 (17%) had PA, and 90 (27%) had neither. MTA was associated with worse performance on memory, language, and attention (all, P<.05), and PA was associated with worse performance on visuospatial and executive functioning (both, P<.05). Stratification for age showed in patients with late-onset AD (n=173) associations between MTA and impairment on memory, language, visuospatial functioning, and attention (all, P<.05); in early-onset AD (n=156), patients with PA tended to perform worse on visuospatial functioning.
  
  
  CONCLUSIONS
  Regional atrophy is related to impairment in specific cognitive domains in AD. The prevalence of PA in a large set of patients with AD and its association with cognitive functioning provides support for the usefulness of this visual rating scale in the diagnostic evaluation of AD.
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: l.smits@vumc.nl.
authors.forename: Lieke L
authors.initials: LL
authors.lastname: Smits
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Betty M
authors.initials: BM
authors.lastname: Tijms
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marije R
authors.initials: MR
authors.lastname: Benedictus
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Esther L G E
authors.initials: EL
authors.lastname: Koedam
authors.affiliation: Alzheimer Center and Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Teddy
authors.initials: T
authors.lastname: Koene
authors.affiliation: Alzheimer Center and Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ilona E W
authors.initials: IE
authors.lastname: Reuling
authors.affiliation: Alzheimer Center and Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Yolande A L
authors.initials: YA
authors.lastname: Pijnenburg
authors.affiliation: Alzheimer Center and Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mike P
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands; Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Wiesje M
authors.initials: WM
authors.lastname: van der Flier
mesh_terms: D017668:Age of Onset; D000368:Aged; D000375:Aging / Q000473:pathology / Q000523:psychology; D000544:Alzheimer Disease / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology*; D001284:Atrophy; D001288:Attention; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000473:pathology / Q000503:physiopathology; D004522:Educational Status; D056344:Executive Function; D005260:Female; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012727:Sex Characteristics; D013028:Space Perception
keywords: Alzheimer's disease; Cognition; Magnetic resonance imaging; Neuropsychology; Visual rating scales