title: Applying Automated MR-Based Diagnostic Methods to the Memory Clinic: A Prospective Study.
abstract: Several studies have demonstrated that fully automated pattern recognition methods applied to structural magnetic resonance imaging (MRI) aid in the diagnosis of dementia, but these conclusions are based on highly preselected samples that significantly differ from that seen in a dementia clinic. At a single dementia clinic, we evaluated the ability of a linear support vector machine trained with completely unrelated data to differentiate between Alzheimer's disease (AD), frontotemporal dementia (FTD), Lewy body dementia, and healthy aging based on 3D-T1 weighted MRI data sets. Furthermore, we predicted progression to AD in subjects with mild cognitive impairment (MCI) at baseline and automatically quantified white matter hyperintensities from FLAIR-images. Separating additionally recruited healthy elderly from those with dementia was accurate with an area under the curve (AUC) of 0.97 (according to Fig. 4). Multi-class separation of patients with either AD or FTD from other included groups was good on the training set (AUC >  0.9) but substantially less accurate (AUC = 0.76 for AD, AUC = 0.78 for FTD) on 134 cases from the local clinic. Longitudinal data from 28 cases with MCI at baseline and appropriate follow-up data were available. The computer tool discriminated progressive from stable MCI with AUC = 0.73, compared to AUC = 0.80 for the training set. A relatively low accuracy by clinicians (AUC = 0.81) illustrates the difficulties of predicting conversion in this heterogeneous cohort. This first application of a MRI-based pattern recognition method to a routine sample demonstrates feasibility, but also illustrates that automated multi-class differential diagnoses have to be the focus of future methodological developments and application studies.
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Germany.|Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.|Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klöppel
authors.affiliation: Freiburg Brain Imaging, University Medical Center Freiburg, Germany.|Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.|Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Peter
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Ludl
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Pilatus
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Maier
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Irina
authors.initials: I
authors.lastname: Mader
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Heimbach
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.|Department of Nuclear Medicine, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Frings
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Egger
authors.affiliation: F. Hoffmann-La Roche, pRED, Pharma Research and Early Development, DTA Neuroscience, Basel, Switzerland.|Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Dukart
authors.affiliation: Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany.
authors.forename: Matthias L
authors.initials: ML
authors.lastname: Schroeter
authors.affiliation: Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College of Science, Technology and Medicine London, United Kingdom.|Cognitive Impairment and Dementia Services, Lakeside Mental Health Unit, West London Mental Health NHS Trust, London, UK.|Departments of Psychiatry and Psychotherapy, Technical University München, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Perneczky
authors.forename: Peter
authors.initials: P
authors.lastname: Häussermann
authors.affiliation: Center for Medical Biometry and Medical Informatics, University of Freiburg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.affiliation: Departments of Psychosomatic Medicine, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Teipel
authors.affiliation: Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.|Clinics for Geronto- and Neuropsychiatry, ZfP Emmendingen, Emmendingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hüll
authors.affiliation: Freiburg Brain Imaging, University Medical Center Freiburg, Germany.|Department of Computer Science and BIOSS Centre for Biological Signaling Studies, University of Freiburg, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdulkadir
mesh_terms: D000368:Aged; D000375:Aging / Q000473:pathology; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000473:pathology; D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D057180:Frontotemporal Dementia / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D020961:Lewy Body Disease / Q000175:diagnosis* / Q000473:pathology; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D060388:Support Vector Machine; D066127:White Matter / Q000473:pathology
keywords: Dementia diagnostics; machine learning; magnetic resonance imaging; prognosis; support vector machine