title: Multimodal EEG-MRI in the differential diagnosis of Alzheimer's disease and dementia with Lewy bodies.
abstract: Differential diagnosis of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) remains challenging; currently the best discriminator is striatal dopaminergic imaging. However this modality fails to identify 15-20% of DLB cases and thus other biomarkers may be useful. It is recognised electroencephalography (EEG) slowing and relative medial temporal lobe preservation are supportive features of DLB, although individually they lack diagnostic accuracy. Therefore, we investigated whether combined EEG and MRI indices could assist in the differential diagnosis of AD and DLB. Seventy two participants (21 Controls, 30 AD, 21 DLB) underwent resting EEG and 3 T MR imaging. Six EEG classifiers previously generated using support vector machine algorithms were applied to the present dataset. MRI index was derived from medial temporal atrophy (MTA) ratings. Logistic regression analysis identified EEG predictors of AD and DLB. A combined EEG-MRI model was then generated to examine whether there was an improvement in classification compared to individual modalities. For EEG, two classifiers predicted AD and DLB (model: χ(2) = 22.1, df = 2, p < 0.001, Nagelkerke R(2) = 0.47, classification = 77% (AD 87%, DLB 62%)). For MRI, MTA also predicted AD and DLB (model: χ(2) = 6.5, df = 1, p = 0.01, Nagelkerke R(2) = 0.16, classification = 67% (77% AD, 52% DLB). However, a combined EEG-MRI model showed greater prediction in AD and DLB (model: χ(2) = 31.1, df = 3, p < 0.001, Nagelkerke R(2) = 0.62, classification = 90% (93% AD, 86% DLB)). While suggestive and requiring validation, diagnostic performance could be improved by combining EEG and MRI, and may represent an alternative to dopaminergic imaging.
authors.affiliation: Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK. Electronic address: sean.colloby@ncl.ac.uk.
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Colloby
authors.affiliation: Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Cromarty
authors.affiliation: Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Peraza
authors.affiliation: Mentis Cura, Laugavegur 176, 105 Reykjavík, Iceland.
authors.forename: Kristinn
authors.initials: K
authors.lastname: Johnsen
authors.affiliation: Mentis Cura, Laugavegur 176, 105 Reykjavík, Iceland.
authors.forename: Gísli
authors.initials: G
authors.lastname: Jóhannesson
authors.affiliation: Department of Neurology, Aging Research Center, Ce.S.I., Gabriele d'annunzio, University Foundation, University G. D'annunzio of Chieti-Pescara, Via Fonte Romana, 65124 Pescara, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonanni
authors.affiliation: Department of Neurology, Aging Research Center, Ce.S.I., Gabriele d'annunzio, University Foundation, University G. D'annunzio of Chieti-Pescara, Via Fonte Romana, 65124 Pescara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Onofrj
authors.affiliation: Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.affiliation: Department of Psychiatry, University of Cambridge, Level E4, Box 189, Cambridge CB2 0QC, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
authors.affiliation: Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000145:classification / Q000000981:diagnostic imaging*; D001284:Atrophy / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000145:classification / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D012146:Rest; D012680:Sensitivity and Specificity
keywords: Alzheimer's disease; Dementia with Lewy bodies; Differential diagnosis; Dopaminergic imaging; EEG; MRI