title: Lower cerebral blood flow is associated with faster cognitive decline in Alzheimer's disease.
abstract: OBJECTIVE
  To determine whether lower cerebral blood flow (CBF) is associated with faster cognitive decline in patients with Alzheimer's disease (AD).
  
  
  METHODS
  We included 88 patients with dementia due to AD from the Amsterdam Dementia Cohort. Mean follow-up was 2 ± 1 years. Linear mixed models were used to determine associations of lower whole brain and regional pseudo-continuous arterial spin labelling measured CBF with rate of cognitive decline as measured with repeated mini-mental state examination (MMSE). Model 1 was adjusted for age, sex, and education. Model 2 was additionally adjusted for normalized gray matter volume, medial temporal lobe atrophy, white matter hyperintensities, microbleeds, and lacunes. Analyses were repeated after partial volume correction (PVC) of CBF. Statistical significance was set at p ≤ 0.05.
  
  
  RESULTS
  Patients were 65 ± 7 years old, 44 (50 %) were women, and mean baseline MMSE was 22 ± 4. Annual decline (β[SE]) on the MMSE was estimated at -2.11 (0.25) points per year. Lower whole brain (β[SE]-0.50[0.25]; p ≤ 0.05) and parietal (β[SE]-0.59[0.25]; p < 0.05) CBF were associated with faster cognitive decline. PVC cortical CBF was not associated with cognitive decline.
  
  
  CONCLUSIONS
  Lower CBF, in particular in the posterior brain regions, may have value as a prognostic marker for rate of cognitive decline in AD.
  
  
  CONCLUSIONS
  • In AD, lower CBF is associated with more rapid cognitive decline. • Decreasing CBF does not reach a plateau early in AD. • PcASL-CFB has additive value to conventional structural MRI measures in AD.
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. m.Benedictus@vumc.nl.
authors.forename: Marije R
authors.initials: MR
authors.lastname: Benedictus
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Annebet E
authors.initials: AE
authors.lastname: Leeuwis
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Maja A A
authors.initials: MA
authors.lastname: Binnewijzend
authors.affiliation: Department of Physics and Medical Technology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Joost P A
authors.initials: JP
authors.lastname: Kuijer
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|Department of Epidemiology & Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Wiesje M
authors.initials: WM
authors.lastname: van der Flier
authors.affiliation: Alzheimer Centre & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Niels D
authors.initials: ND
authors.lastname: Prins
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000523:psychology; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation; D018450:Disease Progression; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013113:Spin Labels; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors
chemical_list: D013113:Spin Labels
keywords: Alzheimer’s disease; dementia; perfusion; prognosis; progression