Hippocampus and Basal Forebrain Volumetry for Dementia and Mild Cognitive Impairment Diagnosis: Could It Be Useful in Primary Care?
Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations.



To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy.



We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias.



Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy.



Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.|Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.
Stefan J
SJ
Teipel
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.|Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.
Felix
F
Keller
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany.
Jochen R
JR
Thyrian
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany.|Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Urs
U
Strohmaier
Institute of General Practice, University of Rostock, Rostock, Germany.
Attila
A
Altiner
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany.|Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Wolfgang
W
Hoffmann
German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.|Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.
Ingo
I
Kilimann
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D066187:Basal Forebrain / Q000000981:diagnostic imaging / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000473:pathology*; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D066128:Gray Matter / Q000000981:diagnostic imaging; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011320:Primary Health Care / Q000379:methods*; D066127:White Matter / Q000000981:diagnostic imaging
Alzheimer’s disease; basal forebrain; hippocampus; magnetic resonance imaging; mild cognitive impairment; primary care