RPS 1511 - Modern approaches to dementia evaluation

Author Block: H. ZHANG¹, S. Laws², L. XIE³, S. Ma³; ¹DaZhou/CN, ²Joondalup, WA/AU, ³Shantou, Guangdong/CN
Purpose: To test whether resting-state EEG–fMRI coupling strength (R²) indexes cognitive performance across AD, MCI, and healthy ageing, and to identify stage- and domain-specific brain–cognition signatures via multimodal imaging.
Methods or Background: Simultaneous resting-state EEG–fMRI from 99 participants (AD=14, MCI=45, HC=40) was analyzed. EEG features were convolved with a canonical hemodynamic response function and regressed against voxel-wise fMRI via general linear models. Regional R² maps were derived and correlated with MoCA and MMSE within groups.
Results or Findings: In AD, MoCA correlated negatively with R² in the supplementary motor area (right; r=−0.65, p=.012), inferior temporal gyrus (left; r=−0.72, p=.004), and occipital superior gyrus (right; r=−0.71, p=.005), indicating lower cognition with higher coupling in sensorimotor/visual cortices. In MCI, MoCA showed negative correlations in thalamic regions (pulvinar anterior, left; r=−0.37, p=.013) and the parahippocampal gyrus (r=−0.32, p=.028). For MMSE, AD exhibited positive R² associations in cerebellar vermis 8 (r=+0.76, p=.002) and cerebellum lobule 10 (right; r=+0.60, p=.022), whereas MCI and HC showed widespread negative R²–MMSE relationships, notably in superior temporal gyrus (right; r=−0.57, p<.001), Rolandic operculum (r=−0.39, p=.012), and thalamic anterior ventral nucleus (r=−0.38, p=.018). Overall patterns differed by group and cognitive domain, underscoring stage specificity.
Conclusion: EEG–fMRI coupling strength (R²) delineates discrete, clinically meaningful neural signatures across the dementia continuum. Multidomain cognitive testing captures complementary vulnerability profiles, underscoring the value of coupling metrics for individualized diagnosis and monitoring. Coupling-based biomarkers show promise for early detection, risk stratification, and precision intervention, with clear potential for integration into multimodal clinical workflows.
Limitations: Single-center, cross-sectional cohort (n=99) with class imbalance (AD=14) and no external replication limits generalizability and causal inference; reliance on a canonical HRF and atlas parcellation may bias regional estimates.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study protocol was approved by the Institutional Ethics Committee of the First Affiliated Hospital of Shantou University Medical College (Approval No.: SDFY-EC-SOP-044-B-2022-188).

Author Block: F. Sodaei¹, M. Noroozian², T. M. Sheldrick-Michel¹, H. Salighe Rad³; ¹Odense/DK, ²Tehran/IR, ³tehran/IR
Purpose: Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder, with amnestic mild cognitive impairment (aMCI) representing an early transitional stage. Subtle white matter changes may remain undetected using standard magnetic resonance imaging (MRI). Limbic tracts, crucial for memory, can be examined with diffusion tensor imaging (DTI) to detect microstructural alterations. This study investigates whether DTI-derived measures of limbic fiber bundles can act as sensitive early biomarkers for differentiating aMCI and mild AD from cognitively healthy controls and evaluates their diagnostic potential.
Methods or Background: This study involved 46 participants divided into three groups: 17 with AD, 17 with amnestic aMCI, and 12 cognitively normal controls. All participants completed neuropsychological assessments and MRI, including 3D T1-weighted and DTI sequences. Diffusion data were analyzed using ExploreDTI 4.8.6 with atlas-based parcellation of limbic white matter. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AxD), and radial diffusivity (RD) were extracted. Group differences were assessed with one-way ANOVA, correlations with cognition were examined, and diagnostic performance was evaluated using accuracy, sensitivity, specificity, and area under the curve (AUC).
Results or Findings: Region-of-interest analyses showed widespread group differences, including changes in DTI metrics within the cingulum bundle, higher MD in the uncinate fasciculus, and increased RD in the left fornix, all correlating with cognitive performance. Cross-validated diagnostic assessment of left fornix RD demonstrated strong performance (accuracy 83%, sensitivity 85%, specificity 80%, AUC 0.87), indicating early limbic white matter microstructural degeneration, with the fornix exhibiting particularly marked alterations.
Conclusion: DTI-derived radial diffusivity in the fornix appears to be a sensitive and non-invasive biomarker for early detection of Alzheimer’s disease, which may facilitate the identification of at-risk individuals.
Limitations: The limitations of the study are the relatively small sample size and cross-sectional design.
Funding for this study: Funding was provided by Tehran University of Medical Sciences.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the ethics committee of Tehran University of Medical Sciences, Iran.

Author Block: J. Logre, P. NARANG, K. Bansal, A. Ranga; New Delhi/IN
Purpose: To assess the role of arterial spin labeling (ASL-MRI) in detection of perfusion changes and patterns that distinguish Alzheimer’s Disease (AD) from Frontotemporal Dementia (FTD).
Methods or Background: Fifteen patients each with AD, FTD and healthy controls underwent 3D-Pseudocontinous ASL-MRI
in addition to routine structural imaging on 3T MRI. Assessment of regional atrophy was
done using visual rating scales with quantification of mean cerebral blood flow (CBF)
in various regions of brain.
Results or Findings: Regional patterns of atrophy were seen as asymmetrical bifrontal and temporal atrophy in FTD whereas, AD showed parietal and temporal predominance, with further progressive involvement of occipital as well as frontal lobes. Significant hypoperfusion was seen in the areas corresponding to regional atrophy, predominantly in anterior cingulate gyrus in FTD which helped in differentiation of AD from controls with specificity of 80% and sensitivity of 86.6 at a cut-off mean CBF value of 31.91 ml/100gm/min in the anterior cingulate gyrus. There was significant hypoperfusion in posterior cingulate gyrus seen in AD which differentiated it from controls satisfactorily, with a specificity and sensitivity of 73.3% and 86.6% respectively, at a cut-off mean CBF value of 38.29 ml/100gm/min.
Conclusion: The use of functional neuroimaging techniques like ASL as an adjunct to conventional MRI
can provide unique insights into the changes seen in neurodegenerative diseases as disease-
specific patterns of differences in perfusion without radiation exposure, contrast administration or significant increase in scan time.
Limitations: The cross-sectional design and duration of study didn't allow establishment of a temporal relationship, hence, limiting our ability to draw inferences.The sample may not be a true representation of the disease population. Since, histopathological examination couldn't be done due to humanitarian reasons, there was a lack of confirmation of the diagnosis.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional Ethics Committee, Maulana Azad Medical College, New Delhi, India-110002

Author Block: F. Bruno, G. Saporito, G. Saltarelli, A. Innocenzi, G. Di Cerbo, C. De Felici, E. Di Cesare, F. Pistoia, A. Splendiani; L'Aquila/IT
Purpose: To assess structural and functional brain changes on advanced MRI in patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI) undergoing transcranial pulse stimulation (TPS).
Methods or Background: Seventeen consecutive patients with AD/MCI scheduled for TPS underwent 3T MRI at baseline and 6 months. The protocol included structural MRI with volumetry, diffusion tensor imaging (DTI) with whole-brain and hippocampal/cingulate reconstructions, single-voxel spectroscopy of the cingulate cortex, and arterial spin labeling (ASL) perfusion. Brain volumes were segmented with dedicated software; DTI was processed in DSI-Studio; ASL was analyzed in MRI Cloud Brain Mapping to derive absolute and relative cerebral blood flow (CBF).
Results or Findings: Spectroscopy showed no significant post-treatment change in CH ratio (mean Δ = +0.09; p = 0.076) or NAA ratio, with a non-significant trend toward higher CH ratio. In the hippocampus, fractional anisotropy (FA) and mean diffusivity (MD) decreased after TPS (FA Δ = −0.093; p = 0.021; MD Δ = −0.255; p = 0.039), while quantitative anisotropy was unchanged. ASL revealed widespread CBF increases, with significant cortical rises bilaterally and in the right frontal lobe (p = 0.03), left parietal lobe (p = 0.05), right parietal lobe (p = 0.01), and right temporal lobe (p = 0.04). Among subcortical regions, CBF increased in the right thalamus (p = 0.05) and left cingulate gyrus (p = 0.05). No significant changes were observed in white matter, occipital and insular cortices, basal ganglia, limbic system, or cerebellum.
Conclusion: Advanced MRI sequences, combining volumetry, DTI, spectroscopy, and ASL, can detect subtle structural and perfusion modifications after TPS in AD and MCI.
Limitations: These exploratory findings support the feasibility of MRI for monitoring TPS-related effects; larger controlled studies are warranted to confirm clinical significance and durability.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local IRB

Author Block: W. N. Machaj, P. Podgórski, J. Maciaszek, D. Szcześniak, J. Rymaszewska, P. Piotrowski, A. Zimny; Wrocław/PL
Purpose: Mild cognitive impairment (MCI) is considered a transitional state between normal aging and dementia, characterized by subjective
complaints, measurable cognitive decline, and preserved daily functioning. The aim of this study was to investigate alterations in resting-state functional connectivity and brain structure in individuals with MCI, with particular emphasis on the medial temporal lobe and its interactions with other brain regions.
Methods or Background: We included 27 patients with MCI and 25 age-matched healthy controls. 3D T1 volumetric imaging followed by resting-state fMRI were performed on a 3T Philips Ingenia scanner equipped with a 32-channel head and neck coil. Seed-to-voxel functional connectivity analyses were performed using the bilateral hippocampi and anterior/posterior parahippocampal gyri as seed regions. Volumetric analysis was conducted with the Desikan-Killiany and Destrieux atlases to assess cortical thickness.
Results or Findings: MCI patients demonstrated significantly increased functional connectivity between bilateral medial temporal lobe regions and the right thalamus compared to controls. Volumetric analysis revealed reduced cortical thickness in temporal, frontal, orbitofrontal, limbic, parietal, sensorimotor, and occipito-temporal regions.
Conclusion: Increased medial temporal-thalamic connectivity together with widespread cortical atrophy indicates early neurodegenerative changes in MCI. These alterations may represent compensatory mechanisms in response to cognitive decline and highlight the value of combining functional and structural MRI for early detection of cognitive impairment.
Limitations: The main limitations of the study are its cross-sectional design and the small sample size.
Funding for this study: This study was supported by Wroclaw Medical University grants SUBZ.C270.24.078 and SUBK.C230.23.065.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was conducted under the guidance and approval of the Bioethical Committee at Wroclaw Medical University (KB-400/2018/2506), date of approval 25 June 2018.

Author Block: L. Yang, F. Zhou, Y. Yang, G. F. Sun, S. Tang; Kunming/CN
Purpose: To assess cardio-cerebral oxygenation reserve in heart failure (HF) patients using OS-MRI and BOLD techniques, and explore its correlation with cognitive decline and potential mediating role in HF-related cognitive impairment.
Methods or Background: 160 heart failure (HF) patients and 40 age- and sex-matched healthy controls (HC) were enrolled. HF patients were stratified into four subgroups according to the NYHA functional classification (Class I–IV). All participants underwent cardiac oxygen-sensitive magnetic resonance imaging (OS-MRI) and cerebral blood oxygen level–dependent (BOLD) imaging to determine parameters including myocardial oxygenation reserve (MORE), cerebral oxygenation reserve (CORE), left ventricular ejection fraction (LVEF), and stroke volume (SV). Cognitive function in HF patients was assessed using the Montreal Cognitive Assessment (MoCA) scale. Statistical analyses included intergroup comparisons, correlation analysis, and mediation effect testing.
Results or Findings: Myocardial oxygenation reserve (MORE), cerebral oxygenation reserve (CORE), and MoCA scores were significantly lower in heart failure (HF) patients compared to healthy controls (HCs) (all P < 0.05). Notably, Among early-stage patients (NYHA Class I-II) with preserved LVEF (≥50%), these indicators, although better than those in advanced-stage (NYHA Class III-IV) patients (all P < 0.05), were already significantly lower than in the healthy control group (all P < 0.05). MoCA scores showed positive correlations with MORE (r=0.648, P=0.014), CORE (r=0.783, P=0.025), and LVEF (r=0.462, P=0.033). Furthermore, MORE and CORE played significant mediating roles in the relationship between LVEF and MoCA scores.
Conclusion: The decline in cardio-cerebral oxygenation reserve is a key factor associated with cognitive dysfunction in HF, including its early stages, and holds potential value as an imaging biomarker for early warning of cognitive impairment.
Limitations: The cross-sectional design precludes causal inference. The single-center sample may limit generalizability, and residual confounding cannot be ruled out.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective study was approved by the Institutional Review Board of [Yan’an Hospital Affiliated to Kunming Medical University] (Approval No. [2024-143-02]), and the requirement for written informed consent was waived due to the observational design.

Author Block: M. T. Horan, J. F. Meaney, R-A. Kenny, C. DeLooze; Dublin/IE
Purpose: There is a critical link between vascular disease and the progression to dementia. The hippocampus has been implicated in the development of memory decline and whole hippocampal atrophy has been identified consistently in patients with cognitive decline.
Methods or Background: We investigate the independent and moderating effects of increased arterial stiffness (AS) and reduced cerebral blood flow (CBF) on total hippocampal volume (HV) in a large MRI sample of community-dwelling older adults (n=395) from a nationally representative population-based study, the Irish Longitudinal Study on Ageing (TILDA). We also examine if these effects are specific to certain hippocampal subfields which are known to be selectively vulnerable to ischemia. Arterial spin labelling MRI was used for CBF quantification. Automated Segmentation of the Hippocampal was performed using FreeSurfer v6.0.
Results or Findings: This four-year follow up longitudinal study demonstrated that (i) prolonged elevated AS (at baseline and at four-year follow-up), (ii) the interaction between higher AS at baseline and lower CBF at follow-up 3 and (iii) the interaction between prolonged elevated AS (at baseline and four-year follow-up) and reduced CBF at follow-up were associated with smaller hippocampal volumes. We propose that the subsequent reduction in cerebral blood flow observed with elevated arterial stiffness may be the missing link in the pathway linking arterial stiffness to hippocampal atrophy.
Conclusion: Our study shows that increased AS and reduced CBF are not independently associated with whole hippocampal or subfield volumes. However, when combined, increased arterial stiffness for a longer duration in combination with a reduction in cerebral blood flow is associated with lower hippocampal volumes. These effects were equally exerted across all hippocampal subfields tested in this study.
Limitations: There are reported limitations to automated segmentation tools in the literature.
Funding for this study: Funding for The Irish Longitudinal Study on Ageing (TILDA) is provided by the Irish Government, the Health Research Board (HRB), The Atlantic Philanthropies, and the Irish Life PLC. CDL is supported with funding from the Health Research Board (HRB) of Ireland under an Emerging Investigator Award (EIA-2017-012).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Trinity College Faculty of Health Sciences Research Ethics Committee, Dublin, Ireland. Protocols conformed with the Declaration of Helsinki. Signed informed consent was obtained from all respondents prior to participation. Additional ethics approval was received for the magnetic resonance imaging (MRI) sub-study from the St James’s Hospital/Adelaide and Meath Hospital, Inc. National Children’s Hospital, Tallaght (SJH/AMNCH) Research Ethic Committee, Dublin, Ireland. Those attending for MRI also completed an additional MRI-specific consent form.

Author Block: T. Schömig, J. Kottlors, M. Schlamann, M. Schönfeld; Köln/DE
Purpose: Cerebral microbleeds (CMBs) are a safety concern in patients considered for anti-amyloid antibody therapy in Alzheimer’s disease. More than four CMBs constitute an exclusion criterion for Lecanemab or Donanemab. Detection rates vary with MRI field strength and sequence type. This study evaluated the impact of these parameters on CMB detection and their relevance for treatment eligibility in a clinical cohort.
Methods or Background: We retrospectively analyzed 284 of 1575 patients from two memory clinics classified within the Alzheimer’s continuum, defined by a pathological cerebrospinal fluid amyloid-β 1-42/1-40 ratio and/or a positive amyloid-PET scan (visual assessment by standardized criteria). CMBs were quantified when a hemorrhage-sensitive MRI sequence was available. Patients were grouped by field strength (1.5T vs. 3T) and sequence type (T2* vs. SWI). Detection rates, CMB counts, and the proportion exceeding exclusion thresholds (>4 CMBs) were compared using Mann–Whitney U and Chi² tests.
Results or Findings: Of 284 eligible patients, 263 (mean age 71.3 years, 53 % female) were screened. A total of 162 underwent 1.5T MRI (all T2*) and 101 underwent 3T MRI (66 T2*, 35 SWI). CMBs were detected significantly more often at 3T than at 1.5T (43.6 % vs. 23.5 %, p<0.001), with higher mean counts (1.86 ± 4.7 vs. 1.12 ± 3.9, p=0.004). Within the 3T subgroup, SWI showed a non-significant trend toward higher detection than T2* (54.3 % vs. 37.9 %, p=0.057). Importantly, the proportion with >4 CMBs—rendering them ineligible—was significantly higher at 3T than at 1.5T (10.9 % vs. 4.3 %, p = 0.040).
Conclusion: MRI field strength and sequence type substantially affect CMB detection and may directly alter eligibility for anti-amyloid antibody therapy. Standardization of imaging protocols is required to ensure consistent patient selection and reliable risk assessment.
Limitations: None
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: X. Li, B. Zhang; Nanjing/CN
Purpose: Neurodegeneration and microvascular injury were associated with cognitive decline in type 2 diabetes (T2D). Overweight/obesity or non-alcoholic fatty liver disease (NAFLD) were also related to brain damage. We aimed to investigate the gray and white matter changes in T2D patients with NAFLD or high body mass index (BMI).
Methods or Background: The 451 patients with T2D and 65 normal controls were enrolled. The patients were further divided into four subgroups based on the presence of NAFLD or high BMI: 156 with both NAFLD and high BMI, 66 with NAFLD, 76 with high BMI, and 153 with neither NAFLD nor high BMI. All participants underwent magnetic resonance, clinical assessments, and cognitive tests. Brain gray volume and cortical thickness represent neurodegeneration, and peak width of skeletonized mean diffusivity (PSMD) and white matter hyperintensity (WMH) reflect microvascular injury. Partial correlation, canonical correlation, and mediation effect were employed to assess relationship between metabolic measures, imaging markers and cognitive performance.
Results or Findings: 1) The patients with T2D exhibited widespread brain atrophy involving global gray matter, subcortical structures, and hippocampal subfields. Both NAFLD and high BMI were independently associated with neurodegeneration, with no significant interaction effect; 2) No significant differences were found in PSMD or WMH volume between the T2D and normal controls groups, and neither NAFLD nor high BMI had significant impacts on white matter injury; 3) The T2D group showed multiple damage in cognitive domains, and both NAFLD and high BMI independently effected executive function; 4) Mediation analysis indicated that neurodegeneration mediated the association between metabolic dysregulation and cognitive impairment, while white matter injury did not.
Conclusion: The results revealed neurodegeneration contributes more to cognitive impairment than cerebral small vessel injury in middle-aged and young-old patients with T2D.
Limitations: Not applicable
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No

Author Block: S. Petrović¹, M. Nguyen², N. Villain², F-X. Lejeune², A. Kas², M-O. Habert², N. Pyatigorskaya²; ¹Novi Sad/RS, ²Paris/FR
Purpose: The aim of this study is to identify distinct patterns of atrophy and hypometabolism for differential diagnosis of dementia and compare qualitative and quantitative biomarker classification performance.
Methods or Background: The study included 274 patients from Pitié-Salpêtrière Memory Clinic who underwent PET/MRI scanning with the diagnosis of Alzheimer's disease (AD), frontotemporal dementia (FTD), Lewy Body dementia (LBD). Qualitative and quantitative region of interest (ROI) analysis of T1W and FDG-PET images was performed. ROI were chosen according everyday clinical practice and functional characteristics. Statistical Data Integration Analysis for Biomarker Discovery using the Latent components was performed.
Results or Findings: Quantitative metabolism showed good separation of FTD from other groups, mainly involving the temporal pole and caudate, while visual metabolism distinguished FTD from LBD, with hypometabolism in the prefrontal and insular regions versus parietal regions, respectively. AD was separated from the other groups by hypometabolism in the mesial temporal region in both visual and quantitative metabolism, and by posterior cingulate hypometabolism in the quantitative block. The AUC was higher in metabolism blocks (0.778–0.954) compared to volume blocks (0.691–0.864), with the best performance from visual metabolism (LBD vs. others 0.954; FTD vs. others 0.938; AD vs. others 0.81). Qualitative volume contributed mainly to FTD separation, involving temporal pole, prefrontal, and anterior cingulate, while quantitative volume showed no clear separation. No significant AUC differences were found between qualitative and quantitative approaches for both metabolism and atrophy (p>0.05).
Conclusion: FTD demonstrated a characteristic pattern across both modalities and analytic approaches, allowing easier differentiation from other dementias. FDG-PET added sensitivity to functional changes, while MRI highlighted complementary structural alterations. Visual and quantitative analyses showed comparable diagnostic performance, suggesting no significant added value of implementing quantitative software in clinical practice.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by national ethical committee.

Author Block: M. Kawaguchi, D. Yoshimaru, Y. Nakamura, K. Touma, K. Saito; Nishishinnjyuku,Tokyo/JP
Purpose: While MCI is traditionally viewed as an intermediate stage to AD, the dynamic nature of brain-cognition relationships during this transition remains unclear. This study investigated disease-specific white matter-cognition interaction patterns and their correlations using automated OpenMAP-T1 analysis to characterize the pathological continuum of cognitive decline.
Methods or Background: We analyzed 74 participants: 10 healthy controls (68.3±9.1 years), 16 MCI (75.4±4.0 years), and 48 AD patients (78.8±7.5 years). White matter regions were automatically segmented from 3D T1-weighted images using OpenMAP-T1. Multiple regression analyses with/without disease-by-cognition interaction terms were performed for MMSE and MoCA-J, adjusting for TIV, age, and sex. Spearman correlations between white matter volumes and cognitive scores were calculated for interaction-significant regions in the healthy-MCI combined group.
Results or Findings: Disease-by-cognition interactions were exclusively observed in MCI but completely absent in AD and controls. MoCA-J demonstrated superior sensitivity, detecting interactions in five regions (SS_R, IFO_L, IFO_R, SS_L, SLF_R; all p<0.05) versus one for MMSE (SS_L, p=0.024). Correlation analysis in MCI revealed that interaction-significant regions maintained strong positive correlations with MoCA-J (SS_L: ρ=0.767, p=0.001; IFO_R: ρ=0.725, p=0.002; SS_R: ρ=0.702, p=0.004; SLF_R: ρ=0.632, p=0.011; IFO_L: ρ=0.622, p=0.013), indicating preserved brain-cognition relationships in MCI. In baseline regression, cognition-related significant regions progressively decreased from controls (MMSE: 17, MoCA-J: 18) through MCI (MMSE: 13, MoCA-J: 12) to AD (MMSE: 4, MoCA-J: 9), demonstrating stage-dependent network disruption.
Conclusion: Our findings reveal MCI as a unique dynamic state with active brain-cognition remodeling and preserved correlations, fundamentally distinct from AD's terminal state with disrupted relationships. This distinction indicates MCI represents a critical therapeutic window. MoCA-J emerged as the optimal detection tool, providing important implications for early diagnosis and intervention strategies.
Limitations: Cross-sectional design limits assessment of longitudinal changes. Small sample size, particularly in controls (n=10).
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by Tokyo Medical University Hospital IRB (T2022-0215).

Author Block: M. B. Nallino, P. Acevedo, L. Gangui Araoz, M. I. Cañizares, L. Zamer, A. A. Ojeda; Rosario/AR
Purpose: In patients with cognitive impairment (CI), identifying atrophy patterns and assessing white matter integrity is crucial for accurate diagnosis and treatment. This study aims to correlate visual scales of atrophy, including Medial Temporal Atrophy (MTA), Global Cortical Atrophy (GCA), KOEDAM score, Evans Index and evaluation of leukoaraiosis (Fazekas scale) in brain magnetic resonance imaging (bMRI), with automated volumetric analyses using artificial intelligence software.
Methods or Background: The retrospective study involved 104 patients (49 women and 55 men) with CI who underwent bMRI at our institution between January 2023 and August 2023. Visual assessments were performed using scales (MTA), (GCA), (KOEDAM), Evans Index, and Fazekas scale by a neuroradiologist with over 15 years of experience. Additionally, automated brain volumetric analyses were conducted using the Entelai artificial intelligence software. Spearman correlation coefficients were computed to assess the relationship between brain volumes and the corresponding visual atrophy scales.
Results or Findings: Results revealed a moderate inverse correlation between global brain volume and GCA scores (-0.47), particularly pronounced in patients over 70 years old. Grey matter volume showed a strong inverse correlation with GCA (-0.62). Both right and left hippocampal volumes had significant inverse correlations with MTA (-0.568 and -0.577, respectively). Furthermore, the Evans Index exhibited a strong positive relationship with ventricular volume (0.789), especially in older patients.
Conclusion: The results show a consistent association between visual measures of cerebral atrophy and quantitative volumes obtained through software. As scores on the visual scales (GCA, MTA, Koedam, Evans) increase, a reduction in brain volumes or an increase in ventricular volume is observed, with a more significant impact on the older age groups. This supports the validity of the scales used and suggests that automatic quantification could be a useful supplement.
Limitations: Patient number
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: L. Chang; Hefei/CN
Purpose: This study aimed to longitudinally evaluate the dynamic changes in glymphatic system function and regional cerebral hemodynamics during anti-Aβ therapy in patients with Alzheimer’s disease (AD) using multimodal MRI techniques, specifically the DTI-ALPS index and arterial spin labeling (ASL).
Methods or Background: Forty-five clinically diagnosed patients with mild-to-moderate AD undergoing 6 months of anti-Aβ monoclonal antibody therapy
underwent brain MRI at baseline and post-treatment. We analyzed diffusion tensor imaging along the perivascular space (DTI-ALPS index, bilateral hemispheres) and ASL-derived CBF. Neurocognitive function was assessed using the Clinical Dementia Rating (CDR) and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog).
Results or Findings: Glymphatic Function and Cognitive Improvement The left hemispheric ALPS index significantly increased post-treatment (baseline: 1.22 ± 0.21 vs. posttreatment: 1.38 ± 0.19, p < 0.01), positively correlating with improvements in the ADAS-Cog (18.6% reduction) and CDR total scores (r = 0.43, p = 0.008). In contrast, the right ALPS index showed no significant change (p = 0.23) or clinical correlation. Hemodynamic CharacteristicsASL imaging revealed a significant elevation in CBF in the PCC and posterior temporal parietal lobe post-treatment (12.5% increase, p = 0.015). Notably, the improvement in PCC perfusion inversely correlated with the reduction in ADAS-Cog scores (r = −0.51, p = 0.002).
Conclusion: Anti-Aβ therapy may exert neuroprotective effects by enhancing glymphatic clearance efficiency in the left hemisphere and restoring PCC perfusion. The left ALPS index and PCC CBF serve as sensitive imaging biomarkers for dynamic therapeutic monitoring. This study underscores the synergistic value of multimodal DTI-ALPS and ASL in evaluating treatment responses for Alzheimer's disease, providing imaging evidence for personalized strategies targeting glymphatic-hemodynamic coupling mechanisms.
Limitations: 5.0T MRI effectively quantifies neurorestoration induced by anti-Aβ therapy in Alzheimer’s disease.
Funding for this study: This study was supported by grants from The National Natural Science Foundation of China (32071054).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the medical ethics committee of affiliated hospital of University of Science and Technology of China (2021-RE-118). Parents of the neonates gave informed consent and signed the informed consent form.