This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Background: Mild cognitive impairment (MCI) is a clinical syndrome characterized by memory deficits without functional impact on daily living, and thus not severe enough to allow a diagnosis of dementia. Clinical studies of elderly individuals with MCI suggest a fast rate of progression to dementia. Memory impairment is usually the initial presentation of dementia in AD, suggesting that in the elderly population, significant memory impairment may be the transition phase between normal aging process and AD, therefore, MCI is considered as the pre-AD status. However, also for patients who develop some form of dementia different from AD, the transition from the normal cognitive state to clinically recognizable dementia occurs gradually over years. Participants and Methods: 104 patients (64% females, mean age 71+8 years) were evaluated from April 2002 to March 2005. Patients are taken from a prospective project on the natural history of MCI ('Mild Cognitive Impairment in Brescia - MCIBs'), aimed to study the natural history of non demented persons with apparently primary cognitive deficits. The study protocol was approved by the local ethics committee and all participants signed an informed participation consent. All of these underwent: (i) semi-structured interview with the patient and whenever possible with another informant (usually the patient's spouse or a child) by a geriatrician; (ii) physical and neurological examinations; (iii) performance-based tests of physical function, gait and balance; (iv) neuropsychological battery assessing verbal and non-verbal memory, attention and executive functions abstract thinking; language; and apraxia and visuo-constructional abilities; (v) assessment of depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). They underwent brain magnetic resonance imaging in the neuroradiology department of the Citt di Brescia Hospital, Brescia, with a 1.0 tesla Philips Gyroscan scanner with the following protocol: sagittal FFE 3D sequence (TR 10 ms, TE 4 ms, TI 700 ms, flip angle 10 , FOV 250 mm, matrix 256 256, slice thickness 1.3 mm), axial T2-DP sequence, and axial FLAIR. T1-weighted 3D images acquired in the sagittal plane were resliced into 2-mm thick slices in the coronal plane.Enrolled patients undergo an yearly follow-up visit consisting in complete clinical and neuropsychological examination. Conversion to dementia is diagnosed according with the clinical diagnostic criteria for AD, VaD, FTD, etc.On the MR images will be perform a hippocampal radial mapping analysis. In order to do this MRI images will be normalized by linear (12 parameter) transformation to a customized template using the Statistical Parametric Mapping (SPM99) software. The hippocampi will be manually traced according to a formal protocol with established inter- and intra-rater reliability and 3D parametric surface mesh models will be created to represent the hippocampus in each subject. To assess hippocampal morphology, a medial curve will be automatically defined as the 3D curve traced out by the centroid of the hippocampal boundary in each image slice. The radial size of each hippocampus at each boundary point will be assessed by automatically measuring the radial 3D distance from the surface points to the medial curve defined for individual's hippocampal surface model. Shorter radial distances will be used as an index of atrophy. Statistical maps will be generated indicating local group differences in radial hippocampal distance. Objectives and conclusion:
The aim of our study is to perform a hippocampal radial mapping analysis for all patients and controls at baseline time and after one year. We will compare the hippocampal volume and morphometry between MCI converted and MCI not converted. The findings of this study could give important evidence for a better pre clinical diagnosis of dementia and in this way permit to set a better treatment.
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