Alzheimer's Disease & Serial (Not Cereal) Brain MRI

I'm attending the AAFP Congress of Delegates meeting this week followed by the Scientific Assembly so my output probably won't be the same as it usually is until I return home next Sunday.  With that said, I wanted to expand upon last Wednesday's post in which biomarkers weren't really useful in predicting the conversion of mild cognitive impairment to Alzheimer's disease, although cognitive testing & brain imaging was.

It turns out that a case-control study published last month in Archives of Neurology pointed out similar findings: patients w/presymptomatic Alzheimer's disease had significantly thinner cortical regions compared to normal patients although both had normal hippocampal volumes.  In those patients who progressed onward towards Alzheimer's disease, their rate of cortical thinning actually increased, peaking around a Folstein Mini-Mental State Examination (MMSE) score of 21 (out of 30 maximum), after which the rate of thinning declined.  However, hippocampal volume loss increased during this whole period down towards an MMSE of 15.

My take home point is that a single image isn't enough.  Serial imaging is required.  Now that that's settled, we just have to come up with the funding!

Likewise, a single cognitive test isn't enough but rather, serial testing is required.  So regardless of whether your patient comes in complaining of upper respiratory symptoms, to follow up his/her chronic diseases, or to re-evaluate his/her cognitive function, we should also check his/her MMSE and look for trends (sudden drops should make us suspicious for a coincident worsening or new onset medical condition).