Structural Brain Magnetic Resonance Imaging to Rule Out Comorbid Pathology in the Assessment of Alzheimer's Disease Dementia: Findings from the Ontario Neurodegenerative Disease Research Initiative (ONDRI) Study and Clinical Trials Over the Past 10 Years.
Aged
Aged, 80 and over
Alzheimer Disease
/ diagnosis
Brain
/ diagnostic imaging
Clinical Trials as Topic
Cognitive Dysfunction
/ diagnosis
Cohort Studies
Comorbidity
Dementia, Vascular
/ diagnosis
Diagnosis, Differential
Female
Humans
Incidence
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Neurodegenerative Diseases
/ diagnosis
Neuroimaging
Ontario
/ epidemiology
Tomography, X-Ray Computed
Journal
Journal of Alzheimer's disease : JAD
ISSN: 1875-8908
Titre abrégé: J Alzheimers Dis
Pays: Netherlands
ID NLM: 9814863
Informations de publication
Date de publication:
2020
2020
Historique:
pubmed:
3
3
2020
medline:
20
4
2021
entrez:
3
3
2020
Statut:
ppublish
Résumé
Structural brain magnetic resonance imaging (MRI) is not mandatory in Alzheimer's disease (AD) research or clinical guidelines. We aimed to explore the use of structural brain MRI in AD/mild cognitive impairment (MCI) trials over the past 10 years and determine the frequency with which inclusion of standardized structural MRI acquisitions detects comorbid vascular and non-vascular pathologies. We systematically searched ClinicalTrials.gov for AD clinical trials to determine their neuroimaging criteria and then used data from an AD/MCI cohort who underwent standardized MRI protocols, to determine type and incidence of clinically relevant comorbid pathologies. Of 210 AD clinical trials, 105 (50%) included structural brain imaging in their eligibility criteria. Only 58 (27.6%) required MRI. 16,479 of 53,755 (30.7%) AD participants were in trials requiring MRI. In the observational AD/MCI cohort, 141 patients met clinical criteria; 22 (15.6%) had relevant MRI findings, of which 15 (10.6%) were exclusionary for the study. In AD clinical trials over the last 10 years, over two-thirds of participants could have been enrolled without brain MRI and half without even a brain CT. In a study sample, relevant comorbid pathology was found in 15% of participants, despite careful screening. Standardized structural MRI should be incorporated into NIA-AA diagnostic guidelines (when available) and research frameworks routinely to reduce diagnostic heterogeneity.
Sections du résumé
BACKGROUND/OBJECTIVE
Structural brain magnetic resonance imaging (MRI) is not mandatory in Alzheimer's disease (AD) research or clinical guidelines. We aimed to explore the use of structural brain MRI in AD/mild cognitive impairment (MCI) trials over the past 10 years and determine the frequency with which inclusion of standardized structural MRI acquisitions detects comorbid vascular and non-vascular pathologies.
METHODS
We systematically searched ClinicalTrials.gov for AD clinical trials to determine their neuroimaging criteria and then used data from an AD/MCI cohort who underwent standardized MRI protocols, to determine type and incidence of clinically relevant comorbid pathologies.
RESULTS
Of 210 AD clinical trials, 105 (50%) included structural brain imaging in their eligibility criteria. Only 58 (27.6%) required MRI. 16,479 of 53,755 (30.7%) AD participants were in trials requiring MRI. In the observational AD/MCI cohort, 141 patients met clinical criteria; 22 (15.6%) had relevant MRI findings, of which 15 (10.6%) were exclusionary for the study.
DISCUSSION
In AD clinical trials over the last 10 years, over two-thirds of participants could have been enrolled without brain MRI and half without even a brain CT. In a study sample, relevant comorbid pathology was found in 15% of participants, despite careful screening. Standardized structural MRI should be incorporated into NIA-AA diagnostic guidelines (when available) and research frameworks routinely to reduce diagnostic heterogeneity.
Identifiants
pubmed: 32116253
pii: JAD191097
doi: 10.3233/JAD-191097
pmc: PMC7242844
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
747-757Références
Alzheimers Dement. 2011 May;7(3):270-9
pubmed: 21514249
Biol Psychiatry. 1998 Jan 1;43(1):60-8
pubmed: 9442345
Nat Rev Neurol. 2010 Feb;6(2):67-77
pubmed: 20139996
Neurology. 2005 Oct 25;65(8):1227-31
pubmed: 16247049
Arch Neurol. 2011 May;68(5):656-9
pubmed: 21555643
Alzheimers Dement. 2019 Jan;15(1):158-167
pubmed: 30642436
Alzheimers Res Ther. 2016 Nov 15;8(1):47
pubmed: 27846868
Neuroimage Clin. 2019;24:101943
pubmed: 31351228
Clin Transl Sci. 2018 Mar;11(2):147-152
pubmed: 28767185
J Am Geriatr Soc. 2000 Oct;48(10):1204-10
pubmed: 11037005
Alzheimers Dement. 2011 May;7(3):263-9
pubmed: 21514250
Can Geriatr J. 2012 Dec;15(4):120-6
pubmed: 23259025
Stroke. 2015 Jan;46(1):255-7
pubmed: 25468879
Int J Geriatr Psychiatry. 2005 Jul;20(7):645-50
pubmed: 16021656
JAMA. 2018 Jan 9;319(2):130-142
pubmed: 29318278
Alzheimers Dement. 2018 Apr;14(4):535-562
pubmed: 29653606
Lancet Neurol. 2013 Aug;12(8):822-38
pubmed: 23867200
Brain. 2010 Apr;133(Pt 4):1163-72
pubmed: 20375138
Neuroimage Clin. 2019;21:101645
pubmed: 30584016
Stroke. 2002 Jan;33(1):95-8
pubmed: 11779895
N Engl J Med. 2013 Jul 25;369(4):341-50
pubmed: 23883379
Neurology. 2009 Mar 17;72(11):999-1007
pubmed: 19289740
Neurology. 2017 Oct 31;89(18):1869-1876
pubmed: 28978655
Science. 2002 Jul 19;297(5580):353-6
pubmed: 12130773
J Magn Reson Imaging. 2019 Feb;49(2):456-465
pubmed: 30635988
Alzheimers Res Ther. 2014 Jul 03;6(4):37
pubmed: 25024750
Neurology. 2017 May 2;88(18):1768-1775
pubmed: 28381506
J Neuroimaging. 2013 Jan;23(1):28-32
pubmed: 22607584
JAMA Neurol. 2017 Sep 1;74(9):1105-1112
pubmed: 28715552
Alzheimers Res Ther. 2016 May 12;8(1):18
pubmed: 27176461
Neuropsychiatr Dis Treat. 2014 Feb 21;10:391-401
pubmed: 24591834
N Engl J Med. 2018 Jan 25;378(4):321-330
pubmed: 29365294
Neurology. 1992 Jan;42(1):183-8
pubmed: 1734300
Neurobiol Aging. 2017 Jun;54:94-99
pubmed: 28347929
BMC Neurol. 2012 Jun 06;12:33
pubmed: 22672344
Neurology. 2018 Oct 9;91(15):e1402-e1412
pubmed: 30217936
Ont Health Technol Assess Ser. 2014 Feb 01;14(1):1-64
pubmed: 24592296
Brain. 1996 Dec;119 ( Pt 6):2001-7
pubmed: 9010004
Can J Neurol Sci. 2017 Mar;44(2):196-202
pubmed: 28003035
Alzheimers Dement. 2019 Jan;15(1):153-157
pubmed: 30642435
Int J Stroke. 2018 Feb;13(2):117-120
pubmed: 29125055
Alzheimers Dement (Amst). 2019 Feb 26;11:191-204
pubmed: 30859119
J Neurol Neurosurg Psychiatry. 2006 Dec;77(12):1307-12
pubmed: 16868066