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Alzheimer's, Dementia & Mental Health
Pre-Alzheimer's Memory Loss May Affect More of Brain
than Assumed
Follow-up
planned to this small study
revealing problems in frontal lobe
 June 27, 2006 - Memory loss associated with early
Alzheimer's disease (AD) may be linked to altered activity in several
areas of the brain, and not just the temporal lobe, according to a study
in the July issue of Radiology.
For the first time, researchers at Duke University
Medical Center in Durham, N.C., used a special, high-field- strength,
functional magnetic resonance imaging (fMRI) scanner to study the brain
activity of people with amnestic mild cognitive impairment (MCI), a
precursor to AD, and found altered functionality in both the frontal and
temporal lobes of the brain.
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Previous studies looking at structural changes
alone have shown evidence that brain atrophy in the earliest stages of
AD tends to be restricted to the temporal lobe, a region critical to
long-term memory formation.
"Involvement of both the frontal and temporal lobes
in the earliest stages of AD suggests the possibility of a breakdown in
the communication pathway between these two regions, which house
short-term and long-term memory, respectively," said lead author Jeffrey
R. Petrella, M.D., associate professor of radiology and director of
Alzheimer's Disease Imaging Research Laboratory at Duke.
"So in many ways the AD brain may be like a
computer that is having problems with both its temporary files and its
hard-drive files."
MCI affects an estimated 15 percent of the elderly
population in the United States. Ten to 15 percent of people with MCI
develop AD every year compared to one percent of the normal elderly
population.
Amnestic MCI is characterized by mild memory
impairment and is often confused with ordinary age-related
forgetfulness.
The researchers used 4-Tesla fMRI, which has a very
strong magnetic field, to observe the brain activity of 20 elderly
patients with amnestic MCI and 20 age-matched controls with no memory
impairment during a memory task that tested memory formation and
retrieval.
"It's like doing a treadmill test for heart
patients, except this test puts your brain on a treadmill," Dr. Petrella
said.
The test required 40 patients to recall names of
familiar faces and to learn and recall unfamiliar face-name
associations.
All patients showed brain activation in several
brain regions during the task, but, compared with the controls, the
patients with MCI showed a lower level of activation in the prefrontal
cortex (during formation and retrieval), left hippocampus (during
retrieval) and left cerebellum (during formation) and an increased level
of activation in the posterior frontal lobes (during retrieval).
"These findings suggest that we should be paying
closer attention to frontal lobe function in detecting people at risk
for AD and may also point to new preventive strategies," said
co-principal investigator P. Murali Doraiswamy, M.D., chief of the
Division of Biological Psychiatry in the Department of Psychiatry at
Duke.
Both researchers caution that their findings are
preliminary. They are in the process of completing a larger study to
confirm these results and to examine their value as a diagnostic or
predictive test.
There have also been a number of previous fMRI
studies in people with MCI, and researchers are working to put these
findings together to develop a synergistic combination of memory
testing, genetic and imaging studies that together can best predict
early onset and monitor progression of AD.
"If memory problems are beginning to impact the
day-to-day life of you and your family, you should undergo comprehensive
testing by a physician, as memory loss can be caused by many underlying
factors such as depression, thyroid problems and stress, and doesn't
necessarily indicate early AD," Dr. Petrella said.
About Radiological Society
Radiology is a monthly scientific journal devoted
to clinical radiology and allied sciences. The journal is edited by
Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth
University, Richmond, Va. Radiology is owned and published by the
Radiological Society of North America, Inc. (RSNA.org/radiologyjnl)
The Radiological Society of North America (RSNA)
is an association of more than 38,000 radiologists, radiation
oncologists, medical physicists and related scientists committed to
promoting excellence in radiology through education and by fostering
research, with the ultimate goal of improving patient care. The Society
is based in Oak Brook, Ill. (RSNA.org)
"Mild Cognitive Impairment: Evaluation with 4-T
Functional MR Imaging." Collaborating with Drs. Petrella and Doraiswamy
on this paper were Sriyesh Krishnan, B.A., Melissa J. Slavin, Ph.D.,
Thanh-Thu T. Tran, B.S., and Lakshmi Murty, B.S.
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