Dissociating Statistically-Determined Alzheimer’s Disease/Vascular Dementia Neuropsychological Syndromes Using White and Gray Neuroradiological Parameters

Article type: Research Article

Authors: Price, Catherine C.^{a; *} | Tanner, Jared J.^a | Schmalfuss, Ilona M.^{b; c} | Brumback, Babette^d | Heilman, Kenneth M.^e | Libon, David J.^{f; *}

Affiliations: [a] Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA | [b] Department of Radiology, University of Florida, Gainesville, Florida, USA | [c] Department of Radiology, North Florida/South Georgia Veteran Administration, Gainesville, Florida, USA | [d] Department of Biostatistics, University of Florida, Gainesville, Florida, USA | [e] Department of Neurology, University of Florida, Gainesville, Florida, USA | [f] Drexel Neuroscience Institute, Drexel University, College of Medicine, Philadelphia, PA, USA

Correspondence: [*] Correspondence to: Catherine C. Price, PhD, ABPP/Cn, Associate Professor, Clinical and Health Psychology, 101S. Newell Drive, PO Box 100165, University of Florida, Gainesville, Florida 32610, USA. Tel.: +1 352 273 5929; Fax: +1 352 265 0096; E-mail: cep23@phhp.ufl.edu

Correspondence: [*] Correspondence to: David J. Libon, Professor, Neurology, Drexel University, College of Medicine, Philadelphia, PA 19129, USA. djlibon@drexelmed.edu

Abstract: Background: There is remarkable heterogeneity in clinical Alzheimer’s disease (AD) or vascular dementia (VaD). Objectives: 1) To statistically examine neuropsychological data to determine dementia subgroups for individuals clinically diagnosed with AD or VaD and then 2) examine group differences in specific gray/white matter regions of interest. Methods: A k-means cluster analysis requested a 3-group solution from neuropsychological data acquired from individuals diagnosed clinically with AD/VaD. MRI measures of hippocampal, caudate, ventricular, subcortical lacunar infarction, whole brain volume, and leukoaraiosis (LA) were analyzed. Three regions of LA volumes were quantified and these included the periventricular (5 mm around the ventricles), infracortical (5 mm beneath the gray matter), and deep (between periventricular and infracortical) regions. Results: Cluster analysis sorted AD/VaD patients into single domain amnestic (n = 41), single-domain dysexecutive (n = 26), and multi-domain (n = 26) phenotypes. Multi-domain patients exhibited worst performance on language tests; however, multi-domain patients were equally impaired on memory tests when compared to amnestic patients. Statistically-determined groups dissociated using neuroradiological parameters: amnestic and multi-domain groups presented with smaller hippocampal volume while the dysexecutive group presented with greater deep, periventricular, and whole brain LA. Neither caudate nor lacunae volume differed by group. Caudate nucleus volume negatively correlated with total LA in the dysexecutive and multi-domain groups. Conclusions: There are at least three distinct subtypes embedded within patients diagnosed clinically with AD/VaD spectrum dementia. We encourage future research to assess a) the neuroradiological substrates underlying statistically-determined AD/VaD spectrum dementia and b) how statistical modeling can be integrated into existing diagnostic criteria.

Keywords: Caudate nucleus, executive function, hippocampus, lacune, learning, leukoaraiosis, memory, Philadelphia (repeatable) Verbal Learning Test, ventricles, white matter abnormalities

DOI: 10.3233/JAD-150407

Journal: Journal of Alzheimer's Disease, vol. 48, no. 3, pp. 833-847, 2015