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Evaluation of Whole Brain Health in Aging and Alzheimer's Disease: A Standard Procedure for Scoring an MRI-Based Brain Atrophy and Lesion Index

Article type: Research Article

Authors: Guo, Huia; b | Song, Xiaoweia; c; * | Schmidt, Matthias H.d; e | Vandorpe, Robertd; e | Yang, Zhana; f | LeBlanc, Emilya | Zhang, Jingb | Beyea, Stevena; d; g | Zhang, Yuntingb | Rockwood, Kennethc; h; * | for the Alzheimer's Disease Neuroimaging Initiative1

Affiliations: [a] Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics – Atlantic), Halifax, NS, Canada | [b] Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China | [c] Department of Medicine, Dalhousie University, Halifax, NS, Canada | [d] Department of Radiology, Dalhousie University, Halifax, NS, Canada | [e] Department of Diagnostic Imaging, Capital District Health Authority, NS, Canada | [f] Department of Biology, Crandall University, Moncton, NB, Canada | [g] School of Health Sciences, Dalhousie University, Halifax, NS, Canada | [h] Centre for Healthcare of the Elderly, Capital District Health Authority, NS, Canada

Correspondence: [*] Correspondence to: Xiaowei Song, PhD, MSCS, Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, Suite 3900, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada. Tel.: +1 902 473 1876; Fax: +1 902 473 1050; E-mail: Xiaowei.Song@dal.ca; Kenneth Rockwood, MD, FRCPC, FRCP, Division of Geriatric Medicine, QEII Health Sciences Centre, Suite 1421-5955 Veterans Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada. Tel.: +1 902 473 8631; Fax: +1 902 473 1050; E-mail: Kenneth.Rockwood@dal.ca.

Note: [1] Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (http://adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at: http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf. This paper obtained ADNI approval in January 2014.

Keywords: Aging, Alzheimer's disease, brain, Brain Atrophy and Lesion Index (BALI), cognition, structural MRI

DOI: 10.3233/JAD-140333

Journal: Journal of Alzheimer's Disease, vol. 42, no. 2, pp. 691-703, 2014

Published: 28 August 2014
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Supplementary Materials:

Supplementary Tables.

Abstract

Background:

The Brain Atrophy and Lesion Index (BALI), a semi-quantitative rating scale, has been developed to evaluate whole brain structural changes in aging and Alzheimer’s disease (AD).

Objective:

This study describes a standard procedure to score the BALI and train new raters for reliable BALI evaluation following this procedure.

Methods:

Structural MRI of subjects in the Alzheimer’s Disease Neuroimaging Initiative dataset who had 3.0T, T1, and T2 weighted MRI scans at baseline and at 6, 12, and 24 month follow-ups were retrieved (n = 122, including 24 AD, 51 mild cognitive impairment patients, and 47 healthy control subjects). Images were evaluated by four raters following training with a step-by-step BALI process. Seven domains of structural brain changes were evaluated, and a total score was calculated as the sum of the sub-scores.

Results:

New raters achieved >90% accuracy after two weeks of training. Reliability was shown in both intra-rater correlation coefficients (ICC ≥ 0.92, p < 0.001) and inter-rater correlation coefficients (ICC ≥0.88, p < 0.001). Mean BALI total scores differed by diagnosis (F ≥ 2.69, p ≤ 0.049) and increased consistently over two years.

Conclusion:

The BALI can be introduced using a standard procedure that allows new users to achieve highly reliable evaluation of structural brain changes. This can advance its potential as a robust method for assessing global brain health in aging, AD, and mild cognitive impairment.

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