Original ArticleComparisons between Global and Focal Brain Atrophy Rates in Normal Aging and Alzheimer Disease: Boundary Shift Integral versus Tracing of the Entorhinal Cortex and HippocampusEzekiel, Frank BA*†; Chao, Linda PhD*†‡; Kornak, John PhD*†∥; Du, An-Tao MD*†; Cardenas, Valerie PhD*†; Truran, Diana BA*†; Jagust, William MD#; Chui, Helena MD**; Miller, Bruce MD§; Yaffe, Kristine MD‡§∥; Schuff, Norbert PhD*†; Weiner, Michael MD*†‡§¶Author Information From the *Magnetic Resonance Unit, San Francisco Veterans Affairs Medical Center, San Francisco, California; †Department of Radiology, University of California, San Francisco, California; ‡Department of Psychiatry, University of California, San Francisco, California; §Department of Neurology, University of California, San Francisco, California; ∥Department of Epidemiology and Biostatistics, University of California, San Francisco, California; ¶Department of Medicine; University of California, San Francisco, California; #University of California, Berkeley Neuroscience Institute, Berkeley, California; **University of Southern California, Department of Neurology, Los Angeles, California. Received for publication March 16, 2004; accepted September 30, 2004. Reprints: Michael W. Weiner, MD, VA Medical Center (114M), 4150 Clement St., San Francisco, CA 94121 (e-mail: email@example.com). This work was supported by VA Research Service grant (MIRECC), VA REAP grant, NIH/NIA RO1 AG10897, and NIH/NIA PO1 AG12435. Alzheimer Disease & Associated Disorders: October-November-December 2004 - Volume 18 - Issue 4 - p 196-201 Buy Abstract The objectives of this study were to (1) compare atrophy rates associated with normal aging and Alzheimer disease (AD) using the semi-automated Boundary Shift Integral (BSI) method and manual tracing of the entorhinal cortex (ERC) and hippocampus and (2) calculate power of BSI vs. ERC and hippocampal volume changes for clinical trials in AD. We quantified whole brain and ventricular BSI atrophy rates and ERC and hippocampal atrophy rates from longitudinal MRI data in 20 AD patients and 22 age-matched healthy controls. All methods revealed significant brain atrophy in controls and AD patients. AD patients had approximately 2.5 times greater whole brain BSI atrophy rates and more than 5 times greater ERC and hippocampal atrophy rates than controls. ERC and hippocampal atrophy rates were higher in both groups than whole brain BSI atrophy rates, but lower than ventricular BSI atrophy rates. Effect size and power calculations suggest that ERC and hippocampal measurements may be more sensitive than ventricular or whole brain BSI for detecting AD progression and the potential effects of disease modifying agents. Logistic regression analysis revealed that combined rates of ERC and ventricular BSI were the best explanatory variables for classifying AD from controls. © 2004 Lippincott Williams & Wilkins, Inc.