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Cortical and Subcortical Atrophy in Alzheimer Disease: Parallel Atrophy of Thalamus and Hippocampus

Štěpán-Buksakowska, Irena MD*,†; Szabó, Nikoletta MD†,‡; Hořínek, Daniel MD, PhD†,§; Tóth, Eszter MD; Hort, Jakub MD, PhD†,∥; Warner, Joshua BS; Charvát, František MD, PhD#; Vécsei, László MD, PhD‡,**; Roček, Miloslav MD, PhD*; Kincses, Zsigmond T. MD, PhD†,‡

Alzheimer Disease & Associated Disorders: January-March 2014 - Volume 28 - Issue 1 - p 65–72
doi: 10.1097/WAD.0b013e318299d3d6
Original Articles

Brain atrophy is a key imaging hallmark of Alzheimer disease (AD). In this study, we carried out an integrative evaluation of AD-related atrophy. Twelve patients with AD and 13 healthy controls were enrolled. We conducted a cross-sectional analysis of total brain tissue volumes with SIENAX. Localized gray matter atrophy was identified with optimized voxel-wise morphometry (FSL-VBM), and subcortical atrophy was evaluated by active shape model implemented in FMRIB’s Integrated Registration Segmentation Toolkit. SIENAX analysis demonstrated total brain atrophy in AD patients; voxel-based morphometry analysis showed atrophy in the bilateral mediotemporal regions and in the posterior brain regions. In addition, regarding the diminished volumes of thalami and hippocampi in AD patients, subsequent vertex analysis of the segmented structures indicated shrinkage of the bilateral anterior thalami and the left medial hippocampus. Interestingly, the volume of the thalami and hippocampi were highly correlated with the volume of the thalami and amygdalae on both sides in AD patients, but not in healthy controls. This complex structural information proved useful in the detailed interpretation of AD-related neurodegenerative process, as the multilevel approach showed both global and local atrophy on cortical and subcortical levels. Most importantly, our results raise the possibility that subcortical structure atrophy is not independent in AD patients.

Departments of Neurology, Memory Disorders Clinic

*Radiology, Charles University, 2nd Faculty of Medicine, University Hospital Motol

§Department of Neurosurgery, Charles University in Prague, 1st Faculty of Medicine, University Central Military Hospital

#Department of Radiodiagnostics, University Central Military Hospital, Prague

International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

Department of Neurology, Albert Szent-Györgyi Clinical Center, Faculty of Medicine

**Neuroscience Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary

Department of Biomedical Engineering, Mayo Clinic, Rochester, MN

Supported by IGA NT 11536 from Ministry of Health’s Departmental Research and Development Programme III, Research Goal MSM 0021620816 from Ministry of Education, by European Regional Development Fund-Project FNUSA-ICRC (No.CZ.1.05/1.1.00/02.0123), “Neuroscience Research Group of the Hungarian Academy of Sciences and University of Szeged” and the OTKA PD 104715 grant. Z.T.K. was supported by the Bolyai Scholarship Programme of the Hungarian Academy of Sciences.

The authors declare no conflicts of interest.

Reprints: Miloslav Roček, MD, PhD, Department of Radiology, Charles University, 2nd Medical Faculty, University Hospital Motol, V Úvalu 84 150 06 Prague 5, Prague, Czech Republic (e-mail:

Received May 23, 2012

Accepted March 11, 2013

© 2014 by Lippincott Williams & Wilkins.