Alzheimer Dementia Clinical Trial
Official title:
Application of Diffusion Tensor Imaging in Alzheimer's Disease:Quantification of White Matter Micro-structural Changes
Diffusion Tensor imaging of white matter degeneration in Alzheimer disease
Alzheimer's disease (AD) is the most common cause of dementia in the elderly, accountings for
60-70% of all demented cases. It is a neuro-pathological diagnosis determined by presence of
neurofibrillary tangles and senile plaques in the brain of patients with dementia. The
disease frequently starts with memory impairment, but is invariably followed by a progressive
global cognitive impairment. The major risk factor for Alzheimer disease is age, with
prevalence doubling every 5 years after the age of 65.
Diagnosis of Alzheimer's typically involves physical and neurological exams, as medical
history and mental status evaluation, laboratory investigations and it involves brain imaging
(such as MRI) which could identify other causes of problems such as stroke, tumor or head
trauma. By physical and neurological examination, Alzheimer's disease characterized by
gradual onset and progressive decline in cognition with sparring of motor and sensory
function until later stages; the average course of Alzheimer's disease is approximately a
decade, with a range of 3 to 20 years duration from diagnosis to death .Memory impairment is
present in the earliest stages of the disease; patients have difficulty learning new
information and retaining it for more than few minutes. As the disease advances, the ability
to learn increasingly compromised, more distant memories are lost. Other cognitive loses
include aphasia, apraxia, disorientation and impaired judgment. Cognitive impairment affects
daily life; patients have difficulty planning meals, managing finances or medication, using
telephone, driving. Many capacities may remain intact until later stages including
performance of self-care activities of daily living as eating, bathing. Patients evidence
personality alteration, irritability, anxiety, depression. Delusion, hallucination and
aggression. Laboratory Evaluation includes Biochemical markers as measurement of
Cerebrospinal fluid including Tau protein, amyloid beta peptides or neural thread protein and
measurement of urinary biomarkers including neural thread protein. Also testing including Apo
lipoprotein E epsilon 4 allele presenilin genes, amyloid precursor gene or TREM2. Diffusion
tensor imaging (DTI) is an imaging technology based on magnetic resonance diffusion weighted
imaging, which can make quantitative analysis of anisotropy of water molecules in different
directions, so as to observe the microstructure of tissues non-invasively. So Diffusion
tensor imaging can provide information of fiber orientation, the injury of fiber, and
membrane permeability which cannot be obtained from conventional MRI. Diffusion tensor
imaging enables mapping of White matter microstructure changes in development, aging and
neurological disorders, From the tensor, it's possible to derive the mean diffusivity (DM)
and the fractional anisotropy (FA) which is the most robust measures of anisotropy which
measure the degree of deviation from isotropic diffusion. ). More recently, an additional
DT-MRI derived index has been proposed .This index measures the degree of similarity of
orientation of neighboring voxels and its named inter-voxel coherence (C).
So Diffusion tensor imaging has therefore become a powerful technique in the study of
neurodegenerative diseases in recent years.
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