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 New MRI Test Can Diagnose AD, LBD, FTLD 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post New MRI Test Can Diagnose AD, LBD, FTLD
Someone in our local support group alerted me to this news story today in the Alzheimer's Reading Room. The story is about some Mayo Rochester research that entailed looking at autopsied brains of dementia patients and reviewing the MRIs taken when these patients were alive. "The researchers identified unique patterns in the brain and then developed a scoring system for diagnosis." This new test, called the STAND-Map, is potentially useful to diagnosing patients with AD, FTLD, and LBD.

Obviously, this research highlights the importance of brain donation.

You might remember Dr. Ron Petersen, the lead Mayo Rochester researcher, from the HBO video of a patient with mild cognitive impairment and RBD (REM sleep behavior disorder). Dr. Petersen told the patient that his diagnosis had changed to LBD. See:
http://community.lbda.org/forum/viewtopic.php?t=1579

Robin



http://www.alzheimersreadingroom.com/20 ... gnose.html

Saturday, July 11, 2009
New Structural MRI Test Can Diagnose Alzheimer's and Lewy Body Disease

This is interesting news that is being discussed today at the Alzheimer's Association International Conference on Alzheimer's Disease (ICAD) in Vienna.

A new test called "STructural Abnormality iNDex" or STAND-Map shows great promise in being able to diagnose dementia while patients are alive. The STructural Abnormality iNDexa is a scoring system for MRI images that determines whether someone has Alzheimer's disease, frontotemporal lobar degeneration, and Lewy body disease. The test was developed by looking at autopsied brains and then going back and comparing them to the MRIs of patients. The researchers identified unique patterns in the brain and then developed a scoring system for diagnosis.

Dr. Ron Petersen, director of the Mayo Alzheimer's Disease Research Center, said researchers followed Mayo patients all the way from diagnosis through death.

"Then we got autopsies on them and ... went back and looked at the imaging that had been done," Petersen said. Researchers compared those results with the patients' MRI images that had been taken over the years. Then they developed the new diagnosis technique.

Petersen said researchers made a scoring system for MRI images that determines whether someone has one of the three dementias or not and, if so, which dementia it is.



Mayo Clinic Study Using Structural MRI May Help Accurately Diagnose Dementia Patients

A new Mayo Clinic study may help physicians differentially diagnose three common neurodegenerative disorders in the future. The study will be presented at the Alzheimer's Association International Conference on Alzheimer's Disease on July 11 in Vienna.

In this study, Mayo Clinic researchers developed a framework for MRI-based differential diagnosis of three common neurodegenerative disorders: Alzheimer's disease, frontotemporal lobar degeneration, and Lewy body disease using Structural MRI. Currently, examination of the brain at autopsy is the only way to confirm with certainty that a patient had a specific form of dementia. The framework, which is called "STructural Abnormality iNDex" or STAND-Map, shows promise in accurately diagnosing dementia patients while they are alive. The rationale is that if each neurodegenerative disorder can be associated with a unique pattern of atrophy specific on MRI, then it may be possible to differentially diagnose new patients. The study looked at 90 patients from the Mayo Clinic database who were confirmed to have only a single dementia pathology and also underwent an MRI at the time of clinical diagnosis of dementia. Using the STAND-Map framework, researchers predicted an accurate pathological diagnosis 75 to 80 percent of the time.

"The STAND-Map framework might have great potential in early diagnosis of dementia patients," says Prashanthi Vemuri, Ph.D., a senior research fellow at the Mayo Clinic aging and dementia imaging research lab and lead author of the study. "The next step would be to test the framework on a larger population to see if we can replicate these results and improve the accuracy level we achieved in this proof of concept study. In turn, this may lead to better treatment options for dementia patients."

The senior author of this Mayo Clinic research study is Clifford Jack, M.D. Other members included Kejal Kantarci, M.D.; Matthew L. Senjem; Jeffrey Gunter; Jennifer Whitwell, Ph.D.; Keith Josephs, M.D.; David Knopman, M.D.; Bradley Boeve, M.D.; Tanis Ferman, Ph.D.; Dennis Dickson, M.D.; and Ronald Petersen, Ph.D., M.D.

This work was supported in part by National Institutes of Health (NIH) grants, Robert H. Smith Family Foundation Research Fellowship, Alexander Family Alzheimer's Disease Research Professorship.

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,300 physicians, scientists and researchers and 46,000 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.


Sun Jul 12, 2009 12:32 am
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About a week ago, Mayo Clinic posted this video to YouTube; it's a Mayo researcher (unidentified) talking about this new MRI test:
http://www.youtube.com/watch?v=2Yd1eQuSStY


Thu Jul 16, 2009 9:35 am
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Thanks, Robin! I know that the subjects have to be part of the research study and that it is not available universally, yet. I just wondered if there were any new data from their ongoing study. It's exciting and, with a 75-80% correlation of MRI to post-mortem dx, looks promising.


Mon Mar 22, 2010 11:32 am
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I'm in email contact with some of the researchers listed and all they will say is "the data looks good" and "we hope to publish more soon."

Note that the number of participants studied is rather small -- 90. And I wouldn't say that these 90 represented real-world situations because they only had ONE brain pathology. In all of the brain donations that I've been involved in, I've never seen a person have only DLBD (or TLBD). Sometimes there are NINE pathologies in the brain!

And since DLB frequently co-occurs with AD, researchers are not going to be able to differentiate those patients, if they are relying on "maps" from single-pathology patients.

But...we have to start somewhere.


Mon Mar 22, 2010 12:31 pm
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Copied below is the abstract of a new paper out from Mayo Rochester about their MRI test now called "Differential-STAND," which must be the same thing as "STAND-Map," which was the name in 2009 (see 2009 posts above).

This MRI is for giving a differential diagnosis between AD, LBD, and FTLD. This sentence gives their key results: The Differential-STAND classification "showed reasonable performance compared to the autopsy gold-standard and clinical diagnosis: AD (sensitivity: 90.7%; specificity: 84%), LBD (sensitivity: 78.6%; specificity: 98.8%) and FTLD-TDP (sensitivity: 84.4%; specificity: 93.8%)."

The abstract is *mostly* understandable.

Robin



Neuroimage. 2010 Dec 30. [Epub ahead of print]

Antemortem Differential Diagnosis of Dementia Pathology using Structural MRI: Differential-STAND.

Vemuri P, Simon G, Kantarci K, Whitwell JL, Senjem ML, Przybelski SA, Gunter JL, Josephs KA, Knopman DS, Boeve BF, Ferman TJ, Dickson DW, Parisi JE, Petersen RC, Jack CR Jr.
Department of Radiology, Mayo Clinic Rochester, MN.

The common neurodegenerative pathologies underlying dementia are Alzheimer's disease (AD), Lewy body disease (LBD) and Frontotemporal lobar degeneration (FTLD). Our aim was to identify patterns of atrophy unique to each of these diseases using antemortem structural-MRI scans of pathologically-confirmed dementia cases and build an MRI-based differential diagnosis system.

Our approach of creating atrophy maps using structural-MRI and applying them for classification of new incoming patients is labeled Differential-STAND (Differential-diagnosis based on STructural Abnormality in NeuroDegeneration).

Pathologically-confirmed subjects with a single dementing pathologic diagnosis who had an MRI at the time of clinical diagnosis of dementia were identified: 48 AD, 20 LBD, 47 FTLD-TDP (pathology-confirmed FTLD with TDP-43).

Gray matter density in 91 regions-of-interest was measured in each subject and adjusted for head-size and age using a database of 120 cognitively normal elderly.

The atrophy patterns in each dementia type when compared to pathologically-confirmed controls mirrored known disease-specific anatomic patterns: AD-temporoparietal association cortices and medial temporal lobe; FTLD-TDP-frontal and temporal lobes and LBD-bilateral amygdalae, dorsal midbrain and inferior temporal lobes.

Differential-STAND based classification of each case was done based on a mixture model generated using bisecting k-means clustering of the information from the MRI scans.

Leave-one-out classification showed reasonable performance compared to the autopsy gold-standard and clinical diagnosis: AD (sensitivity:90.7%;specificity:84 %), LBD (sensitivity:78.6%;specificity:98.8%) and FTLD-TDP (sensitivity:84.4%;specificity:93.8%).

The proposed approach establishes a direct a priori relationship between specific topographic patterns on MRI and "gold standard" of pathology which can then be used to predict underlying dementia pathology in new incoming patients.

Copyright © 2010. Published by Elsevier Inc.

PubMed ID#: 21195775 (see pubmed.gov for this abstract only)


Thu Jan 06, 2011 12:50 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Thanks Robin, There is a glimmer of hope for the future.
Gerry

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Thu Jan 06, 2011 6:44 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Robin, this is interesting research, thanks for posting it. I was wondering, have you ever come across anything on adjusting an MRI procedure (or developing new MRI instrumentation) so that someone with a pacemaker can have one? This is a major wall for us and I'm sure for others.

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Annie, daughter of brave Marie, dx 2007 and in ALF


Thu Jan 06, 2011 11:08 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
I went to mom's neuro today so he could sign FMLA paperwork for me. I told him about this research. Info found on this forum seems to open doors of communication with the medical professionals. A little knowledge of the lingo goes a long way.

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Katie (36) daughter of Marcia (70)


Thu Jan 06, 2011 11:13 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
AnnieN - Sorry, I haven't heard anything about this. - Robin


Thu Jan 06, 2011 11:36 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD (Annie)
Yes, Annie. I have heard about this. They reset the machine and put in something different....magnet???...and the test takes severl times longer to complete. They did this for my husband before his second Deep Brain Stimulator was implanted. They do an MRI and a CT Scan and "marry" the two tests to give them the pictures of the brain so that they can precisely target the place they want to leads implanted. We were told to never have an MRI where they were not skilled in doing this change up.

Smiles, Nan


Thu Jan 06, 2011 11:48 am
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Nan! -
Your husband has had DBS! I hope this was in the early days when clinicians didn't know that we shouldn't do DBS on people with LBD (or those who might get LBD, as indicated on neuropsychological exams). Did you notice a bit hit on his cognition after DBS?
Robin


Thu Jan 06, 2011 5:06 pm
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Robin, I'm glad you said that. When Derek was first diagnosed, we had heard about DBS and thought it might help but his neuro said it was not recommended in his case. I thought it was just because he didn't have a tremor. I didn't know it made LBD worse!

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Jan 06, 2011 5:20 pm
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Funny...This nis the first time I have ever heard that LBD patients shouldn't have DBS. Del had his surgeries in 2005 and was not diagnosed with LBD until a year ago. The DBS surgeries were done in two stages....first the side with the most pronounced symptoms and then the second side. I was after the second surgery that things started to go South on us. That was his first episode of delirium following anesthesia. So I suppose it was in force even then.

Sadly, Nan


Thu Jan 06, 2011 6:12 pm
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
Also, his neuropsych tests were all within normal limits for a man his age. They did a whole day of testing at the Booth Gardner Center here.

Nan


Thu Jan 06, 2011 6:14 pm
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Post Re: New MRI Test Can Diagnose AD, LBD, FTLD
In May 2003 the letter after Coy's neuropsych tests said he was "normal for a man is age." In June 2003 he had full blown LBD symptoms. Can you say "sudden onset"? 8)

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Thu Jan 06, 2011 10:39 pm
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