| Abstrakt: |
Background: Medial temporal atrophy (MTA) has long been demonstrated as a prognostic measure for transition from normal cognition to MCI and from MCI to Dementia, often but not only due to Alzheimer's disease (AD). However, brain scans availability and costs do not allow for it to be implemented as common practice, for early detection of MTA in cognitively normal patients. We tested "Delphi", a non‐invasive measure that probes brain network responses via induction of focused magnetic stimulation over selected brain networks in order to detect MTA. Method: A multicenter study (3 US, 2 OUS), in which one site recruited the derivation cohort (n = 220) which was used for establishing "Delphi" thresholds, and four sites recruited the validation cohort (n = 263, mean age 61.5 (±7.1), 57% females). The study included healthy subjects aged 50‐75 with at least one risk factor for stroke or dementia and no history of neurodegenerative disease. All subjects underwent multiple evaluations including a neurological exam, cognitive tests, MRI scans and "Delphi". Three experienced neuroradiologists blindly rated the scans for MTA (Schelten's scale, 'Normal'‐MTA = 0, 'Abnormal'‐MTA> = 1) and other findings. Result: 263 subjects were included in the validation cohort, out of which 23 subjects were rated MTA≥1 (69% MTA = 1, 17% MTA = 2 and 13% MTA = 3) while the rest were MTA = 0 on MRI scanning. Out of the total sample 11% had abnormal result in MMSE (≤27) and 15% had abnormal result in MoCA (≤23) and only 13% had abnormal result in each of MMSE and MoCA in the MTA≥1 subgroup. "Delphi" discriminated subjects with MTA = 0 from MTA≥1 with AUC = 0.81, sensitivity = 82% [95%CI 62.86%:93.02%], specificity = 75% [95% CI 63.62:81.0%]. Conclusion: Brain network physiology evaluation using the "Delphi" technology may serve to detect early stages of MTA, preceding cognitive impairment with substantial accuracy in the outpatient office setting in a generally healthy population. This could allow the expansion of the physician's in‐office tools, potentially improving patient management. [ABSTRACT FROM AUTHOR] |
