A pattern of brain atrophy that shows up on a standard MRI may signal how quickly a person with early-onset Alzheimer's disease will move from mild cognitive impairment to dementia, according to researchers at the Mass General Brigham Neuroscience Institute. The findings appear in Neurology, an official journal of the American Academy of Neurology.
Early-onset Alzheimer's, which begins before age 65, is rare and tends to advance faster than the more common later-onset form. But the pace varies widely between individuals, which makes it very hard for clinicians to tell any given patient what the next few years are likely to look like. The research team analyzed 130 people aged 40 to 64 who had mild cognitive impairment due to early-onset Alzheimer's, along with 97 cognitively normal people of similar age, drawn from the Longitudinal Early-Onset Alzheimer's Disease Study (LEADS), a US multi-center consortium and the largest study of the condition worldwide.
The practical appeal here is that the scan is already part of the workup. As the researchers put it, using an MRI that clinicians are ordering anyway to estimate the likely speed of decline could help families plan ahead for caregiving and living arrangements, and let doctors tailor decisions to the individual rather than to an average.
People diagnosed in their 40s, 50s and early 60s often still have jobs, mortgages and dependent children, so the timing of decline carries consequences that go well beyond the clinic. A prognostic marker does not change the course of the disease, but a clearer sense of what is coming is something patients and caregivers in this group have largely gone without.