New imaging biomarkers emerge for Alzheimer’s and its impairments
Brain MRI of the choroid plexus, the main supplier of cerebrospinal fluid, can deliver independent biomarkers for Alzheimer’s disease without an assist from clinical tests for amyloid abnormality or neurodegeneration, according to a study conducted in South Korea and published May 17 in Radiology.[1]
Led by radiologists and neurologists at Konkuk University Medical Center in Seoul, the study team found the choroid plexus’s volume and permeability consistently correlated with cognitive impairment. Falloff in the structure’s volume reflected increasingly symptomatic functional decline, and reductions in its permeability appeared in patients with confirmed Alzheimer’s but not in undiagnosed patients with mild symptoms of impairment.
Jong Duck Choi, Won-Jin Moon and co-authors reviewed past cases of 532 patients. Of these, 78 had subjective (patient-reported) cognitive impairment, 158 had early mild cognitive impairment (MCI), 149 had late-stage MCI and 147 had Alzheimer’s.
All were imaged with 3-Tesla brain MRI, including 132 whose scans used dynamic contrast or quantitative susceptibility mapping protocols. Another 94 had amyloid PET images available.
The team found falling choroid plexus volume was associated with worsening symptom severity, while age, male sex and hypertension—but not amyloid positivity—were associated with larger choroid plexus volume.
Further, decreasing volume—along with female sex, hippocampus volume and other measures—arose as “an additional independent factor” predicting worse cognition.
Choroid plexus volume also proved an independent predictor of memory status, executive function and scores on mental-state exercises, while permeability negatively correlated with volume but not susceptibility.
In their discussion, Choi, Moon and co-authors comment:
Choroid plexus volume and permeability may be potential imaging markers for cognitive impairment in Alzheimer disease, independent of amyloid abnormality or neurodegeneration. Further validation and longitudinal studies are required to determine whether choroid plexus volume can be used in combination with other volumetric measures as a surrogate parameter for cognitive decline.”
RSNA has posted the study in full for free.
In an accompanying editorial,[2] Weill Cornell neuroradiologist Gloria Chiang, MD, writes:
Interestingly, 17.7% of the patients had amyloid PET scans, and amyloid deposition levels were not associated with choroid plexus volume. On the other hand, choroid plexus volume was associated with vascular risk factors such as hypertension, diabetes and a history of cardiovascular disease, as well as periventricular white matter hyperintensity volumes. … In the future, one can envision therapies that potentiate choroid plexus function in older age, leading to preserved cerebrospinal fluid secretion and potentially increased glymphatic flow to clear out toxic proteins.”
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References:
- Jong Duck Choi, Won-Jin Moon, et al., “Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum.” Radiology, May 17, 2022. DOI: https://doi.org/10.1148/radiol.212400
- Gloria C. Chiang, “The Blood–Cerebrospinal Fluid Barrier May Play a Role in Alzheimer Disease Pathogenesis.” Radiology, May 17, 2022. DOI: https://doi.org/10.1148/radiol.220740
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.