Free Access
Dement Geriatr Cogn Disord 2010;30:121–130

An MRI-Based Semiquantitative Index for the Evaluation of Brain Atrophy and Lesions in Alzheimer’s Disease, Mild Cognitive Impairment and Normal Aging

Chen W.a, g · Song X.a, b · Zhang Y.g · Darvesh S.c, e · Zhang N.a, g · D’Arcy R.C.N.a, d · Black S.f · Rockwood K.b, e
aNational Research Council Canada, Institute for Biodiagnostics (Atlantic), bDivision of Geriatric Medicine, Department of Medicine, cDepartments of Medicine (Neurology) and Anatomy and Neurobiology, and dDepartments of Radiology and Psychology and Neuroscience, Dalhousie University, and eCentre for Health Care of the Elderly, QEII Health Sciences Centre, Halifax, N.S., and fDepartment of Medicine (Neurology) and Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont., Canada; gDepartment of Radiology of the General Hospital, Tianjin Medical University, Tianjin, China
email Corresponding Author

 goto top of outline Key Words

  • Aging
  • Alzheimer’s disease
  • Brain lesions
  • Brain atrophy
  • Mild cognitive impairment

 goto top of outline Abstract

Background: This study investigates how T1-weighted MRI can be used to evaluate brain anatomical changes. We investigated these changes in Alzheimer’s disease (AD) and normal aging. Methods: A semiquantitative brain atrophy and lesion index (BALI) was constructed by adapting existing visual rating scales and validated in 3 datasets. Results: The T1- and T2-weighted-imaging-based scores were highly correlated. They were both closely associated with age and with cognitive test scores. Conclusion: The T1-based BALI helps describe brain structural variability in AD, mild cognitive impairment and normal aging.

Copyright © 2010 S. Karger AG, Basel

 goto top of outline References
  1. Drayer BP: Imaging of the aging brain. Part 1. Normal findings. Radiology 1988;166:785–796.
  2. Black S, Gao F, Bilbao J: Understanding white matter disease: imaging-pathological correlations in vascular cognitive impairment. Stroke 2009;40:S48–S52.
  3. Schneider JA, Boyle PA, Arvanitakis Z, Bienias JL, Bennett DA: Subcortical infarcts, Alzheimer’s disease pathology, and memory function in older persons. Ann Neurol 2007;62:59–66.
  4. Chen X, Wen W, Anstey KJ, Sachdev PS: Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. Neurology 2009;73:266–272.
  5. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A: Incidental findings on brain MRI in the general population. N Engl J Med 2007;357:1821–1828.
  6. Scheltens P, Erkinjuntti T, Leys D, Wahlund LO, Inzitari D, del Ser T, Pasquier F, Barkhof F, Mäntylä R, Bowler J, Wallin A, Ghika J, Fazekas F, Pantoni L: White matter changes on CT and MRI: an overview of visual rating scales. European Task Force on Age-Related White Matter Changes. Eur Neurol 1998;39:80–89.
  7. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: MRI signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 1987;149:351–356.
  8. Scheltens P, Barkhof F, Leys D, Pruvo JP, Nauta JJ, Vermersch P, Steinling M, Valk J: A semiquantitative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci 1993;114:7–12.
  9. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjögren M, Wallin A, Ader H, Leys D, Pantoni L, Pasquier F, Erkinjuntti T, Scheltens P: European Task Force on Age-Related White Matter Changes: a new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;32:1318–1322.
  10. Bakshi R, Benedict RH, Bermel RA, Jacobs L: Regional brain atrophy is associated with physical disability in multiple sclerosis: semiquantitative magnetic resonance imaging and relationship to clinical findings. J Neuroimaging 2001;11:129–136.
  11. Barkhof F, Scheltens P: Imaging of white matter lesions. Cerebrovasc Dis 2002;13(suppl 2):21–30.
  12. Desmond DW: Cognition and white matter lesions. Cerebrovasc Dis 2002;13(suppl 2):53–57.
  13. van der Flier WM, van Straaten EC, Barkhof F, Verdelho A, Madureira S, Pantoni L, Inzitari D, Erkinjuntti T, Crisby M, Waldemar G, Schmidt R, Fazekas F, Scheltens P: Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke 2005;36:2116–2120.
  14. Rockwood K, Black SE, Song X, Hogan DB, Gauthier S, MacKnight C, Vandorpe R, Guzman A, Montgomery P, Kertesz A, Bouchard RW, Feldman H: Clinical and radiographic subtypes of vascular cognitive impairment in a clinic-based cohort study. J Neurol Sci 2006;240:7–14.
  15. Heo JH, Lee ST, Kon Chu, Park HJ, Shim JY, Kim M: White matter hyperintensities and cognitive dysfunction in Alzheimer disease. J Geriatr Psychiatry Neurol 2009;22:207–212.
  16. Geerlings MI, Appelman AP, Vincken KL, Mali WP, van der Graaf Y, SMART Study Group: Association of white matter lesions and lacunar infarcts with executive functioning: the SMART-MR study. Am J Epidemiol 2009;170:1147–1155.
  17. Mueller SG, Weiner MW, Thal LJ, Petersen RC, Jack C, Jagust W, Trojanowski JQ, Toga AW, Beckett L: The Alzheimer’s disease neuroimaging initiative. Neuroimaging Clin N Am 2005;15:869–877.
  18. Jack CR Jr, Bernstein MA, Fox NC, Thompson P, Alexander G, Harvey D, et al: The Alzheimer’s Disease Neuroimaging Initiative (ADNI): MRI methods. J Magn Reson Imaging 2008;27:685–691.
  19. Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420–428.
  20. Holland CM, Smith EE, Csapo I, Gurol ME, Brylka DA, Killiany RJ, Blacker D, Albert MS, Guttmann CR, Greenberg SM: Spatial distribution of white matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Stroke 2008;39:1127–1133.
  21. Kesslak JP, Nalcioglu O, Cotman CW: Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer’s disease. Neurology 1991;41:51–54.
  22. Wahlund LO, Julin P, Johansson SE, Scheltens P: Visual rating and volumetry of the medial temporal lobe on magnetic resonance imaging in dementia: a comparative study. J Neurol Neurosurg Psychiatry 2000;69:630–635.
  23. Duara R, Loewenstein DA, Potter E, Appel J, Greig MT, Urs R, Shen Q, Raj A, Small B, Barker W, Schofield E, Wu Y, Potter H: Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology 2008;71:1986–1992.
  24. Jack CR Jr, Shiung MM, Gunter JL, O’Brien PC, Weigand SD, Knopman DS, Boeve BF, Ivnik RJ, Smith GE, Cha RH, Tangalos EG, Petersen RC: Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD. Neurology 2004;62:591–600.
  25. Saka E, Dogan EA, Topcuoglu MA, Senol U, Balkan S: Linear measures of temporal lobe atrophy on brain magnetic resonance imaging (MRI) but not visual rating of white matter changes can help discrimination of mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Arch Gerontol Geriatr 2007;44:141–151.
  26. Devanand DP, Pradhaban G, Liu X, Khandji A, de Santi S, Segal S, Rusinek H, Pelton GH, Honig LS, Mayeux R, Stern Y, Tabert MH, de Leon MJ: Hippocampal and entorhinal atrophy in mild cognitive impairment: prediction of Alzheimer disease. Neurology 2007;68:828–836.
  27. de Leeuw FE, Korf E, Barkhof F, Scheltens P: White matter lesions are associated with progression of medial temporal lobe atrophy in Alzheimer disease. Stroke 2006;37:2248–2252.
  28. Cho H, Kwon JH, Seo HJ: Medial temporal lobe atrophy in vascular dementia: visual temporal lobe rating scale. Arch Gerontol Geriatr 2009;48:415–418.
  29. Knoops AJ, van der Graaf Y, Appelman AP, Gerritsen L, Mali WP, Geerlings MI: Visual rating of the hippocampus in non-demented elders: does it measure hippocampal atrophy or other indices of brain atrophy? The SMART-MR study. Hippocampus 2009;19:1115–1122.
  30. Black S, Iadecola C: Vascular cognitive impairment – small vessels, big toll: introduction. Stroke 2009;40:S38–S39.
  31. Richard E, Gouw AA, Scheltens P, van Gool WA: Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of white matter lesions on MRI: the Evaluation of Vascular Care in Alzheimer’s Disease (EVA) study. Stroke 2010;41:554–556.

 goto top of outline Author Contacts

Xiaowei Song, PhD, MSCS; Kenneth Rockwood, MD, FRCPC
Neuroimaging Research Laboratory, National Research Council Canada
Institute for Biodiagnostics (Atlantic)
Suite 3900, 1796 Summer Street, Halifax, NS B3H 3A7 (Canada)

 goto top of outline Article Information

Data used in the preparation of this article were partly obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database ( As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in the analysis or writing of this report. The principal investigator of the initiative is Dr. Michael W. Weiner. A complete list of the ADNI investigators can be found at the following website:

Accepted: July 6, 2010
Published online: August 21, 2010
Number of Print Pages : 10
Number of Figures : 5, Number of Tables : 4, Number of References : 31

 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 30, No. 2, Year 2010 (Cover Date: September 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information:

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.