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Recently proposed criteria for prodromal Alzheimer disease (AD),1 mild cognitive impairment (MCI) due to AD,2 and probable AD dementia3 incorporate molecular evidence of amyloid-β (Aβ) pathology and also consider measures of brain structure and function as supportive biomarkers. MRI-based biomarkers are also proposed as supportive evidence for a diagnosis of preclinical AD4 in cognitively normal individuals, posing new challenges for definition, validation, and interpretation of these biomarkers. A number of MRI-based biomarkers, such as volumes of hippocampus and entorhinal cortex, show robust differences between groups of patients with AD and controls. However, these measures have limited sensitivity and specificity in predicting who will develop AD in individual patients. The development and validation of new structural neuroimaging biomarkers sensitive to early changes in the disease process will be critical to implementation of the new research criteria for preclinical AD.
In this issue of Neurology®, Dickerson and Wolk5 investigate the utility of a potential MRI biomarker of neurodegeneration, based on a previously identified set of 9 brain regions that show cortical thinning in AD, MCI, and cognitively normal individuals with Aβ deposition on PET imaging. Using …
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