Detection of changes in the locus coeruleus in patients with mild cognitive impairment and Alzheimer's disease: high-resolution fast spin-echo T1-weighted imaging

Abstract

Aim: Neuronal degeneration in the locus coeruleus occurs in the early phase of Alzheimer's disease, similar to mild cognitive impairment. The locus coeruleus produces norepinephrine, a deficiency of which causes both memory disturbance and psychological symptoms. Thus, we evaluated signal alterations in the locus coeruleus of patients with Alzheimer's disease and mild cognitive impairment using a high-resolution fast spin-echo T1-weighted imaging.

Methods: A total of 22 patients with Alzheimer's disease, 47 patients with mild cognitive impairment and 26 healthy controls were prospectively examined by high-resolution fast spin-echo T1-weighted imaging at 3 Tesla. Signal intensities in the locus coeruleus were manually measured and expressed relative to those in the adjacent white matter structures as contrast ratios.

Results: Locus coeruleus contrast ratios were significantly reduced in patient groups with Alzheimer's disease, mild cognitive impairment that converted to Alzheimer's disease and mild cognitive impairment that did not convert to Alzheimer's disease (1.80-16.09% [median, 9.30%], 3.45-14.84% [median 6.87%] and 3.01-19.19% [median 7.72%], respectively) compared with the healthy control group (6.24-20.94% [median 14.35%]; P < 0.0001). The sensitivity and specificity for discriminating these diseases were 85.0% and 69.2%, respectively, which suggests that this measurement can be carried out reliably. There was no significant difference in the locus coeruleus contrast ratios among the Alzheimer's disease, mild cognitive impairment-converted and mild cognitive impairment-non-converted groups.

Conclusions: High-resolution fast spin-echo T1-weighted imaging can show signal attenuation in the locus coeruleus of patients with Alzheimer's disease or with mild cognitive impairment whose pathology may or may not eventually convert to Alzheimer's disease.

Keywords: Alzheimer's disease; locus coeruleus; magnetic resonance imaging; mild cognitive impairment; neuromelanin.