Baumeister Hannah, Gellersen Helena M, Polk Sarah E, Lattmann René, Wuestefeld Anika, Wisse Laura E M, Glenn Trevor, Yakupov Renat, Stark Melina, Kleineidam Luca, Roeske Sandra, Morgado Barbara Marcos, Esselmann Hermann, Brosseron Frederic, Ramirez Alfredo, Lüsebrink Falk, Synofzik Matthis, Schott Björn H, Schmid Matthias C, Hetzer Stefan, Dechent Peter, Scheffler Klaus, Ewers Michael, Hellmann-Regen Julian, Ersözlü Ersin, Spruth Eike, Gemenetzi Maria, Fliessbach Klaus, Bartels Claudia, Rostamzadeh Ayda, Glanz Wenzel, Incesoy Enise I, Janowitz Daniel, Rauchmann Boris-Stephan, Kilimann Ingo, Sodenkamp Sebastian, Coenjaerts Marie, Spottke Annika, Peters Oliver, Priller Josef, Schneider Anja, Wiltfang Jens, Buerger Katharina, Perneczky Robert, Teipel Stefan, Laske Christoph, Wagner Michael, Ziegler Gabriel, Jessen Frank, Düzel Emrah, Berron David
German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
Alzheimers Dement. 2025 Jul;21(7):e70482. doi: 10.1002/alz.70482.
Structural magnetic resonance imaging (MRI) often lacks diagnostic, prognostic, and monitoring value in Alzheimer's disease (AD), particularly in early disease stages. To improve its utility, we aimed to identify optimal atrophy markers for different intended uses.
We included 363 older adults; cognitively unimpaired individuals who were negative or positive for amyloid beta (Aβ) and Aβ-positive patients with subjective cognitive decline, mild cognitive impairment, or dementia of the Alzheimer type. MRI and neuropsychological assessments were administered annually for up to 3 years.
Accelerated atrophy of medial temporal lobe subregions was evident already during preclinical AD. Symptomatic disease stages most notably differed in their hippocampal and parietal atrophy signatures. Atrophy-cognition relationships varied by intended use and disease stage.
With the appropriate marker, MRI can detect abnormal atrophy already during preclinical AD. To optimize performance, atrophy markers should be tailored to the targeted disease stage and intended use.
Subregional atrophy markers detect ongoing atrophy in preclinical Alzheimer's disease (AD). Subjective cognitive decline in preclinical AD links to manifest atrophy. Optimal atrophy markers differ by the disease stage and intended use.
结构磁共振成像（MRI）在阿尔茨海默病（AD）中常常缺乏诊断、预后和监测价值，尤其是在疾病早期阶段。为提高其效用，我们旨在确定适用于不同用途的最佳萎缩标志物。
我们纳入了363名老年人；淀粉样β蛋白（Aβ）阴性或阳性的认知未受损个体，以及Aβ阳性的主观认知下降、轻度认知障碍或阿尔茨海默型痴呆患者。每年进行MRI和神经心理学评估，最长持续3年。
在临床前AD阶段，内侧颞叶亚区域的加速萎缩就已很明显。有症状的疾病阶段在海马体和顶叶萎缩特征上差异最为显著。萎缩与认知的关系因用途和疾病阶段而异。
使用合适的标志物，MRI在临床前AD阶段就能检测到异常萎缩。为优化性能，萎缩标志物应根据目标疾病阶段和用途进行定制。
亚区域萎缩标志物可检测临床前阿尔茨海默病（AD）中正在发生的萎缩。临床前AD中的主观认知下降与明显萎缩相关。最佳萎缩标志物因疾病阶段和用途而异。
