Abstract
Patients with mild cognitive impairment (MCI) are at risk of progressing to Alzheimer’s dementia, yet only a fraction of them do. We explore here whether a very high-risk MCI subgroup can be identified using cognitive assessments and structural neuroimaging. A multimodal signature of Alzheimer’s dementia was first extracted using machine learning tools in the ADNI1 sample, and was comprised of cognitive deficits across multiple domains as well as atrophy in temporal, parietal and occipital regions. We then validated the predictive value of this signature on two MCI cohorts. In ADNI1 (N=235), the presence of the signature predicted progression to dementia over three years with 80.4% positive predictive value, adjusted for a “typical” MCI baseline rate of 33% (95.6% specificity, 55.1% sensitivity). These results were replicated in ADNI2 (N=235), with 87.8% adjusted positive predictive value (96.7% specificity, 47.3% sensitivity). Our results demonstrate that, even for widely used markers, marked improvement in positive predictive value over the literature can be achieved by focusing on a subgroup of individuals with similar brain characteristics. The signature can be readily applied for the enrichment of clinical trials.
Footnotes
↵* Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at: http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf