Grant: Operating Grant

The prospect of disease-modifying therapies in the pipeline for Alzheimer's Disease (AD) has intensified efforts to use brain imaging more effectively for diagnosis and monitoring of dementing illnesses. There is also emerging awareness of the destructive interplay between AD and Cerebrovascular Disease in our aging population; both disorders share common vascular risk factors and may respond to similar prevention treatments. Brain mapping techniques capitalize on the fact that different neurodegenerative diseases target particular brain areas. Brain shrinkage and stroke disease can be quantified on Magnetic Resonance Imaging (MRI) using computerized analysis. Our ongoing study applies advanced MR imaging analysis, genetic testing and standardized cognitive and functional assessments to measure and monitor longitudinal change in patients with AD, Vascular, and other neurodegenerative diseases, to enable us to measure outcomes as new therapies emerge. We have collected a comprehensive archive of over 1000 patients (Mild Cognitive Impairment or dementia from AD, Vascular, Frontotemporal or Lewy Body Disease) and 150 normal elderly, with serial MRI and functional imaging, and have detailed their patterns of mental and behavioural difficulties. We have developed special imaging analysis software packages to reliably quantify brain tissue volumes and small vessel disease, the most common type of cerebrovascular. We have shown how both large and small vessel disease, not just of brain arteries but also brain veins, may contribute to cognitive decline in AD. We also learn from our autopsy studies, which have highlighted that a combination of brain pathologies is more common than pure disease, especially in the elderly. Results from our studies will help to improve diagnosis, to customize treatment, and to better monitor disease-modifying therapies currently under investigation should they become applicable to everyday practice.