J Clin Neurol.  2010 Dec;6(4):204-211. 10.3988/jcn.2010.6.4.204.

Topographical Disorientation in Mild Cognitive Impairment: A Voxel-Based Morphometry Study

Affiliations
  • 1Department of Neurology, Ajou University School of Medicine, Suwon, Korea. symoon.bv@gmail.com
  • 2Department of Psychology, University of Calgary, Calgary, Canada.

Abstract

BACKGROUND AND PURPOSE
To assess the neural substrates underlying topographical disorientation (TD) in patients affected by mild cognitive impairment (MCI), forty-one patients diagnosed with MCI and 24 healthy control individuals were recruited.
METHODS
TD was assessed clinically in all participants. Neurological and neuropsychological evaluations and a volumetric-head magnetic resonance imaging scan were performed in each participant. Voxel-based morphometry was used to compare patterns of gray-matter atrophy between patients with and without TD, and a group of normal controls.
RESULTS
We found TD in 17 out of the 41 MCI patients (41.4%). The functional abilities were significantly impaired in MCI patients with TD compared to in MCI patients without TD. Voxel-based morphometry analyses showed that the presence of TD in MCI patients is associated with loss of gray matter in the medial temporal regions, including the hippocampus and parahippocampal cortex, the fusiform gyrus, the inferior occipital gyrus, the amygdala, and the cerebellum.
CONCLUSIONS
The findings found in this study represent the first evidence that the presence of TD in patients with MCI is associated with loss of gray matter in those brain regions that have been documented to be responsible for orientation in both neuropsychological and neuroimaging studies.

Keyword

mild cognitive impairment; topographical disorientation; voxel-based morphometry; dementia

MeSH Terms

Amygdala
Atrophy
Brain
Dementia
Hippocampus
Humans
Magnetic Resonance Imaging
Mild Cognitive Impairment
Neuroimaging
Orientation

Figure

  • Fig. 1 Patterns of statistically significant loss of gray matter in patients with mild cognitive impairment (MCI) in combination with topographical disorientation (TD) compared to healthy control subjects (p<0.001, uncorrected for multiple comparisons). In the right hemisphere, MCI-TD patients exhibited loss of gray matter from the anterior temporal pole, through the medial temporal regions (including the parahippocampal and fusiform gyri), extending to the middle and inferior temporal gyri toward the most posterior regions of the fusiform and inferior occipital gyri. Similar regions were involved in the left hemisphere, although to a lesser extent. In addition, gray matter loss was observed in the right amygdala, left angular gyrus, and cerebellum.

  • Fig. 2 Patterns of statistically significant loss of gray matter in patients with MCI without TD (MCI-noTD) compared to healthy control subjects (p<0.001, uncorrected for multiple comparisons). MCI-noTD patients exhibited gray matter loss restricted to the left frontal and occipital regions when compared to the group of healthy controls.

  • Fig. 3 Regions of gray matter loss in mild cognitive impairment-topographical disorientation (MCI-TD) patients compared to MCI-noTD patients (p<0.01, uncorrected for multiple comparisons). MCI-TD patients exhibited a greater loss of gray matter loss bilaterally in the temporo-occipital regions. These regions included the hippocampi and parahippocampal gyri, the fusiform gyrus, the inferior occipital gyrus, the amygdala, and the cerebellum.


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