TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background: Cortical atrophy is discussed as a topographical marker of the Alzheimer's disease (AD). Structural MRI has been shown to be sensitive in detecting brain changes associated with AD. However, data are conflicting regarding the correlation of MRI findings with the clinical stage of AD.

Case presentation: Here, we report the case of a 74-year-old white woman presented initially with predominantly cognitive complains. AD in a stage between mild and moderate was suspected. In contrast, MRI showed bilateral severe atrophy of entorhinal cortex and hippocampus. Within following seven months disease progressed with development of psychosis. We suggest that clinical presentation and neuroimaging data were dissociated at the first presentation in neurology setting.

Conclusions: This case represents an interesting presentation which brings arguments into hypothesis of predictive value of neuroimaging data for diagnosis of AD

Cao Q, Tan CC, Xu W, Hu H, Cao XP, Dong Q, Tan L, Yu JT. The Prevalence of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis. 2020;73(3):1157-1166.

GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105-e125.

Kelley AS, McGarry K, Gorges R, Skinner JS. The burden of health care costs for patients with dementia in the last 5 years of life. Ann Intern Med. 2015 Nov 17;163(10):729-36.

Landeiro F, Harris C, Groves D, O'Neill S, Jandu KS, Tacconi EMC, Field S, Patel N, Göpfert A, Hagson H, Leal J, Luengo-Fernández R. The economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, with projection to 2050: an evaluation of two cohort studies. Lancet Healthy Longev. 2024 Aug;5(8):e514-e523.

Nandi A, Counts N, Bröker J, Malik S, Chen S, Han R, Klusty J, Seligman B, Tortorice D, Vigo D, Bloom DE. Cost of care for Alzheimer's disease and related dementias in the United States: 2016 to 2060. NPJ Aging. 2024 Feb 8;10(1):13.

Markesbery WR. Neuropathological criteria for the diagnosis of Alzheimer's disease. Neurobiol Aging. 1997 Jul-Aug;18(4 Suppl):S13-9.

DeTure MA, Dickson DW. The neuropathological diagnosis of Alzheimer's disease. Mol Neurodegener. 2019 Aug 2;14(1):32.

Husain MM, Garrett RK. Clinical diagnosis and management of Alzheimer's disease. Neuroimaging Clin N Am. 2005 Nov;15(4):767-77.

Anoop A, Singh PK, Jacob RS, Maji SK. CSF Biomarkers for Alzheimer's Disease Diagnosis. Int J Alzheimers Dis. 2010 Jun 23;2010:606802.

Dubois B, Feldman HH, Jacova C, Cummings JL, Dekosky ST, Barberger-Gateau P, Delacourte A, Frisoni G, Fox NC, Galasko D, Gauthier S, Hampel H, Jicha GA, Meguro K, O'Brien J, Pasquier F, Robert P, Rossor M, Salloway S, Sarazin M, de Souza LC, Stern Y, Visser PJ, Scheltens P. Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurol. 2010 Nov;9(11):1118-27.

McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, Klunk WE, Koroshetz WJ, Manly JJ, Mayeux R, Mohs RC, Morris JC, Rossor MN, Scheltens P, Carrillo MC, Thies B, Weintraub S, Phelps CH. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):263-9.

Budson AE, Solomon PR. New criteria for Alzheimer disease and mild cognitive impairment: implications for the practicing clinician. Neurologist. 2012 Nov;18(6):356-63.

Wheatley SH, Mohanty R, Poulakis K, Levin F, Muehlboeck JS, Nordberg A, Grothe MJ, Ferreira D, Westman E. Divergent neurodegenerative patterns: Comparison of [18F] fluorodeoxyglucose-PET- and MRI-based Alzheimer's disease subtypes. Brain Commun. 2024 Nov 23;6(6):fcae426.

Pasquier F, Leys D, Weerts J, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and Intraobserver Reproducibility of Cerebral Atrophy Assessment on MRI Scans with Hemispheric Infarcts. Eur Neurol. 1996; 36(5):268-72.

Chakraborty S., Mandal S., Kundu S., Sau A. Correlation between Clinical Dementia Rating and brain neuroimaging metrics of Alzheimer's disease: An observational study from a tertiary care institute of Eastern India. Archives of Mental Health 23(1):p 56-61, Jan–Jun 2022.

Whitwell JL, Dickson DW, Murray ME, Weigand SD, Tosakulwong N, Senjem ML, Knopman DS, Boeve BF, Parisi JE, Petersen RC, Jack CR Jr, Josephs KA. Neuroimaging correlates of pathologically defined subtypes of Alzheimer's disease: a case-control study. Lancet Neurol. 2012 Oct;11(10):868-77.

Ossenkoppele R, Cohn-Sheehy BI, La Joie R, Vogel JW, Möller C, Lehmann M, van Berckel BN, Seeley WW, Pijnenburg YA, Gorno-Tempini ML, Kramer JH, Barkhof F, Rosen HJ, van der Flier WM, Jagust WJ, Miller BL, Scheltens P, Rabinovici GD. Atrophy patterns in early clinical stages across distinct phenotypes of Alzheimer's disease. Hum Brain Mapp. 2015 Nov; 36(11):4421-37.

van Oostveen WM, de Lange ECM. Imaging Techniques in Alzheimer’s Disease: A Review of Applications in Early Diagnosis and Longitudinal Monitoring. International Journal of Molecular Sciences. 2021; 22(4):2110.

Baumeister H, Gellersen HM, Polk SE, Lattmann R, Wuestefeld A, Wisse LEM, Glenn T, Yakupov R, Stark M, Kleineidam L, Roeske S, Morgado BM, Esselmann H, Brosseron F, Ramirez A, Lüsebrink F, Synofzik M, Schott BH, Schmid MC, Hetzer S, Dechent P, Scheffler K, Ewers M, Hellmann-Regen J, Ersözlü E, Spruth E, Gemenetzi M, Fliessbach K, Bartels C, Rostamzadeh A, Glanz W, Incesoy EI, Janowitz D, Rauchmann BS, Kilimann I, Sodenkamp S, Coenjaerts M, Spottke A, Peters O, Priller J, Schneider A, Wiltfang J, Buerger K, Perneczky R, Teipel S, Laske C, Wagner M, Ziegler G, Jessen F, Düzel E, Berron D; DELCODE study group. Disease stage-specific atrophy markers in Alzheimer's disease. Alzheimers Dement. 2025 Jul;21(7):e70482.

Aramadaka S, Mannam R, Sankara Narayanan R, Bansal A, Yanamaladoddi VR, Sarvepalli SS, Vemula SL. Neuroimaging in Alzheimer's Disease for Early Diagnosis: A Comprehensive Review. Cureus. 2023 May 4;15(5):e38544.

Henriques AD, Benedet AL, Camargos EF, Rosa-Neto P, Nóbrega OT. Fluid and imaging biomarkers for Alzheimer's disease: Where we stand and where to head to. Exp Gerontol. 2018 Jul 1;107:169-177.

Lombardi G, Crescioli G, Cavedo E, Lucenteforte E, Casazza G, Bellatorre AG, Lista C, Costantino G, Frisoni G, Virgili G, Filippini G. Structural magnetic resonance imaging for the early diagnosis of dementia due to Alzheimer's disease in people with mild cognitive impairment. Cochrane Database Syst Rev. 2020 Mar 2;3(3):CD009628.

Lee J, Kim HJ. Normal Aging Induces Changes in the Brain and Neurodegeneration Progress: Review of the Structural, Biochemical, Metabolic, Cellular, and Molecular Changes. Front Aging Neurosci. 2022 Jun 30;14:931536.

Ballard C, Kales HC, Lyketsos C, Aarsland D, Creese B, Mills R, Williams H, Sweet RA. Psychosis in Alzheimer's Disease. Curr Neurol Neurosci Rep. 2020 Oct 13; 20(12):57.

Cipriani G, Vedovello M, Ulivi M, Lucetti C, Di Fiorino A, Nuti A. Delusional misidentification syndromes and dementia: a border zone between neurology and psychiatry. Am J Alzheimers Dis Other Demen. 2013 Nov;28(7):671-8.

Fischer CE, Ismail Z, Youakim JM, Creese B, Kumar S, Nuñez N, Ryan Darby R, Di Vita A, D'Antonio F, de Lena C, McGeown WJ, Ramit R, Rasmussen J, Bell J, Wang H, Bruneau MA, Panegyres PK, Lanctôt KL, Agüera-Ortiz L, Lyketsos C, Cummings J, Jeste DV, Sano M, Devanand DP, Sweet RA, Ballard C. Revisiting Criteria for Psychosis in Alzheimer's Disease and Related Dementias: Toward Better Phenotypic Classification and Biomarker Research. J Alzheimers Dis. 2020;73(3):1143-1156.

Nabizadeh F, Sheykhlou S, Mahmoodi S, Khalili E, Zafari R, Hosseini H. Neuroimaging Findings of Psychosis in Alzheimer's Disease: A Systematic Review. Brain Behav. 2025 Jan;15(1):e70205.

Breithaupt AG, Naasan G, Shdo SM, Lopez L, Spina S, Grinberg L, Seeley WW, Gorno-Tempini ML, Rabinovici G, Kramer JH, Rosen HJ, Miller BL, Rankin KP. Toward Localizing Psychosis in Pathologically Confirmed Neurodegenerative Disease. medRxiv 2025.02.06.25321537

Lee YM, Chung YI, Park JM, Lee BD, Moon E, Jeong HJ, Kim JH, Kim HJ, Mun CW, Kim TH, Kim YH, Kim EJ. Decreased gray matter volume is associated with the subtypes of psychotic symptoms in patients with antipsychotic-naïve mild or moderate Alzheimer's disease: A voxel-based morphometry study. Psychiatry Res Neuroimaging. 2016 Mar 30; 249:45-51.

McLachlan E, Bousfield J, Howard R, Reeves S. Reduced parahippocampal volume and psychosis symptoms in Alzheimer's disease. Int J Geriatr Psychiatry. 2018 Feb;33(2):389-395.