Default mode network connectivity in stable vs progressive mild cognitive impairment

Default mode network (DMN) connectivity, measured by fMRI during a face-name memory task, distinguishes people with mild cognitive impairment (MCI) who later develop Alzheimer disease (AD) from those who remain stable over 2 to 3 years. In a cohort of 68 subjects (25 normal controls, 31 MCI, 12 AD), DMN connectivity goodness-of-fit indices were highest in controls, intermediate in MCI, and lowest in AD. Among MCI subjects, baseline connectivity correlated with later decline in functional status, but added no predictive value beyond baseline delayed recall scores. The findings suggest different functional brain connectivity patterns for early versus late MCI.

Study at a glance

Abstract

OBJECTIVE: Dysfunction of the default mode network (DMN) has been identified in prior cross-sectional fMRI studies of Alzheimer disease (AD) and mild cognitive impairment (MCI); however, no studies have examined its utility in predicting future cognitive decline. METHODS: fMRI scans during a face-name memory task were acquired from a cohort of 68 subjects (25 normal control, 31 MCI, and 12 AD). Subjects with MCI were followed for 2.4 years (±0.8) to determine progression to AD. Maps of DMN connectivity were compared with a template DMN map constructed from elderly normal controls to obtain goodness-of-fit (GOF) indices of DMN expression. Indices were compared between groups and correlated with cognitive decline. RESULTS: GOF indices were highest in normal controls, intermediate in MCI, and lowest in AD (p < 0.0001). In a predictive model (that included baseline GOF indices, age, education, Mini-Mental State Examination score, and an index of DMN gray matter volume), the effect of GOF index on progression from MCI to dementia was significant. In MCI, baseline GOF indices were correlated with change from baseline in functional status (Clinical Dementia Rating-sum of boxes) (r = -0.40, p < 0.04). However, there was no additional predictive value for DMN connectivity when baseline delayed recall was included in the models. CONCLUSIONS: fMRI connectivity indices distinguish patients with MCI who undergo cognitive decline and conversion to AD from those who remain stable over a 2- to 3-year follow-up period. Our data support the notion of different functional brain connectivity endophenotypes for "early" vs "late" MCI, which are associated with different baseline memory scores and different rates of progression and conversion.