N-acetylaspartate, choline and myoinositol concentration changes in MR spectroscopy (1H MRS) of hippocampal formation in patients with mild cognitive impairment (MCI) - preliminary study

Cognitive and memory impairment are very common problems in elderly patients. Mild cognitive impairment (MCI) is known as a transitional clinical state between normal ('successful') aging and dementia. In some cases MCI may be a precursor to Alzheimer's disease (AD). Early neuronal loss and metabolic changes have been documented in previous studies in AD patients in some 'strategic ' regions of the brain, mainly in hippocampal formation. Our goal was to determine whether there are statistically significant changes in hippocampal N-acetylaspartate, choline and myoinositol levels obtained by single-voxel spectroscopy in MCI patients and normal aging and to evaluate its clinical diagnostic utility. 30 patients with MCI and 15 cognitively normal elderly subjects underwent proton MR spectroscopy at 1.5 T system. MR spectra were obtained from anterior and posterior part of hippocampal formation bilaterally, using the point-resolved spectroscopy sequence. Metabolite ratios of NAA/H2O, Cho/H2O and mI/H2O were calculated from the peak height measurements. Relative to the control group, patients with MCI demonstrated elevated mI/H2O and Cho/H2O ratios in both hippocampal formations. The most significant increase was observed in mI/H2O ratio in anterior part of left hippocampus and in Cho/H2O ratio in posterior part of right hippocampus, in MCI patients vs.cognitively normal elderly. There were no significant differences between mean NAA/H2O ratios measured in hippocampal formation in both groups. Proton MRS may be used as valuable additional tool in the evaluation of regional metabolic changes in patients with MCI. Increase of mI and Cho levels in hippocampal formation may be an early sign of cognitive impairment in elderly subjects that can be measured using MRS. (author)