Methods to assess changes in human brain structure across the lifecourse

Human brain structure can be measured across the lifecourse (“in vivo”) with magnetic resonance imaging (MRI). MRI data are often used to create “atlases” and statistical models of brain structure across the lifecourse. These methods may define how brain structure changes through life and support diagnoses of increasingly common, yet still fatal, age-related neurodegenerative diseases. As diseases such as Alzheimer’s (AD) cast an ever growing shadow over our ageing population, it is vitally important to robustly define changes which are normal for age and those which are pathological. This work therefore assessed existing MR brain image data, atlases, and statistical models. These assessments led me to propose novel methods for accurately defining the distributions and boundaries of normal ageing and pathological brain structure. A systematic review found that there were fewer than 100 appropriately tested normal subjects aged ≥60 years openly available worldwide. These subjects did not have the range of MRI sequences required to effectively characterise the features of brain ageing. The majority of brain image atlases identified in this review were found to contain data from few or no subjects aged ≥60 years and were in a limited range of MRI sequences. All of these atlases were created with parametric (mean-based) statistics that require the assumptions of equal variance and Gaussian distributions. When these assumptions are not met, mean-based atlases and models may not well represent the distributions and boundaries of brain structure. I tested these assumptions and found that they were not met in whole brain, subregional, and voxel-based models of ~580 subjects from across the lifecourse (0- 90 years). I then implemented novel whole brain, subregional, and voxel-based statistics, e.g. percentile rank atlases and nonparametric effect size estimates. The equivalent parametric statistics led to errors in classification and inflated effects by up to 45% in normal ageing-AD comparisons. I conclude that more MR brain image data, age appropriate atlases, and nonparametric statistical models are needed to define the true limits of normal brain structure. Accurate definition of these limits will ultimately improve diagnoses, treatment, and outcome of neurodegenerative disease