Vascular lesions and brain atrophy in Alzheimer's, vascular and mixed dementia: an optimized 3T MRI protocol reveals distinctive radiological profiles

Background Behavioral and psychological symptoms of dementia (BPSD) are a distressful condition. We aimed to investigate the BPSD distribution in subjects with cognitive impairment, and the potential correlations between BPSD and neurodegeneration in terms of cerebrospinal fluid (CSF) tau and brain atrophy. Methods Seventy-six subjects received a diagnosis of Alzheimer’s (AD=32), vascular (VD=26) or mixed (MD=18) dementia according to Hachinski scale and NINCDS-ADRDA criteria. Three independent raters assessed the brain images acquired according to a high resolution 3T MRI protocol (including 3D FLAIR, T1, SWI and 2D coronal T2 sequences) with semiquantitative scales for vascular lesions (periventricular and deep white matter lesions, PVL and DWML, deep grey matter lesions, DGML, enlarged perivascular spaces, PVS, and microbleeds, MB) and brain atrophy (medial temporal atrophy, MTA, posterior atrophy, PA, global cortical atrophy-frontal, GCA-F, and Evans’ index). The inter-rater agreement was assessed with the intraclass correlation coefficient (ICC). Results Raters reached a good-to-excellent agreement for all scales (ICC ranging 0.78-0.96). A greater number of PVL (p<0.001), DWML (p<0.001), DGML (p=0.010) and PVS (p=0.001) was observed in VD compared to AD, while MD showed a significant greater number of PVL (p=0.001), DWML (p=0.002), DGML (p=0.018) and deep and juxtacortical MB (p=0.006 and p