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January 2011

New Lessons From the Alzheimer's Disease Neuroimaging Initiative

Author Affiliations

Author Affiliations: Departments of Neurology, Butler Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island.

Arch Neurol. 2011;68(1):19-21. doi:10.1001/archneurol.2010.344

The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a public sector–industry partnership founded in 2004 to develop biomarkers to predict the progression from normal aging or mild cognitive impairment (MCI) to the dementia phase of Alzheimer disease (AD).1 The ADNI has created the infrastructure to conduct a longitudinal observational trial, standardized methods for multicenter biomarker analysis, and established a widely available data repository. The study consists of 3 groups of individuals aged 55 to 90 years. Individuals with normal cognition, amnestic MCI, and mild AD are followed up annually with volumetric magnetic resonance imaging and positron emission tomography with fluorine-18–labeled deoxyglucose scans,cognitive and neurological evaluations, and analysis of cerebrospinal fluid (CSF) markers in individuals consenting to examination. In its short lifespan, this valuable data set has produced important advances in biochemical and imaging biomarkers of cognitive decline. Shaw and colleagues2 recently reported further evidence that lowering of CSF Aβ42 and increases in total tau are early changes predicting progression from amnestic MCI to AD. The ADNI is also designed to measure clinical factors affecting cognitive decline. In this issue of the Archives, Schneider and colleagues3 add to the ADNI literature by reporting the differences in the 2-year cognitive and functional performance ratings of 402 MCI patients and 188 patients with mild AD in the ADNI cohort who were taking and not taking antidementia medications. The ratings included the AD Assessment Scale–cognitive subscale (ADAS-cog), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR) scale, and Functional Activities Questionnaire. Baseline and 2-year outcomes for MCI patients were compared for 3 groups: patients receiving no treatment, those receiving a cholinesterase inhibitor (ChEI) only, and those receiving combination treatment. The AD patients receiving ChEIs were compared with those receiving combined treatment.

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