Identifying distinguishable clinical characteristics in cognitive decline
between cerebral small vessel disease and Alzheimer disease at mild cognitive 
   Lead Investigator:    Dixon Yang
   Institution      :    NYU
   E-Mail           :    dixon.yang@nyumc.org
   Proposal ID      :    1503



   Proposal Description:
   Alzheimer disease (AD) and cerebral small vessel disease are common causes of age-related cognitive decline. They often coexist but can be difficult to distinguish and their exact clinical interactions are unclear, especially at earlier stages. Clinically differentiating AD and cerebrovascular related     cognitive decline can help guide therapeutics and prognosis, as mortality, comorbidities, progression, and cognitive phenotype may differ. Both pathologies may have variable courses and severity, highlighting the challenge in clinical diagnosis. We recently demonstrated in a small neuropathology         subset from NACC that distinguishing demographics, comorbidities, and neuropsychiatric metrics between pure cerebral arteriolosclerosis, pure AD, and mixed pathologies emerge at early dementia rather than mild cognitive impairment. We hope to expand this work by evaluating for any early               distinguishing features in adjunctive diagnostics like brain MRI and CSF biomarkers as this may aid in early diagnosis, treatment, research study enrollment, and counseling.    -        Our objective is to determine any early clinical distinguishing characteristics in adjunctive brain imaging between pure cerebral arteriolosclerosis, pure AD, and mixed pathologies defined from the NACC neuropathology subset.  -        We wish to create three groups for comparison: pure cerebral arteriolosclerosis, pure AD, and mixed pathologies defined from the NACC neuropathology subset and evaluate them at CDR 0.5 and CDR 1.0 stages.  -        At CDR 0.5 and CDR 1.0 stages, we wish to compare available MRI brain volumetric data between the three neuropathologically defined groups and determine any distinguishable volumetric characteristics.  -        MRI brain variables of particular interest include brain volume, gray matter volume, white matter hyperintensity volume, lateral ventricular volumes, and hippocampi volumes.  -        If data available, another variable of interest would