%0 Journal Article %J J Alzheimers Dis %D 2020 %T Structural Brain Magnetic Resonance Imaging to Rule Out Comorbid Pathology in the Assessment of Alzheimer's Disease Dementia: Findings from the Ontario Neurodegenerative Disease Research Initiative (ONDRI) Study and Clinical Trials Over the Past 10 Years. %A Kapoor, Arunima %A Bartha, Robert %A Black, Sandra E %A Borrie, Michael %A Freedman, Morris %A Gao, Fuqiang %A Herrmann, Nathan %A Mandzia, Jennifer %A Ozzoude, Miracle %A Ramirez, Joel %A Scott, Christopher J M %A Symons, Sean %A Fischer, Corinne E %A Frank, Andrew %A Seitz, Dallas %A Wolf, Michael Uri %A Verhoeff, Nicolaas Paul L G %A Naglie, Gary %A Reichman, William %A Masellis, Mario %A Mitchell, Sara B %A Tang-Wai, David F %A Tartaglia, Maria Carmela %A Kumar, Sanjeev %A Pollock, Bruce G %A Rajji, Tarek K %A Finger, Elizabeth %A Pasternak, Stephen H %A Swartz, Richard H %X

BACKGROUND/OBJECTIVE: Structural brain magnetic resonance imaging (MRI) is not mandatory in Alzheimer's disease (AD) research or clinical guidelines. We aimed to explore the use of structural brain MRI in AD/mild cognitive impairment (MCI) trials over the past 10 years and determine the frequency with which inclusion of standardized structural MRI acquisitions detects comorbid vascular and non-vascular pathologies.

METHODS: We systematically searched ClinicalTrials.gov for AD clinical trials to determine their neuroimaging criteria and then used data from an AD/MCI cohort who underwent standardized MRI protocols, to determine type and incidence of clinically relevant comorbid pathologies.

RESULTS: Of 210 AD clinical trials, 105 (50%) included structural brain imaging in their eligibility criteria. Only 58 (27.6%) required MRI. 16,479 of 53,755 (30.7%) AD participants were in trials requiring MRI. In the observational AD/MCI cohort, 141 patients met clinical criteria; 22 (15.6%) had relevant MRI findings, of which 15 (10.6%) were exclusionary for the study.

DISCUSSION: In AD clinical trials over the last 10 years, over two-thirds of participants could have been enrolled without brain MRI and half without even a brain CT. In a study sample, relevant comorbid pathology was found in 15% of participants, despite careful screening. Standardized structural MRI should be incorporated into NIA-AA diagnostic guidelines (when available) and research frameworks routinely to reduce diagnostic heterogeneity.

%B J Alzheimers Dis %V 74 %P 747-757 %8 2020 %G eng %N 3 %1 https://www.ncbi.nlm.nih.gov/pubmed/32116253?dopt=Abstract %R 10.3233/JAD-191097