Gary S. Figiel

Quantitative cerebral anatomy of the aging human brain A cross‐sectional study using magnetic resonance imaging

Seventy-six healthy adults underwent magnetic resonance imaging (1.5 T) to investigate the effects of age on regional cerebral volumes and on the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. Increasing age was associated with (1) decreasing volumes of the cerebral hemispheres (0.23% per year), the frontal lobes (0.55% per year), the temporal lobes (0.28% per year), and the amygdalahippocampal complex (0.30% per year); (2) increasing volumes of the third ventricle (2.8% per year) and the lateral ventricles (3.2% per year); and (3) increasing odds of cortical atrophy (8.9% per year), lateral ventricular enlargement (7.7% per year), and subcortical hyperintensity in the deep white matter (6.3% per year) and the pons (8.1% per year). Many elderly subjects did not exhibit cortical atrophy or lateral ventricular enlargement, however, indicating that such changes are not inevitable consequences of advancing age. These data should provide a useful clinical context within which to interpret changes in regional brain size associated with “abnormal” aging.

A magnetic resonance imaging study of putamen nuclei in major depression

The basal ganglia are recognized as putative mediators of certain cognitive and behavioral symptoms of major depression. Moreover, patients with basal ganglia lesions have repeatedly exhibited significant affective symptomatology, including apathy, depressive mood, and psychosis. Using high resolution, axial T2 intermediate magnetic resonance images, and a systematic sampling stereologic method, we assessed putamen nuclei volumes in 41 patients with major depression (DSM-III) and 44 healthy volunteer controls of similar age. Depressed patients had significantly smaller putamen nuclei compared with controls. Age was negatively correlated with putamen size in both groups. These results are the first demonstration of diminished putamen volumes in depression and further support a role for basal ganglia structures in the etiopathogenesis of depression.

Cerebral white matter disease in late-onset paranoid psychosis

We examined magnetic resonance (MR) scans of the heads of 8 patients with late onset psychosis and 8 aged controls. Although some patients had mild cognitive impairment, none had depression or a history or examination suggesting focal brain disease. Thus, all patients met DSM-III-R criteria for late-onset schizophrenia. All 8 patients showed significant leukoencephalopathy or vascular pathology on MR imaging, and temporoparietal and occipital lesions were especially prominent. Little such pathology was evident on control scans. We suggest that focal brain disease of vascular origin may be associated with late-onset psychosis, and that MR scanning of such cases may provide important clues to pathogenesis.

Posterior fossa abnormalities in major depression: a controlled magnetic resonance imaging study

High‐field magnetic resonance (MR) images were used to study posterior fossa morphology in 27 patients with major depression and 36 normal control subjects. Depressed patients demonstrated smaller brain stem and cerebellar vermis than controls. These differences were highly significant for the anterior cerebellar vermis and medulla. There was also a striking age‐related decline in midbrain size in depressed patients as well as in controls. Our results are consistent with several lines of evidence implicating a role for the cerebellar vermis in affective disorders and, in addition, provide the first MR documentation of the differential effects of aging on posterior fossa morphology in normal subjects compared with patients with major depression.

In vivo stereological assessment of caudate volume in man: Effect of normal aging

Using intermediate weighted magnetic resonance imaging (MRI) and a systematic sampling stereological method in 39 normal volunteers aged 24-79 years old, we demonstrated a marked age-associated decline in caudate nuclei volume (r = -0.69, p less than 0.0001). The mean absolute volume of the caudate nuclei in this study (9.4 cm3) was almost identical to that reported in a previous autopsy study and further confirms the validity of this stereological technique for use with MR images. This technique will provide a method for measuring the caudate and other nuclei in vivo, from brain images and, as such, a research tool to correlate age-associated changes in cognitive, sensory and motor function with caudate nucleus volume and other brain regions.

MRI Abnormalities in Adolescent Bipolar Affective Disorder

There is increasing evidence for structural differences in the brains of patients with affective disorders. Recent magnetic resonance imaging (MRI) studies have reported focal signal hyperintensities in the deep white matter of bipolar patients. These previous reports had focused on adult patients with prior episodes of illness. In this case report, the authors discuss a young adolescent patient during her first episode of mania and the finding of subcortical focal signal hyperintensities on brain MRI. The etiology, pathophysiology, and clinical correlates of these lesions will be reviewed.

Subcortical Structural Changes in ECT-Induced Delirium

A prolonged (interictal) delirium was induced by electroconvulsive therapy (ECT) in 6/36 (17%) elderly depressed patients. Brain magnetic resonance imaging or brain computerized axial tomography revealed structural changes in the basal ganglia and white matter in all six patients who developed delirium. These findings are consistent with our previous work and with several lines of data that have implicated the basal ganglia and subcortical white matter in the development of delirium from other causes. These results suggest that lesions in these areas may predispose one to developing an interictal delirium during a course of ECT. (J Geriatr Psychiatry Neurol 1990;3:172-176).

A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia

Magnetic resonance imaging (MRI) of the brain was used to examine the morphology and dimensions of the pituitary gland in 18 patients with eating disorders (8 anorectics and 10 bulimics), in comparison with 13 healthy volunteers. None of the 18 patients with anorexia or bulimia had any radiological evidence suggestive of pituitary macroadenoma, cyst, or empty sella. Measurements revealed that the anorectics and bulimics had smaller pituitary gland cross-sectional areas (p less than 0.05) and smaller pituitary gland heights, compared with healthy controls. These preliminary findings in anorectics and bulimics are suggestive of pituitary atrophy secondary to nutritional or endocrine alterations, rather than a primary pituitary pathology.

Human cortical asymmetries determined with 3D MR technology

A method is described for obtaining clear 3D magnetic resonance (MR) images of the cortical surface of the brain in living human subjects. By combining volume composite and depth encoded images, we have obtained surface coordinate data that resulted in highly repeatable measurements of sulcal lengths and cortical surface areas in eight normal adult volunteers. Sulcal lengths were determined for specific parts of the Sylvian fissure, central sulcus and frontal operculum. Additionally, angles were computed between the anterior and posterior limbs of the pars triangularis and the ascending and horizontal limbs of the posterior Sylvian fissure. The cortical surface areas enclosed by these limbs were also computed. Finally, thirteen non-metric cortical features (e.g., petalias) were scored from the 3D MR images. All measurements were compared in right and left hemispheres. In addition to corroborating cortical asymmetries reported in the literature, we observed previously unrecognized directional asymmetries in the length of the anterior limb of the pars triangularis, length of the ascending limb of the posterior Sylvian fissure, and position of the lateral end of the central sulcus. We attribute the finding of three new directional asymmetries for the human cortex, as well as the high repeatability of our measurements, to the sensitivity and accuracy of the 3D MR imaging technology that has recently become available.

A magnetic resonance image study of age-related changes in human putamen nuclei.

Putamen nuclei were assessed in 36 normal volunteers using magnetic resonance imaging and a systematic sampling method. There was a significant decrease in the volume of the putamen nuclei with advancing age (r = -0.74, p less than 0.0001), and an associated decline in the volume of the caudate nuclei (r = 0.60, p less than 0.0001). The implications of these findings in age-associated motor abnormalities are discussed.