A FMRI Episodic Memory Study A longitudinal protocol in 31 patients presenting with early memory complain F. Gelbert C. Belin, A.M. Ergis, C. Moroni, C. Baclet-Roussel, C. Nioche, J.L. Sarrazin Paris- France This fMRI study is part of a multimodal protocol including clinical, biological, neuropsychological and standard MR. The goal of the study was to evaluate the feasability of a FMRI memory protocol in a routine clinical situation Normal Aging MCI Memory Disorders < 1.5 SD AD Early Detection Futur Therapeutic Approaches Episodic Memory Longitudinal multimodal study concerning 36 aged patients who complained for Memory Loss 2 FMRI Paradigms PARADIGM 1 Memory paradigm PARADIGM 2 Fluency Verbal letter fluency is preserved in MCI Results to the Fluency test = a baseline standard for each patient 8 blocks of rest and stimulation periods Each period : 28 seconds. During the rest periods, subjects were instructed to think of something unrelated t the stimulation. Total scanning time: 3 minutes 56 seconds. Temps Activation A A A A R R R R R Paradigms 1.5 Tesla MR scanner : (GE Healhtcare Signa ExHD,) using a phased array 8-elements head coil. Functional images : T2 EPI/GE. TR : 4.0 ms, TE :60 ms, flip angle 90, FOV 260 mm, matrix size 64x64, slice thickness 5.0 mm. Anatomical images : 3D SPGR TR 7.6 ms, TE 1.6 ms, FOV 260 mm, matrix 256x256, NEX 1, slice thickness 1.4 mm. Image acquisition Memory paradigm from the Memory DSM 48 test (Barbeau et al, Neurology 2002) Before scanning Visual stimuli were generated using a laptop and a video projector positioned on the scanner bed. The images projected on a white wall were seen by the patients using a mirror adapted to the head coil. visual memory task 2 runs more or less than 3 colors. ? silently answer with yes or no. 3 COLORS ? MORE ? LESS ? Subjects were asked to retrieve as many words as possible with a particular letter defined by an instruction slide P R S T Verbal Fluency task Each target is paired with a distractor on the left or right side of the slide. Instructions are given just before scanning The patient is asked to silently answered Right or Left for the identified item Right or Left ? Recognition task of the Memory test Right or Left ? Statistical Parametric Mapping SPM99 and BAR (home software, HIA Val de Grce. Paris) individual T-test maps comparing rest and experimental conditions on a voxel-by-voxel basis. Data were modeled with a fixed response (box-car) Data analysis and image processing 36 patients were included in the fMRI protocol (Age ranged : 70-88, mean age : 78) 19 males, 17 females 14 patients had a normal cognitive status 22 patients presented with MCI Along the evolution we categorized 3 groups Cognitively normal individual that remain stable: 12 MCIpatients that remain stable :7 MCI patients developing dementia :3 Results 22 patients have completed the MR protocol at the time being. Results Strongly lateralised activation in the left hemisphere in the dorsolateral prefontal cortex More bilateralized pattern than younger patients Verbal Fluency task Normal subjects left right Normal subjects Memory test Bilateral activation parietal,inferior temporal cortex Medial temporal cortex Cingulate cortex Visual areas Middle frontal cortex Fluency test MCI patients Bilateralized pattern MCI Memory test MCI AD Convertors Fluency test Initial exam MCI- AD convertors Memory test Initial exam Conclusion We did not faced technical limitations related to the age of the patients. No problem to read the letters and analyse the images The entire procedure was performed within a 30 min examination time Considering the results, the verbal fluency test was reproductively performed even in the early MCI stage. The memory test suffered for the short numbert of patients at the time being. This experience confirmed the feasability of a Fmri study in a routine clinical practice at least in the first stage of memory loss Special Thanks to the Fondation Philippe Chatrier Sabine Tranchant, Aurlie Sager Mrs Gelbert aged 85 who kindly helped us to adapt the different visual parameters to this specific clinical condition And before memory fade away ..