Identifying individuals with Alzheimer's disease-like brains based on structural imaging in the Human Connectome Project Aging cohort

Given the difficulty in factoring out typical age effects from subtle Alzheimer's disease (AD) effects on brain structure, identification of very early, as well as younger preclinical “at-risk” individuals has unique challenges. We examined whether age-correction procedures could be used to better identify individuals at very early potential risk from adults who did not have any existing cognitive diagnosis. First, we obtained cross-sectional age effects for each structural feature using data from a selected portion of the Human Connectome Project Aging (HCP-A) cohort. After age detrending, we weighted AD structural deterioration with patterns quantified from data of the Alzheimer's Disease Neuroimaging Initiative. Support vector machine was then used to classify individuals with brains that most resembled atrophy in AD across the entire HCP-A sample. Additionally, we iteratively adjusted the pipeline by removing individuals classified as AD-like from the HCP-A cohort to minimize atypical brain structural contributions to the age detrending. The classifier had a mean cross-validation accuracy of 94.0% for AD recognition. It also could identify mild cognitive impairment with more severe AD-specific biomarkers and worse cognition. In an independent HCP-A cohort, 8.8% were identified as AD-like, and they trended toward worse cognition. An “AD risk” score derived from the machine learning models also significantly correlated with cognition. This work provides a proof of concept for the potential to use structural brain imaging to identify asymptomatic individuals at young ages who show structural brain patterns similar to AD and are potentially at risk for a future clinical disorder.