Hippocampal volume and shape are known magnetic resonance imaging biomarkers of neurodegeneration. Recently, hippocampal texture has been shown to improve prediction of dementia in patients with mild cognitive impairment, but it is unknown whether texture adds prognostic information beyond volume and shape and whether the predictive value extends to cognitively healthy individuals. Using 510 subjects from the Rotterdam Study, a prospective, population-based cohort study, we investigated if hippocampal volume, shape, texture, and their combination were predictive of dementia and determined how predictive performance varied with time to diagnosis and presence of early clinical symptoms of dementia. All features showed significant predictive performance with the area under the receiver operating characteristic curve ranging from 0.700 for texture alone to 0.788 for the combination of volume and texture. Although predictive performance extended to those without objective cognitive complaints or mild cognitive impairment, performance decreased with increasing follow-up time. We conclude that a combination of multiple hippocampal features on magnetic resonance imaging performs better in predicting dementia in the general population than any feature by itself.

Shape analysis is increasingly becoming important to study changes in brain structures in relation to clinical neurological outcomes. This is a challenging task due to the high dimensionality of shape representations and the often limited number of available shapes. Current techniques counter the poor ratio between dimensions and sample size by using regularization in shape space, but do not take into account the spatial relations within the shapes. This can lead to models that are biologically implausible and difficult to interpret. We propose to use P-spline based regression, which combines a generalized linear model (GLM) with the coefficients described as B-splines and a penalty term that constrains the regression coefficients to be spatially smooth. Owing to the GLM, this method can naturally predict both continuous and discrete outcomes and can include non-spatial covariates without penalization. We evaluated our method on hippocampus shapes extracted from magnetic resonance (MR) images of 510 non-demented, elderly people. We related the hippocampal shape to age, memory score, and sex. The proposed method retained the good performance of current techniques, such as ridge regression, but produced smoother coefficient fields that are easier to interpret.