Comparison of Brain Age With Standard MRI Assessment for Dementia Risk Stratification in Subjective and Mild Cognitive Impairment

BACKGROUND AND OBJECTIVES: Early dementia risk-stratification is crucial for timely intervention. Brain-predicted age difference (brain-PAD) derived from structural MRI reflects the gap between computer-estimated age and chronological age and has been linked to clinical progression to dementia. We evaluate whether brain-PAD has prognostic value for progression to dementia in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and whether brain-PAD provides added value beyond visual rating scales. METHODS: This retrospective cohort study included patients with SCD and MCI with up to 10-year follow-up assessments from the Amsterdam Dementia Cohort and SCIENCe project. Brain-PAD was computed from baseline MRI using 2 pretrained methods. Cox proportional hazards models assessed the association between brain-PAD and risk of progression to dementia, controlling for age, sex, Mini Mental State Examination, and visual rating scales. We tested interactions between brain-PAD and baseline diagnosis to assess stage-specific value and evaluated the added value beyond amyloid status in a biomarker-available subset. RESULTS: = 0.351). DISCUSSION: MRI-derived brain-PAD predicts progression to dementia in memory clinic patients with SCD or MCI. In particular, brain-PAD provided additional predictive value to visual rating scales in patients with SCD.