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The study has 3 major findings. First, our results revealed that a significant volume loss in the frontal cortex and hippocampus and decreases in the intracranial volume, brain tissue, gray matter, and white matter were observed in CN elderly. Second, after controlling for ICV, age, sex, and scanner information, we found that Asians had significantly larger volumes of the frontal cortex and hippocampus and significantly lower values of ICV than Caucasians, while the volumes of the lateral ventricles and temporal lobe showed no significant differences. Third, the prediction models showed that the volumes of the frontal lobe and hippocampus decreased gradually over time, while those of the lateral ventricles, basal ganglia, and whole brain increased gradually. However, the results of the prediction model on the lateral ventricles showed that the volume of the lateral ventricles was larger in Asians than in Caucasians. Furthermore, the prediction model on the hippocampus showed that the volumes of the hippocampus increased from the early stage of CN to MCI and AD in both ethnicities. These findings may help explain the cultural differences in the pattern of disease progression.

The lobar volumes of the Korean elderly were on the average lower than those of the Caucasian elderly and predicted volumes were lower than the actual volumes for some lobar regions. These biases could have been the result of an effect of the ethnic groups' different average ages. We included sex, ICV, scanner manufacturer, and MFS in the prediction models to determine whether these factors accounted for the differences in brain volumes.

We found that the Korean brain had smaller volumes of cerebellum (by 0.8%) and left hippocampus (by 0.9%), but larger volumes of right hippocampus (by 0.6%), left amygdala (by 1.4%), and left posterior cingulate gyrus (by 1.4%) than the Caucasian sample. Asian brain volumes were significantly smaller than Caucasian volumes and showed a significant decrease for all brain regions as a function of age. Sex, ICV, scanner manufacturer, and MFS explained most of the variance in the volume of each brain region in each ethnicity. The effect of ethnicity on brain volumes was different across brain regions. We found that the volume of the right hippocampus decreased more rapidly than that of the left hippocampus across aging in the Caucasian sample; however, this difference was not significant in the Asian sample. We also found that the average volume of the subcortical structures was greater in the male than female brain. All of the effects showed sex and ethnicity differences, which were also reflected in the main age-related differences.

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