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Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease

From the Wien Center for Alzheimer's Disease and Memory Disorders (R.D., D.A.L., E.P., M.T.G., R.U., Q.S., W.B.) and Department of Radiology (J.A.), Mount Sinai Medical Center, Miami Beach, FL; Center on Aging and Department of Psychiatry and Behavioral Sciences, Department of Neurology (D.A.L.), and Departments of Medicine, Neurology, and Psychiatry and Behavioral Sciences (R.D.), Miller School of Medicine, University of Miami School of Medicine, Miami, FL; Byrd Alzheimer's Center and Research Institute (R.D., D.A.L., E.P., A.R., B.S., E.S., Y.W., H.P.), Tampa, FL; and University of South Florida (A.R., B.S., E.S., Y.W., H.P.), Tampa.

Address correspondence and reprint requests to Dr. Ranjan Duara, Wien Center for Alzheimer's Disease, Mount Sinai Medical Center, 4300 Alton Rd., Miami Beach, FL 33140 ranjan-duara{at}msmc.com

Background: Despite convenience, accessibility, and strong correlation to severity of Alzheimer disease (AD) pathology, medial temporal lobe atrophy (MTA) has not been used as a criterion in the diagnosis of prodromal and probable AD.

Methods: Using a newly validated visual rating system, mean MTA scores of three bilateral medial temporal lobe structures were compared for subjects with no cognitive impairment (NCI) (n = 117), nonamnestic mild cognitive impairment (MCI) (n = 46), amnestic MCI (n = 45), and probable AD (n = 53). Correlations between MTA scores and neuropsychological test scores at baseline, and predictors of change in diagnosis at 1-year follow-up were evaluated.

Results: With NCI as the reference group, a mean MTA cut score of 1.33 yielded an optimal sensitivity/specificity of 85%/82% for probable AD subjects and 80%/82% for amnestic MCI subjects. MTA and Clinical Dementia Rating Sum of Boxes scores at baseline were independent and additive predictors of diagnosis at baseline, and of transition from NCI to MCI or from MCI to dementia at 1-year follow-up.

Conclusion: Medial temporal lobe atrophy (MTA) scores 1) distinguish probable Alzheimer disease (AD) and amnestic mild cognitive impairment (MCI) subjects from nonamnestic MCI and no cognitive impairment (NCI) subjects, 2) help predict diagnosis at baseline, and 3) predict transition from NCI to MCI and from MCI to probable AD. MTA scores should be used as a criterion in the clinical diagnosis of AD.

AD = Alzheimer disease; ADRDA = Alzheimer's Disease and Related Disorders Association; aMCI = amnestic mild cognitive impairment; ANOVA = analysis of variance; CDRSB = Clinical Dementia Rating Sum of Boxes; ERC = entorhinal cortex; FADRC-CC = Florida Alzheimer's Disease Research Center–Clinical Core; HPC = hippocampus; HR = hazard ratio; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; MTA = medial temporal lobe atrophy; MTL = medial temporal lobe; NACC = National Alzheimer's Coordinating Center; naMCI = nonamnestic mild cognitive impairment; NCI = no cognitive impairment; NINCDS = National Institute of Neurological and Communicative Disorders and Stroke; NS = not significant; PRC = perirhinal cortex; VRS = visual rating system.

Received July 11, 2008. Accepted in final form September 15, 2008.

Supplemental data at www.neurology.org

Supported by 1P50AG025711-01 from the National Institute of Aging and by a grant from the Byrd Alzheimer Center and Research Institute.

Disclosure: The authors report no disclosures.

This article has been cited by other articles:

				J. Appel, E. Potter, N. Bhatia, Q. Shen, W. Zhao, M.T. Greig, A. Raj, W.W. Barker, H. Potter, E. Schofield, et al. Association of White Matter Hyperintensity Measurements on Brain MR Imaging with Cognitive Status, Medial Temporal Atrophy, and Cardiovascular Risk Factors AJNR Am. J. Neuroradiol., November 1, 2009; 30(10): 1870 - 1876. [Abstract] [Full Text] [PDF]