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From the Departments of Radiology (F.B.) and Neurology (E.C.W.v.S., P.S.), VU University Medical Centre, Amsterdam, The Netherlands; Wolfson Centre (T.M.P., R.N.K.), Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK; School of Public Health and Clinical Nutrition (R.S.), University of Kuopio and Rheumatism Foundation Hospital, Heinola; Department of Radiology (H.J.A.), University of Helsinki, Centre for Military Medicine, the Finnish Defence Forces, Lahti, and Functional Brain Imaging Unit, Helsinki Brain Research Center, Helsinki; Katriina Hospital (L.N.), Vantaa; Department of Neuroscience and Neurology (S.R.), University of Kuopio; Departments of Neurosurgery and Pathology (M.O.), University of Helsinki, and Helsinki University Central Hospital; and Memory Research Unit (T.E.), Department of Neurology, Helsinki University Central Hospital, Finland.
Address correspondence and reprint requests to Prof. F. Barkhof, Department of Radiology, VU Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands f.barkhof{at}vumc.nl
Background: Medial temporal lobe atrophy (MTA) is a sensitive radiologic marker for Alzheimer disease (AD) and associated with cognitive impairment. The value of MTA in the oldest old (>85 years old) is largely unknown.
Methods: A total of 132 formalin-fixed brains from the Vantaa 85+ community-based study were subjected to postmortem MRI. Visual ratings of MTA were determined in a blinded fashion and compared with neuropathologic findings and clinical assessment (dementia according to Diagnostic and Statistical Manual of Mental Disorders-III-R).
Results: A strong relationship was found between MTA scores and Alzheimer pathology (p < 0.001). The previously proposed cutoff MTA score >2 correctly excluded subjects with no or borderline Alzheimer-type pathology (45/48), but was not very sensitive for AD (modified National Institute on Aging-Reagan Institute criteria). MTA scores >2 were also found in subjects with other primary neurodegenerative hippocampal pathology including hippocampal sclerosis, Lewy-related pathology, and argyrophilic grain disease, either alone or in combination with Alzheimer-type pathology. High MTA scores were associated with clinical dementia—in this subgroup, sensitivity was 63% and specificity 69% for AD.
Conclusion: Medial temporal lobe atrophy (MTA) on postmortem MRI is sensitive to primary degenerative hippocampal pathology in the very old, but not specific for Alzheimer-type pathology. MTA scores of 2 or less are not frequently associated with dementia.
GLOSSARY: AD = Alzheimer disease; AgD = argyrophilic grain disease; CERAD = Consortium to Establish a Registry for Alzheimer’s Disease; DLB = dementia with Lewy bodies; HS = hippocampal sclerosis; L-rP = Lewy-related pathology; MCI = mild cognitive impairment; MTA = medial temporal lobe atrophy.
The Alzheimer Centre VUMC is supported by the Stichting Alzheimer & Neuropsychiatrie Foundation Amsterdam and Alzheimer Nederland, Bunnik, The Netherlands. The Newcastle group is supported by grants from the Medical Research Council (UK), Alzheimer’s Research Trust (UK), and the Alzheimer Association (US). The VANTAA study group is supported by grants from the Research Council for Health of the Academy of Finland (project no. 48173).
Disclosure: The authors report no conflicts of interest.
Received December 19, 2006. Accepted in final form April 24, 2007.
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