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Wittens MMJ, Allemeersch GJ, Sima DM, Vanderhasselt T, Raeymaeckers S, Fransen E, Smeets D, de Mey J, Bjerke M, Engelborghs S. Towards validation in clinical routine: a comparative analysis of visual MTA ratings versus the automated ratio between inferior lateral ventricle and hippocampal volumes in Alzheimer's disease diagnosis. Neuroradiology 2024; 66:487-506. [PMID: 38240767 PMCID: PMC10937807 DOI: 10.1007/s00234-024-03280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/28/2023] [Indexed: 03/14/2024]
Abstract
PURPOSE To assess the performance of the inferior lateral ventricle (ILV) to hippocampal (Hip) volume ratio on brain MRI, for Alzheimer's disease (AD) diagnostics, comparing it to individual automated ILV and hippocampal volumes, and visual medial temporal lobe atrophy (MTA) consensus ratings. METHODS One-hundred-twelve subjects (mean age ± SD, 66.85 ± 13.64 years) with varying degrees of cognitive decline underwent MRI using a Philips Ingenia 3T. The MTA scale by Scheltens, rated on coronal 3D T1-weighted images, was determined by three experienced radiologists, blinded to diagnosis and sex. Automated volumetry was computed by icobrain dm (v. 5.10) for total, left, right hippocampal, and ILV volumes. The ILV/Hip ratio, defined as the percentage ratio between ILV and hippocampal volumes, was calculated and compared against a normative reference population (n = 1903). Inter-rater agreement, association, classification accuracy, and clinical interpretability on patient level were reported. RESULTS Visual MTA scores showed excellent inter-rater agreement. Ordinal logistic regression and correlation analyses demonstrated robust associations between automated brain segmentations and visual MTA ratings, with the ILV/Hip ratio consistently outperforming individual hippocampal and ILV volumes. Pairwise classification accuracy showed good performance without statistically significant differences between the ILV/Hip ratio and visual MTA across disease stages, indicating potential interchangeability. Comparison to the normative population and clinical interpretability assessments showed commensurability in classifying MTA "severity" between visual MTA and ILV/Hip ratio measurements. CONCLUSION The ILV/Hip ratio shows the highest correlation to visual MTA, in comparison to automated individual ILV and hippocampal volumes, offering standardized measures for diagnostic support in different stages of cognitive decline.
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Affiliation(s)
- Mandy M J Wittens
- Dept. of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Dept. of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
| | - Gert-Jan Allemeersch
- Dept. of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium.
| | - Diana M Sima
- Icometrix, Kolonel Begaultlaan 1b, 3012, Leuven, Belgium
- AI Supported Modelling in Clinical Sciences (AIMS), Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Tim Vanderhasselt
- Dept. of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
| | - Steven Raeymaeckers
- Dept. of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Dirk Smeets
- Icometrix, Kolonel Begaultlaan 1b, 3012, Leuven, Belgium
| | - Johan de Mey
- Dept. of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
| | - Maria Bjerke
- Dept. of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- NEUR (Neuroprotection & Neuromodulation), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Av. du Laerbeek 101, 1090, Brussels, Belgium
- Laboratory of Neurochemistry, Dept. of Clinical Chemistry, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
| | - Sebastiaan Engelborghs
- Dept. of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Dept. of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Av. du Laerbeek 101, 1090, Brussels, Belgium
- NEUR (Neuroprotection & Neuromodulation), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Av. du Laerbeek 101, 1090, Brussels, Belgium
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Loreto F, Gontsarova A, Scott G, Patel N, Win Z, Carswell C, Perry R, Malhotra P. Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort. Ann Clin Transl Neurol 2023; 10:619-631. [PMID: 36872523 PMCID: PMC10109315 DOI: 10.1002/acn3.51749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES Visual rating scales (VRS) are the quantification method closest to the approach used in routine clinical practice to assess brain atrophy. Previous studies have suggested that the medial temporal atrophy (MTA) rating scale is a reliable diagnostic marker for AD, equivalent to volumetric quantification, while others propose a higher diagnostic utility for the Posterior Atrophy (PA) scale in early-onset AD. METHODS Here, we reviewed 14 studies that assessed the diagnostic accuracy of PA and MTA, we explored the issue of cut-off heterogeneity, and assessed 9 rating scales in a group of patients with biomarker-confirmed diagnosis. A neuroradiologist blinded to all clinical information rated the MR images of 39 amyloid-positive and 38 amyloid-negative patients using 9 validated VRS assessing multiple brain regions. Automated volumetric analyses were performed on a subset of patients (n = 48) and on a group of cognitively normal individuals (n = 28). RESULTS No single VRS could differentiate amyloid-positive from amyloid-negative patients with other neurodegenerative conditions. 44% of amyloid-positive patients were deemed to have age-appropriate levels of MTA. In the amyloid-positive group, 18% had no abnormal MTA or PA scores. These findings were substantially affected by cut-off selection. Amyloid-positive and amyloid-negative patients had comparable hippocampal and parietal volumes, and MTA but not PA scores correlated with the respective volumetric measures. INTERPRETATION Consensus guidelines are needed before VRS can be recommended for use in the diagnostic workup of AD. Our data are suggestive of high intragroup variability and non-superiority of volumetric quantification of atrophy over visual assessment.
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Affiliation(s)
- Flavia Loreto
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | - Gregory Scott
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Neva Patel
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Zarni Win
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - Richard Perry
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
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Park HY, Park CR, Suh CH, Shim WH, Kim SJ. Diagnostic performance of the medial temporal lobe atrophy scale in patients with Alzheimer's disease: a systematic review and meta-analysis. Eur Radiol 2021; 31:9060-9072. [PMID: 34510246 DOI: 10.1007/s00330-021-08227-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance and reliability of the medial temporal lobe atrophy (MTA) scale in patients with Alzheimer's disease. METHODS A systematic literature search of MEDLINE and EMBASE databases was performed to select studies that evaluated the diagnostic performance or reliability of MTA scale, published up to January 21, 2021. Pooled estimates of sensitivity and specificity were calculated using a bivariate random-effects model. Pooled correlation coefficients for intra- and interobserver agreements were calculated using the random-effects model based on Fisher's Z transformation of correlations. Meta-regression was performed to explain the study heterogeneity. Subgroup analysis was performed to compare the diagnostic performance of the MTA scale and hippocampal volumetry. RESULTS Twenty-one original articles were included. The pooled sensitivity and specificity of the MTA scale in differentiating Alzheimer's disease from healthy control were 74% (95% CI, 68-79%) and 88% (95% CI, 83-91%), respectively. The area under the curve of the MTA scale was 0.88 (95% CI, 0.84-0.90). Meta-regression demonstrated that the difference in the method of rating the MTA scale was significantly associated with study heterogeneity (p = 0.04). No significant difference was observed in five studies regarding the diagnostic performance between MTA scale and hippocampal volumetry (p = 0.40). The pooled correlation coefficients for intra- and interobserver agreements were 0.85 (95% CI, 0.69-0.93) and 0.83 (95% CI, 0.66-0.92), respectively. CONCLUSIONS Our meta-analysis demonstrated a good diagnostic performance and reliability of the MTA scale in Alzheimer's disease. KEY POINTS • The pooled sensitivity and specificity of the MTA scale in differentiating Alzheimer's disease from healthy control were 74% and 88%, respectively. • There was no significant difference in the diagnostic performance between MTA scale and hippocampal volumetry. • The reliability of MTA scale was excellent based on the pooled correlation coefficient for intra- and interobserver agreements.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae Ri Park
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Al-Janahi E, Ponirakis G, Al Hamad H, Vattoth S, Elsotouhy A, Petropoulos IN, Khan A, Gad H, Chandran M, Sankaranarayanan A, Ramadan M, Elorrabi M, Gadelseed M, Tosino R, Gawhale PV, Arasn A, Alobaidi M, Khan S, Manikoth P, Hamdi Y, Osman S, Nadukkandiyil N, AlSulaiti E, Thodi N, Almuhannadi H, Mahfoud ZR, Own A, Shuaib A, Malik RA. Corneal Nerve and Brain Imaging in Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 77:1533-1543. [PMID: 32925064 PMCID: PMC7683060 DOI: 10.3233/jad-200678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Visual rating of medial temporal lobe atrophy (MTA) is an accepted structural neuroimaging marker of Alzheimer’s disease. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic technique that detects neuronal loss in peripheral and central neurodegenerative disorders. Objective: To determine the diagnostic accuracy of CCM for mild cognitive impairment (MCI) and dementia compared to medial temporal lobe atrophy (MTA) rating on MRI. Methods: Subjects aged 60–85 with no cognitive impairment (NCI), MCI, and dementia based on the ICD-10 criteria were recruited. Subjects underwent cognitive screening, CCM, and MTA rating on MRI. Results: 182 subjects with NCI (n = 36), MCI (n = 80), and dementia (n = 66), including AD (n = 19, 28.8%), VaD (n = 13, 19.7%), and mixed AD (n = 34, 51.5%) were studied. CCM showed a progressive reduction in corneal nerve fiber density (CNFD, fibers/mm2) (32.0±7.5 versus 24.5±9.6 and 20.8±9.3, p < 0.0001), branch density (CNBD, branches/mm2) (90.9±46.5 versus 59.3±35.7 and 53.9±38.7, p < 0.0001), and fiber length (CNFL, mm/mm2) (22.9±6.1 versus 17.2±6.5 and 15.8±7.4, p < 0.0001) in subjects with MCI and dementia compared to NCI. The area under the ROC curve (95% CI) for the diagnostic accuracy of CNFD, CNBD, CNFL compared to MTA-right and MTA-left for MCI was 78% (67–90%), 82% (72–92%), 86% (77–95%) versus 53% (36–69%) and 40% (25–55%), respectively, and for dementia it was 85% (76–94%), 84% (75–93%), 85% (76–94%) versus 86% (76–96%) and 82% (72–92%), respectively. Conclusion: The diagnostic accuracy of CCM, a non-invasive ophthalmic biomarker of neurodegeneration, was high and comparable with MTA rating for dementia but was superior to MTA rating for MCI.
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Affiliation(s)
- Eiman Al-Janahi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK
| | - Hanadi Al Hamad
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mani Chandran
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Marwan Ramadan
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Marwa Elorrabi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Masharig Gadelseed
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rhia Tosino
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Priya V Gawhale
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anjum Arasn
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maryam Alobaidi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shafi Khan
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pravija Manikoth
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yasmin Hamdi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Susan Osman
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Navas Nadukkandiyil
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Essa AlSulaiti
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Noushad Thodi
- MRI Unit, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Almuhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ahmed Own
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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Lombardi G, Crescioli G, Cavedo E, Lucenteforte E, Casazza G, Bellatorre A, Lista C, Costantino G, Frisoni G, Virgili G, Filippini G. Structural magnetic resonance imaging for the early diagnosis of dementia due to Alzheimer's disease in people with mild cognitive impairment. Cochrane Database Syst Rev 2020; 3:CD009628. [PMID: 32119112 PMCID: PMC7059964 DOI: 10.1002/14651858.cd009628.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) due to Alzheimer's disease is the symptomatic predementia phase of Alzheimer's disease dementia, characterised by cognitive and functional impairment not severe enough to fulfil the criteria for dementia. In clinical samples, people with amnestic MCI are at high risk of developing Alzheimer's disease dementia, with annual rates of progression from MCI to Alzheimer's disease estimated at approximately 10% to 15% compared with the base incidence rates of Alzheimer's disease dementia of 1% to 2% per year. OBJECTIVES To assess the diagnostic accuracy of structural magnetic resonance imaging (MRI) for the early diagnosis of dementia due to Alzheimer's disease in people with MCI versus the clinical follow-up diagnosis of Alzheimer's disease dementia as a reference standard (delayed verification). To investigate sources of heterogeneity in accuracy, such as the use of qualitative visual assessment or quantitative volumetric measurements, including manual or automatic (MRI) techniques, or the length of follow-up, and age of participants. MRI was evaluated as an add-on test in addition to clinical diagnosis of MCI to improve early diagnosis of dementia due to Alzheimer's disease in people with MCI. SEARCH METHODS On 29 January 2019 we searched Cochrane Dementia and Cognitive Improvement's Specialised Register and the databases, MEDLINE, Embase, BIOSIS Previews, Science Citation Index, PsycINFO, and LILACS. We also searched the reference lists of all eligible studies identified by the electronic searches. SELECTION CRITERIA We considered cohort studies of any size that included prospectively recruited people of any age with a diagnosis of MCI. We included studies that compared the diagnostic test accuracy of baseline structural MRI versus the clinical follow-up diagnosis of Alzheimer's disease dementia (delayed verification). We did not exclude studies on the basis of length of follow-up. We included studies that used either qualitative visual assessment or quantitative volumetric measurements of MRI to detect atrophy in the whole brain or in specific brain regions, such as the hippocampus, medial temporal lobe, lateral ventricles, entorhinal cortex, medial temporal gyrus, lateral temporal lobe, amygdala, and cortical grey matter. DATA COLLECTION AND ANALYSIS Four teams of two review authors each independently reviewed titles and abstracts of articles identified by the search strategy. Two teams of two review authors each independently assessed the selected full-text articles for eligibility, extracted data and solved disagreements by consensus. Two review authors independently assessed the quality of studies using the QUADAS-2 tool. We used the hierarchical summary receiver operating characteristic (HSROC) model to fit summary ROC curves and to obtain overall measures of relative accuracy in subgroup analyses. We also used these models to obtain pooled estimates of sensitivity and specificity when sufficient data sets were available. MAIN RESULTS We included 33 studies, published from 1999 to 2019, with 3935 participants of whom 1341 (34%) progressed to Alzheimer's disease dementia and 2594 (66%) did not. Of the participants who did not progress to Alzheimer's disease dementia, 2561 (99%) remained stable MCI and 33 (1%) progressed to other types of dementia. The median proportion of women was 53% and the mean age of participants ranged from 63 to 87 years (median 73 years). The mean length of clinical follow-up ranged from 1 to 7.6 years (median 2 years). Most studies were of poor methodological quality due to risk of bias for participant selection or the index test, or both. Most of the included studies reported data on the volume of the total hippocampus (pooled mean sensitivity 0.73 (95% confidence interval (CI) 0.64 to 0.80); pooled mean specificity 0.71 (95% CI 0.65 to 0.77); 22 studies, 2209 participants). This evidence was of low certainty due to risk of bias and inconsistency. Seven studies reported data on the atrophy of the medial temporal lobe (mean sensitivity 0.64 (95% CI 0.53 to 0.73); mean specificity 0.65 (95% CI 0.51 to 0.76); 1077 participants) and five studies on the volume of the lateral ventricles (mean sensitivity 0.57 (95% CI 0.49 to 0.65); mean specificity 0.64 (95% CI 0.59 to 0.70); 1077 participants). This evidence was of moderate certainty due to risk of bias. Four studies with 529 participants analysed the volume of the total entorhinal cortex and four studies with 424 participants analysed the volume of the whole brain. We did not estimate pooled sensitivity and specificity for the volume of these two regions because available data were sparse and heterogeneous. We could not statistically evaluate the volumes of the lateral temporal lobe, amygdala, medial temporal gyrus, or cortical grey matter assessed in small individual studies. We found no evidence of a difference between studies in the accuracy of the total hippocampal volume with regards to duration of follow-up or age of participants, but the manual MRI technique was superior to automatic techniques in mixed (mostly indirect) comparisons. We did not assess the relative accuracy of the volumes of different brain regions measured by MRI because only indirect comparisons were available, studies were heterogeneous, and the overall accuracy of all regions was moderate. AUTHORS' CONCLUSIONS The volume of hippocampus or medial temporal lobe, the most studied brain regions, showed low sensitivity and specificity and did not qualify structural MRI as a stand-alone add-on test for an early diagnosis of dementia due to Alzheimer's disease in people with MCI. This is consistent with international guidelines, which recommend imaging to exclude non-degenerative or surgical causes of cognitive impairment and not to diagnose dementia due to Alzheimer's disease. In view of the low quality of most of the included studies, the findings of this review should be interpreted with caution. Future research should not focus on a single biomarker, but rather on combinations of biomarkers to improve an early diagnosis of Alzheimer's disease dementia.
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Affiliation(s)
- Gemma Lombardi
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Giada Crescioli
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Enrica Cavedo
- Pitie‐Salpetriere Hospital, Sorbonne UniversityAlzheimer Precision Medicine (APM), AP‐HP47 boulevard de l'HopitalParisFrance75013
| | - Ersilia Lucenteforte
- University of PisaDepartment of Clinical and Experimental MedicineVia Savi 10PisaItaly56126
| | - Giovanni Casazza
- Università degli Studi di MilanoDipartimento di Scienze Biomediche e Cliniche "L. Sacco"via GB Grassi 74MilanItaly20157
| | | | - Chiara Lista
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo BestaNeuroepidemiology UnitVia Celoria, 11MilanoItaly20133
| | - Giorgio Costantino
- Ospedale Maggiore Policlinico, Università degli Studi di MilanoUOC Pronto Soccorso e Medicina D'Urgenza, Fondazione IRCCS Ca' GrandaMilanItaly
| | | | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Graziella Filippini
- Carlo Besta Foundation and Neurological InstituteScientific Director’s Officevia Celoria, 11MilanItaly20133
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Falgàs N, Sánchez-Valle R, Bargalló N, Balasa M, Fernández-Villullas G, Bosch B, Olives J, Tort-Merino A, Antonell A, Muñoz-García C, León M, Grau O, Castellví M, Coll-Padrós N, Rami L, Redolfi A, Lladó A. Hippocampal atrophy has limited usefulness as a diagnostic biomarker on the early onset Alzheimer's disease patients: A comparison between visual and quantitative assessment. NEUROIMAGE-CLINICAL 2019; 23:101927. [PMID: 31491836 PMCID: PMC6627030 DOI: 10.1016/j.nicl.2019.101927] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
Abstract
NIA-AA diagnostic criteria include volumetric or visual rating measures of hippocampal atrophy (HA) as a diagnostic biomarker of Alzheimer's disease (AD). We aimed to determine its utility as a diagnostic biomarker for early onset Alzheimer's disease (EOAD) by assessing Medial Temporal Atrophy (MTA) and hippocampal volume (HV) determination. MTA score and HV quantified by FreeSurfer were assessed in 140 (aged ≤65) subjects with biomarker supported diagnosis: 38 amnesic (A-EOAD), 20 non-amnesic (NA-EOAD), 30 late onset AD (LOAD), 20 fronto-temporal dementia (FTD) and 32 healthy controls (HC). The results showed that the proportion of MTA ≥ 1.5 was higher on LOAD and FTD than EOAD and HC but none of the MTA thresholds (≥1, ≥1.5 and ≥ 2) showed acceptable diagnostic accuracy. LOAD had lower HV than the other groups. A-EOAD HV was lower than NA-EOAD and HC but equal to FTD. The 6258 mm3 cut-off showed good diagnostic accuracy between A-EOAD and HC. Both tools showed a moderate inverse correlation. In conclusion, MTA has a limited diagnostic utility as an EOAD biomarker as it does not discriminate AD from FTD or HC in initial symptomatic stages. HV may discriminate A-EOAD from HC but not from FTD. FTD had higher MTA scores than AD patients. MTA scores visual assessment had low diagnostic performance in EOAD. Amnesic EOAD patients had lower hippocampal volume than the non-amnesic ones. Quantitative assessment only discriminate between amnesic EOAD from controls.
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Affiliation(s)
- Neus Falgàs
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Núria Bargalló
- Imaging Diagnostic Center, Hospital Clínic, Barcelona, Spain; Magnetic Resonance Image Core Facility, IDIBAPS, Spain
| | - Mircea Balasa
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Guadalupe Fernández-Villullas
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Beatriz Bosch
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Jaume Olives
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Adrià Tort-Merino
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Anna Antonell
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Cristina Muñoz-García
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - María León
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Oriol Grau
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Magdalena Castellví
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Nina Coll-Padrós
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Lorena Rami
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Alberto Redolfi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology - LANE, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Albert Lladó
- Alzheimer's disease and other cognitive disorders Unit, Neurology department, IDIBAPS, Hospital Clínic, Barcelona, Spain.
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Falgàs N, Tort-Merino A, Balasa M, Borrego-Écija S, Castellví M, Olives J, Bosch B, Férnandez-Villullas G, Antonell A, Augé JM, Lomeña F, Perissinotti A, Bargalló N, Sánchez-Valle R, Lladó A. Clinical applicability of diagnostic biomarkers in early-onset cognitive impairment. Eur J Neurol 2019; 26:1098-1104. [PMID: 30793432 DOI: 10.1111/ene.13945] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Several diagnostic biomarkers are currently available for clinical use in early-onset cognitive impairment. The decision on which biomarker is used in each patient depends on several factors such as its predictive value or tolerability. METHODS There were a total of 40 subjects with early-onset cognitive complaints (<65 years of age): 26 with Alzheimer's disease (AD), five with frontotemporal dementia and nine with diagnostic suspicion of non-neurodegenerative disorder. Clinical and neuropsychological evaluation, lumbar puncture for cerebrospinal fluid (CSF) AD core biochemical marker determination, medial temporal atrophy evaluation on magnetic resonance imaging, amyloid-positron emission tomography (PET) and 18 F-fluorodeoxyglucose-PET were performed. Neurologists provided pre- and post-biomarker diagnosis, together with diagnostic confidence and clinical/therapeutic management. Patients scored the tolerability of each procedure. RESULTS Cerebrospinal fluid biomarkers and amyloid-PET increased diagnostic confidence in AD (77.4%-86.2% after CSF, 92.4% after amyloid-PET, P < 0.01) and non-neurodegenerative conditions (53.6%-75% after CSF, 95% after amyloid-PET, P < 0.05). Biomarker results led to diagnostic (32.5%) and treatment (32.5%) changes. All tests were well tolerated. CONCLUSIONS Biomarker procedures are well tolerated and have an important diagnostic/therapeutic impact on early-onset cognitive impairment.
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Affiliation(s)
- N Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Tort-Merino
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - S Borrego-Écija
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Castellví
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Olives
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - B Bosch
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Férnandez-Villullas
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Antonell
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona
| | - F Lomeña
- Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona
| | - A Perissinotti
- Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona
| | - N Bargalló
- Image Diagnostic Centre, IDIBAPS, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
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8
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Frey A, Sell R, Homola GA, Malsch C, Kraft P, Gunreben I, Morbach C, Alkonyi B, Schmid E, Colonna I, Hofer E, Müllges W, Ertl G, Heuschmann P, Solymosi L, Schmidt R, Störk S, Stoll G. Cognitive Deficits and Related Brain Lesions in Patients With Chronic Heart Failure. JACC-HEART FAILURE 2018; 6:583-592. [DOI: 10.1016/j.jchf.2018.03.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
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9
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Rhodius-Meester HFM, Benedictus MR, Wattjes MP, Barkhof F, Scheltens P, Muller M, van der Flier WM. MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis. Front Aging Neurosci 2017; 9:117. [PMID: 28536518 PMCID: PMC5422528 DOI: 10.3389/fnagi.2017.00117] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Aim: To assess the associations of age and diagnosis with visual ratings of medial temporal lobe atrophy (MTA), parietal atrophy (PA), global cortical atrophy (GCA), and white matter hyperintensities (WMH) and to investigate their clinical value in a large memory clinic cohort. Methods: We included 2,934 patients (age 67 ± 9 years; 1,391 [47%] female; MMSE 24 ± 5) from the Amsterdam Dementia Cohort (1,347 dementia due to Alzheimer's disease [AD]; 681 mild cognitive impairment [MCI]; 906 controls with subjective cognitive decline). We analyzed the effect of age, APOE e4 and diagnosis on visual ratings using linear regression analyses. Subsequently, we compared diagnostic and predictive value in three age-groups (<65 years, 65-75 years, and >75 years). Results: Linear regression analyses showed main effects of age and diagnosis and an interaction age*diagnosis for MTA, PA, and GCA. For MTA the interaction effect indicated steeper age effects in MCI and AD than in controls. PA and GCA increased with age in MCI and controls, while AD patients have a high score, regardless of age. For WMH we found a main effect of age, but not of diagnosis. For MTA, GCA and PA, diagnostic value was best in patients <65 years (optimal cut-off: ≥1). PA and GCA only discriminated in patients <65 years and MTA in patients <75 years. WMH did not discriminate at all. Taking into account APOE did not affect the identified optimal cut-offs. When we used these scales to predict progression in MCI using Cox proportional hazard models, only MTA (cut-off ≥2) had any predictive value, restricted to patients >75 years. Conclusion: Visual ratings of atrophy and WMH were differently affected by age and diagnosis, requiring an age-specific approach in clinical practice. Their diagnostic value seems strongest in younger patients.
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Affiliation(s)
- Hanneke F M Rhodius-Meester
- Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands
| | - Marije R Benedictus
- Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands.,Institutes of Neurology and Healthcare Engineering, UCLLondon, UK
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands
| | - Majon Muller
- Department of Internal Medicine, Section Geriatrics, VU University Medical CentreAmsterdam, Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam NeuroscienceAmsterdam, Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical CentreAmsterdam, Netherlands
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10
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Ferreira D, Verhagen C, Hernández-Cabrera JA, Cavallin L, Guo CJ, Ekman U, Muehlboeck JS, Simmons A, Barroso J, Wahlund LO, Westman E. Distinct subtypes of Alzheimer's disease based on patterns of brain atrophy: longitudinal trajectories and clinical applications. Sci Rep 2017; 7:46263. [PMID: 28417965 PMCID: PMC5394684 DOI: 10.1038/srep46263] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/08/2017] [Indexed: 12/27/2022] Open
Abstract
Atrophy patterns on MRI can reliably predict three neuropathological subtypes of Alzheimer’s disease (AD): typical, limbic-predominant, or hippocampal-sparing. A method to enable their investigation in the clinical routine is still lacking. We aimed to (1) validate the combined use of visual rating scales for identification of AD subtypes; (2) characterise these subtypes at baseline and over two years; and (3) investigate how atrophy patterns and non-memory cognitive domains contribute to memory impairment. AD patients were classified as either typical AD (n = 100), limbic-predominant (n = 33), or hippocampal-sparing (n = 35) by using the Scheltens’ scale for medial temporal lobe atrophy (MTA), the Koedam’s scale for posterior atrophy (PA), and the Pasquier’s global cortical atrophy scale for frontal atrophy (GCA-F). A fourth group with no atrophy was also identified (n = 30). 230 healthy controls were also included. There was great overlap among subtypes in demographic, clinical, and cognitive variables. Memory performance was more dependent on non-memory cognitive functions in hippocampal-sparing and the no atrophy group. Hippocampal-sparing and the no atrophy group showed less aggressive disease progression. Visual rating scales can be used to identify distinct AD subtypes. Recognizing AD heterogeneity is important and visual rating scales may facilitate investigation of AD heterogeneity in clinical routine.
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Affiliation(s)
- Daniel Ferreira
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Chloë Verhagen
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Lena Cavallin
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Huddinge, Sweden
| | - Chun-Jie Guo
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, The First Hospital of Jilin University, Jilin, China
| | - Urban Ekman
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Simmons
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, London, UK.,NIHR Biomedical Research Unit for Dementia, London, UK
| | - José Barroso
- Faculty of Psychology, University of La Laguna, Tenerife, Spain
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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11
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Claus JJ, Staekenborg SS, Holl DC, Roorda JJ, Schuur J, Koster P, Tielkes CEM, Scheltens P. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population. Eur Radiol 2017; 27:3147-3155. [PMID: 28083697 PMCID: PMC5491609 DOI: 10.1007/s00330-016-4726-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022]
Abstract
Objective To provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer’s disease (AD). Methods Patients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined. Results MTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65–74, 75–84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%. Conclusion From this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited. Key Points • We suggest decade-specific MTA cut-off scores for AD. • MTA cut-off after the age of 85 years has limited use. • CT is feasible and accurate for visual MTA rating.
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Affiliation(s)
- Jules J Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Salka S Staekenborg
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands.,Department of Neurology, Alzheimer Center, VU University Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Dana C Holl
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Jelmen J Roorda
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Jacqueline Schuur
- Department of Geriatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Pieter Koster
- Department of Radiology, Tergooi Hospital, Blaricum, The Netherlands
| | | | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
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12
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Rhodius-Meester HF, Koikkalainen J, Mattila J, Teunissen CE, Barkhof F, Lemstra AW, Scheltens P, Lötjönen J, van der Flier W. Integrating Biomarkers for Underlying Alzheimer’s Disease in Mild Cognitive Impairment in Daily Practice: Comparison of a Clinical Decision Support System with Individual Biomarkers. J Alzheimers Dis 2015; 50:261-70. [PMID: 26577521 DOI: 10.3233/jad-150548] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Hanneke F.M. Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | | | - Jussi Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Charlotte E. Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Afina W. Lemstra
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Wiesje M. van der Flier
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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13
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Ferreira D, Cavallin L, Larsson EM, Muehlboeck JS, Mecocci P, Vellas B, Tsolaki M, Kłoszewska I, Soininen H, Lovestone S, Simmons A, Wahlund LO, Westman E. Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment. J Intern Med 2015; 278:277-90. [PMID: 25752192 DOI: 10.1111/joim.12358] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Atrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria. AIMS The aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, for both diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs. METHODS AddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 patients with AD, 480 patients with MCI and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated. RESULTS The MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) ε4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94 years, the following cut-offs should be used. MTA: ≥1.5, ≥1.5, ≥2 and ≥2.5; GCA-F, ≥1, ≥1, ≥1 and ≥1; and PA, ≥1, ≥1, ≥1 and ≥1, respectively, with an adjustment for early-onset ApoE ε4 noncarrier AD patients (MTA: ≥2, ≥2, ≥3 and ≥3; and GCA-F: ≥1, ≥1, ≥2 and ≥2, respectively). CONCLUSIONS If successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.
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Affiliation(s)
- D Ferreira
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - L Cavallin
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - E-M Larsson
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
| | - J-S Muehlboeck
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - P Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - B Vellas
- INSERM U 558, University of Toulouse, Toulouse, France
| | - M Tsolaki
- 3rd Department of Neurology, Aristoteleion Panepistimeion Thessalonikis, Thessaloniki, Greece
| | | | - H Soininen
- University of Eastern Finland, University Hospital of Kuopio, Kuopio, Finland
| | - S Lovestone
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - A Simmons
- Institute of Psychiatry, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, London, UK.,NIHR Biomedical Research Unit for Dementia, London, UK
| | - L-O Wahlund
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - E Westman
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
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