Abstract
BackgroundVisual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. Most prior studies involved patients with known or probable Alzheimer’s disease (AD). This study investigated the validity and reliability of MTA in a memory clinic population.MethodsMTA was rated in 752 MRI examinations, of which 105 were performed in cognitively healthy participants (CH), 184 in participants with subjective cognitive impairment, 249 in subjects with mild cognitive impairment, and 214 in patients with dementia, including AD, subcortical vascular dementia and mixed dementia. Hippocampal volumes, measured manually or using FreeSurfer, were available in the majority of cases. Intra- and interrater reliability was tested using Cohen’s weighted kappa. Correlation between MTA and quantitative hippocampal measurements was ascertained with Spearman’s rank correlation coefficient. Moreover, diagnostic ability of MTA was assessed with receiver operating characteristic (ROC) analysis and suitable, age-dependent MTA thresholds were determined.ResultsRater agreement was moderate to substantial. MTA correlation with quantitative volumetric methods ranged from -0.20 (p< 0.05) to -0.68 (p < 0.001) depending on the quantitative method used. Both MTA and FreeSurfer are able to distinguish dementia subgroups from CH. Suggested age-dependent MTA thresholds are 1 for the age group below 75 years and 1.5 for the age group 75 years and older.ConclusionsMTA can be considered a valid marker of medial temporal lobe atrophy and may thus be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population.
Highlights
Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup
MTA can be considered a valid marker of medial temporal lobe atrophy and may be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population
Twenty-three patients were reclassified as healthy controls when they upon examination had neither objective nor subjective signs of cognitive impairment
Summary
Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. The medial temporal lobe (MTL) is an early affected site for Alzheimer’s disease (AD) related neurodegeneration [1]. Absolute hippocampal volumes will be biased by the quantitative measuring method used, since manual volumetry and the various automated software programs tend to delineate the anatomical structures differently [16]. In terms of easy clinical applicability, visual assessment of MTL atrophy is still superior to volumetric measuring methods. For visual assessment the medial temporal lobe atrophy scale (MTA) introduced by Scheltens et al is widely used [17, 18]. Studies of MTA with regard to reliability, validity and diagnostic ability, have mostly focused on AD and its prodromal phases, fewer on SVD or mixed dementia
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