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The significance of medial temporal lobe atrophy: A postmortem MRI study in the very old

Lookup NU author(s): Dr Tuomo Polvikoski, Professor Raj KalariaORCiD, Dr Timo Erkinjuntti


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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.

Publication metadata

Author(s): Barkhof F, Polvikoski T, van Straaten I, Kalaria RN, Sulkava R, Aronen H, Niinisto L, Rastas S, Oinas M, Scheltens P, Erkinjuntti T

Publication type: Article

Publication status: Published

Journal: Neurology

Year: 2007

Volume: 69

Issue: 15

Pages: 1521-1527

ISSN (print): 0028-3878

ISSN (electronic): 1526-632X

Publisher: Lippincott Williams & Wilkins


DOI: 10.1212/01.wnl.0000277459.83543.99


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