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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Apr 2002; 72(4): 491–497.
PMCID: PMC1737837

Medial temporal lobe atrophy predicts Alzheimer's disease in patients with minor cognitive impairment


Objectives: To investigate whether medial temporal lobe atrophy predicted outcome in patients with minor cognitive impairment and whether assessment of the medial temporal lobe could increase the predictive accuracy of age and delayed recall for outcome. Quantitative and qualitative methods of assessing the medial temporal lobe were also compared.

Methods: Patients with minor cognitive impairment older than 50 years (n=31) were selected from a memory clinic and were followed up for on average 1.9 years. The medial temporal lobe was assessed in three different ways: volumetry of the hippocampus, volumetry of the parahippocampal gyrus, and qualitative rating of medial temporal lobe atrophy (MTA). Outcome measures were Alzheimer type dementia or cognitive decline at follow up. Delayed recall was tested with a verbal learning test.

Results: Ten patients had experienced cognitive decline at follow up, of whom seven had probable Alzheimer type dementia. All medial temporal lobe measurements were associated with cognitive decline at follow up (p trend analysis between 0.001 (hippocampus) and 0.05 (parahippocampal gyrus)). Only the hippocampal volume and MTA score were associated with Alzheimer type dementia at follow up (p trend analysis respectively 0.003 and 0.01). All medial temporal lobe measurements increased the predictive accuracy of age and the delayed recall score for cognitive decline (p increase in predictive accuracy varied between <0.001 (hippocampus) and 0.02 (parahippocampal gyrus and MTA score)) and the hippocampal volume and the MTA score increased the predictive accuracy of age and the delayed recall score for Alzheimer type dementia (p= 0.02).

Conclusions: The ability to detect patients at high risk for Alzheimer type dementia among those with minor cognitive impairment increases when data on age and memory function are combined with measures of medial temporal lobe atrophy. Volumetry of the hippocampus is preferred, but qualitative rating of medial temporal lobe atrophy is a good alternative.

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Selected References

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  • Felician O, Sandson TA. The neurobiology and pharmacotherapy of Alzheimer's disease. J Neuropsychiatry Clin Neurosci. 1999 Winter;11(1):19–31. [PubMed]
  • Masur DM, Sliwinski M, Lipton RB, Blau AD, Crystal HA. Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology. 1994 Aug;44(8):1427–1432. [PubMed]
  • Tierney MC, Szalai JP, Snow WG, Fisher RH, Nores A, Nadon G, Dunn E, St George-Hyslop PH. Prediction of probable Alzheimer's disease in memory-impaired patients: A prospective longitudinal study. Neurology. 1996 Mar;46(3):661–665. [PubMed]
  • Sliwinski M, Buschke H, Stewart WF, Masur D, Lipton RB. The effect of dementia risk factors on comparative and diagnostic selective reminding norms. J Int Neuropsychol Soc. 1997 Jul;3(4):317–326. [PubMed]
  • Visser PJ, Verhey FR, Ponds RW, Cruts M, Van Broeckhoven CL, Jolles J. Course of objective memory impairment in non-demented subjects attending a memory clinic and predictors of outcome. Int J Geriatr Psychiatry. 2000 Apr;15(4):363–372. [PubMed]
  • de Leon MJ, Golomb J, George AE, Convit A, Tarshish CY, McRae T, De Santi S, Smith G, Ferris SH, Noz M, et al. The radiologic prediction of Alzheimer disease: the atrophic hippocampal formation. AJNR Am J Neuroradiol. 1993 Jul-Aug;14(4):897–906. [PubMed]
  • Golomb J, Kluger A, de Leon MJ, Ferris SH, Mittelman M, Cohen J, George AE. Hippocampal formation size predicts declining memory performance in normal aging. Neurology. 1996 Sep;47(3):810–813. [PubMed]
  • Fox NC, Warrington EK, Freeborough PA, Hartikainen P, Kennedy AM, Stevens JM, Rossor MN. Presymptomatic hippocampal atrophy in Alzheimer's disease. A longitudinal MRI study. Brain. 1996 Dec;119(Pt 6):2001–2007. [PubMed]
  • Kaye JA, Swihart T, Howieson D, Dame A, Moore MM, Karnos T, Camicioli R, Ball M, Oken B, Sexton G. Volume loss of the hippocampus and temporal lobe in healthy elderly persons destined to develop dementia. Neurology. 1997 May;48(5):1297–1304. [PubMed]
  • Visser PJ, Scheltens P, Verhey FR, Schmand B, Launer LJ, Jolles J, Jonker C. Medial temporal lobe atrophy and memory dysfunction as predictors for dementia in subjects with mild cognitive impairment. J Neurol. 1999 Jun;246(6):477–485. [PubMed]
  • Jack CR, Jr, Petersen RC, Xu YC, O'Brien PC, Smith GE, Ivnik RJ, Boeve BF, Waring SC, Tangalos EG, Kokmen E. Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment. Neurology. 1999 Apr 22;52(7):1397–1403. [PMC free article] [PubMed]
  • Verhey FR, Jolles J, Ponds RW, Rozendaal N, Plugge LA, de Vet RC, Vreeling FW, van der Lugt PJ. Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach. J Neuropsychiatry Clin Neurosci. 1993 Winter;5(1):78–85. [PubMed]
  • Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982 Sep;139(9):1136–1139. [PubMed]
  • HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960 Feb;23:56–62. [PMC free article] [PubMed]
  • Visser PJ, Verhey FR, Ponds RW, Kester A, Jolles J. Distinction between preclinical Alzheimer's disease and depression. J Am Geriatr Soc. 2000 May;48(5):479–484. [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
  • Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968 Jul;114(512):797–811. [PubMed]
  • McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. [PubMed]
  • Brand N, Jolles J. Learning and retrieval rate of words presented auditorily and visually. J Gen Psychol. 1985 Apr;112(2):201–210. [PubMed]
  • van Boxtel MP, Buntinx F, Houx PJ, Metsemakers JF, Knottnerus A, Jolles J. The relation between morbidity and cognitive performance in a normal aging population. J Gerontol A Biol Sci Med Sci. 1998 Mar;53(2):M147–M154. [PubMed]
  • van Walderveen MA, Barkhof F, Hommes OR, Polman CH, Tobi H, Frequin ST, Valk J. Correlating MRI and clinical disease activity in multiple sclerosis: relevance of hypointense lesions on short-TR/short-TE (T1-weighted) spin-echo images. Neurology. 1995 Sep;45(9):1684–1690. [PubMed]
  • Visser PJ, Krabbendam L, Verhey FR, Hofman PA, Verhoeven WM, Tuinier S, Wester A, Den Berg YW, Goessens LF, Werf YD, et al. Brain correlates of memory dysfunction in alcoholic Korsakoff's syndrome. J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):774–778. [PMC free article] [PubMed]
  • Tisserand DJ, Visser PJ, van Boxtel MP, Jolles J. The relation between global and limbic brain volumes on MRI and cognitive performance in healthy individuals across the age range. Neurobiol Aging. 2000 Jul-Aug;21(4):569–576. [PubMed]
  • Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J. Atrophy of medial temporal lobes on MRI in "probable" Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):967–972. [PMC free article] [PubMed]
  • Barber R, Gholkar A, Scheltens P, Ballard C, McKeith IG, O'Brien JT. Medial temporal lobe atrophy on MRI in dementia with Lewy bodies. Neurology. 1999 Apr 12;52(6):1153–1158. [PubMed]
  • Scheltens P, Launer LJ, Barkhof F, Weinstein HC, van Gool WA. Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol. 1995 Sep;242(9):557–560. [PubMed]
  • Jack CR, Jr, Petersen RC, Xu YC, Waring SC, O'Brien PC, Tangalos EG, Smith GE, Ivnik RJ, Kokmen E. Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease. Neurology. 1997 Sep;49(3):786–794. [PMC free article] [PubMed]
  • Wahlund LO, Julin P, Lindqvist J, Scheltens P. Visual assessment of medical temporal lobe atrophy in demented and healthy control subjects: correlation with volumetry. Psychiatry Res. 1999 Jun 30;90(3):193–199. [PubMed]
  • Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999 Mar;56(3):303–308. [PubMed]

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