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. 2017 Aug;27(8):3147-3155.
doi: 10.1007/s00330-016-4726-3. Epub 2017 Jan 12.

Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population

Jules J Claus  1 , Salka S Staekenborg  1   2 , Dana C Holl  1 , Jelmen J Roorda  1 , Jacqueline Schuur  3 , Pieter Koster  4 , Caroline E M Tielkes  5 , Philip Scheltens  6
Affiliations

Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population

Jules J Claus et al. Eur Radiol. 2017 Aug.

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.

Keywords: Alzheimer’s disease; Clinical practice; Computed tomography; Diagnostic imaging; Temporal lobe.

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Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Philip Scheltens.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by the Tergooi Academy, Tergooi Hospital.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

Retrospective, cross-sectional study, performed at one institution.

Figures

Fig. 1
Fig. 1
Medial temporal atrophy (MTA) scores (visual rating, Scheltens scale) on computed tomography in patients with subjective cognitive impairment (SCI) and Alzheimer’s disease (AD) in relation to age. The x-axis shows age (years), the y-axis shows mean of right and left MTA scores (± 1 standard deviation). Age correlated significantly with MTA in both SCI and AD patients, adjusted for gender and level of education. The effect of age on MTA was similar in both groups and was stronger before 80 years than after 80 years
Fig. 2
Fig. 2
Diagnostic performance of the visual medial temporal atrophy (MTA) rating scale (Scheltens) with receiver operator characteristic curves comparing patients with subjective cognitive impairment and Alzheimer’s disease per age decade. Optimal cut-off values are: ≥1.0 for <65, ≥1.5 for 65–74, ≥ 2.0 for 75–84, and ≥2.0 for ≥85 years
See this image and copyright information in PMC

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