Data used in the preparation of this article were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database (adni.loni.ucla.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data, but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at: http://supp.apa.org/psycarticles/supplemental/a0034057/ADNI_Acknowledgement_List.pdf.
Influence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut-offs
Article first published online: 29 OCT 2013
© 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 275, Issue 3, pages 317–330, March 2014
How to Cite
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum 5th floor, SE-141 86 Stockholm, SwedenInfluence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut-offs. J Intern Med 2014; 275: 317–330., , , , , , , , , , , , , , .
- Issue published online: 8 MAR 2014
- Article first published online: 29 OCT 2013
- Accepted manuscript online: 11 OCT 2013 02:30AM EST
- European Union of the Sixth Framework. Grant Number: FP6-2004-LIFESCIHEALTH-5
- Alzheimer's Disease Neuroimaging Initiative (ADNI)
- National Institutes of Health. Grant Number: U01 AG024904
- National Institute on Aging
- National Institute of Biomedical Imaging and Bioengineering
- Canadian Institutes of Health Research
- NIH. Grant Numbers: P30 AG010129, K01 AG030514
- Kuopio University Hospital
- National Institute for Health Research (NIHR)
- Biomedical Research Centre for Mental Health
- NIHR Biomedical Research
- Marie Curie. Grant Number: FP7-PEOPLE-2012-IEF
- Alzheimer's disease;
- Alzheimer's Disease Neuroimaging Initiative;
- magnetic resonance imaging;
- medial temporal lobe atrophy
Visual assessment of medial temporal lobe atrophy (MTA; range 0–4, from no atrophy to increasing atrophy of the choroid fissure, temporal horns and hippocampus) is a sensitive radiological marker of Alzheimer's disease (AD). One of the critical elements for visual MTA assessment is the cut-off score that determines deviation from normality.
In this study, we assessed the sensitivity and specificity of different MTA cut-off scores to classify control subjects, individuals with mild cognitive impairment (MCI) and AD patients from two large independent cohorts, AddNeuroMed and Alzheimer's Disease Neuroimaging Initiative. Of note, we evaluated the effects of clinical, demographic and genetic variables on the classification performance according to the different cut-offs.
A cut-off of ≥1.5 based on the mean MTA scores of both hemispheres showed higher sensitivity in classifying patients with AD (84.5%) and MCI subjects (75.8%) who converted to dementia compared to an age-dependent cut-off. The age-dependent cut-off showed higher specificity or ability to correctly identify control subjects (83.2%) and those with MCI who remained stable (65.5%). Increasing age, early-onset disease and absence of the ApoE ε4 allele had a stronger influence on classifications using the ≥1.5 cut-off. Above 75 years of age, an alternative cut-off of ≥2.0 should be applied to achieve a classification accuracy for both patients with AD and control subjects that is clinically useful.
Clinical, demographic and genetic variables can influence the classification of MTA cut-off scores, leading to misdiagnosis in some cases. These variables, in addition to the differential sensitivity and specificity of each cut-off, should be carefully considered when performing visual MTA assessment.