Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Oct;55(10):967–972. doi: 10.1136/jnnp.55.10.967

Atrophy of medial temporal lobes on MRI in "probable" Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates.

P Scheltens 1, D Leys 1, F Barkhof 1, D Huglo 1, H C Weinstein 1, P Vermersch 1, M Kuiper 1, M Steinling 1, E C Wolters 1, J Valk 1
PMCID: PMC1015202  PMID: 1431963

Abstract

Magnetic resonance imaging (MRI) has shown a great reduction in medial temporal lobe and hippocampal volume of patients with Alzheimer's disease as compared to controls. Quantitative volumetric measurements are not yet available for routine clinical use. We investigated whether visual assessment of medial temporal lobe atrophy (MTA) on plain MRI films could distinguish patients with Alzheimer's disease (n = 21) from age matched controls (n = 21). The degree of MTA was ascertained with a ranking procedure and validated by linear measurements of the medial temporal lobe including the hippocampal formation and surrounding spaces occupied by cerebrospinal fluid. Patients with Alzheimer's disease showed a significantly higher degree of subjectively assessed MTA than controls (p = 0.0005). Linear measurements correlated highly with subjective assessment of MTA and also showed significant differences between groups. Ventricular indices did not differ significantly between groups. In Alzheimer's disease patients the degree of MTA correlated significantly with scores on the mini-mental state examination and memory tests, but poorly with mental speed tests. This study shows that MTA may be assessed quickly and easily with plain MRI films. MTA shown on MRI strongly supports the clinical diagnosis of Alzheimer's disease, is related to memory function, and seems to occur earlier in the disease process than does generalised brain atrophy.

Full text

PDF
967

Images in this article

968Image
on p.968
968Image
on p.968
969Image
on p.969
969Image
on p.969

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ball M. J., Fisman M., Hachinski V., Blume W., Fox A., Kral V. A., Kirshen A. J., Fox H., Merskey H. A new definition of Alzheimer's disease: a hippocampal dementia. Lancet. 1985 Jan 5;1(8419):14–16. doi: 10.1016/s0140-6736(85)90965-1. [DOI] [PubMed] [Google Scholar]
  2. Crystal H. A., Horoupian D. S., Katzman R., Jotkowitz S. Biopsy-proved Alzheimer disease presenting as a right parietal lobe syndrome. Ann Neurol. 1982 Aug;12(2):186–188. doi: 10.1002/ana.410120210. [DOI] [PubMed] [Google Scholar]
  3. Damasio A. R., Eslinger P. J., Damasio H., Van Hoesen G. W., Cornell S. Multimodal amnesic syndrome following bilateral temporal and basal forebrain damage. Arch Neurol. 1985 Mar;42(3):252–259. doi: 10.1001/archneur.1985.04060030070012. [DOI] [PubMed] [Google Scholar]
  4. Folstein M. F., Folstein S. E., McHugh P. R. "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. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  5. George A. E., de Leon M. J., Stylopoulos L. A., Miller J., Kluger A., Smith G., Miller D. C. CT diagnostic features of Alzheimer disease: importance of the choroidal/hippocampal fissure complex. AJNR Am J Neuroradiol. 1990 Jan-Feb;11(1):101–107. [PMC free article] [PubMed] [Google Scholar]
  6. Gur R. C., Mozley P. D., Resnick S. M., Gottlieb G. L., Kohn M., Zimmerman R., Herman G., Atlas S., Grossman R., Berretta D. Gender differences in age effect on brain atrophy measured by magnetic resonance imaging. Proc Natl Acad Sci U S A. 1991 Apr 1;88(7):2845–2849. doi: 10.1073/pnas.88.7.2845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hachinski V. C., Iliff L. D., Zilhka E., Du Boulay G. H., McAllister V. L., Marshall J., Russell R. W., Symon L. Cerebral blood flow in dementia. Arch Neurol. 1975 Sep;32(9):632–637. doi: 10.1001/archneur.1975.00490510088009. [DOI] [PubMed] [Google Scholar]
  8. Hyman B. T., Van Hoesen G. W., Damasio A. R. Memory-related neural systems in Alzheimer's disease: an anatomic study. Neurology. 1990 Nov;40(11):1721–1730. doi: 10.1212/wnl.40.11.1721. [DOI] [PubMed] [Google Scholar]
  9. Jack C. R., Jr, Twomey C. K., Zinsmeister A. R., Sharbrough F. W., Petersen R. C., Cascino G. D. Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults. Radiology. 1989 Aug;172(2):549–554. doi: 10.1148/radiology.172.2.2748838. [DOI] [PubMed] [Google Scholar]
  10. Kesslak J. P., Nalcioglu O., Cotman C. W. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology. 1991 Jan;41(1):51–54. doi: 10.1212/wnl.41.1.51. [DOI] [PubMed] [Google Scholar]
  11. Leys D., Pruvo J. P., Petit H., Gaudet Y., Clarisse J. Maladie d'Alzheimer. Analyse statistique des résultats du scanner X. Rev Neurol (Paris) 1989;145(2):134–139. [PubMed] [Google Scholar]
  12. Leys D., Soetaert G., Petit H., Fauquette A., Pruvo J. P., Steinling M. Periventricular and white matter magnetic resonance imaging hyperintensities do not differ between Alzheimer's disease and normal aging. Arch Neurol. 1990 May;47(5):524–527. doi: 10.1001/archneur.1990.00530050040010. [DOI] [PubMed] [Google Scholar]
  13. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. 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. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  14. Press G. A., Amaral D. G., Squire L. R. Hippocampal abnormalities in amnesic patients revealed by high-resolution magnetic resonance imaging. Nature. 1989 Sep 7;341(6237):54–57. doi: 10.1038/341054a0. [DOI] [PubMed] [Google Scholar]
  15. SCOVILLE W. B., MILNER B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry. 1957 Feb;20(1):11–21. doi: 10.1136/jnnp.20.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sass K. J., Spencer D. D., Kim J. H., Westerveld M., Novelly R. A., Lencz T. Verbal memory impairment correlates with hippocampal pyramidal cell density. Neurology. 1990 Nov;40(11):1694–1697. doi: 10.1212/wnl.40.11.1694. [DOI] [PubMed] [Google Scholar]
  17. Seab J. P., Jagust W. J., Wong S. T., Roos M. S., Reed B. R., Budinger T. F. Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease. Magn Reson Med. 1988 Oct;8(2):200–208. doi: 10.1002/mrm.1910080210. [DOI] [PubMed] [Google Scholar]
  18. Tierney M. C., Fisher R. H., Lewis A. J., Zorzitto M. L., Snow W. G., Reid D. W., Nieuwstraten P. The NINCDS-ADRDA Work Group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology. 1988 Mar;38(3):359–364. doi: 10.1212/wnl.38.3.359. [DOI] [PubMed] [Google Scholar]
  19. Wahlund L. O., Agartz I., Almqvist O., Basun H., Forssell L., Säf J., Wetterberg L. The brain in healthy aged individuals: MR imaging. Radiology. 1990 Mar;174(3 Pt 1):675–679. doi: 10.1148/radiology.174.3.2305048. [DOI] [PubMed] [Google Scholar]
  20. Zola-Morgan S., Squire L. R., Amaral D. G. Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci. 1986 Oct;6(10):2950–2967. doi: 10.1523/JNEUROSCI.06-10-02950.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. de Leon M. J., George A. E., Stylopoulos L. A., Smith G., Miller D. C. Early marker for Alzheimer's disease: the atrophic hippocampus. Lancet. 1989 Sep 16;2(8664):672–673. doi: 10.1016/s0140-6736(89)90911-2. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES