Visser 1999.

Study characteristics
Patient sampling	Primary objectives: to determine whether the medial temporal lobe is atrophic in participants with MCI, and whether atrophy of this structure is a better predictor of dementia than memory dysfunction Study population: participants affected by minimal dementia in the Amsterdam Study of the Elderly (AMSTEL) Selection criteria: participants from AMSTEL: for the brain‐imaging substudy 73 participants with minimal dementia were randomly selected, 33 were asked to participate and 28 agreed. 8 cases were not included because of missing baseline MRI. Exclusion criteria: not reported Study design: prospective longitudinal study
Patient characteristics and setting	Clinical presentations: minimal dementia according to CAMDEX criteria (CAMDEX: Cambridge Examination of Mental Disorders of the Elderly). The diagnosis of minimal dementia was made when the DSM‐IIIR criteria of dementia were not met, but based on an overall clinical impression, there was limited and variable impairment in cognitive and social functioning such as difficulty with learning and recalling events, a tendency to misplace possessions, and minor errors in orientation. Similar entities are QD or a score of 0.5 on the CDR scale, and “mild cognitive impairment” or a score of 3 on the global deterioration scale (Reisberg 1982) Age mean (SD): minimal dementia who progressed to AD: 79 ± 4; stable minimal dementia: 78 ± 7 Gender (% men): minimal dementia who progressed to AD: 33%; stable minimal dementia: 0% Education years mean (SD): minimal dementia who progressed to AD: 7.1 ± 2.3; stable minimal dementia: 8 ± 2.3 ApoE4 carriers (%): not stated Neuropsychological tests: employed; MMSE mean (SD): minimal dementia who progressed to AD: 23.1 ± 1.2; stable minimal dementia: 21 ± 1.8 Clinical stroke excluded: not specified Co‐morbidities: not reported Number enrolled: 20 Number available for analysis: 13 Setting: population‐based study of mental functioning in non‐institutionalised persons (AMSTEL cohort: minimal dementia group) Country: Netherlands Period: not reported Language: English
Index tests	Index test: MRI manual method for estimation of hippocampus, parahippocampal gyrus and lateral temporal lobe; MTA score was also available Manufacturer: Teslacon II (Technicare, Solon, Ohio) Tesla strength: 0.6 Tesla Assessment methods: volumetry was carried out on a SUN workstation with software developed in‐house. The hippocampus, parahippocampal gyrus, and intracranial area, as a measure of the intracranial volume, were outlined by hand. A seed function was used for the temporal lobe. The volumes of the hippocampus and parahippocampal gyrus were subtracted from the volume of the total temporal lobe to give the volume of the lateral temporal lobe Description of positive cases definition by index test as reported: not specified Examiners: all measurements were carried out by 1 rater who was blinded to the participants' age, diagnosis, and sex Interobserver variability: not reported. The average difference between the 1st and 2nd measurement of the brain structures on 10 scans was −0.08 ± 0.29 cm3 for the parahippocampal gyrus, −0.07 ± 0.20 cm3 for the hippocampus, 0.14 ± 1.1 cm3 for the lateral temporal lobe, and −1.9 ± 1.4 cm3 for the intracranial area
Target condition and reference standard(s)	Target condition: AD Prevalence of AD in the sample: 9/13 (69% of participants included in the analysis) Stable minimal dementia or converted to other dementia: 4 (31%) stable MCI Reference standards: NINCDS‐ADRDA criteria (McKhann 1984). Mean clinical follow‐up: 3 years
Flow and timing	Withdrawals explained and losses to follow‐up: 7/20 participants with minimal dementia (35%): participants dropped out before the 1st assessment Uninterpretable MRI results not reported
Comparative
Key conclusions by the authors	Severe MTA was present in some participants who had MCI at baseline and subsequently developed dementia due to AD. The absence of MTA, however, does not exclude the development of dementia. Memory impairment was a better predictor for dementia than atrophy of the medial temporal lobe, but the combination of the two increased diagnostic accuracy
Conflict of interests	Information not available
Notes	Source of funding: not reported 2 x 2 table: data to complete 2 x 2 table provided by the study authors
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
		Unclear	Low
DOMAIN 2: Index Test All tests
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
Did the study provide a clear pre‐specified definition of what was considered to be a "positive" result of the index test?	No
Was the index test performed by a single operator or interpreted by consensus in a joint session?	Yes
		High	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
		High