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Visual atrophy scales are not a useful tool to help the clinician in diagnosing clinical or preclinical AD
Author(s) -
Socher Karen LR,
Lopes Deborah,
Nunes Douglas Mendes,
Busatto Geraldo,
Nitrini Ricardo,
Brucki Sonia MD
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.042220
Subject(s) - atrophy , dementia , magnetic resonance imaging , entorhinal cortex , medicine , clinical dementia rating , pathology , cerebral atrophy , disease , psychology , audiology , radiology , hippocampus
Background Visual atrophy scales are useful as auxiliary methods in Alzheimer's disease (AD) diagnosis. Atrophy of temporal medial region is an established risk factor for conversion from mild cognitive impairment (MCI) to AD dementia. Our aims were to compare two visual magnetic resonance imaging (MRI) scales and establish accuracy of these scales in classifying patients in relation to clinical diagnosis and amyloid status Method A Brazilian multi ethnic group was analyzed using two visual MRI scale (ERICA for quantification of atrophy in the entorhinal cortex) and MTA scale (medial temporal atrophy). 113 MRI were classified by 2 neurologists trained by a radiologist; all patients had amyloid PET (PIB) and clinical diagnosis as: 31 AD dementia, 52 MCI, and 30 normal cognition. Result In this sample, 51(45%) had PIB‐PET positive for amyloid deposition. Visual scales had great to excellent inter‐rater reliability (0.8‐1) by Cohen k analysis. AD patients have higher ERICA scores (mean: 1.92) and MTA score (mean: 1.7) for both hemispheres comparing to subgroups without dementia (p<0.01). MTA has greater specificity and ERICA has greater sensitivity in the DA and MCI groups (above 70%). The accuracy for ERICA and MTA scores were 56.6% and 70% in controls, 53.8% and 59.6% in MCI, 67% and 41% in AD, respectively. The PVV was 84%, for DA group in both scores and NPV were above 68% in non dementia group. Conclusion On clinical practice of a neurologist who has no availability of amyloid status tests and would like to monitor visual scales of atrophy as a prognostic biomarker, they have a moderate sensitivity for the MCI and AD subgroup, moderate specificity for controls and MCI, and poor accuracy. These findings could be explained by the fact that atrophy is present in advanced stages of the disease, not allowing an early diagnosis.