title: The significance of medial temporal lobe atrophy: a postmortem MRI study in the very old.
abstract: BACKGROUND
  Medial temporal lobe atrophy (MTA) is a sensitive radiologic marker for Alzheimer disease (AD) and associated with cognitive impairment. The value of MTA in the oldest old (>85 years old) is largely unknown.
  
  
  METHODS
  A total of 132 formalin-fixed brains from the Vantaa 85+ community-based study were subjected to postmortem MRI. Visual ratings of MTA were determined in a blinded fashion and compared with neuropathologic findings and clinical assessment (dementia according to Diagnostic and Statistical Manual of Mental Disorders-III-R).
  
  
  RESULTS
  A strong relationship was found between MTA scores and Alzheimer pathology (p < 0.001). The previously proposed cutoff MTA score >2 correctly excluded subjects with no or borderline Alzheimer-type pathology (45/48), but was not very sensitive for AD (modified National Institute on Aging-Reagan Institute criteria). MTA scores >2 were also found in subjects with other primary neurodegenerative hippocampal pathology including hippocampal sclerosis, Lewy-related pathology, and argyrophilic grain disease, either alone or in combination with Alzheimer-type pathology. High MTA scores were associated with clinical dementia-in this subgroup, sensitivity was 63% and specificity 69% for AD.
  
  
  CONCLUSIONS
  Medial temporal lobe atrophy (MTA) on postmortem MRI is sensitive to primary degenerative hippocampal pathology in the very old, but not specific for Alzheimer-type pathology. MTA scores of 2 or less are not frequently associated with dementia.
authors.affiliation: Department of Radiology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. f.barkhof@vumc.nl
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.forename: T M
authors.initials: TM
authors.lastname: Polvikoski
authors.forename: E C W
authors.initials: EC
authors.lastname: van Straaten
authors.forename: R N
authors.initials: RN
authors.lastname: Kalaria
authors.forename: R
authors.initials: R
authors.lastname: Sulkava
authors.forename: H J
authors.initials: HJ
authors.lastname: Aronen
authors.forename: L
authors.initials: L
authors.lastname: Niinistö
authors.forename: S
authors.initials: S
authors.lastname: Rastas
authors.forename: M
authors.initials: M
authors.lastname: Oinas
authors.forename: P
authors.initials: P
authors.lastname: Scheltens
authors.forename: T
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000544:Alzheimer Disease / Q000473:pathology* / Q000503:physiopathology; D001284:Atrophy / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D003072:Cognition Disorders / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006624:Hippocampus / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D020961:Lewy Body Disease / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers