title: Minimal atrophy of the entorhinal cortex and hippocampus: progression of cognitive impairment.
abstract: BACKGROUND
  In Alzheimer's disease, neurodegenerative atrophy progresses from the entorhinal cortex (ERC) to the hippocampus (HP), limbic system and neocortex. The significance of very mild atrophy of the ERC and HP on MRI scans among elderly subjects is unknown.
  
  
  METHODS
  A validated visual rating system on coronal MRI scans was used to identify no atrophy of the HP or ERC (HP(0); ERC(0)), or minimal atrophy of the HP or ERC (HP(ma); ERC(ma)), among 414 participants. Subjects fell into the following groups: (1) ERC(0)/HP(0), (2) ERC(ma)/HP(0), (3) ERC(0)/HP(ma), and (4) ERC(ma)/HP(ma). HP volume was independently measured using volumetric methods.
  
  
  RESULTS
  In comparison to ERC(0)/HP(0) subjects, those with ERC(0)/HP(ma) had impairment on 1 memory test, ERC(ma)/HP(0) subjects had impairment on 2 memory tests and the Mini Mental State Examination (MMSE), while ERC(ma)/HP(ma) subjects had impairment on 3 memory tests, the MMSE and Clinical Dementia Rating. Progression rates of cognitive and functional impairment were significantly greater among subjects with ERC(ma).
  
  
  CONCLUSIONS
  Minimal atrophy of the ERC results in greater impairment than minimal atrophy of the HP, and the combination is additive when measured by cognitive and functional tests. Rates of progression to greater impairment were higher among ERC(ma) subjects.
authors.affiliation: Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA. dvaron@msmc.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Varon
authors.forename: David A
authors.initials: DA
authors.lastname: Loewenstein
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Potter
authors.forename: Maria T
authors.initials: MT
authors.lastname: Greig
authors.forename: Joscelyn
authors.initials: J
authors.lastname: Agron
authors.forename: Qian
authors.initials: Q
authors.lastname: Shen
authors.forename: Weizhao
authors.initials: W
authors.lastname: Zhao
authors.forename: Maria
authors.initials: M
authors.lastname: Celeste Ramirez
authors.forename: Isael
authors.initials: I
authors.lastname: Santos
authors.forename: Warren
authors.initials: W
authors.lastname: Barker
authors.forename: Huntington
authors.initials: H
authors.lastname: Potter
authors.forename: Ranjan
authors.initials: R
authors.lastname: Duara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000235:genetics / Q000473:pathology*; D001057:Apolipoproteins E / Q000235:genetics; D001284:Atrophy; D003072:Cognition Disorders / Q000235:genetics / Q000473:pathology*; D018450:Disease Progression; D018728:Entorhinal Cortex / Q000473:pathology*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index
chemical_list: D001057:Apolipoproteins E