J Clin Neurol.  2018 Jul;14(3):275-282. 10.3988/jcn.2018.14.3.275.

Age-Specific Cutoff Scores on a T1-Weighted Axial Medial Temporal-Lobe Atrophy Visual Rating Scale in Alzheimer's Disease Using Clinical Research Center for Dementia of South Korea Data

• Choi GS
• Kim GH
• Choi JH
• Hwang J
• Kwon E
• Lee SA
• Kong KA
• Kang HJ
• Yoon B
• Kim BC
• Yang DW
• Na DL
• Kim EJ
• Na HR
• Han HJ
• Lee JH
• Kim JH
• Lee KY
• Park KH
• Park KW
• Kim S
• Han SH
• Kim SY
• Yoon SJ
• Moon SY
• Youn YC
• Choi SH
• Jeong JH

• KMID: 2415041
• DOI: http://doi.org/10.3988/jcn.2018.14.3.275

Abstract

BACKGROUND AND PURPOSE
Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people.
METHODS
The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50-59, 60-69, 70-79, and 80-89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve.
RESULTS
The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50-59, 60-69, 70-79, and 80-89 years, respectively (all p < 0.001).
CONCLUSIONS
These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.

Keyword

medial temporal-lobe atrophy; T1-weighted axial Visual Rating Scale; cutoff score; Alzheimer's disease

MeSH Terms

Aged
Alzheimer Disease*
Atrophy*
Cognition Disorders
Dementia*
Diagnosis
Humans
Korea*
Pemetrexed
ROC Curve
Pemetrexed

Figure

• 

  Fig. 1 A: Dimensions measured when scoring on the T1-weighted axial medial temporal-lobe atrophy VRS: width of the hippocampus (A′), width of the perimesencephalic cistern (C′), and width of the temporal horn (D′). B: Examples of grades 0 to 4 on the VRS. VRS: Visual Rating Scale.

• 

  Fig. 2 AUC for optimal medial temporal-lobe atrophy Visual Rating Scale cutoff scores in subjects aged 50–59 years (A), 60–69 years (B), 70–79 years (C), and 80–89 years (D). AUC: area under the receiver operating characteristics curve.

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