Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment

Daniel Ferreira; Lena Cavallin; Elna-Marie Larsson; J-Sebastian Muehlboeck; Patrizia Mecocci; Bruno Vellas; Magda Tsolaki; Iwona Kłoszewska; Hilkka Soininen; Simon Lovestone; Andrew Simmons; Lars-Olof Wahlund; Eric Westman; The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative

doi:10.1111/joim.12358

Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment

Daniel Ferreira, Lena Cavallin, Elna-Marie Larsson, J-Sebastian Muehlboeck, Patrizia Mecocci, Bruno Vellas, Magda Tsolaki, Iwona Kłoszewska, Hilkka Soininen, Simon Lovestone, Andrew Simmons, Lars-Olof Wahlund, Eric Westman, The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Atrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria.

AIMS: The aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, both for diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs.

METHODS: AddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 AD patients, 480 MCI patients and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated.

RESULTS: The MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) ε4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94 years, the following cut-offs should be used. MTA: ≥1.5, ≥1.5, ≥2 and ≥2.5; GCA-F, ≥1, ≥1, ≥1 and ≥1; and PA, ≥1, ≥1, ≥1 and ≥1, respectively, with an adjustment for early-onset ApoE ε4 non-carrier AD patients (MTA: ≥2, ≥2, ≥3 and ≥3; and GCA-F: ≥1, ≥1, ≥2 and ≥2, respectively).

CONCLUSIONS: If successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.

Original language	English
Number of pages	14
Journal	Journal of Internal Medicine
Early online date	13 Apr 2015
DOIs	https://doi.org/10.1111/joim.12358
Publication status	Published - 2015

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10.1111/joim.12358

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Ferreira, D., Cavallin, L., Larsson, E.-M., Muehlboeck, J.-S., Mecocci, P., Vellas, B., Tsolaki, M., Kłoszewska, I., Soininen, H., Lovestone, S., Simmons, A., Wahlund, L.-O., Westman, E., & The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative (2015). Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment. Journal of Internal Medicine. https://doi.org/10.1111/joim.12358

@article{63684a679fe34c799efb7ba8888bfb17,

title = "Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment",

abstract = "BACKGROUND: Atrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria.AIMS: The aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, both for diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs.METHODS: AddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 AD patients, 480 MCI patients and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated.RESULTS: The MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) ε4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94 years, the following cut-offs should be used. MTA: ≥1.5, ≥1.5, ≥2 and ≥2.5; GCA-F, ≥1, ≥1, ≥1 and ≥1; and PA, ≥1, ≥1, ≥1 and ≥1, respectively, with an adjustment for early-onset ApoE ε4 non-carrier AD patients (MTA: ≥2, ≥2, ≥3 and ≥3; and GCA-F: ≥1, ≥1, ≥2 and ≥2, respectively).CONCLUSIONS: If successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.",

author = "Daniel Ferreira and Lena Cavallin and Elna-Marie Larsson and J-Sebastian Muehlboeck and Patrizia Mecocci and Bruno Vellas and Magda Tsolaki and Iwona K{\l}oszewska and Hilkka Soininen and Simon Lovestone and Andrew Simmons and Lars-Olof Wahlund and Eric Westman and {The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative}",

year = "2015",

doi = "10.1111/joim.12358",

language = "English",

journal = "Journal of Internal Medicine",

issn = "0954-6820",

publisher = "Wiley-Blackwell",

}

Ferreira, D, Cavallin, L, Larsson, E-M, Muehlboeck, J-S, Mecocci, P, Vellas, B, Tsolaki, M, Kłoszewska, I, Soininen, H, Lovestone, S , Simmons, A, Wahlund, L-O, Westman, E & The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative 2015, 'Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment', Journal of Internal Medicine. https://doi.org/10.1111/joim.12358

TY - JOUR

T1 - Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment

AU - Ferreira, Daniel

AU - Cavallin, Lena

AU - Larsson, Elna-Marie

AU - Muehlboeck, J-Sebastian

AU - Mecocci, Patrizia

AU - Vellas, Bruno

AU - Tsolaki, Magda

AU - Kłoszewska, Iwona

AU - Soininen, Hilkka

AU - Lovestone, Simon

AU - Simmons, Andrew

AU - Wahlund, Lars-Olof

AU - Westman, Eric

AU - The AddNeuroMed consortium, the Alzheimer's Disease Neuroimaging, Initiative

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Atrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria.AIMS: The aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, both for diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs.METHODS: AddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 AD patients, 480 MCI patients and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated.RESULTS: The MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) ε4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94 years, the following cut-offs should be used. MTA: ≥1.5, ≥1.5, ≥2 and ≥2.5; GCA-F, ≥1, ≥1, ≥1 and ≥1; and PA, ≥1, ≥1, ≥1 and ≥1, respectively, with an adjustment for early-onset ApoE ε4 non-carrier AD patients (MTA: ≥2, ≥2, ≥3 and ≥3; and GCA-F: ≥1, ≥1, ≥2 and ≥2, respectively).CONCLUSIONS: If successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.

AB - BACKGROUND: Atrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria.AIMS: The aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, both for diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs.METHODS: AddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 AD patients, 480 MCI patients and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated.RESULTS: The MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) ε4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94 years, the following cut-offs should be used. MTA: ≥1.5, ≥1.5, ≥2 and ≥2.5; GCA-F, ≥1, ≥1, ≥1 and ≥1; and PA, ≥1, ≥1, ≥1 and ≥1, respectively, with an adjustment for early-onset ApoE ε4 non-carrier AD patients (MTA: ≥2, ≥2, ≥3 and ≥3; and GCA-F: ≥1, ≥1, ≥2 and ≥2, respectively).CONCLUSIONS: If successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.

U2 - 10.1111/joim.12358

DO - 10.1111/joim.12358

M3 - Article

C2 - 25752192

SN - 0954-6820

JO - Journal of Internal Medicine

JF - Journal of Internal Medicine

ER -

Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment

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