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Medial temporal lobe atrophy on MRI in dementia with Lewy bodies
R Barber1, A Gholkar, P Scheltens
1Institute for the Health of the Elderly, Newcastle General Hospital, Newcastle upon Tyne, UK. robert.barber@ncl.ac.uk
Objective:
To investigate whether medial temporal lobe atrophy (MTA) on MRI is less frequent in dementia with Lewy bodies (DLB) compared with AD and vascular dementia (VaD), and to determine the diagnostic utility of MTA in the differential diagnosis of dementia.
Method:
Coronal T1-weighted 1.0-T MR images were acquired in patients with DLB (consensus criteria; n = 26; mean age, 75.9 years), AD (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association; n = 28; mean age, 77.4 years), VaD (National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences; n = 24; mean age, 76.9 years), and normal control subjects (n = 26; mean age, 76.2 years). Cognitive function was assessed using the Cambridge Cognitive Examination (CAMCOG), and MTA was rated visually using a standardized scale.
Results:
MTA was more frequent and severe in all dementia groups compared with control subjects (AD, 100%; VaD, 88%; DLB, 62%; control subjects, 4%; p < 0.001). Comparing dementia groups, MTA scores were significantly lower in DLB than AD (p = 0.002), with a trend toward less atrophy in DLB compared with VaD (p = 0.07). The absence of MTA had a specificity of 100% and 88% for separating DLB from AD and VaD respectively, and a sensitivity of 38%. In patients with DLB, MTA increased with age (r = 0.58, p = 0.002), and in all dementia patients MTA correlated with memory impairment (combined memory score, r = -0.34, p = 0.003) but not total CAMCOG score or other subscales.
Conclusion:
Patients with DLB have significantly greater MTA than control subjects but significantly less than those with AD. The authors confirmed that the presence of MTA is useful in detecting AD but less useful in differentiating between dementias. However, in the differentiation of DLB from AD and VaD, the absence of MTA is highly suggestive of a diagnosis of DLB.
Insights
Medial temporal lobe atrophy (MTA) is less common in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD) or vascular dementia (VaD). Absence of MTA strongly suggests DLB, aiding differential diagnosis.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- Medial temporal lobe atrophy (MTA) is a common neuroimaging finding in dementia.
- Differentiating between dementia with Lewy bodies (DLB), Alzheimer's disease (AD), and vascular dementia (VaD) can be challenging.
Purpose of the Study:
- To compare the frequency and severity of MTA in DLB versus AD and VaD.
- To assess the diagnostic utility of MTA in distinguishing DLB from other dementia types.
Main Methods:
- Coronal T1-weighted MRI scans were analyzed in patients with DLB (n=26), AD (n=28), VaD (n=24), and controls (n=26).
- Visual rating of MTA was performed using a standardized scale.
- Cognitive function was assessed using the Cambridge Cognitive Examination (CAMCOG).
Main Results:
- MTA was present in 100% of AD, 88% of VaD, 62% of DLB, and 4% of controls.
- MTA was significantly less frequent and severe in DLB compared to AD (p=0.002).
- Absence of MTA had 100% specificity for differentiating DLB from AD and 88% from VaD.
Conclusions:
- DLB patients exhibit less MTA than AD and VaD patients.
- MTA is useful for detecting AD but less so for differentiating dementia subtypes.
- The absence of MTA is a strong indicator for diagnosing DLB, particularly when differentiating from AD and VaD.