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Updated: Jan 30, 2026

A Comprehensive Protocol for Manual Segmentation of the Medial Temporal Lobe Structures
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A Comprehensive Protocol for Manual Segmentation of the Medial Temporal Lobe Structures

Published on: July 2, 2014

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Medial temporal lobe atrophy is associated with age and pathologies, especially small vessel disease

Danielle van Westen1,2, Erik Stomrud3,4, Luigi Lorenzini5

  • 1Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Klinikgatan 28, 222 42, Lund, Sweden. danielle.van_westen@med.lu.se.

Scientific Reports
|January 28, 2026
PubMed

Insights

Medial temporal lobe atrophy (MTA) increases with age, influenced significantly by white matter hyperintensities (WMH). An age-independent MTA cutoff shows comparable accuracy to age-adjusted methods for clinical use.

Area of Science:

  • Neuroimaging
  • Neuropathology
  • Geriatric Medicine

Background:

  • Medial temporal lobe atrophy (MTA) assessment is crucial for cognitive impairment diagnosis and traditionally corrected for age.
  • Common age-related pathologies like amyloid, tau, alpha-synuclein, TDP-43, and white matter hyperintensities (WMH) may influence the age-MTA relationship.

Purpose of the Study:

  • To investigate the association between age, common pathologies, and MTA in cognitively unimpaired (CU) and cognitively impaired (CI) individuals.
  • To develop and validate an age-independent cutoff for MTA to aid in clinical diagnosis.

Main Methods:

  • Analysis of 949 CU and 854 CI individuals, focusing on in vivo measured amyloid, tau, and alpha-synuclein.
  • Statistical modeling to assess the impact of age, pathologies, and WMH on MTA.
  • Derivation and comparison of age-independent and age-adjusted MTA cutoffs using a subset of 195 CU participants.

Main Results:

  • MTA remained associated with age even after accounting for measured pathologies.
  • White matter hyperintensities (WMH) were the strongest predictor of MTA, mediating 32-41% of the age-MTA association.
  • The proposed age-independent MTA cutoff demonstrated accuracy, sensitivity, and specificity comparable to existing age-adjusted cutoffs.

Conclusions:

  • Age and WMH are the most significant factors associated with MTA.
  • The developed age-independent MTA cutoff is a parsimonious and potentially useful tool for clinical settings.
  • This approach may simplify the diagnostic workup of cognitive impairment.
Keywords:
Amyloid pathologyMedial temporal lobe atrophyTau pathologyVisual assessmentWhite matter hyperintensities

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