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Basil H. Ridha, MRCP; Josephine Barnes, MA, PhD; Laura A. van de Pol, MD; Jonathan M. Schott, MD, MRCP; Richard G. Boyes, ME; Musib M. Siddique, PhD; Martin N. Rossor, MD, FRCP; Philip Scheltens, MD, PhD, FRCP; Nick C. Fox, MD, FRCP

Arch Neurol. 2007;64(6):849-854.

Objective  To compare an automated intensity-based measure of medial temporal atrophy in Alzheimer disease (AD) with existing volumetric and visually based methods.

Design  Longitudinal study comparing a medial temporal atrophy measure with 2 criterion standards: (1) total hippocampal (HC) volume adjusted for total intracranial volume and (2) standard visual rating scale of medial temporal atrophy.

Setting  Cognitive disorders specialist clinic.

Participants  Forty-seven patients with AD and 26 age- and sex-matched controls.

Intervention  Subjects were scanned using volumetric T1-weighted magnetic resonance imaging at baseline and 1 year later.

Main Outcome Measure  Automated Medial Temporal Lobe Atrophy Scale (ATLAS) score, derived from dividing mean intensity of a standardized perihippocampal volume by that of a standardized pontine volume.

Results  Patients with AD had significantly reduced ATLAS scores and HC volumes and increased visual rating scores at baseline and repeat scanning. Rates of HC atrophy and decline in the ATLAS score were significantly higher in patients with AD compared with controls. The ATLAS scores were significantly correlated with HC volumes and visual rating scores. With specificity set at 85%, the sensitivities of HC volume and visual rating scale score were similar (84% and 86%, respectively), whereas ATLAS score had a lower sensitivity (73%). At repeat scanning, all 3 measures had similar sensitivities (86%-87%). Rate of decline in the ATLAS score required a similar sample size to HC atrophy rate to provide statistical power to clinical trials, but being automated, it is less labor intensive.

Conclusions  Like the visual rating scale, ATLAS is a simple medial temporal atrophy measure, which has the additional advantage of being able to track AD progression on serial imaging.

Author Affiliations: Dementia Research Centre, Institute of Neurology, University College London, London, England (Drs Ridha, Barnes, Schott, and Siddique, Mr Boyes, and Profs Rossor and Fox); and Alzheimer Center, Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (Dr van de Pol and Prof Scheltens).