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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(01): s00451802960
DOI: 10.1055/s-0045-1802960
Original Article

Diagnosing preclinical and clinical Alzheimer's disease with visual atrophy scales in the clinical practice

Karen Luiza Ramos Socher 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
,
Douglas Mendes Nunes 
2   Universidade de São Paulo, Faculdade de Medicina, Instituto de Radiologia, Unidade de Neurorradiologia, São Paulo SP, Brazil.
,
Deborah Cristina P. Lopes 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
,
Artur Martins Novaes Coutinho 
3   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Laboratório de Medicina Nuclear (LIM/43), São Paulo SP, Brazil.
,
Daniele de Paula Faria 
3   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Laboratório de Medicina Nuclear (LIM/43), São Paulo SP, Brazil.
,
Paula Squarzoni 
4   Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brazil
,
Geraldo Busatto Filho 
4   Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brazil
,
Carlos Alberto Buchpiguel 
3   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Laboratório de Medicina Nuclear (LIM/43), São Paulo SP, Brazil.
,
Ricardo Nitrini 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
,
Sonia Maria Dozzi Brucki 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
› Author Affiliations
Funding The authors declare that Karen Luiza Ramos Socher received a research grant from the Alzheimer's Association (Alzheimer's Association Clinician Scientist Fellowship to Promote Diversity [AACSF-D] research grant number 1029216).
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Abstract

Background Visual atrophy scales from the medial temporal region are auxiliary biomarkers of neurodegeneration in Alzheimer's disease (AD). Therefore, they may correlate with progression from cognitively unimpaired (CU) status to mild cognitive impairment (MCI) and AD, and they become a valuable tool for diagnostic accuracy.

Objective To compare the medial temporal lobe atrophy (MTA) and entorhinal cortex atrophy (ERICA) scores measured through magnetic resonance image (MRI) scans as a useful method for probable AD diagnosis regarding clinical diagnosis and amyloid positron-emission tomography (PET).

Methods Two neurologists blinded to the diagnoses classified 113 older adults (age > 65 years) through the MTA and ERICA scores. We investigated the correlations involving these scores and sociodemographic data, amyloid brain cortical burden measured through PET imaging with (11)C-labeled Pittsburgh Compound-B (11C-PIB PET), and clinical cognitive status, in individuals diagnosed as CU (CU; N = 30), presenting mild cognitive impairment (MCI, N = 52), and AD patients (N = 31).

Results The inter-rater reliability of the atrophy scales was excellent (0.8–1) according to the Cohen analysis. The CU group presented lower MTA scores (median value: 0) than ERICA (median value: 1) scores in both hemispheres. The 11C-PIB-PET was positive in 45% of the sample. In the MCI and AD groups, the ERICA score presented greater sensitivity, and the MTA score presented greater specificity. The accuracy of the clinical diagnosis was sufficient and no more than 70% for both scores in AD.

Conclusion In the present study, we found moderate sensitivity for the ERICA score, which could be a better screening tool than the MTA score for the diagnosis of AD or MCI. However, none of the scores were useful imaging biomarkers in preclinical AD.

Keywords

Alzheimer Disease - Magnetic Resonance Imaging - Atrophy

Authors' Contributions

KLRS: study conception and design, and acquisition and analysis and/or interpretation of data; DMN: study conception and design, and acquisition and interpretation of data; DCPL: acquisition of data; AMNC: acquisition of data and critical review of the manuscript for important intellectual content; DPF and PS: acquisition of data and study supervision; GBF: acquisition of data and critical review of the manuscript for important intellectual content and study supervision; CAB and RN: study supervision; and SMDB: analysis and interpretation of data, critical review of the manuscript for important intellectual content, and study supervision.


Editor-in-Chief: Hélio A. G. Teive.


Associate Editor: Leonardo Cruz de Souza.




Publication History

Received: 01 May 2024

Accepted: 13 October 2024

Article published online:
28 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Karen Luiza Ramos Socher, Douglas Mendes Nunes, Deborah Cristina P. Lopes, Artur Martins Novaes Coutinho, Daniele de Paula Faria, Paula Squarzoni, Geraldo Busatto Filho, Carlos Alberto Buchpiguel, Ricardo Nitrini, Sonia Maria Dozzi Brucki. Diagnosing preclinical and clinical Alzheimer's disease with visual atrophy scales in the clinical practice. Arq Neuropsiquiatr 2025; 83: s00451802960.
DOI: 10.1055/s-0045-1802960