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Jobst et al's “Detection in Life of Confirmed Alzheimer's Disease Using a Simple Measurement of Medial Temporal Lobe Atrophy by Computed Tomography”

Published online by Cambridge University Press:  02 January 2018

Michael Philpot
Affiliation:
Guy's and Lewisham NHS Trust, Hither Green Hospital, Hither Green Lane, London SE13 6RU
Alistair Burns
Affiliation:
University of Manchester, Withington Hospital, West Didsbury, Manchester M20 8LR

Abstract

‘The medial temporal lobe of the brain is important for normal cognitive function, notably for memory, and is the region with the most extensive pathological change in Alzheimer's disease (AD). We wanted to find out if atrophy of the medial temporal lobe could be detected in life in patients in whom a diagnosis of AD was subsequently established histopathologically. The minimum width of the medial temporal lobe, measured by temporal-lobe-oriented computed tomography (CT) about one year before death, in 44 patients with a histopathological diagnosis of AD (cases) was nearly half (0.56 of the median) that in 75 controls of the same age with no clinical evidence of dementia (95% confidence interval 0.51–0.61). There was little overlap between the distributions of measurements in cases and controls. A cut-off (< 0.79 MoM) selected to yield a 5% false-positive rate gave an expected detection rate of 92%. A cut-off selected to yield a false-positive rate of 1 % (< 0.70 MoM) yielded a 79% detection rate. 20 of the 44 patients with histopathologically diagnosed AD had been scanned more than once before death, and the test (cut-off < 0.79 MoM) was positive in all 20 more than a year before and in 9/10 more than 2 years before death. In 10 subjects with dementia but with histopathology excluding AD, the mean minimum width of the medial temporal lobe was significantly greater than that in the cases with AD, but was not significantly different from that in controls. Medial temporal lobe CT is a non-invasive, rapid, simple and effective test for AD which could have immediate application firstly in improving the accuracy of prevalence and incidence studies and, secondly, for the identification of groups of high-risk patients in the evaluation of novel treatments for AD. In the future, it could be applied as a screening test.”

Type
The Current Literature
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Brayne, C. & Calloway, P. (1988) Normal ageing, impaired cognitive function and senile dementia of the Alzheimer's type: a continuum? Lancet, i, 12651266.Google Scholar
Burns, A. (1990) Cranial computerised tomography in dementia of the Alzheimer type. British Journal of Psychiatry, 157 (suppl. 9), 1015.Google Scholar
Burns, A., Jacoby, R., Philpot, M., et al (1991) Computerised tomography in Alzheimer's disease. Methods of scan analysis, comparison with normal controls, and clinical radiological associations. British Journal of Psychiatry, 159, 609614.CrossRefGoogle ScholarPubMed
Byrne, E. (1987) Reversible dementia. International Journal of Geriatric Psychiatry, 2, 7381.CrossRefGoogle Scholar
Byrne, E. & Arie, T. (1991) The diagnosis of dementia: I. Clinical and pathological criteria: a review of the literature. International Journal of Geriatric Psychiatry, 6, 199208.Google Scholar
Claviera, L., Moseley, I. & Stevenson, J. (1977) The clinical significance of ‘cerebral atrophy’ as shown on CAT. In Computerised Axial Tomography in Clinical Practice (eds Du Boulay, G. & Moseley, I.). Berlin: Springer.Google Scholar
DeLeon, M., Golomb, J., Convit, A., et al (1993) Measurement of medial temporal lobe atrophy in diagnosis of Alzheimer's disease (Letter). Lancet, 341, 125.Google Scholar
Folstein, M. F., Folstein, S. E. & McHugh, R. R. (1975) Minimental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Jacoby, R. (1981) Dementia, depression and the CT scan. Psychological Medicine, 11, 673676.CrossRefGoogle ScholarPubMed
Jacoby, R. & Levy, R. (1980) Computed tomography in the elderly: II. Senile dementia: diagnosis and functional impairment. British Journal of Psychiatry, 136, 249255.CrossRefGoogle Scholar
Jacoby, R. & Levy, R. & Dawson, J. (1980) Computed tomography in the elderly: I. The normal population. British Journal of Psychiatry, 136, 249255.CrossRefGoogle ScholarPubMed
Jobst, K. A., Smith, A. D., Szatmari, M., et al (1992a) Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet, 340, 11791183.Google Scholar
Jobst, K. A., Barker, C. S., et al (1992b) Association of atrophy of the medial temporal lobe with reduced blood flow in the posterior parietotemporal cortex in patients with a clinical and pathological diagnosis of Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 55, 190194.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., et al (1984) Clinical diagnosis of Alzheimer's disease. Neurology, 34, 939944.Google Scholar
Spano, A., Forstl, H., Almeida, O. P., et al (1992) Neuroimaging and the differential diagnosis of early dementia: quantitative CT scan analysis in patients attending a memory clinic. International Journal of Geriatric Psychiatry, 7, 879883.Google Scholar
Tierney, M. C., Fisher, R. H., Lewis, A. J., et al (1988) The NINCDS-ADRDA Work Group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathological study of 57 cases. Neurology, 38, 359364.Google Scholar
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