Posterior cerebral atrophy in the absence of medial temporal lobe atrophy in pathologically-confirmed Alzheimer's disease

Manja Lehmann, Esther L G E Koedam, Josephine Barnes, Jonathan W Bartlett, Natalie S Ryan, Yolande A L Pijnenburg, Frederik Barkhof, Mike P Wattjes, Philip Scheltens, Nick C Fox

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69 Citations (SciVal)


Medial temporal lobe atrophy (MTA) is a recognized marker of Alzheimer's disease (AD), however, it can be prominent in frontotemporal lobar degeneration (FTLD). There is an increasing awareness that posterior atrophy (PA) is important in AD and may aid the differentiation of AD from FTLD. Visual rating scales are a convenient way of assessing atrophy in a clinical setting. In this study, 2 visual rating scales measuring MTA and PA were used to compare atrophy patterns in 62 pathologically-confirmed AD and 40 FTLD patients. Anatomical correspondence of MTA and PA was assessed using manually-delineated regions of the hippocampus and posterior cingulate gyrus, respectively. Both MTA and PA scales showed good inter- and intrarater reliabilities (kappa > 0.8). MTA scores showed a good correspondence with manual hippocampal volumes. Thirty percent of the AD patients showed PA in the absence of MTA. Adding the PA to the MTA scale improved discrimination of AD from FTLD, and early-onset AD from normal aging. These results underline the importance of considering PA in AD diagnosis, particularly in younger patients where medial temporal atrophy may be less conspicuous.

Original languageEnglish
Pages (from-to)627.e1-627.e12
JournalNeurobiology of Aging
Issue number3
Early online date18 May 2011
Publication statusPublished - Mar 2012


  • Aged
  • Alzheimer Disease/diagnosis
  • Atrophy
  • Disease Progression
  • Female
  • Frontotemporal Lobar Degeneration/diagnosis
  • Gyrus Cinguli/pathology
  • Hippocampus/pathology
  • Humans
  • Magnetic Resonance Imaging/methods
  • Male
  • Middle Aged
  • Organ Size/physiology
  • Severity of Illness Index
  • Temporal Lobe/pathology


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