Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment
Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer's disease and mild cognitive impairment
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DOI：
10.1111/joim.12358
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发表时间：
2015-09-01
影响因子：
11.1
通讯作者：
Westman, E.
中科院分区：
文献类型：
--
作者：
Ferreira, D.;Cavallin, L.;Westman, E.
研究背景颞叶内侧、额叶和后皮质的萎缩可以分别用视觉评定量表如颞叶内侧萎缩（MTA）、额叶皮质萎缩量表（GCA-F）和后皮质萎缩量表（PA）来测量。然而，迫切需要实际的截止值，特别是现在阿尔茨海默病（AD）的不同表现包括在修订的诊断criterials.AimsThe本研究的目的是产生一个列表的MTA，GCA-F和PA规模的实际截止值，为AD的诊断和确定预后的轻度认知障碍（MCI），并评估这些cut-offs.MethodsAddNeuroMed和ADNI队列的关键人口和临床因素的影响，共1147名参与者（322例AD患者，480例MCI患者和345名对照组）。MTA，GCA-F和PA规模被应用和广泛的截止值evaluated. ResultsMTA规模表现出更好的诊断和预测性能比GCA-F和PA规模。年龄、载脂蛋白E（ApoE）β 4状态和疾病发作时的年龄影响所有三个量表。对于45-64岁、65-74岁、75-84岁和85- 94岁的年龄范围，应使用以下临界值。MTA：1.5、1.5、2和2.5; GCA-F分别为1、1、1、1和1; PA分别为1、1、1和1，对早发性ApoE ≥ 4非携带者AD患者进行了调整（MTA：2、2、3和3; GCA-F：1，1，2和2，分别）。ConclusionsIf在临床环境中成功验证，这里提出的实际截止值列表可能是有用的，在临床实践中。它们的使用也可能（i）促进对萎缩亚型的研究，（ii）增加对AD不同表现的理解，（iii）改善诊断和预后，以及（iv）帮助临床试验的人群选择和富集。
BackgroundAtrophy in the medial temporal lobe, frontal lobe and posterior cortex can be measured with visual rating scales such as the medial temporal atrophy (MTA), global cortical atrophy - frontal subscale (GCA-F) and posterior atrophy (PA) scales, respectively. However, practical cut-offs are urgently needed, especially now that different presentations of Alzheimer's disease (AD) are included in the revised diagnostic criteria.AimsThe aim of this study was to generate a list of practical cut-offs for the MTA, GCA-F and PA scales, for both diagnosis of AD and determining prognosis in mild cognitive impairment (MCI), and to evaluate the influence of key demographic and clinical factors on these cut-offs.MethodsAddNeuroMed and ADNI cohorts were combined giving a total of 1147 participants (322 patients with AD, 480 patients with MCI and 345 control subjects). The MTA, GCA-F and PA scales were applied and a broad range of cut-offs was evaluated.ResultsThe MTA scale showed better diagnostic and predictive performances than the GCA-F and PA scales. Age, apolipoprotein E (ApoE) epsilon 4 status and age at disease onset influenced all three scales. For the age ranges 45-64, 65-74, 75-84 and 85-94years, the following cut-offs should be used. MTA: 1.5, 1.5, 2 and 2.5; GCA-F, 1, 1, 1 and 1; and PA, 1, 1, 1 and 1, respectively, with an adjustment for early-onset ApoE epsilon 4 noncarrier AD patients (MTA: 2, 2, 3 and 3; and GCA-F: 1, 1, 2 and 2, respectively).ConclusionsIf successfully validated in clinical settings, the list of practical cut-offs proposed here might be useful in clinical practice. Their use might also (i) promote research on atrophy subtypes, (ii) increase the understanding of different presentations of AD, (iii) improve diagnosis and prognosis and (iv) aid population selection and enrichment for clinical trials.