Diagnosing Preclinical and Clinical Alzheimer’s Disease with Visual Atrophy Scales in Clinical Practice

Sep 29, 2026

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Visual atrophy scales from the medial temporal region are auxiliary biomarkers for neurodegeneration in Alzheimer’s disease (AD), supporting clinical tracking from cognitively unimpaired (CU) to mild cognitive impairment (MCI) and AD. This study compares medial temporal lobe atrophy (MTA) and entorhinal cortex atrophy (ERICA) scores on MRI for probable AD diagnosis against clinical diagnosis and amyloid PET. Two blinded neurologists assessed 113 older adults and analyzed correlations with sociodemographic factors and 11C-PIB PET.

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CategoryHealthcare

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Abstract

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Article published online: 2025-02-28 Original Article 1 Diagnosing preclinical and clinical Alzheimer’s disease with visual atrophy scales in the clinical practice Karen Luiza Ramos Socher 1 Douglas Mendes Nunes2 Deborah Cristina P. Lopes 1 Artur Martins Novaes Coutinho3 Daniele de Paula Faria3 Paula Squarzoni4 Geraldo Busatto Filho4 Carlos Alberto Buchpiguel3 Ricardo Nitrini 1 Sonia Maria Dozzi Brucki 1 1 Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil. 2 Universidade de São Paulo, Faculdade de Medicina, Instituto de Radiologia, Unidade de Neurorradiologia, São Paulo SP, Brazil. 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. 4 Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brazil Arq. Neuro-Psiquiatr. 2025;83(1):s00451802960 . Address for correspondence Karen Luiza Ramos Socher (email: [klrsocher@gmail.com](klrsocher@gmail.com)) Abstract Keywords ► Alzheimer Disease ► Magnetic Resonance Imaging ► Atrophy 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 ¼ 30), presenting mild cognitive impairment (MCI, N ¼ 52), and AD patients (N ¼ 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. received May 1, 2024 received in its ﬁnal form September 20, 2024 accepted October 13, 2024 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1802960 . ISSN 0004-282X. Editor-in-Chief: Hélio A. G. Teive. Associate Editor: Leonardo Cruz de Souza. © 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/](https://creativecommons.org/licenses/by/4.0/)). Thieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil 2 Visual atrophy scales in Alzheimer’s disease Socher et al. INTRODUCTION According to the World Health Organization (WHO), currently there are 50 million people with dem

FAQs

What was the study objective regarding MRI atrophy scales?

To compare MTA and ERICA scores measured on MRI as a useful method for probable AD diagnosis in relation to clinical diagnosis and amyloid PET findings.

How were participants classified and who performed the scoring?

Two neurologists blinded to diagnoses classified 113 adults over 65 years using MTA and ERICA scores, comparing CU, MCI, and AD groups.

Which scale showed higher sensitivity and specificity?

ERICA demonstrated greater sensitivity in the MCI and AD groups, while MTA showed greater specificity.

Sep 29, 2026

Uploaded by Logic