Magnetic resonance imaging (MRI) has shown a great reduction in medial temporal lobe and hippocampal volume of

We conducted an interobserver study to assess agreement on visual rating of medial temporal lobe atrophy on coronal T1-weighted MRI. A total of 100 studies of elderly individuals, using two different MRI techniques (spin echo and inversion recovery sequences), were analysed by four raters (three neurologists and one neuroradiologist) using a five-point rating scale. Complete agreement was found in 37% of the total sample. Interobserver agreement as expressed by kappa values was 0.44 (95% CI = 0.34-0.54) and 0.51 (95% CI = 0.41-0.61) for the two techniques. After dichotomizing medial temporal lobe atrophy into present or absent, a post hoc analysis revealed higher complete agreement (70%), with kappa values of 0.59 (95% CI = 0.51-0.67) and 0.62 (95% CI = 0.48-0.075), for the two techniques (all four raters). From this study we conclude that visual rating of medial temporal lobe atrophy on MRI in the coronal plane yields fair to good agreement among observers. We recommend this type of visual rating for use in clinical settings when a quick judgement on the presence of medial temporal lobe atrophy is needed.

Similar clinical and histopathologic findings have been reported in members of a Swedish pedigree. The homogeneity of the findings strongly suggests that HDLS is a distinct disease entity. In the absence of a biochemical or genetic marker, a definitive diagnosis requires histopathologic confirmation in one of the affected family members. Neuroaxonal spheroids.

Medial temporal lobe structures may be important for memory. We examined the cognitive, brain atrophy, and sociomedical correlates of medial temporal lobe atrophy (MTA) in 59 individuals (79.2 +/- 4.6 years old) randomly selected from a population-based study within strata of age and severity of clinically assessed DSM-III-R dementia (45 clinically normal and 14 mild/severely demented). MTA was qualitatively assessed on coronal T-1-weighted MRI. Thirty-three percent of the sample showed MTA, which was associated with dementia severity (p < 0.01), and cortical and white matter atrophy. MTA was not associated with age, education, sex, depressive symptoms, or presence of infarction. Controlling for age, education, and associated brain atrophy, those with MTA performed more poorly on a general test of cognitive function (the neuropsychological test component of the Cambridge Examination for Mental Disorders of the Elderly; p < 0.04) and its subtests of memory function (p < 0.02) and memory-related functions, including perception, fluency, and orientation (p < 0.05). In the clinically normal subsample, those with MTA performed more poorly on the memory function (p < 0.05) subtests. We conclude that MTA is common among very old persons, is associated with other brain abnormalities implicated in cognitive function, but may specifically contribute to memory dysfunction in the general population of very old persons.

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