Medial temporal lobe atrophy (MTA), a morphological hallmark of Alzheimers disease (AD), is also encountered in normal aging, cerebrovascular disease and neurodegenerative disorders other than AD [1]. MTA is easily and reliably assessed from computed tomography (CT) using a visual rating scale that has shown very good agreement with manual volumetry and is related to memory function in AD [2, 3]. However, when imaging is performed outside the workup of dementia, MTA may be underreported for example when cognitive decline may not yet have been...

Medical records from 200 consecutive medical inpatients aged over 60 years who had been subjected to cognitive tests in our previous intervention study [4, 5], were reviewed for cranial CT performed within a year from cognitive testing. Coronal slices were reassessed for MTA according to Scheltens visual rating scale (0-4) with abnormal score being >1 under and >2 over the age of 75, respectively (Fig 1). Findings were compared with the original radiological reports and cognitive tests, and survival analysis was performed.

CT had been performed in 94 of 200 (47%) patients. The interval between scan and cognitive testing was 12 days (median, interquartile range 1-132 days). The referral for CT was issued by the ED or a hospital ward in 87 patients, by outpatient clinics at the hospital in 5 patients and by GPs in 2 patients. Symptoms of or simply cognitive impairment were mentioned in 35/94 (37%) of referrals. In 34/94 (36%) MTA was abnormal. None of the patients with abnormal MTA was reported as...

MTA in routine cranial CT performed on medical inpatients over 60 years is underreported and holds important clinical correlates with prognostic value. Our results suggest that reporting MTA in this population should be part of the routine radiological workup.

1. Barber R, Gholkar A, Scheltens P, Ballard C, McKeith IG, O'Brien JT. Medial temporal lobe atrophy on MRI in dementia with Lewy bodies. Neurology. 1999 Apr 12;52(6):1153-8. 2. Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J. Atrophy of medial temporal lobes on MRI in "probable" Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):967-72. 3. Boutet C, Chupin M, Colliot O, Sarazin M, Mutlu G,...