Cochrane for Clinicians

Putting Evidence into Practice

Structural MRI for the Early Diagnosis of Alzheimer Disease in Patients with MCI

 

Am Fam Physician. 2021 Mar 1;103(5):273-274.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is magnetic resonance imaging (MRI) accurate in the early diagnosis of Alzheimer disease in patients with mild cognitive impairment (MCI)?

Evidence-Based Answer

There is insufficient evidence to recommend structural brain MRI to diagnose Alzheimer disease in patients with MCI. Because of its low accuracy, it should not be used as a stand-alone tool in identifying evidence of Alzheimer disease in patients with MCI.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

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SUMMARY TABLE

Utility of MRI for Diagnosing the Progression of Mild Cognitive Impairment to Alzheimer Disease*

Region of MRIParticipants (studies)Sensitivity (%)Specificity (%)PPV (%)NPV (%)

Hippocampus

2,209 (22)

73

71

52

86

Medial temporal lobe

1,077 (7)

64

65

44

81

Lateral ventricles

1,077 (5)

57

64

40

78


MRI = magnetic resonance imaging; NPV = negative predictive value; PPV = positive predictive value.

*—Assuming Alzheimer disease prevalence of 30%.

SUMMARY TABLE

Utility of MRI for Diagnosing the Progression of Mild Cognitive Impairment to Alzheimer Disease*

Region of MRIParticipants (studies)Sensitivity (%)Specificity (%)PPV (%)NPV (%)

Hippocampus

2,209 (22)

73

71

52

86

Medial temporal lobe

1,077 (7)

64

65

44

81

Lateral ventricles

1,077 (5)

57

64

40

78


MRI = magnetic resonance imaging; NPV = negative predictive value; PPV = positive predictive value.

*—Assuming Alzheimer disease prevalence of 30%.

Practice Pointers

Alzheimer disease is the most common cause of dementia, accounting for 60% to 80% of dementia cases.2 Onset typically occurs after 65 years of age and is often preceded by a predementia phase called MCI.2 MCI has progressed to dementia when these cognitive changes significantly interfere with a person's work or usual daily activities.3 Identifying which patients with MCI will progress to Alzheimer disease could be helpful in early intervention and planning for patients and their families.

MCI is characterized by a noticeable decline in cognition or memory with preserved function in daily living.4 Although memory difficulty is the most common symptom in patients with MCI, there can also be deficits in attention, executive functioning, language, and visuospatial skills. People with MCI and memory loss develop Alzheimer disease at a rate of about 10% to 15% annually compared with 1% to 2% per year in the general population.5 Currently there is no clinical tool to reliably identify which patients with MCI will go on to develop Alzheimer disease.

The authors of this Cochrane review assessed the diagnostic accuracy of structural brain MRI in detecting Alzheimer disease in patients with MCI.1 They included 33 prospective cohort studies (N = 3,935) published from 1999 to 2019 from tertiary care centers in Europe (19 studies), North America (nine studies), North America and Europe (three studies), Taiwan (one study), and Australia (one study).

Patients were diagnosed with MCI by history and neuropsychological testing; their baseline Mini Mental State Examination score was 22 to 29 (median = 27). Because the criteria for diagnosing MCI have changed over the past 20 years, the review authors accepted studies that used varying diagnostic criteria and included all

Author disclosure: No relevant financial affiliations.

References

show all references

1. Lombardi G, Crescioli G, Cavedo E, et al. Structural magnetic resonance imaging for the early diagnosis of dementia due to Alzheimer's disease in people with mild cognitive impairment. Cochrane Database Syst Rev. 2020;(3):CD009628....

2. Alzheimer's Association. What is Alzheimer's disease? Accessed July 1, 2020. https://www.alz.org/alzheimers-dementia/what-is-alzheimers

3. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):263–269.

4. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270–279.

5. Petersen RC, Roberts RO, Knopman DS, et al. Mild cognitive impairment: ten years later. Arch Neurol. 2009;66(12):1447–1455.

6. National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline [NG97]. June 20, 2018. Accessed July 1, 2020. https://www.nice.org.uk/guidance/ng97

7. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology. 1984;34(7):939–944.

 

 

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