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Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease
Jack CR, Petersen RC, Xu YC, Waring SC, O'Brien PC, Tangalos EG, Smith GE, Ivnik RJ et al.. Neurology, 1997-09-01
Topic: Amyloid, tau and blood-test diagnosis
Magnetic resonance imaging (MRI)-based volumetric measurements of medial temporal lobe (MTL) structures can discriminate between normal elderly control subjects and patients with Alzheimer's disease (AD) of moderate to advanced severity. In terms of clinical utility, however, a more important issue concerns the ability of the technique to differentiate between normal elderly control subjects and AD patients with the very mildest form of the disease. We performed MRI-based volumetric measurements of the hippocampus, parahippocampal gyrus, and amygdala in 126 cognitively normal elderly control subjects and 94 patients with probable AD. The diagnosis of AD was made according to NINDS/ADRDA criteria, and disease severity was categorized by Clinical Dementia Rating (CDR) scores. Patients with CDR 0.5 were classified as very mild, CDR 1 as mild, and CDR 2 as moderate disease severity. Volumes of each structure declined with increasing age in control subjects and did so in parallel for men and women. The volume of each measured MTL structure also declined with age in patients with AD. The volume of each MTL structure was significantly smaller in AD patients than control subjects (p < 0.001). Of the several MTL measures, the total hippocampal volumetric measurements were best at discriminating control subjects from AD patients. The mean hippocampal volumes for AD patients relative to control subjects by severity of disease were as follows: very mild AD (CDR 0.5) -1.75 SD below the control mean, mild AD (CDR 1) -1.99 SD, and moderate AD (CDR 2) -2.22 SD. Age- and gender-adjusted, normalized MRI-based hippocampal volumetric measurements provide a sensitive marker of the MTL neuroanatomic degeneration in AD early in the disease process.
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APA 7th
Jack, C. R., Petersen, R. C., Xu, Y. C., Waring, S. C., O'Brien, P. C., Tangalos, E. G., et al. (1997). Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease. Neurology. https://doi.org/10.1212/wnl.49.3.786
Vancouver
Jack CR, Petersen RC, Xu YC, Waring SC, O'Brien PC, Tangalos EG, et al. Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease. Neurology. 1997. doi:10.1212/wnl.49.3.786. PMID: 9305341.
BibTeX
@article{jack1997-9305341,
author = {Jack, C. R. and Petersen, R. C. and Xu, Y. C. and Waring, S. C. and O'Brien, P. C. and Tangalos, E. G. and Smith, G. E. and Ivnik, R. J. and others},
title = {{Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease}},
journal = {Neurology},
year = {1997},
doi = {10.1212/wnl.49.3.786},
pmid = {9305341},
url = {https://doi.org/10.1212/wnl.49.3.786}
}
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Key findings
- The volume of each MTL structure was significantly smaller in AD patients than control subjects (p < 0.001).
Why it matters
In 126 cognitively normal older adults and 94 people with probable Alzheimer's disease, this 1997 MRI study found that the hippocampus, parahippocampal gyrus and amygdala were all smaller in Alzheimer's (p < 0.001). Hippocampal volume separated the groups best, and it was already 1.75 standard deviations below the control average at the very mildest stage (CDR 0.5), compared with 2.22 at the moderate stage. These are group averages, and hippocampal volume also shrank with age in healthy people, so the study does not show how accurate a single person's scan is; no treatment was tested.
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Study details
- Participants94
- Evidence strengthLow
How this study scored 57/100
Published in a leading specialty journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1997 — older than 20 years, still counted |
| Sample size | 1 / 4 | 94 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 1,135 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 36.6 citations a year over 31 year(s) since 1997 |
| Impact for its field and year | 4 / 6 | Cited 17.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 87 other studies in this library |
| Still being cited | 3 / 4 | Cited 104 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Emre Kokmen: h-index 48 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Mayo Clinic: institution h-index 1,606 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 9305341) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
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