Medial temporal atrophy and memory impairment in early stage of Alzheimer's disease: an MRI volumetric and memory assessment study

Memory impairment and medial temporal lobe (MTL) involvement are the earliest and most prominent features of Alzheimer's disease (AD). A psychological assessment of memory function and an evaluation of the morphological changes in MTL structures, as found in the mild form of AD, are important for early diagnosis as well as for understanding the pathophysiology of the disease. In the present study, we aimed to evaluate correlations in these psychoanatomical changes in terms of the stage of AD. We performed MRI-based volumetric measurements of the MTL structure and neuropsychological tests, using: MMSE and the Wechsler memory scale-revised (WMS-R), on 27 elderly normal subjects and 46 probable AD patients, and then checked for possible correlations between the volumetric measurements and memory dysfunction. The severity of the AD patients' condition was assessed by CDR scale. Each MTL structure decreased in volume with increasing severity of AD. In very early AD, the reduction in the amygdala volume was pronounced, while the hippocampal volumes were relatively unchanged. Neuropsychological scores also declined with increasing severity of AD; Scores on the main WMS-R subsets examined (verbal memory, visual memory, and delayed recall) decreased significantly in the very mild group, as compared with normal controls. The WMS-R test scores correlated significantly with the amygdala volumes in normal control subjects and very mild AD patients. Our findings suggest that MRI-based amygdaloid volumetric measurement provides a sensitive marker, and that the degeneration of the amygdala may begin very early in the course of AD. (C) 2000 Elsevier Science B.V. All rights reserved.