Skip to main content Accessibility help

Does posterior cortical atrophy on MRI discriminate between Alzheimer's disease, dementia with Lewy bodies, and normal aging?

  • James O'Donovan (a1), Rosie Watson (a1), Sean J. Colloby (a1), Michael J. Firbank (a1), Emma J. Burton (a1), Robert Barber (a1), Andrew. M. Blamire (a2) and John T. O'Brien (a1)...


Background: Previous studies suggest that posterior cortical atrophy may be a useful marker for early onset Alzheimer's disease (AD). Dementia with Lewy bodies (DLB) is associated with less temporal lobe atrophy than AD, though posterior cortical atrophy may be greater. Therefore, we assessed whether visual rating scales for assessing posterior atrophy (PA), medial temporal lobe atrophy (MTA), and ventricular enlargement (VEn) aid in the discrimination between AD, DLB, and normal aging.

Methods: T1-weighted MRI scans acquired at 3 Tesla were visually rated for PA (range 0–3), MTA (range 0–4), and VEn (range 0–3) in older subjects with AD (n = 36), DLB (n = 35), and healthy controls (n = 35). The diagnostic utility of MTA, PA, and VEn visual ratings in distinguishing AD and DLB from controls as well as AD from DLB was investigated.

Results: Significantly higher MTA ratings were associated with AD and DLB compared to controls (p < 0.001). MTA ratings were greater in AD relative to DLB (U = 384.5, p = 0.004). For PA ratings, scores did not differ between groups (p = 0.20). VEn ratings were significantly higher in AD and DLB compared to controls (p = 0.003), but similar between AD and DLB (U = 384.5, p = 0.4).

Conclusions: Unlike findings reported in younger subjects, visual ratings for PA are not a reliable marker at older ages for distinguishing AD from controls, or for distinguishing DLB from AD. However, visual ratings of MTA and VEn may be useful markers in distinguishing both AD and DLB from older subjects without dementia.


Corresponding author

Correspondence should be addressed to: Dr Sean Colloby, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK. Phone: +44 191 248 1321; Fax: +44 191 248 1301. Email:


Hide All
Barber, R., Gholkar, A., Scheltens, P., Ballard, C., McKeith, I. G. and O'Brien, J. T. (1999). Medial temporal lobe atrophy on MRI in dementia with Lewy bodies. Neurology, 52, 11531158.
Barnes, al. (2007). Atrophy rates of the cingulate gyrus and hippocampus in AD and FTLD. Neurobiology of Aging, 28, 2028.
Bastos-Leite, A. J., Van Der Flier, W. M., Van Straaten, E. C. W., Staekenborg, S. S., Scheltens, P. and Barkhof, F. (2007). The contribution of medial temporal lobe atrophy and vascular pathology to cognitive impairment in vascular dementia. Stroke, 38, 31823185.
Beyer, M. K., Larsen, J. P. and Aarsland, D. (2007). Gray matter atrophy in Parkinson disease with dementia and dementia with Lewy bodies. Neurology, 69, 47754.
Bucks, R. S., Ashworth, D. L., Wilcock, G. K. and Siegfried, K. (1996). Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. Age Ageing, 25, 113120.
Burton, E. al. (2009). Medial temporal lobe atrophy on MRI differentiates Alzheimer's disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain, 132, 195203.
Colloby, S. al. (2002). A comparison of 99mTc-HMPAO SPET changes in dementia with Lewy bodies and Alzheimer's disease using statistical parametric mapping. European Journal of Nuclear Medicine, 29, 615622.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Dubois, al. (2007). Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria. Lancet Neurology, 6, 734746.
Fahn, S. and Elton, R. (1987). Unified Parkinson's Disease Rating Scale. In Fahn, S., Marsden, C. D., Goldstein, M. and Calne, D. B. (eds.), Recent Development in Parkinson's Disease (pp. 153164). Florham Park, NJ: Macmillan Health Care Information.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Frisoni, G. B., Testa, C., Sabattoli, F., Beltramello, A., Soininen, H. and Laakso, M. P. (2005). Structural correlates of early and late onset Alzheimer's disease: voxel based morphometric study. Journal of Neurology, Neurosurgery and Psychiatry, 76, 112114.
Frisoni, G. al. (2007). The topography of grey matter involvement in early and late onset Alzheimer's disease. Brain, 130, 720730.
Galton, C. J., Patterson, K., Xuereb, J. H. and Hodges, J. R. (2000). Atypical and typical presentations of Alzheimer's disease: a clinical, neuropsychological, neuroimaging and pathological study of 13 cases. Brain, 123, 484498.
Goldman, W. al. (2001). Absence of cognitive impairment or decline in preclinical Alzheimer's disease. Neurology, 56, 361367.
Hodges, J. R. (2006). Alzheimer's centennial legacy: origins, landmarks and the current status of knowledge concerning cognitive aspects. Brain, 129, 28112822.
Hort, al. (2010). EFNS guidelines for the diagnosis and management of Alzheimer's disease. European Journal of Neurology, 17, 12361248.
Ishii, K., Yamaji, S., Kitagaki, H., Imamura, T., Hirono, N. and Mori, E. (1999). Regional cerebral blood flow difference between dementia with Lewy bodies and AD. Neurology, 53, 413416.
Karas, al. (2007). Precuneus atrophy in early-onset Alzheimer's disease: a morphometric structural MRI study. Neuroradiology, 49, 967976.
Koedam, E. L. G. al. (2011). Visual assessment of posterior atrophy development of a MRI rating scale. European Radiology, 21, 26182625.
Lehmann, al. (2011). Posterior cerebral atrophy in the absence of medial temporal lobe atrophy in pathologically-confirmed Alzheimer's disease. Neurobiology of Aging, 33, 627.e1–627.e12.
Lippa, C. al. (2007). DLB and PDD boundary issues: diagnosis, treatment, molecular pathology, and biomarkers. Neurology, 68, 812819.
Lobotesis, al. (2001). Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology, 56, 643649.
McKeith, I. al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.
McKeith, al. (2004). Dementia with Lewy bodies. Lancet Neurology, 3, 1928.
McKeith, I. al. (2005). Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology, 65, 18631872.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). 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, 34, 939944.
McKhann, G. al. (2011). 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. Alzheimer's and Dementia, 7, 263269.
Rodrigue, K. al. (2012). β-amyloid burden in healthy aging: regional distribution and cognitive consequences. Neurology, 78, 387395.
Scheltens, al. (1992). Atrophy of medial temporal lobes on MRI in ‘‘probable’’ Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. Journal of Neurology, Neurosurgery and Psychiatry, 55, 967972.
Scheltens, P., Pasquier, F., Weerts, J. G. E., Barkhof, F. and Leys, D. (1997). Qualitative assessment of cerebral atrophy on MRI: inter- and intra-observer reproducibility in dementia and normal aging. European Neurology, 37, 9599.
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165173.
Sperling, R. al. (2011). Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7, 280292.
Terry, R. al. (1991). Physical basis of cognitive alterations in Alzheimer's disease: synapse loss is the major correlate of cognitive impairment. Annals of Neurology, 30, 572580.
Watson, R., Blamire, A. M. and O'Brien, J. T. (2009). Magnetic resonance imaging in Lewy body dementias. Dementia and Geriatric Cognitive Disorders, 28, 493506.
Watson, R., O'Brien, J. T., Barber, R. and Blamire, A. M. (2012). Patterns of gray matter atrophy in dementia with Lewy bodies: a voxel-based morphometry study. International Psychogeriatrics, 24, 532540.
Whitwell, J. al. (2007). Focal atrophy in dementia with Lewy bodies on MRI: a distinct pattern from Alzheimer's disease. Brain, 130, 708719.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed