Alzheimer’s: the ERICA score distinguishes certain cognitive stages, based on evidence that remains limited

A visual score focused on the entorhinal cortex

The entorhinal cortex is among the first brain structures affected in Alzheimer’s disease, according to the review’s abstract. The ERICA score visually assesses its atrophy. Neuroradiologists use it in clinical practice to help with diagnosis.

The authors examined its ability to distinguish three conditions: subjective cognitive decline, mild cognitive impairment and Alzheimer’s dementia. The question therefore concerns distinguishing cognitive states, not the effectiveness of a treatment or disease prevention.

Six studies, with a trade-off between sensitivity and specificity

The literature search identified 1,413 studies, six of which were included, involving 844 participants. These comprised two retrospective cohort studies and four cross-sectional studies. Their methodological quality was assessed using the Newcastle-Ottawa Scale, but the detailed results of that assessment are not included in the supplied abstract.

Compared with the medial temporal atrophy score, known as MTA, ERICA had lower sensitivity and higher specificity. This trade-off means it may miss more cases while producing fewer false positives. However, the abstract provides neither numerical performance values nor uncertainty intervals.

Inter-rater reproducibility was similar to or higher than that of the MTA score. This supports consistency in interpretation, but a reproducible score is not necessarily sufficient to establish a diagnosis.

A diagnostic aid, not an individual prediction

The authors consider ERICA’s accuracy satisfactory for distinguishing subjective cognitive decline or mild cognitive impairment from Alzheimer’s dementia. The abstract does not support the claim that it distinguishes each of the three conditions from one another equally well.

These results also do not demonstrate that ERICA predicts who will develop dementia. The review focuses on diagnostic performance, and the data presented do not establish a benefit for patient care or independence.

What we can take away

ERICA appears to provide useful diagnostic information, but the available data do not justify using it as a standalone test or presenting it as an established tool for predicting Alzheimer’s.