Visual rating scales of brain atrophy in dementia: a systematic review of reliability and diagnostic accuracy

Visual rating scales of brain atrophy allow to quantify brain regional atrophy and could be used as a diagnostic marker for differentiating neurodegenerative diseases. This paper aims to review the visual rating scales for dementia, focusing on their reliability, the correlation with volumetric imaging measures, and their predictive accuracy. Following the PRISMA guidelines, we systematically searched in Pubmed, Web of Science, Scopus, and MEDLINE databases until November 4, 2024. Of the 441 articles extracted, we included in the review 28 papers. All the scales reached a fair to excellent level of inter and intra rater agreement. Furthermore, negative correlations were found between the rating in each scale and brain volumetric measures. Lastly, the discriminative abilities exhibited variability according to the scale and the population comparisons. Visual rating scales of atrophy provide a reliable method for distinguishing physiological aging from pathological conditions, and among neurodegenerative forms. For an accurate differential diagnosis, it is essential to employ scales with the highest diagnostic precision.