Neuroimaging studies in the evaluation of dementia
- Norman Relkin, MD, PhD
Norman Relkin, MD, PhD
- Associate Professor of Neurology
- Director, Memory Disorders Program
- Weill Cornell Medical College, NY
Neuroimaging is most informative when performed as part of a comprehensive dementia evaluation that includes review of the history and medications, a physical examination (including neurologic and psychiatric components), and assessment of cognitive, functional, and behavioral status. This is supplemented in selected cases by blood and urine tests, cerebrospinal fluid analysis, electroencephalography, and other procedures. In this context, neuroimaging provides unique and valuable information that complements the other elements of a dementia evaluation.
Neuroimaging can be divided into structural, functional, and molecular categories. Structural brain imaging studies are generally considered routine parts of dementia evaluations and may be repeated at a later time point for clarification of diagnosis. More specialized functional and molecular imaging studies are performed in selected patients when additional diagnostic information is required.
Diagnostic criteria for Alzheimer disease (AD) and other neurodegenerative disorders acknowledge the existence of precursor states to symptomatic dementia, such as mild cognitive impairment (MCI) and preclinical stages, which lack overt clinical symptoms but can be identified on the basis of biomarkers and imaging evidence [1,2]. In this context, neuroimaging has taken on new importance as an objective means of documenting some of the earliest manifestations of dementia pathology.
Structural, functional, and molecular imaging techniques in dementia will be reviewed here. The clinical presentation and diagnosis of mild cognitive impairment and dementia are discussed elsewhere. (See "Mild cognitive impairment: Epidemiology, pathology, and clinical assessment" and "Evaluation of cognitive impairment and dementia".)
Additional topics relevant to the diagnosis of specific forms of dementia include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007; 6:734.
- Sperling RA, Aisen PS, Beckett LA, et al. 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. Alzheimers Dement 2011; 7:280.
- Filippi M, Agosta F, Barkhof F, et al. EFNS task force: the use of neuroimaging in the diagnosis of dementia. Eur J Neurol 2012; 19:e131.
- Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143.
- Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA 1997; 278:1363.
- Gifford DR, Holloway RG, Vickrey BG. Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia. Arch Intern Med 2000; 160:2855.
- Scheltens P, Fox N, Barkhof F, De Carli C. Structural magnetic resonance imaging in the practical assessment of dementia: beyond exclusion. Lancet Neurol 2002; 1:13.
- Frisoni GB, Fox NC, Jack CR Jr, et al. The clinical use of structural MRI in Alzheimer disease. Nat Rev Neurol 2010; 6:67.
- Neary D. Non Alzheimer's disease forms of cerebral atrophy. J Neurol Neurosurg Psychiatry 1990; 53:929.
- Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43:250.
- Vernooij MW, van der Lugt A, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology 2008; 70:1208.
- Sveinbjornsdottir S, Sigurdsson S, Aspelund T, et al. Cerebral microbleeds in the population based AGES-Reykjavik study: prevalence and location. J Neurol Neurosurg Psychiatry 2008; 79:1002.
- Park JH, Seo SW, Kim C, et al. Pathogenesis of cerebral microbleeds: In vivo imaging of amyloid and subcortical ischemic small vessel disease in 226 individuals with cognitive impairment. Ann Neurol 2013; 73:584.
- Sperling RA, Jack CR Jr, Black SE, et al. Amyloid-related imaging abnormalities in amyloid-modifying therapeutic trials: recommendations from the Alzheimer's Association Research Roundtable Workgroup. Alzheimers Dement 2011; 7:367.
- Relkin N, Marmarou A, Klinge P, et al. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005; 57:S4.
- Manners DN, Parchi P, Tonon C, et al. Pathologic correlates of diffusion MRI changes in Creutzfeldt-Jakob disease. Neurology 2009; 72:1425.
- de la Fuente-Fernández R. Role of DaTSCAN and clinical diagnosis in Parkinson disease. Neurology 2012; 78:696.
- Johnson KA, Minoshima S, Bohnen NI, et al. Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association. J Nucl Med 2013; 54:476.
- Reiman EM, Caselli RJ, Yun LS, et al. Preclinical evidence of Alzheimer's disease in persons homozygous for the epsilon 4 allele for apolipoprotein E. N Engl J Med 1996; 334:752.
- Bateman RJ, Xiong C, Benzinger TL, et al. Clinical and biomarker changes in dominantly inherited Alzheimer's disease. N Engl J Med 2012; 367:795.
- Donohue MC, Sperling RA, Petersen R, et al. Association Between Elevated Brain Amyloid and Subsequent Cognitive Decline Among Cognitively Normal Persons. JAMA 2017; 317:2305.
- Jansen WJ, Ossenkoppele R, Knol DL, et al. Prevalence of cerebral amyloid pathology in persons without dementia: a meta-analysis. JAMA 2015; 313:1924.
- Ossenkoppele R, Jansen WJ, Rabinovici GD, et al. Prevalence of amyloid PET positivity in dementia syndromes: a meta-analysis. JAMA 2015; 313:1939.
- Lobotesis K, Fenwick JD, Phipps A, et al. Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology 2001; 56:643.
- Rabinovici GD, Miller BL. Frontotemporal lobar degeneration: epidemiology, pathophysiology, diagnosis and management. CNS Drugs 2010; 24:375.
- Lehmann M, Ghosh PM, Madison C, et al. Diverging patterns of amyloid deposition and hypometabolism in clinical variants of probable Alzheimer's disease. Brain 2013; 136:844.
- STRUCTURAL NEUROIMAGING
- Indications for structural imaging
- - Computed tomography versus magnetic resonance imaging
- - Use of contrast
- Structural imaging findings
- - Cerebral atrophy
- - Hippocampal atrophy
- - Cerebrovascular disease
- - Microhemorrhage
- - Ventriculomegaly
- - Altered brain diffusivity
- FUNCTIONAL AND MOLECULAR NEUROIMAGING
- Functional imaging modalities
- - Techniques
- - Parameters
- Cerebral perfusion
- Regional glucose metabolism
- Molecular imaging modalities
- - Striatal dopamine transporter imaging
- - Amyloid imaging
- - Magnetic resonance spectroscopy
- Indications for functional and molecular imaging
- Functional imaging findings
- - Alzheimer disease
- - Dementia with Lewy bodies
- - Frontotemporal dementia
- Molecular imaging findings