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Neuroimaging of dementia in 2013: what radiologists need to know

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Abstract

The structural and functional neuroimaging of dementia have substantially evolved over the last few years. The most common forms of dementia, Alzheimer disease (AD), Lewy body dementia (LBD) and fronto-temporal lobar degeneration (FTLD), have distinct patterns of cortical atrophy and hypometabolism that evolve over time, as reviewed in the first part of this article. The second part discusses unspecific white matter alterations on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images as well as cerebral microbleeds, which often occur during normal aging and may affect cognition. The third part summarises molecular neuroimaging biomarkers recently developed to visualise amyloid deposits, tau protein deposits and neurotransmitter systems. The fourth section reviews the utility of advanced image analysis techniques as predictive biomarkers of cognitive decline in individuals with early symptoms compatible with mild cognitive impairment (MCI). As only about half of MCI cases will progress to clinically overt dementia, whereas the other half remain stable or might even improve, the discrimination of stable versus progressive MCI is of paramount importance for both individual patient treatment and patient selection for clinical trials. The fifth and final part discusses the inter-individual variation in the neurocognitive reserve, which is a potential constraint for all proposed methods.

Key Points

• Many forms of dementia have spatial atrophy patterns detectable on neuroimaging.

• Early treatment of dementia is beneficial, indicating the need for early diagnosis.

• Advanced image analysis techniques detect subtle anomalies invisible on radiological evaluation.

• Inter-individual variation explains variable cognitive impairment despite the same degree of atrophy.

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Abbreviations

AD:

Alzheimer disease

CAA:

cerebral amyloid angiopathy

CBD:

cortico-basal degeneration

CBS:

cortico-basal syndrome

CMB:

cerebral microbleeds

CMH:

cerebral microhaemorrhages

DAI:

diffuse axonal injury

CBD:

corticobasal degeneration

DLB:

dementia with Lewy bodies

DTI:

diffusion tensor imaging

FDG:

18F-fluorodeoxyglucose

FLAIR:

fluid-attenuated inversion recovery

FTD:

fronto-temporal dementia

FTLD:

fronto-temporal lobar degeneration

GM:

grey matter

GRE:

gradient-echo

LPA:

logopaenic aphasia

MCI:

mild cognitive impairment

NBIA:

neurodegeneration with brain iron accumulation

PCA:

posterior cortical atrophy

PiB:

11C-Pittsburgh compound B

PiD:

Pick’s disease

PET:

positron emission tomography

PNFA:

progressive non-fluent aphasia

PPA:

primary progressive aphasia

PSP:

progressive supranuclear palsy

SD:

semantic dementia

SPECT:

single photon emission computed tomography

SVM:

support vector machine

SWI:

susceptibility-weighted imaging

TBSS:

tract-based spatial statistics

UBO:

unspecific bright object

VaD:

vascular dementia

VBM:

voxel-based analysis

WM:

white matter

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Acknowledgments

This work is supported by Swiss National Foundation grant SNF 3200B0-116193 and SPUM 33CM30-124111.

Editor’s note

Readers will notice that this issue contains two rather similar review articles on the imaging of dementia. Both articles try to help the average radiologist identify key features which may require expert neuroradiological attention. Two groups spontaneously submitted a review article at roughly the same time. There were merits in both papers; both were favourably reviewed. It was an impossible editorial choice to select one paper over another and hence both are published alongside each other. It will be interesting to see whether the astute readers will identify differences. Indeed this may lead to some interesting discussion in the opinion column on the journal’s website.

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Authors and Affiliations

  1. Department of Imaging and Medical Informatics, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland

    Sven Haller & Karl-Olof Lovblad

  2. Department of Nuclear Medicine, Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland

    Valentina Garibotto

  3. Department of Mental Health and Psychiatry, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland

    Enikö Kövari, Constantin Bouras, Aikaterini Xekardaki, Cristelle Rodriguez, Maciej Jakub Lazarczyk & Panteleimon Giannakopoulos

  4. Service neuro-diagnostique et neuro-interventionnel DISIM, University Hospitals of Geneva, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Sven Haller

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Haller, S., Garibotto, V., Kövari, E. et al. Neuroimaging of dementia in 2013: what radiologists need to know. Eur Radiol 23, 3393–3404 (2013). https://doi.org/10.1007/s00330-013-2957-0

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