European Radiology

, Volume 23, Issue 12, pp 3393–3404

Neuroimaging of dementia in 2013: what radiologists need to know

  • Sven Haller
  • Valentina Garibotto
  • Enikö Kövari
  • Constantin Bouras
  • Aikaterini Xekardaki
  • Cristelle Rodriguez
  • Maciej Jakub Lazarczyk
  • Panteleimon Giannakopoulos
  • Karl-Olof Lovblad
Neuro

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.

Keywords

Dementia Alzheimer MCI Cognitive decline Frontal dementia Fronto-temporal lobar degeneration 

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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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Sven Haller
    • 1
    • 4
  • Valentina Garibotto
    • 2
  • Enikö Kövari
    • 3
  • Constantin Bouras
    • 3
  • Aikaterini Xekardaki
    • 3
  • Cristelle Rodriguez
    • 3
  • Maciej Jakub Lazarczyk
    • 3
  • Panteleimon Giannakopoulos
    • 3
  • Karl-Olof Lovblad
    • 1
  1. 1.Department of Imaging and Medical InformaticsUniversity Hospitals of Geneva and Faculty of Medicine of the University of GenevaGenevaSwitzerland
  2. 2.Department of Nuclear MedicineHospitals of Geneva and Faculty of Medicine of the University of GenevaGenevaSwitzerland
  3. 3.Department of Mental Health and PsychiatryUniversity Hospitals of Geneva and Faculty of Medicine of the University of GenevaGenevaSwitzerland
  4. 4.Service neuro-diagnostique et neuro-interventionnel DISIMUniversity Hospitals of GenevaGeneva 14Switzerland

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