Skip to main content
SpringerLink
Log in

99mTc-HMPAO-SPECT in the diagnosis of senile dementia of Alzheimer's type — a study under clinical routine conditions

  • Full Papers
  • Published:
Journal of Neural Transmission / General Section JNT Aims and scope Submit manuscript

Summary

This study was designed to evaluate, whether investigations of cerebral blood flow can be a helpful diagnostic tool in the differential diagnosis between (senile) dementia of Alzheimer's type [(S)DAT] and geriatric depression with cognitive impairment. Under clinical routine conditions we performed Single Photon Emission Computed Tomography (SPECT) using99mTc-Hexa-methylpropyleneamine Oxime (HMPAO) in 23 patients with (S)DAT (14 f, 9 m; mean age 68.9 y), 17 patients with geriatric depression (9 f, 8 m; mean age 66.4 y) and 12 age-matched controls (9 f, 3m; mean age 69.2 y). Semiquantitative analysis (corticocerebellar ratios) of eight different regions of interest (ROI) revealed a significantly (p < 0.05) reduced perfusion in the (S)DAT patients compared to the control group. The depression group exhibited perfusion values between the (S)DAT and control group. The difference between the depression and (S)DAT group was most prominent in the left parieto-occipital ROI (p=0.008). We discuss the data with extensive regard to the literature and conclude that99mTc-HMPAO SPECT is a valuable additional tool in the differential diagnosis of depression and dementia in the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alexopoulos GS, Young RC, Shindledecker RD (1992) Brain computed tomography findings in geriatric depression and primary degenerative dementia. Biol Psychiatry 31: 591–599

    PubMed  Google Scholar 

  • APA-American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd ed, revised (DSM-III-R). American Psychiatric Association, Washington, DC

    Google Scholar 

  • Asberg M, Montgomery S, Perris C, Schalling D, Sedvall G (1978) Psychiatric rating scale for depression. Acta Psychiatr Scand 271 [Suppl]: 5–27

    Google Scholar 

  • Baron JC, Bousser MG, Comar D, Castaigne P (1980) Crossed cerebellar diaschisis in human supratentorial infarction. Ann Neurol 8: 128–130

    Google Scholar 

  • Battistin L, Pizzolato G, Dam M, Ponza I, Borsato N, Zanco PL, Ferlin G (1990) Regional cerebral blood flow study with99mTc-Hexamethyl-propyleneamine oxime single photon emission computed tomography in Alzheimer's and Multi-infarct dementia. Eur Neurol 30: 296–301

    PubMed  Google Scholar 

  • Baxter LR, Phelps ME, Mazziotta JC, Schwartz JM, Gerner RH, Selin CE, Sumida RM (1985) Cerebral metabolic rates for glucose in mood disorders. Arch Gen Psychiatry 42: 441–447

    PubMed  Google Scholar 

  • Baxter LR, Schwartz JM, Phelps ME, Mazziotta JL, Guze BH, Selin CE, Gerner RH, Sumida RM (1989) Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry 46: 243–250

    PubMed  Google Scholar 

  • Brodaty H, Peters K, Boyce P, Hickie I, Parker G, Mitchell P, Wilhelm K (1991) Age and depression. J Affect Disord 23: 137–149

    PubMed  Google Scholar 

  • Buchsbaum MS, Wu J, DeLisi LE, Holcomb H, Kessler R, Johnson J, King AC, Hazlett E, Langston K, Post RM (1986) Frontal cortex and basal ganglia metabolic rates assessed by positron emission tomography with (18F)2-deoxyglucose in affective illness. J Affect Disord 10: 137–152

    PubMed  Google Scholar 

  • Burns A, Philpot MP, Costa DC, Ell PJ, Levy R (1989) The investigatin of Alzheimer's disease with single photon emission tomography. J Neurol Neurosurg Psychiatry 52: 248–253

    PubMed  Google Scholar 

  • Buschke H, Fuld PA (1974) Evaluating storage retention and retrieval in disordered memory and learning. Neurology 24: 1019–1025

    PubMed  Google Scholar 

  • Chawluk JB, Alavi A, Dann R, Hurtig H, Bais S, Kushner MJ, Zimmermann RA, Reivich M (1987) Positron emission tomography in aging and dementia: effect of cerebral atrophy. J Nucl Med 28: 431–437

    PubMed  Google Scholar 

  • Cohen RM, Weingartner H, Smallberg SA, Pickar D, Murphy DL (1982) Effort and cognition in depression. Arch Gen Psychiatry 39: 593–597

    PubMed  Google Scholar 

  • Curran SM, Murray CM, VanBeck M, Dougall N, O'Carroll RE, Austin MP, Ebmeier KP, Goodwin GM (1993) A single photon emission computerised tomography study of regional cerebral brain function in elderly patients with major depression and with Alzheimer-type dementia. Br J Psychiatry 163: 155–165

    PubMed  Google Scholar 

  • Dahl G (1972) WIP-reduzierter Intelligenztest — Anwendung, Auswertung, statistische Analysen, Normwerte. Hain, Meisenheim am Glan

  • Dolan RJ, Bench CJ, Brown RG, Scott LC, Friston KJ, Frackowiak RS (1992) Regional cerebral blood flow abnormalities in depressed patients with cognitive impairment. J Neurol Neurosurg Psychiatry 55: 768–773

    PubMed  Google Scholar 

  • Duara R, Grady C, Haxby J, Sundaram M, Cutler NR, Heston L, Moore A, Schlageter N, Larson S, Rapoport SI (1986) Positron emission tomography in Alzheimer's disease. Neurology 36: 879–887

    PubMed  Google Scholar 

  • Eberling JL, Reed BR, Baker MG, Jagust WJ (1993) Cognitive correlates of regional cerebral blood flow in Alzheimer's disease. Arch Neurol 50: 761–766

    PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 12: 189–198

    Google Scholar 

  • Foster NL, Chase TN, Fedio P, Patronas NJ, Brooks RA, DiChiro G (1983) Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology 33: 961–965

    PubMed  Google Scholar 

  • Foster NL, Chase TN, Mansi L, Brooks R, Fedio P, Patronas NJ, DiChiro G (1984) Cortical abnormalities in Alzheimer's disease. Ann Neurol 16: 649–654

    PubMed  Google Scholar 

  • Frackowiak RSJ, Pozzilli C, Legg NJ, DuBoulay GH, Marshal J, Lenzi GL, Jones T (1981) Regional cerebral oxygen supply and utilization in dementia. A clinical and physiological study with oxygen-15 and positron tomography. Brain 104: 753–778

    PubMed  Google Scholar 

  • Friedhoff A and the NIH Consensus Development Panel on Depression in Late Life (1992) Diagnosis and treatment of depression in late life. JAMA 168: 1018–1024

    Google Scholar 

  • Friedland RP, Budinger TF, Koss E, Ober BA (1985) Alzheimer's disease: anterior-posterior and lateral hemispheric alterations in cortical glucose utilization. Neurosci Lett 53: 235–240

    PubMed  Google Scholar 

  • Gemmel HG, Sharp PF, Besson JAO, Crawford JR, Ebmeier KP, Davidson J, Smith FW (1987) Differential diagnosis in dementia using cerebral blood flow agent 99mTc HMPAO: a SPECT study. J Comput Assist Tomogr 11: 398–402

    PubMed  Google Scholar 

  • Gemmell HG, Sharp PF, Besson JAO, Ebmeier KP, Smith FW (1988) A comparison of Tc-99m HMPAO and J-123 IMP cerebral SPECT images in Alzheimers disease and multi-infarct-dementia. Eur J Nucl Med 14: 463–466

    PubMed  Google Scholar 

  • Gur RE, Skolnick BE, Gur RC, Caroff S, Rieger W, Obrist WD, Younkin D, Reivich M (1984) Brain function in psychiatric disorders. II. Regional cerebral blood flow in medicated unipolar depressives. Arch Gen Psychiatry 41: 695–699

    PubMed  Google Scholar 

  • Guze B, Baxter LR, Schwartz JM, Szuba MP, Mazziotta JC, Phelps ME (1991) Changes in glucose metabolism in dementia of the Alzheimer type compared with depression: a preliminary report. Psychiatry Res Neuroimaging 40: 195–202

    Google Scholar 

  • Hachinski VC, Iliff LD, Zilkha E, duBoulay GA, Marshall J, Ross Russell RW, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32: 632–637

    PubMed  Google Scholar 

  • Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Psychol 6: 278–296

    Google Scholar 

  • Hart RP, Kwentus JA (1987) Psychomotor slowing and subcortical-type dysfunction in depression. J Neurol Neurosurg Psychiatry 50: 1263–1266

    PubMed  Google Scholar 

  • Heiss WD, Kessler J, Szelies B, Grond M, Fink G, Herholz K (1991) Positron emission tomography in the differential diagnosis of organic dementias. J Neural Transm 33 [Suppl]: 13–19

    Google Scholar 

  • Holman BL, Nagel JS, Johnson KA, Hill TC (1991) Imaging dementia with SPECT. Ann NY Acad Sci 620: 165–174

    PubMed  Google Scholar 

  • Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A (1992) The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99 m-HMPAO SPECT. J Nucl Med 33: 181–185

    PubMed  Google Scholar 

  • Jacoby RJ, Levy R (1980) Computed tomography in the elderly. III. Affective disorders. Br J Psychiatry 136: 270–275

    PubMed  Google Scholar 

  • Jagust WJ, Budinger RF, Reed BR (1987) The diagnosis of dementia with single photon emission computed tomography. Arch Neurol 44: 258–262

    PubMed  Google Scholar 

  • Jagust WJ, Friedland RP, Budinger TF, Koss E, Ober B (1988) Longitudinal studies of regional cerebral metabolism in Alzheimer's disease. Neurology 38: 909–912

    PubMed  Google Scholar 

  • Johnson KA, Müller SP, Walshe TM, English RJ, Holman BL (1987) Cerebral perfusion imaging in Alzheimer's disease. Arch Neurol 44: 165–168

    PubMed  Google Scholar 

  • Komatani A, Yamaguchi K, Sugai Y, Takanashi T, Kera M, Ahinohara M, Kawakatsu S (1988) Assessment of demented patients by dynamic SPECT of inhaled xenon-133. J Nucl Med 129: 1621–1626

    Google Scholar 

  • Kuhl DE, Metter EJ, Riege WH (1985) Patterns of cerebral glucose utilization in depression, multiple infarct dementia, and Alzheimer's disease. In: Sokoloff L (ed) Brain imaging and brain function. Raven, New York, pp 211–226

    Google Scholar 

  • Kukull WA, Larson EB, Reifler BV, Lampe TH, Yerby M, Hughes J (1990) The validity of 3 clinical diagnostic criteria for Alzheimer's disease. Neurology 40: 1364–1369

    PubMed  Google Scholar 

  • Launes J, Sulkava R, Erkinjuntti T, Nikkinen P, Lindroth L, Liewendahl K, Iivanainen M (1991)99mTc-HMPAO-SPECT in suspected dementia. Nucl Med Commun 12: 757–765

    PubMed  Google Scholar 

  • Mathew RJ, Meyer JS, Francis DJ, Semchuk KM, Mortel K, Claghorn JL (1980) Cerebral blood flow in depression. Am J Psychiatry 137: 1449–1450

    PubMed  Google Scholar 

  • McGeer PL, Kamo H, Harrop R, Li DKB, Tuokko H, McGeer EG, Adam MJ, Ammann W, Beattie BL, Calne DB, Martin WRW, Pate BD, Rogers JG, Roth TJ, Sayre CI, Stoessl AJ (1986) Positron emission tomography in patients with clinically diagnosed Alzheimer's disease. Can Med Assoc J 134: 597–601

    Google Scholar 

  • McKhann G, Drachmann D, Folstein M, Katzman R, Price D, Stadlan E (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 34: 939–944

    PubMed  Google Scholar 

  • Miller BL, Mena I, Daly J, Giombetti RJ, Goldberg MA, Lesser I, Garrett K, Villanueva-Meyer J, Liu CK (1990) Temporal-parietal hypoperfusion with single-photon emission computerized tomography in conditions other than Alzheimer's disease. Dementia 1: 41–45

    Google Scholar 

  • Mueller SP, Johnson KA, Hamil D, English RJ, Nagel SJ, Ichise M, Holman BL (1986) Assessment of J-123 IMP SPECT in mild/moderate and severe Alzheimer's disease. J Nucl Med 27: 889

    Google Scholar 

  • Nickel O, Nägele-Wöhrle B, Ulrich P, Eissner D, Rosier A, Grimm W, Hahn K (1989) rCBR quantification with99mTc-HMPAO-SPECT: theory and first results. Eur J Nucl Med 15: 1–8

    PubMed  Google Scholar 

  • Ohnishi T, Hoshi H, Nagamachi S, Jinnouchi S, Futami S, Watanabe K, Mitsuyama Y (1991) Regional cerebral blood flow study with 123-IMP in patients with degenerative dementia. Am J Neuroradiol 12: 513–520

    PubMed  Google Scholar 

  • Orrell MW, Sahakian BJ (1991) Editorial: dementia of frontal lobe type. Psychol Med 21: 553–556

    PubMed  Google Scholar 

  • Pearlson GD, Harris GJ, Powers RE, Barta PE, Camargo EE, Chase GA, Noga T, Tune LE (1992) Quantitative changes in mesial temporal volume, regional cerebral blood flow, and cognition in Alzheimer's disease. Arch Gen Psychiatry 49: 402–408

    PubMed  Google Scholar 

  • Perani D, DiPiero V, Vallar G, Cappa S, Messa C, Bottini G, Berti A, Passafiume D, Scarlato G, Gerundini P, Lenzi GL, Fazio F (1988) Technetium-99 m HMPAO-SPECT Study of regional cerebral perfusion in early Alzheimer's disease. J Nucl Med 29: 1507–1514

    PubMed  Google Scholar 

  • Post RM, DeLisi LE, Holcomb HH, Uhde TW, Cohen R, Buchsbaum MS (1987) Glucose utilization in the temporal cortex of affectively ill patients: positron emission tomography. Biol Psychiatry 22: 545–553

    PubMed  Google Scholar 

  • Powers WJ, Perlmutter JS, Videen TO, Herscovitch P, Griffeth LK, Royal HD, Siegel BA, Morris JC, Berg L (1992) Blinded clinical evaluation of positron emission tomography for diagnosis of probable Alzheimer's disease. Neurology 42: 765–770

    PubMed  Google Scholar 

  • Rapoport SI (1991) Positron emission tomography in Alzheimer's disease in relation to disease pathogenesis: a critical review. Cerebrovasc Brain Metabol Rev 3: 297–335

    Google Scholar 

  • Reischies FM, Hedde JP, Drochner R (1989) Clinical correlates of cerebral blood flow in depression. Psychiatry Res 29 (3): 323–326

    PubMed  Google Scholar 

  • Reitan RM (1958) Validity of the trail making test as an indication of organic brain damage. Percept Mot Skills 9: 127–130

    Google Scholar 

  • Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A (1979) Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 7: 486–488

    Google Scholar 

  • Sackeim HA, Prohovnik I, Moeller JR, Mayeux R, Stern Y, Devanand DP (1993) Regional cerebral blood flow in mood disorders. II. Comparison of major depression and Alzheimer's disease. J Nucl Med 34: 1090–1101

    PubMed  Google Scholar 

  • Schlegel S, Aldenhoff JB, Eissner D, Lindner P, Nickel O (1989) Regional cerebral blood flow in depression: associations with psychopathology. J Affect Disord 17: 211–218

    PubMed  Google Scholar 

  • Stoppe G, Staedt J (1993) Die frühe diagnostische Differenzierung primär Dementer von primär depressiven Syndromen im Alter — ein Beitrag zur Pseudodemenzdiskussion (Early diagnostic differentiation between primary degenerative dementia and primary depressive syndromes in the elderly — a contribution to pseudodementia discussion). Fortschr Neurol Psychiat 61: 172–182

    PubMed  Google Scholar 

  • Stroop JA (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18: 643–648

    Google Scholar 

  • Sulkava R, Wikström J, Aromaa A, Raitasalo R, Lehtinen V, Lahtela K, Palo F (1985) Prevalence of severe dementia in Finland. Neurology 35: 1025–1029

    PubMed  Google Scholar 

  • Syed GMS, Eagger S, Toone BK (1992) Quantification of regional cerebral blood flow (rCBF) using 99m-Tc-HMPAO and SPECT: choice of the reference region. Nucl Med Commun 13: 811–816

    PubMed  Google Scholar 

  • Talairach J, Tournoux P (1988) Coplanar stereotaxic atlas of the human brain. Three dimensional proportional system: an approach to cerebral imaging. Thieme, Stuttgart New York

    Google Scholar 

  • Testa HJ, Snowden JS, Neary D, Shields RA, Burjan HWI, Prescott MC, Northen B, Goulding P (1988) The use of (99 mTc)-HMPAO in the diagnosis of primary degenerative dementia. J Cereb Blood Flow Metab 8: 123–126

    Google Scholar 

  • Tierney MC, Fisher RH, Lewis AJ, Zorzitto ML, Snow WG, Reid DW, Nieuwstraten P (1988) The NINCDS-ADRDA work group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology 38: 359–364

    PubMed  Google Scholar 

  • Tomlinson BE, Blessed G, Roth M (1970) Observation on the brains of demented old people. J Neurol Sci 11: 205–242

    PubMed  Google Scholar 

  • Upadhaya AK, Abou-Saleh MT, Wilson K (1990) A study of depression in old age using single-photon emission computerised tomography. Br J Psychiatry 157 [Suppl9]: 76–81

    PubMed  Google Scholar 

  • Verhoeff NPLG, Bull U, Costa DC, Kirsch G, Lottes G, Moretti JL, Podreka I, Schober O, van Royen EA (1992) Basics and recommendations for brain SPECT. Nucl Med 31: 114–131

    Google Scholar 

  • Waldemar G, Hasselbalch SG, Andersen AR, Delecluse F, Petersen P, Johnson A, Paulson OB (1991)99m Tc-d, 1-HMPAO and SPECT of the brain in normal aging. J Cereb Blood Flow Metab 11: 508–521

    PubMed  Google Scholar 

  • Warren LR, Butler RW, Katholi CR, McFarland CE, Crews EL, Halsey JH (1984) Focal changes in cerebral blood flow produced by monetary incentive during a mental mathematical task in normal and depressed subjects. Brain Cogn 3: 71–85

    PubMed  Google Scholar 

  • Wechsler D (1987) WMS-R. Wechsler Memory Scale, revised. The Psychological Corporation, San Antonio (USA), Harcourt Brace Jovanovich

    Google Scholar 

  • Weinstein HC, Haan J, van Royen EO, Derix MMA, Lanser JBK, van der Zant F, Dunnewold RJW, van Kroonenburgh MJPG, Pauwels EKJ, van der Velde EA, Hijdra A, Buruma OJS (1991) SPECT in the diagnosis of Alzheimer's disease and multi-infarct-dementia. Clin Neurol Neurosurg 93: 39–43

    PubMed  Google Scholar 

  • WHO — World Health Organization (1991) Tenth revision of the international classification of diseases, chapter V (F). Mental and behavioural disorders (including disorders of psychological development). Clinical descriptions and diagnostic guidelines. WHO

Download references

Author information

Author notes

  1. G. Stoppe

    Present address: Department of Psychiatry, University of Goettingen, Federal Republic of Germany

Authors and Affiliations

  1. Department of Psychiatry, University of Goettingen, Federal Republic of Germany

    J. Staedt, R. Schütze, H. J. Kunert & E. Rüther

  2. Department of Nuclear Medicine, University of Goettingen, Federal Republic of Germany

    A. Kögler, D. Sandrock & D. Emrich

  3. Department of Nuclear Medicine, Humboldt University (Charité), Berlin, Federal Republic of Germany

    D. L. Munz

Authors
  1. G. Stoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Staedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Kögler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Schütze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. J. Kunert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Sandrock
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. L. Munz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D. Emrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Rüther
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stoppe, G., Staedt, J., Kögler, A. et al. 99mTc-HMPAO-SPECT in the diagnosis of senile dementia of Alzheimer's type — a study under clinical routine conditions. J. Neural Transmission 99, 195–211 (1995). https://doi.org/10.1007/BF01271479

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01271479

Keywords

Search

Navigation