Abstract
In the normal brain as well as in Alzheimer’s disease (AD), regional cerebral blood flow (CBF) is coupled to metabolic demand and, therefore, changes in CBF reflect variations in neuronal metabolism. The use of radionuclide techniques, such as positron emission tomography (PET) and single photon emission computed tomography (SPECT), provides an accurate assessment of regional functional activity, i.e., CBF and metabolism, and could be very helpful for the differential diagnosis of AD. This disease is characterized by a decrease in global CBF and metabolism. When found, a symmetric bi-parieto-temporal CBF reduction is highly diagnostic for AD, despite the fact that a similar CBF pattern could also be observed in other types of dementia. Many AD patients with parieto-temporal flow reduction also have a diffuse flow reduction in the frontal cortical areas, particularly in advanced stages of the disease. Lateral CBF asymmetry is also very frequent; speech disorders are highly characteristic of left-sided flow reduction, while visuospatial apraxia is dominating in the right-sided cases. In advanced and severe cases of AD, CBF and metabolism tend to be more uniformly reduced throughout the cortex, sparing only the primary visual and sensory-motor cortices. PET and SPECT measurement of brain perfusion and metabolism has added a new dimension to the knowledge of dementia disorders, with a better differential diagnosis between AD and other forms of dementia. The correlation with neuropsychological data has also given new insight into the disease. (Aging Clin. Exp. Res. 5: 19–26, 1993)
Similar content being viewed by others
References
Hafner H.: The brain disease of aging. Epidemiology and risk factors of senile dementia (Alzheimer). In: Beyreuther K., Schettler G. (Eds.), Molecular mechanisms of aging. Springer Verlag, Heidelberg, 1990, pp. 2–17.
McKahn G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E.M.: 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, 1984.
Johnson K.A., Davis K.R., Buonanno F.S., Brady T.J., Rosen J., Growdon J.H.: Comparison of Magnetic Resonance and Roengten Ray Computed Tomography in Dementia. Arch. Neurol. 44: 1075–1080, 1987.
Sandor T., Albert M., Stafford J., Kemper T.: Symmetrical and asymmetrical changes in brain tissue with age as measured on CT scans. Neurobiol. Aging 11: 21–27, 1990.
Stokely E.M., Sveindottir E., Lassen N.A., Rommer P.: A single photon dynamic computer assisted tomograph (DCAT) for imaging brain function in multiple cross sections. J. Comput. Assist. Tomogr. 4: 230–240, 1980.
Celsis P., Goldman T., Henriksen L., Lassen N.A.: A method for calculating regional cerebral blood flow from emission computed tomography of inert gas concentrations. J. Comput. Assist. Tomogr. 5: 641–645, 1981.
Kuhl D.E., Barrio J.R., Huang S.H., Selin C., Ackerman R.F., Lear J.L.: Quantifying local cerebral blood flow by N-isopropyl- (1231) iodoamphetamine (IMP) tomography. J. Nucl. Med. 23: 196–203, 1982.
Hill T.C., Holman B.L., Lovett R., O’Leary D.H., Front D., Magistretti P., Zimmerman R.E., Moore S., Clouse M.E., Wu J.L., Lin T.H., Baldwin R.M.: Initial experience with SPECT (single photon computerized tomography) of the brain using n-isopropyl I-123 iodoamphetamine: concise report. J. Nucl. Med. 23: 191–195, 1982.
Gemmel H.G., Sharp P.F., Evans N.T.S., Besson J.A.O., Lyall D., Smith F.W.: Single photon emission tomography with I-123 isopropylamphetamine in Alzheimer’s disease and multiinfarct dementia. Lancet II: 1348, 1984.
Johnson K.A., Holman B.L., Rosen J., Nagel S., English R.J., Growdon J.H.: Iofetamine I-123 single photon emission computed tomography is accurate in the diagnosis of Alzheimer’s disease. Arch. Intern. Med. 150: 752–756, 1990.
Neirinckx R.D., Canning L.R., Piper I.M., Nowotnik D.P., Pickett R.D., Holmes R.A., Volkert W.A., Forster A.M., Wesiner P.S., Marriott J.A., Chaplin S.B.: Technetium-99m d,l-HMPAO: a new radiopharmaceutical for SPECT imaging of regional perfusion. J. Nucl. Med. 28: 191–202, 1987.
Andersen A.R., Friberg H.H., Schmidt J.F., Hasselbach S.G.: Quantitative measurements of cerebral blood flow using SPECT and (99mTc)-d,l-HMPAO compared to Xenon-133. J. Cereb. Blood Flow Metab. 8: S69–S81, 1988.
Waldemar G., Paulson O.B., Lassen N.A.: Brain imaging with SPECT in Alzheimer’s disease. In: Rapaport S.I., Petit H., Leys D., Christen Y. (Eds.), Imaging Cerebral Topography and Alzheimer’s Disease. Springer Verlag, Berlin, Heidelberg, 1990, pp. 139–144.
Ingvar D.H., Risberg J.: Increase of regional blood flow during mental effort in normals and in patients with focal brain disorders. Exp. Brain Res. 3: 195–211, 1967.
Frackowiak R.S.J., Pozzilli C., Legg N.J., DuBoulay G.H., Marshall J., Lenzi G.L., Jones T.: Regional cerebral oxygen supply and utilization in dementia. A clinical and physiological study with oxygen-15 and positron tomography. Brain 104: 753–778, 1981.
Tikofsky R.S., Hellman R.S.: Brain single photon emission tomography: newer activation and intervention studies. Sem. Nucl. Med. 21: 40–57, 1991.
Kety S.: Human cerebral blood flow and oxygen consumption as related to aging. J. Chronic Dis. 3: 478–486, 1956.
Melamed E., Lavy S., Bentin S., Cooper G., Rinto Y.: Reduction in cerebral blood flow during normal aging in man. Stroke 11: 31–35, 1980.
Shirahata N., Henriksen L., Vorstrup S., Holm S., Lauritzen M., Paulson O.B., Lassen N.A.: Regional cerebral blood flow assessed by Xenon-133 inhalation and emission tomography: normal values. J. Comput. Assist. Tomogr. 9: 861–866, 1985.
Pantano P., Baron J-C., Lebrun-Grandiè P., Duquesnoy N., Bousser M-G., Comar D.: Regional cerebral blood flow and oxygen consumption in human aging. Stroke 15: 635–641, 1984.
Dastur D.K.: Cerebral blood flow and metabolism in normal human aging, and senile dementia. J. Cereb. Blood Flow Metab. 5: 1–9, 1985.
Martin A.J., Friston K.J., Colebatch J.G., Frackowiak R.S.J.: Decreases of regional cerebral blood flow with normal aging. J. Cereb. Blood Flow Metab. 11: 684–689, 1991.
Waldemar G., Hasselbach S.G., Andersen A.R., Delecluse F., Petersen P., Johnsen A., Paulson O.B.: 99mTc-d,l-HMPAO and SPECT of the brain in normal aging. J. Cereb. Blood Flow Metab. 11: 508–521, 1991.
Creasey H., Rapaport S.I.: The aging human brain. Ann. Neurol. 17: 2–10, 1985.
Prigatano G.P.: Neuropsychology of aging. Compr. Ther. 13: 41–45, 1987.
Frackowiak R.S.J.: Measurement and imaging of cerebral function in aging and dementia. Prog. Brain Res. 70: 69–85, 1986.
Kuhl D.E., Metter E.J., Riege W.H., Phelps M.E.: Effects of human aging on patterns of local cerebral glucose utilization determined by (18-F)-fluorodeoxyglucose method. J. Cereb. Blood Flow Metab. 2: 163–171, 1982.
Kuhl D.E., Metter E.J., Markham C.H.: Cerebral metabolism and atrophy in Huntington’s disease determined by 18-FDG and computed tomographic scan. Ann. Neurol. 12: 425–434, 1982.
Duara R., Grady C., Haxby J., Ingvar D., Sokoloff L., Margolin R.A., Manning R.G., Cutler N.R., Rapaport S.I.: Human brain glucose utilization and cognitive function in relation to age. Ann. Neurol. 16: 702–713, 1984.
DeLeon M.J., George A.E., Ferris S.H., Christman D.R., Fowler J.S., Gentes C.I., Brodie J., Reisberg B., Wolf A.P.: Positron emission tomography and computed tomographic assessments of the aging human brain. J. Comput. Assist. Tomogr. 8: 88–94, 1984.
Cohen M.B., Graham L.S., Lake R., Metter E.J., Fitten J., Kulkarni M.K., Sevrin R., Yamada L., Chang C.C., Woodruff N.: Diagnosis of Alzheimer’s disease and multiple infarct dementia by tomographic imaging of iodine-123 IMP. J. Nucl. Med. 27: 769–774, 1986.
Sharp P., Gemmell H., Cherryman G., Besson J., Crawford J., Smith F.: Application of iodine-123-labeled isopropylamphetamine imaging to the study of dementia. J. Nucl. Med. 27: 761–768, 1986.
Smith F.W., Gemmell H.G., Sharp P.F.: The use of Tc-99m-HM-PAO for the diagnosis of dementia. Nucl. Med. Commun. 8: 525–533, 1987.
Jagust W.J., Budinger T.F., Reed B.R.: The diagnosis of dementia with single photon emission computed tomography. Arch. Neurol. 44: 258–262, 1987.
Neary D., Snowden J.S., Shields R.A., Burjan A.W.I., Northern B., MacDermott N., Prescott M.C., Testa H.J.: Single photon emission tomography using Tc-99m-HM-PAO in the investigation of dementia. J. Neurol. Neurosurg. Psychiatry 50: 1101–1109, 1987.
Johnson K.A., Mueller ST., Walshe T.M., English R.J., Holman B.L.: Cerebral perfusion imaging in Alzheimer’s disease: Use of single photon emission computed tomography and iofetamine hydrochloride I-123. Arch. Neurol. 44: 165–168, 1987.
Perani D., Di Piero V., Vallar G., Cappa S., Messa C., Bottini G., Berti A., Passafiume D., Scarlato G., Gerundini P., Lenzi G.L., Fazio F.: Technetium-99m HM- PAO-SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J. Nucl. Med. 29: 1507–1514, 1988.
Bonte F.J., Ross E.D., Chehabi H.H., Devous M.D.: SPECT study of regional cerebral blood flow in Alzheimer’s disease. J. Comput. Assist. Tomogr. 10: 579–583, 1986.
Testa H.J., Snowden J.S., Neary D., Shields R.A., Burjan A.W.L., Prescott M.C., Northern B., Goulding P.: The use of Tc-99m HM-PAO in the diagnosis of primary degenerative dementia. J. Cereb. Blood Flow Metab. 8: S123–S126, 1988.
Hellman R.S., Tikofsky R.S., Collier B.D., Hoffmann R.G., Plamer D.W., Glatt S.L., Antuono P.G., Isitman A.T., Papke R.A.: Alzheimer’s disease: Quantitative analysis of I-123 iodoamphetamine SPECT brain imaging. Radiology 172: 183–188, 1989.
Deutsch G., Tweedy J.R.: Cerebral blood flow in severity-matched Alzheimer and multiinfarct patients. Neurology 37: 431–438, 1987.
Launes J., Sulkava R., Erkinjuntti T., Nikkinen P., Lindroth L., Liewendhal K., Livanainen M.: Tc-99m HMPAO SPECT in suspected dementia. Nucl Med. Commun. 12: 757–765, 1991.
Gemmel H.G., Sharp P.E., Besson J.A.O., Crawford J.R., Ebmeier K.P., Davidson J., Smith F.W.: Differential diagnosis in dementia using the cerebral blood flow agent 99mTc-HMPAO: a SPECT study. J. Comput. Assist. Tomogr. 11: 398–402, 1987.
Costa D.C., Ell P.J., Burns A., Philpot M., Levy R.: CBF tomograms with (99mTc)-HM-PAO in patients with dementia (Alzheimer type and HIV) and Parkinson disease — initial results. J. Cereb. Blood Flow Metab. 8: S109–S115, 1988.
Pizzolato G., Dam M., Borsato N., Saitta B., DaCol C., Perlotto N., Zanco P., Ferlin G., Battistin L.: Tc-99m- HMPAO SPECT in Parkinson’s disease. J. Cereb. Blood Flow Metab. 8: S101–S108, 1988.
Nagel J.S., Ichise M., Holman B.L.: The scintigraphic evaluation of Huntington’s disease and other movement disorders using single photon emission computed tomography perfusion brain scans. Semin. Nucl. Med. 21: 11–23, 1991.
Grumwald F., Ziers S., Broich K., Schumacher S., Bockisch A., Biersack H.J.: HMPAO-SPECT imaging resembling Alzheimer-type dementia in mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS). J. Nucl. Med. 31: 1740–1742, 1990.
Kuwabara Y., Ichiya Y., Otsuka M., Tahara T., Fukumura T., Gunasekera R., Masuda K.: Differential diagnosis of bilateral abnormalities in 123-I IMP SPECT imaging. Clin. Nucl. Med. 15: 893–899, 1990.
Haxby J.V., Grady C.L., Horvitz B., Shapiro M., Fried-land R.P., Rapaport S.I.: Heterogeneous anterior-posterior metabolic patterns in dementia of Alzheimer’s type. Neurology 38: 1853–1863, 1988.
Haxby J.V., Duara R., Grady C.L., Cutler N.R., Rapaport S.I.: Relations between neuropsychological and cerebral metabolic asymmetries in early Alzheimer’s disease. J. Cereb. Blood Flow Metab. 6: 193–200, 1985.
Celsis P., Agniel A., Puel M., Le Tinnier A., Viallard G., Demonet J-F., Rascol A., Marc-Vergnes J-P.: Lateral asymmetries in primary degenerative dementia of the Alzheimer type. A correlative study of cognitive, haemodynamic and EEG data, in relation with severity, age of onset and sex. Cortex 26: 585–596, 1990.
Celsis P., Agniel A., Puel M., Marc-Vergnes J-P.: Focal cerebral hypoperfusion and selective cognitive deficit in dementia of the Alzheimer type. J. Neurol. Neurosurg. Psychiatry 50: 1602–1612, 1987.
Haxby J.V.: Heterogeneous patterns of regional cerebral metabolism in Alzheimer’s disease: cross-sectional and longitudinal studies. In: Agnoli A., Cahn J., Lassen N., Mayeux R. (Eds.), Senile dementias. John Libbey Eurotext, Paris, 1988, pp. 65–72.
Holman B.L., Johnson K.A., Garada B., Carvalho P.A., Satlin A.: The scintigraphic appearance of Alzheimer’s disease: a prospective study using technetium-99m-HMPAO SPECT. J. Nucl. Med. 33: 181–185, 1992.
Friedland R.P., Budinger T.F., Koss E., Ober B.A.: Alzheimer’s disease: anterior-posterior and lateral hemispheric alterations in cortical glucose utilization. Neurosci. Lett. 53: 235–240, 1985.
Benson D.F., Kuhl D.E., Hawkins R.A., Phelps M.E., Cummings J.L., Tsai S.Y.: The fluorodeoxyglucose (18-F) scan in Alzheimer’s disease and multi-infarct dementia. Arch. Neurol. 40: 711–714, 1983.
Kuhl D.E., Metter E.J., Riege W.H.: Pattern of glucose cerebral utilization in depression, multiple infarct dementia, and Alzheimer’s disease. In: Sokoloff L. (Ed.), Brain imaging and brain function. Raven Press, New York, 1985, pp. 211–226.
Duara R., Grady C.L., Haxby J.V.: Positron emission tomography in Alzheimer’s disease. Neurology 36: 879–887, 1987.
Holman B.L., Gibson R., Hill T., Eckelman W., Albert M., Reba R.: Muscarinic acetylcholine receptors in Alzheimer’s disease. JAMA 254: 3063–3066, 1985.
Burns A., Philpot M.P., Costa D.C., Ell P., Levy R.: The investigation of Alzheimer’s disease with single photon emission tomography. J. Neurol. Neurosurg. Psychiatry 52: 248–253, 1989.
Foster N.L., Chase T.N., Fedio P., Patronas N.J., Brooks R.A., DiChiro G.: Alzheimer’s disease: focal changes shown by positron emission tomography. Neurology 33: 961–965, 1983.
Cutler N.E., Haxby J.V., Duara R., Grady C.L., Kay A.D., Kessler R.M., Sundaram M., Rapaport S.I: Clinical history, brain metabolism and neuropsychological function in Alzheimer’s disease. Ann. Neurol. 18: 298–309, 1985.
Pelizzari C.A., Chen G.T.Y., Speibring D.R., Weichselbaum R.R., Chen C.T.: Accurate three-dimensional registration of CT, PET and/or MR images of the brain. J. Comput. Assist. Tomogr. 13: 20–26, 1989.
Holman B.L., Zimmerman R.E., Johnson K.A., Carvalho P.A., Schwartz R.B., Loeffler J.S., Alexander E., Pelizzari A., Chen G.T.Y.: Computed-assisted super-imposition of Magnetic Resonance and high-resolution technetium-99m-HMPAO and Thallium-201 SPECT images of the brain. J. Nucl. Med. 32: 1478–1484, 1991.
Friberg L., Roland P.E.: Functional activation and inhibition of regional cerebral blood flow and metabolism. In: Olesen J., Edvinsson L. (Eds.), Basic mechanism of headache. Elsevier Science Publ., Amsterdam, 1988, pp. 89–98.
Duara R., Barker W., Pascar S., Loewenstein L., Boothe T.: Behavioral activation PET studies in normal aging and Alzheimer’s disease (AD). J. Nucl. Med. 31: 730, 1990.
Battistin L., Pizzolato G., Dam M.: Single photon emission computed tomography studies with 99mTc- hexamethylpropyleneamine oxime in dementia: effects of acute administration of l-acetylcarnitine. Eur. Neurol. 29: 261–265, 1989.
Postiglione A., Soricelli A., Cicerano U., Mansi L., De Chiara S., Gallotta G., Schettini G., Salvatore M.: Effect of acute administration of l-acetyl-carnitine on cerebral blood flow in patients with chronic cerebral infarct. Pharmacol. Res. 23: 241–246, 1991.
Geaney D.P., Soper N., Shepstone B.J., Cowen P.J.: Effect of central cholinergic stimulation on regional cerebral blood flow in Alzheimer disease. Lancet 335: 1484–1487, 1990.
Klinkhammer P., Szelies B., Heiss W.D.: Effect of phosphatidylserine on cerebral glucose metabolism in Alzheimer’s disease. Dementia 1: 197–201, 1990.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Postiglione, A., Lassen, N.A. & Holman, B.L. Cerebral blood flow in patients with dementia of Alzheimer’s type. Aging Clin Exp Res 5, 19–26 (1993). https://doi.org/10.1007/BF03324122
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324122