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The impact of MRI combined with visual rating scales on the clinical diagnosis of dementia: a prospective study

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Abstract

Objectives

Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the dementia subtype. Our first goal was to establish if MRI combined with visual rating scales changes the clinical diagnosis. The second goal was to demonstrate if MRI contributes to a geriatrician’s confidence in the diagnosis.

Methods

The dementia subtype was determined prior to and after MRI. Scoring scales used were: global cortical atrophy (GCA), medial temporal atrophy (MTA), and white matter hyperintensity measured according to the Fazekas scale. The confidence level of the geriatrician was determined using a visual analogue scale.

Results

One hundred and thirty-five patients were included. After MRI, the diagnosis changed in 23.7 % (CI 17.0 %-31.1 %) of patients. Change was due to vascular aetiology in 13.3 % of patients. PRD was found in 2.2 % of all patients. The confidence level in the diagnosis increased significantly after MRI (p = 0.001).

Conclusions

MRI, combined with visual rating scales, has a significant impact on dementia subtype diagnosis and on a geriatrician’s confidence in the final diagnosis.

Key points

• MRI with visual rating scales changes the dementia subtype diagnosis significantly.

• MRI is essential in demonstrating vascular disease as a cause of dementia.

• All suspected dementia patients should undergo an MRI with visual rating scales.

• MRI improves a geriatrician’s confidence in the diagnosis of the dementia subtype.

• MRI remains essential during the workup of dementia to exclude reversible causes.

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Abbreviations

AD:

Alzheimer’s disease

GCA:

global cortical atrophy

MCI:

mild cognitive impairment

MMSE:

mini mental state exam

MTA:

medial temporal atrophy

PRD:

potential reversible dementia

VAS:

visual analogue scale

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Acknowledgments

We thank Ralph Vreeswijk (Msc, department of Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands), for his help with the enrolment of the patients. The scientific guarantor of this publication is Gerard L. Guit (MD, PhD, radiologist, Spaarne Gasthuis, Haarlem, the Netherlands). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Tjeerd van der Ploeg (MsC, statistician, Spaarne Gasthuis, Haarlem, the Netherlands) kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands

    Martijn V. Verhagen & Gerard L. Guit

  2. Department of Geriatrics, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands

    Gerrit Jan Hafkamp & Kees Kalisvaart

Authors
  1. Martijn V. Verhagen
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  2. Gerard L. Guit
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  3. Gerrit Jan Hafkamp
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  4. Kees Kalisvaart
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Correspondence to Martijn V. Verhagen.

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Verhagen, M.V., Guit, G.L., Hafkamp, G.J. et al. The impact of MRI combined with visual rating scales on the clinical diagnosis of dementia: a prospective study. Eur Radiol 26, 1716–1722 (2016). https://doi.org/10.1007/s00330-015-3957-z

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  • DOI: https://doi.org/10.1007/s00330-015-3957-z

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