Abstract
Twenty-three patients with Alzheimer's dementia (AD) in relatively early stages and 40 patients with other cognitive disorders of vascular or degenerative aetiology underwent neuropsychological examination and [99mTc]-HM PAO single photon emission computed tomography (SPECT). In contrast to the commonly accepted notion of a posterior temporoparietal reduction of tracer uptake as the typical SPECT pattern of AD, the most consistent feature found in the SPECT images of our AD patients was a hippocampal uptake deficit, associated with a variable degree of temporal, parietal and frontal deficit (extending from the posterior to the anterior regions), according to the severity of the disease. These results support the theory of AD as a “hippocampal dementia”, at least in the early stages. Neuropsychological tests were found to be somewhat more specific and more accurate than SPECT in distinguishing AD from non-AD cases.
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American Psychiatric Association (1987) Diagnostic and statistic manual of mental disorders, 3rd edn revised. American Psychiatric Association, Washington, DC, pp 103–107
Ball MJ, Fisman M, Hachinski V, et al (1985) A new definition of Alzheimer's disease: a hippocampal dementia. Lancet I: 14–16
Battistin L, Pizzolato G, Dam M, Ponza I, Borsato N, Zando PL, Ferlin G (1990) Regional cerebral blood flow study with 99m Tc-propyleneamine oxime single photon emission computed tomography in Alzheimer's and multi-infarct dementia. Eur Neurol 30: 296–301
Bergman H, Chertkow H, Stern J, et al (1992) HM-PAO (Ceretec) brain scanning in the diagnosis of Alzheimer's disease. Neurobiol Aging 13 [Suppl 1]: S17
Brun A, Englund E (1987) Regional pattern of degeneration in Alzheimer's disease. Neuronal loss and histopathological grading. Histopathology 5: 549–564
Burns A, Philpot M, Costa D, Ell P, Levy R (1989) The investigation of Alzheimer's disease with single photon emission tomography. J Neurol Neurosurg Psychiatry 52: 248–253
Caltagirone C, Gainotti G, Masullo C, Miceli G (1979) Validity of some neuropsychological tests in the assessment of mental deterioration. Acta Psychiatr Scand 60: 50–56
Costa DC, Ell PJ, Burns A, Philpot M, Levy R (1988) CBF tomograms with 99m Tc-HM-PAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease: initial results. J Cereb Blood Flow Metab 8 [Suppl 1]: 109–115
De Leon MJ, George AE, Stylopoulos LA, Smith G, Miller DC (1989) Early marker for Alzheimer's disease: the atrophic hippocampus. Lancet II: 672–673
Deutsch G, Tweedy JR (1987) Cerebral blood flow in severity-matched Alzheimer and multi-infarct patients. Neurology 37: 431–438
Eagger S, Syed GMS, Burns A, Barrett JJ, Levy R (1992) Morphologic (CT) and functional (rCBF-SPECT) correlates in Alzheimer's disease. Nucl Med Communi 13: 644–647
Folstein MF, Folstein SE, McHugh PR (1975) ‘Mini-mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198
Foster NL, Chase TN, Fedio P, et al (1983) Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology 33: 961–965
Frlich L, Eilles C, Ihl R, Maurer K, Lancjik M (1989) Stage-dependent reductions of regional cerebral blood flow measured by HMPAO-SPECT in dementia of Alzheimer type. Psychiatry Res 29: 347–350
Gainotti G, Marra C (1994) Some aspects of memory disorders clearly distinguish dementia of the Alzheimer's type from depressive pseudo-dementia. J Clin Exp Neuropsychol 16: 65–78
Geaney D, Soper N, Shepstone B, Cowen P (1990) The effect of central cholinergic stimulation on regional cerebral blood flow in Alzheimer's disease studied by single photon emission tomography. Lancet 335: 1484–1487
Gemmel HG, Sharp PF, Besson JAO, Crawford JR, Ebmeier KP, Davidson J, Smith FW (1987) Differential diagnosis in dementia using the cerebral blood flow agent 99m Tc HM-PAO: a SPECT study. J Comput Assist Tomogr 11: 398–402
Gemmel HG, Sharp PF, Besson JAO, Ebmeier KP, Smith FW (1988) A comparison of Tc-99m HM-PAO and I-123 IMP cerebral SPECT images in Alzheimer's disease and multi-infarct dementia. Eur J Nucl Med 14: 463–466
Giordano A, Calcagni ML, Di Fazio P, Della Corte F, Barelli A, Pennisi M, Sada E, Colombo S, Galli G (1991) Brain SPECT (99m Tc-HMPAO) and DSPECT (133Xenon) using a new fast rotating 28 slices cerebral tomograph. In Schmidt HAE, Hofer R (eds) Nuclear medicine: nuclear medicine in research and practice, European Nuclear Medicine Congress, Vienna, 1–5 September 1991. Schattauer, Stuttgart, pp 6–8
Habert M, Spampinato U, Mas J, Bourdel MC, Ziegler M, Recondo J de, Askienazy S, Rondot P (1991) 99m Tc-HM-PAO SPECT and cognitive impairment in Parkinson's disease: a comparison with dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry 54: 787–792
Hachinski VC, Ilif LD, Zihka E, Du Boulay GH, McAllister VL, Marshall J, Ross Russel RW, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32: 632–637
Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17: 427–442
Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A (1992) The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium 99m-HMPAO SPECT. J Nucl Med 33: 181–185
Hunter R, McLuskie R, Wyper D, et al (1989) The pattern of function-related regional cerebral blood flow investigated by single photon emission tomography with 99m Tc-HMPAO in patients with presenile Alzheimer's disease and Korsakoff's psychosis. Psychol Med 19: 847–855
Jagust WJ, Buginger TF, Reed BR (1987) The diagnosis of dementia with single photon emission computed tomography. Arch Neurol 44: 258–262
Jobst KA, Smith AD, Szatmari M, et al (1992) Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet 340: 1179–1183
Johnson KA, Mueller SP, Walshe TM, English RJ, Holman BL (1987) Cerebral perfusion imaging in Alzheimer's disease: use of single photon emission computed tomography and iofetamine hydrochloride I-123. Arch Neurol 44: 165–168
Johnson KA, Holman BL, Mueller SP, et al (1988) Single photon emission computed tomography in Alzheimer's disease: abnormal I-123-iofetamine uptake reflects dementia severity. Arch Neurol 45: 392–396
Kushner M, Tobin M, Alavi A, et al (1987) Cerebellar glucose consumption in normal and pathological states using fluorine-FDG and PET. J Nucl Med 28: 1667–1670
Lantos P (1990) Ageing and dementias. In: Weller R (ed) Nervous system, muscle and eyes, 3rd edn, vol 4. Churchill Livingstone, Edinburgh
Maher ER, Lees AJ (1986) The clinical features and natural history of the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology 36: 1005–1008
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (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: 939–994
Montaldi D, Brooks D, McColl J, Wyper D, Patterson J, Barron E, McCulloch J (1990) Measurements of regional cerebral blood flow and cognitive performance in Alzheimer's disease. J Neurol Neurosurg Psychiatry 53: 33–38
Neary D, Snowden JS, Shield RA, Burjan AWI, Northen B, MacDermott N, Prescott MC, Testa HJ (1987) Single photon emission tomography using 99m Tc-HM-PAO. J Neurol Neurosurg Psychiatry 50: 1101–1109
O'Brien JT, Eagger S, Syed GMS, Sahakian BJ, Levy R (1992) A study of regional blood flow and cognitive performance in Alzheimer's disease. J Neurol Neurosurg Psychiatry 55: 1182–1187
Perani D, Di Piero V, Vallar G, Cappa S, Messa C, Bottini G, Berti A, Passafiume D, Scarlato G, Gerundini P, Lenzi GL, Fazio F (1988) Technetium-99m HM-PAO-SPECT study of regional cerebral perfusion in early Alzheimer's disease. J Nucl Med 29: 1507–1514
Risberg J (1985) Application of the nontraumatic xenon 133 method in neuropsychiatry. In: Hartman A, Hoyer S (eds) Cerebral blood flow and metabolism measurement. Springer, Berlin Heidelberg New York, pp 385–390
Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 55: 967–972
Scheltens P, Launer LJ, Weinstein HC, Barkhof F, Jonker C (1994) The value of MRI and SPECT in the early diagnosis of Alzheimer's disease. Neurology 44 [Suppl 2]: 179
Seab JP, Jagust WJ, Wong STS, et al (1988) Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease. Magn Reson Med 8: 200–208
Sharp P, Gemmel H, Cherryman G, Besson J, Crawford J, Smith F (1986) Application of iodine-123-labelled isopropylamphetamine imaging to the study of dementia. J Nucl Med 27: 761–768
Steele JC, Richardson JC, Olszewski J (1964) Progressive supranuclear palsy. Arch Neurol 10: 333–359
Tierney MC, Fisher RH, Lewis AJ, et al (1988) The NINCS-ADRDA work group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology 38: 359–364
Waldemar G, Bruhn P, Kristensen M, Johnsen A, Paulson O B, Lassen N A (1994) Heterogeneity of neocortical cerebral blood flow deficits in dementia of the Alzheimer type: a [99mTc]-d,l-HMPAO SPECT study. J Neurol Neurosurg Psychiatry 57: 285–295
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Villa, G., Cappa, A., Tavolozza, M. et al. Neuropsychological tests and [99mTc]-HM PAO SPECT in the diagnosis of Alzheimer's dementia. J Neurol 242, 359–366 (1995). https://doi.org/10.1007/BF00868390
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DOI: https://doi.org/10.1007/BF00868390