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Diagnosing Alzheimer's disease in elderly, mildly demented patients: the impact of routine single photon emission computed tomography

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Abstract

Based on the observation of bilateral temporoparietal hypoperfusion in Alzheimer's disease (AD), single photon emission computed tomography (SPECT) is advocated by some as a powerful diagnostic tool in the evaluation of demented patients. We studied whether routine brain SPECT in elderly, mildly demented outpatients increases the a priori diagnostic sensitivity and specificity of a careful clinical examination.99mTc-HMPAO SPECT imaging was performed in 110 patients for a first evaluation for dementia. A semiquantitative measure of temporoparietal (TP) perfusion was calculated as the ratio of the activity in the temporoparietal cortex to activity in the cerebellum. A diagnosis of probable AD according to the McKhann criteria was made in 68 patients (mean age of 79.3 years) based on the results of a clinical examination, ancillary investigations and a 6-month follow-up. TP perfusion was significantly lower in AD patients than in 18 age-matched, non-demented controls. However, at a specificity of 89%, sensitivity was only 43% for detecting probable AD. The clinicians judged that SPECT had contributed to the final diagnosis in only 8% of the demented patients investigated. Routine brain SPECT in elderly, mildly demented outpatients does not contribute substantially to diagnostic accuracy after a careful clinical examination using current diagnostic criteria. Clinical guidelines have to be developed for the use of SPECT in patients with (suspected) dementia.

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Authors and Affiliations

  1. Department of Neurology, Academic Medical Center, PO Box 22700, 1100, DE Amsterdam, The Netherlands

    Willem A. Van Gool & Gerard J. M. Walstra

  2. Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Friso M. Van der Zant & Eric A. Van Royen

  3. PCA/Valeriuskliniek, Neuropsychiatry Unit, Amsterdam, The Netherlands

    Henry C. Weinstein

Authors
  1. Willem A. Van Gool
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  2. Gerard J. M. Walstra
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  3. Saskia Teunisse
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  4. Friso M. Van der Zant
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  5. Henry C. Weinstein
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  6. Eric A. Van Royen
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Van Gool, W.A., Walstra, G.J.M., Teunisse, S. et al. Diagnosing Alzheimer's disease in elderly, mildly demented patients: the impact of routine single photon emission computed tomography. J Neurol 242, 401–405 (1995). https://doi.org/10.1007/BF00868397

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  • DOI: https://doi.org/10.1007/BF00868397

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