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Brain perfusion SPECT in patients with mild cognitive impairment and Alzheimer’s disease: comparison of a semiquantitative and a visual evaluation

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Summary.

Due to the increasing importance of early recognition and differential diagnosis of dementias, cerebral perfusion scans using “single photon emission computed tomography” (SPECT) are increasingly integrated into the examination routine.

The goal of this study was to check the diagnostic validity of SPECT scans of MCI- and DAT-patients, two subgroups out of 369 persons with etiologically unclear cognitive dysfunction, which underwent an assessment program for probable dementia including cognitive testing, cranial computed tomography, ultrasound, routine laboratory testing including vascular risk factors.

After exclusion of patients with no or other forms of dementia we analyzed SPECT data of patients with mild cognitive impairment (MCI; n = 85) and dementia of the Alzheimer type (DAT; n = 78) in comparison with a healthy control group (n = 34).

Visual assessment as well as a manual “regions of interest” (ROI) regionalization of the cortex were performed, whereby a ROI/cerebellum ratio was calculated as a semi-quantitative value. Association cortex areas were assessed regarding frontal, temporal, and parietal lobes of both hemispheres. When comparing the ratios of patients with DAT and controls, we found a statistically significant reduction of the cerebral perfusion in all measured cortex areas (p < 0.001). The comparison of patients with MCI with the selected control group also established a statistically significant difference in the cerebral perfusion for the evaluated cortex areas with the exception of the left hemispheric frontal and parietal cortex.

A considerable number of the MCI patients showed an MMSE-score within the normal range, but with regard to the perfusion in the right hemispheric association cortex these patients also could be distinguished unambiguously from controls.

Sensitivity levels found by visual assessment were at least as high as those found by the ROI method (pathological assessment: visual 49.4% vs. ROI 47.1% for MCI; visual 75.6% vs. ROI 73.1% for DAT).

High experienced visual assessment of cerebral perfusion scans using SPECT provides an useful additional tool in diagnosis of cognitive impairment. The used semiquantitative ROI-method is nearly equivalent and does not depend on the experience of the investigator.

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References

  • P Bartenstein F Grünwald T Kuwert et al. (2000) ArticleTitleClinical applications of single photon emission tomography in neuromedicine. Nuklearmedizin 39 218–232 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFWhug%3D%3D Occurrence Handle11189899

    CAS  PubMed  Google Scholar 

  • L Battistin G Pizzolato M Dam et al. (1989) ArticleTitleSingle photon emission tomography studies with 99 m Technetium hexamethylpropylenaminoxime in dementia: effects of acute administration of L-acetylcarnitine. Eur J Neurol 29 261–265 Occurrence Handle1:STN:280:By%2BD3crlsVQ%3D

    CAS  Google Scholar 

  • E Camargo (2001) ArticleTitleBrain SPECT in neurology and psychiatry. J Nucl Med 42 611–623 Occurrence Handle1:STN:280:DC%2BD3MvkvVGjtg%3D%3D Occurrence Handle11337551

    CAS  PubMed  Google Scholar 

  • P Celsis (2000) ArticleTitleAge-related cognitive decline, mild cognitive impairment or preclinical Alzheimer’s disease? Ann Med 32 6–14 Occurrence Handle1:STN:280:DC%2BD3c7nsVOitg%3D%3D Occurrence Handle10711572

    CAS  PubMed  Google Scholar 

  • Dahl G (1986) Reduzierter Wechsler-Intelligenztest. Hogrefe, Göttingen

  • C DeCarli (2001) ArticleTitleThe role of neuroimaging in dementia. Clin Geriatr Med 17 255–279 Occurrence Handle10.1016/S0749-0690(05)70068-9 Occurrence Handle1:STN:280:DC%2BD3M3ptFCksQ%3D%3D Occurrence Handle11375135

    Article  CAS  PubMed  Google Scholar 

  • C DeCarli JA Kaye B Horwitz SI Rapoport (1990) ArticleTitleCritical analysis of the use of computer assisted transverse axial tomography to study human brain in aging and dementia of the Alzheimer type. Neurology 40 884

    Google Scholar 

  • Dougall NJ, Bruggink S, Ebmeier KP, et al. (2003) The clinical use of 99mTc-HMPAO in Alzheimer’s disease. In: Ebmeier KB (ed) SPECT in dementia. Karger, Basel, pp 4–37 (Adv Biol Psychiatry 22)

  • MF Folstein SE Folstein PR McHugh (1975) ArticleTitle“Mini-Mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12 189–198 Occurrence Handle10.1016/0022-3956(75)90026-6 Occurrence Handle1:STN:280:CSmD2s7mtVE%3D Occurrence Handle1202204

    Article  CAS  PubMed  Google Scholar 

  • K Herholz (2003) ArticleTitlePET studies in dementia. Ann Nucl Med 17 79–89 Occurrence Handle12790355

    PubMed  Google Scholar 

  • K Herholz H Schopphoff M Schmidt et al. (2002) ArticleTitleDirect comparison of spatially normalized PET and SPECT scans in Alzheimer’s disease. J Nucl Med 43 21–26 Occurrence Handle11801698

    PubMed  Google Scholar 

  • C Hirsch P Bartenstein D Mösch et al. (1997) ArticleTitleReduction of regional cerebral blood flow and cognitive impairment in patients with Alzheimer’s disease: evaluation of an observer-independent analytic approach. Dement Geriatr Cogn Disord 8 98–104 Occurrence Handle1:STN:280:ByiB3M3psFQ%3D Occurrence Handle9065322

    CAS  PubMed  Google Scholar 

  • JM Hoffmann KA Welsh-Bohmer M Hanson et al. (2000) ArticleTitleFDG PET imaging in patients with pathologically verified dementia. J Nucl Med 41 1920–1928

    Google Scholar 

  • WJ Jagust (2000) ArticleTitleNeuroimaging in dementia. Neurol Clin 18 885–902 Occurrence Handle10.1016/S0733-8619(05)70231-0 Occurrence Handle1:STN:280:DC%2BD3M7htVajtQ%3D%3D Occurrence Handle11072266

    Article  CAS  PubMed  Google Scholar 

  • WJ Jagust MN Haan BR Reed JL Eberling (1998) ArticleTitleBrain perfusion imaging predicts survival in Alzheimer’s disease. Neurology 51 1009–1013 Occurrence Handle1:STN:280:DyaK1cvlt1Orsw%3D%3D Occurrence Handle9781521

    CAS  PubMed  Google Scholar 

  • KA Jobst LB Barnetson BJ Shepstone (1998) ArticleTitleAccurate prediction of histologically confirmed Alzheimer’s disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT and Apo E4 in medial temporal lobe dementias. Oxford Project to Investigate Memory and Aging. Int Psychogeriatr 10 271–302 Occurrence Handle10.1017/S1041610298005389 Occurrence Handle1:STN:280:DyaK1M%2FgtFehtQ%3D%3D Occurrence Handle9785148

    Article  CAS  PubMed  Google Scholar 

  • KA Johnson K Jones BL Holman et al. (1998) ArticleTitlePreclinical prediction of Alzheimer’s disease during SPECT. Neurology 50 1563–1571 Occurrence Handle1:STN:280:DyaK1c3psFCmsA%3D%3D Occurrence Handle9633695

    CAS  PubMed  Google Scholar 

  • K Kantarci CR Jack YC Xu et al. (2000) ArticleTitleMild cognitive impairment and Alzheimer’s disease. A 1H MRS study. Neurology 55 210–217 Occurrence Handle1:CAS:528:DC%2BD3cXlvVymt70%3D Occurrence Handle10908893

    CAS  PubMed  Google Scholar 

  • PM Kemp C Holmes SMA Hoffmann et al. (2003) ArticleTitleAlzheimer’s disease: differences in technetium-99m HMPAO SPECT scan findings between early onset and late onset dementia. J Neurol Neurosurg Psychiatry 74 715–719 Occurrence Handle1:STN:280:DC%2BD3s3ms1Gjuw%3D%3D Occurrence Handle12754337

    CAS  PubMed  Google Scholar 

  • DS Knopman ST De Kosky JL Cummings et al. (2001) ArticleTitlePractice parameter: diagnosis of dementia (an evidence based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 56 1131–1132

    Google Scholar 

  • D Kogure H Matsuda O Takashi et al. (2000) ArticleTitleLongitudinal evaluation of early Alzheimer’s disease using brain perfusion SPECT. J Nucl Med 41 1155–1162 Occurrence Handle1:STN:280:DC%2BD3czpslemsA%3D%3D Occurrence Handle10914904

    CAS  PubMed  Google Scholar 

  • YC Lee RS Liu YC Liao et al. (2003) ArticleTitleStatistical parametric mapping of brain SPECT perfusion abnormalities in patients with Alzheimer’s disease. Eur Neurol 49 142–145 Occurrence Handle10.1159/000069086 Occurrence Handle12646756

    Article  PubMed  Google Scholar 

  • Lehrl S, Merz J, Burkhard G, Fischer S (1991) Mehrfachwahl-Wortschatz-Intelligenztest. Straube, Erlangen

  • H Matsuda (2001) ArticleTitleCerebral blood flow and metabolic abnormalities in Alzheimer’s disease. Ann Nucl Med 5 85–92

    Google Scholar 

  • G McKhann D Drachmann M Folstein R Katzman D Price EM Stadlan (1984) ArticleTitleClinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34 939–944 Occurrence Handle1:STN:280:BiuB2cnis1M%3D Occurrence Handle6610841

    CAS  PubMed  Google Scholar 

  • F Nobili A Brugnolo P Calvini et al. (2005) ArticleTitleResting SPECT-neuropsychology correlation in very mild Alzheimer’s disease. Clin Neurophysiol 116 IssueID2 364–375 Occurrence Handle10.1016/j.clinph.2004.09.001 Occurrence Handle1:CAS:528:DC%2BD2MXkvFOltg%3D%3D Occurrence Handle15661114

    Article  CAS  PubMed  Google Scholar 

  • N Okomura M Shinkawa H Arai et al. (2000) ArticleTitlePrediction of progression in patients with mild cognitive impairment using IMP-SPECT. Nippon Ronen Igakki Zasshi 37 974–978

    Google Scholar 

  • Oswald WD, Fleischmann UM (1997) Nürnberger-Alters-Inventar. Hogrefe, Göttingen

  • SI Rapoport B Horwitz CL Grady JV Haxby C DeCarli MB Schapiro (1991) ArticleTitleAbnormal brain glucose metabolism in Alzheimer’s disease as measured by positron emission tomography. Adv Exp Med Biol 291 231–248 Occurrence Handle1:STN:280:By2D38rltVM%3D Occurrence Handle1927686

    CAS  PubMed  Google Scholar 

  • P Santens H Petit (1997) ArticleTitlePositron emission tomography in dementia. Acta Neurol Belgica 97 192–195 Occurrence Handle1:STN:280:DyaK1c%2FgsFClsg%3D%3D

    CAS  Google Scholar 

  • M Savoiardo M Grisoli (2001) ArticleTitleImaging dementias. Eur J Radiol 11 484–492 Occurrence Handle1:STN:280:DC%2BD3M7pslKksw%3D%3D

    CAS  Google Scholar 

  • P Scheltens ESC Korf (2000) ArticleTitleContribution of neuroimaging in the diagnosis of Alzheimer’s disease and other dementias. Curr Opin Neurol 13 391–396 Occurrence Handle10.1097/00019052-200008000-00005 Occurrence Handle1:STN:280:DC%2BD3M%2Fmt1Knsg%3D%3D Occurrence Handle10970055

    Article  CAS  PubMed  Google Scholar 

  • P Scheltens LJ Launer F Barkhof et al. (1997) ArticleTitleThe diagnostic value of magnetic resonance imaging and technetium 99m-HMPAO single-photon-emission computed tomography for the diagnosis of Alzheimer disease in a community-dwelling elderly population. Alzheimer Dis Assoc Disord 11 63–70 Occurrence Handle1:STN:280:ByiA3sfjvFY%3D Occurrence Handle9194952

    CAS  PubMed  Google Scholar 

  • RL Van Heertum C Drocea M Ichise et al. (2001) ArticleTitleSingle photon emission CT and positron emission tomography in the evaluation of neurologic disease. Update Nucl Med 39 1007–1033 Occurrence Handle1:STN:280:DC%2BD3MrktVyjtA%3D%3D

    CAS  Google Scholar 

  • RL Van Heertum RS Tikofsky (2003) ArticleTitlePositron emission tomography and single-photon emission computed tomography brain imaging in the evaluation of dementia. Sem Nucl Med 33 77–85

    Google Scholar 

  • D Wechsler (1945) ArticleTitleA standardized memory scale for clinical use. J Psychol 19 87–95

    Google Scholar 

  • BD Weiss R Reed EW Kligman et al. (1995) ArticleTitleLitteracy and performance on the Mini-Mental State Examination. J Am Geriatr Soc 43 IssueID7 807–810 Occurrence Handle1:STN:280:ByqA38rlt1A%3D Occurrence Handle7602038

    CAS  PubMed  Google Scholar 

  • H Wolf V Jelic HJ Gertz A Nordberg P Julin LO Wahlund (2003) ArticleTitleA critical discussion of the role of neuroimaging in mild cognitive impairment. Acta Neurol Scand [Suppl] 179 52–76

    Google Scholar 

  • S Yamaguchi K Meguro M Itho et al. (1997) ArticleTitleDecreased cortical glucose metabolism correlates with hippocampal atrophy in Alzheimer’s disease as shown by MRI and PET. J Neurol Neurosurg Psychiatry 62 596–600 Occurrence Handle1:STN:280:ByiA28zksFY%3D Occurrence Handle9219745

    CAS  PubMed  Google Scholar 

  • Zerssen D, Koeller DM (1976) Depressivitäts-Skala. Beltz, Weinheim

  • Zung WWK (1986) Depressions-Status-Inventar (DSI). Fremdbeurteilungsskala. Beltz, Weinheim

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Authors and Affiliations

  1. Department of Neurology, Christian-Doppler-Klinik, Paracelsus University, Salzburg, Austria

    W. Staffen, U. Schönauer, I. Spindler, A. Mair, B. Iglseder & G. Ladurner

  2. Rehabilitation Center of the Pensionsversicherungsanstalt, Großgmain, Austria

    H. Zauner

  3. Institute of Zoology, University of Salzburg, Austria

    G. Bernroider

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  1. W. Staffen
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  2. U. Schönauer
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  3. H. Zauner
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  4. I. Spindler
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  5. A. Mair
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  6. B. Iglseder
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  7. G. Bernroider
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  8. G. Ladurner
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Staffen, W., Schönauer, U., Zauner, H. et al. Brain perfusion SPECT in patients with mild cognitive impairment and Alzheimer’s disease: comparison of a semiquantitative and a visual evaluation. J Neural Transm 113, 195–203 (2006). https://doi.org/10.1007/s00702-005-0321-5

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  • DOI: https://doi.org/10.1007/s00702-005-0321-5

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