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Role of Diagnostic Imaging
in Dementia
Satoshi Minoshima, MD, PhD
Radiology & Imaging Sciences
University of Utah
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• Neurodegenerative Diseases
Alzheimer’s disease (AD)
Dementia with Lewy bodies (DLB)
Frontotemporal dementia (FTD)
Other atypical neurodegenerative disorders
• Acquired Brain Disorders
Vascular dementia
Intracranial neoplasms, trauma
Hydrocephalus
Encephalitis (e.g., Creutzfeldt-Jakob, paraneoplastic)
Multiple sclerosis
Infection, metabolic, endocrine disorders
Examples of Dementing Disorders
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ChE Inhibitor Neuroleptics
Alzheimer’s disease (AD) Good Applicable
Dementia with Lewy
bodies (DLB)Excellent Adverse reaction
Frontotemporal Dementia
(FTD)No effect Applicable
Vascular Dementia (VaD) Risk factor / vascular management
Therapeutic Implications
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Dementia Clinical Workup
• Interview with patient / family member
• Physical examination
• Neurological examination
• Mental status examination (MMSE)
• Assessment for functional status
• Laboratory tests (e.g., CBC, thyroid, B12)
• Neuropsychological examination
• Neuroimaging (CT or MRI, PET or SPECT)
• EEG, lumbar puncture (when required)
• Genetic test (e.g., APOE) - not clinically accepted
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• Excluding structural abnormalities
• Differential diagnosis
• Early diagnosis
• Therapeutic trials
Roles of Imaging in Dementia Care
• Excluding structural abnormalities CT / MRI
• Differential diagnosis
• Early diagnosis PET / SPECT / MRI
• Therapeutic trials
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T1-weighted T2-weighted FLAIR
Magnetic Resonance Imaging (MRI)
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Cerebral
infarction
Microvascular
ischemia
MRI Findings in Dementia Patients
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Alzheimer’s disease No dementia
FDG PET shows more marked abnormalities.Which patient has Alzheimer’s disease?
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CBF SPECT FDG PET DAT SPECT Amyloid PET
Molecular Imaging in Neurology Clinic 2017
Perfusion Glucose Dopamine Amyloid
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Minoshima et al. J Nucl Med 1995
Computer-Assisted Diagnosis of PET / SPECT
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Minoshima et al. 2002
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Robin Smithuis, Radiology Department of the Rijnland Hospital, Leiderdorp, the Netherlands
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Posterior Cingulate CortexRegional Vulnerability in Alzheimer’s Disease
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MCI: Prediction of Conversion to AD
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Amyloid
Senile Plaque
Neurofibrillary tangle
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Rowe CC and Villemagne VL J Nucl Med 2011;52:1733-1740 Chet Mathis, ALZForum
Negative Positive
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Lewy Body
dementia
[18F]FDG PET
metabolism
[123I]FP-CIT SPECTDopamin transporters
Alzheimer
dementia
[11C]PIB PET Beta-
amyloid
Dementia with Lewy bodies vs. AD
Drzezga, Technical University of Munich
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• Unexplained MCI, persistent and progressive
• Possible AD with an atypical clinical course or an
etiologically mixed presentation
• Atypically early age of onset (65 years or less)
Appropriate Use of Amyloid PET
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• Monoclonal antibodies
• β-secretase inhibitors
• γ-secretase inhibitors
• Aβ fibril aggregation inhibitors
• Aβ plasma clearance enhancer
• Active Aβ vaccine
Amyloid-targeting Therapy
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Amyloid PET Assessment of Therapy
Rinne, Brooks, Rossor et al., Lancet Neurol 2010;9:363-372
Bapineuzumab
Screening Follow up (78 weeks)
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Summary
• Molecular imaging using nuclear technologies
• FDG PET, Amyloid PET, Perfusion SPECT, and
Dopamine transporter SPECT
• Differential diagnosis
• Early diagnosis
• Therapeutic trials
Role of Imaging in Dementia Care
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Thank you