We see indicators of Alzheimer’s disease and other dementias years before clinical symptoms show up

According to the Alzheimer’s Association, there are approximately 5.3 million people of all ages in the U.S. with Alzheimer’s disease and another 1 million with other types of dementia. It is estimated that by 2050, there will be 23 million people worldwide with some form of dementia. Women are twice as likely as men to get Alzheimer’s.

At CereScan, we strictly adhere to the 2014 American College of Radiology Practice Guidelines for SPECT brain imaging. Part II of these guidelines contain the indications when SPECT brain imaging should be used and the first indication is for, “Evaluating patients with suspected dementia.” The common belief is that Alzheimer’s can only truly be diagnosed in an autopsy. That is no longer true. Both SPECT and PET/CT imaging, when done properly and with advanced processing software, allow CereScan’s reading specialists to differentiate Alzheimer’s disease from other forms of dementia, antemortem.

Misdiagnosis of Alzheimer’s disease is unfortunately all too common. In one study, Dr. Lon White (professor of geriatric medicine at Univ. of Hawaii) conducted autopsies on 400 Japanese men previously diagnosed with Alzheimer’s. Only half of these brains showed the familiar beta amyloid plaques associated with Alzheimer’s. The other half had other forms of dementia such as Lewy Bodies, stroke related dementia, brain injury related dementia, or various co-morbid combinations of these. A second study with another 400 subjects showed very similar results.

“Diagnosing specific dementias . . . is complex, but with the large increase in dementia cases expected within the next 10 years in the United States, it will be increasingly important to correctly recognize, diagnose, prevent and treat age-related cognitive decline,” said study author Dr. Lon White in a news release from the American Academy of Neurology.

Recent scientific studies clearly show that neuroimaging of the type performed at CereScan can improve a doctor’s clinical accuracy in properly diagnosing Alzheimer’s Disease from the 70% – 80% range into the 90%+ accuracy range. CereScan’s functional brain imaging provides valuable information for differentiating between these various dementias. If your patients show clinical symptoms and/or have a family history of dementia, a quantitative brain scan can show patterns of perfusion levels in the brain that will indicate the type of dementia, or if it is dementia at all. Our PET/CT imaging will provide an evaluation of dementia; SPECT imaging will also evaluate dementia and in addition will provide a more comprehensive assessment of your patient’s brain condition.

Becoming more forgetful as age increases is usually normal and may not be an indication of any brain disorder. However, if certain risk factors exist, you may want to investigate further. These risk factors include:

  • Family history of dementia
  • Previous head injuries
  • Poor cardiovascular health
  • High blood pressure
  • Stroke
  • High cholesterol
  • Diabetes
  • Obesity in middle age
  • Smoking

There are many causes of cognitive decline other than dementia. For example, a brain infection may lead to symptoms that look like dementia, and brain infections are usually treatable. Thyroid problems and certain vitamin deficiencies can also masquerade as cognitive decline even in the absence of dementia. CereScan’s neuroimaging capabilities can give you a clear assessment of what is really going on in a person’s brain.

The sequelae of a traumatic brain injury include memory loss, cognitive decline, foggy thinking, verbal difficulties, and concentration problems. It is difficult to arrive at a confident diagnosis when clinical symptoms overlap. A clear picture of brain functioning via CereScan’s advanced imaging can provide the evidence you need to make an accurate diagnosis and develop an appropriate treatment plan. Outcomes will be better and your patients will most certainly be happier.

If you have questions, we have answers. Call today to learn more about our diagnostic brain imaging. Call toll-free at 866-722-4806.

Relevant Literature

ACR-SPR Practice Parameter for the Performance of Single Photon Emission Computed Tomography (SPECT) Brain Perfusion and for Brain Death Examinations. (2014). American College of Radiology. http://www.acr.org/~/media/55108DB59AFD44FDB0E5339DC73DC821.pdf

Almkvist O, Axelman K, Basun H, Jensen M, Viitanen M, Wahlund LO, Lannfelt L (2003). Clinical findings in nondemented mutation carriers predisposed to Alzheimer’s disease: a model of mild cognitive impairment. Acta Neurol.Scand Suppl 179: 77-82. http://www.ncbi.nlm.nih.gov/pubmed/12603253

Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, et al. (2011). Molecular neuroimaging in the study of cognitive impairment: contribution of the cerebral blood flow SPECT with 99mTc-HMPAO and 18F-FDG PET/CT scan. Rev Esp Med Nucl. 2011 Sep-Oct;30(5):301-6. http://www.ncbi.nlm.nih.gov/pubmed/21640440

Bonte FJ, Harris TS, Roney CA, Hynan LS (2004). Differential diagnosis between Alzheimer’s and frontotemporal disease by the posterior cingulate sign. J Nucl Med 45: 771-774. http://www.ncbi.nlm.nih.gov/pubmed/15136625

Bonte FJ, Harris TS, Hynan LS, Bigio EH, White CL III (2006). Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation. Clin Nucl Med 31: 376-378. http://www.ncbi.nlm.nih.gov/pubmed/16785801

Cappa A, Calcagni ML, Villa G, Giordano A, Marra C, De Rossi G, Puopolo M, Gainotti G (2001). Brain perfusion abnormalities in Alzheimer’s disease: comparison between patients with focal temporal lobe dysfunction and patients with diffuse cognitive impairment. Journal of Neurology, Neurosurgery, and Psychiatry 70: 22-27. http://www.ncbi.nlm.nih.gov/pubmed/11118243

Davison, CM, O’Brien JT (2014). A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. Int J Geriatr Psychiatry. 29(6):551-61. http://www.ncbi.nlm.nih.gov/pubmed/24123413

Devous MD, Sr. (2002). Functional brain imaging in the dementias: role in early detection, differential diagnosis, and longitudinal studies. Eur.J.Nucl.Med.Mol.Imaging 29: 1685-1696. http://www.ncbi.nlm.nih.gov/pubmed/12458405

Engel P, Cummings JL, Villanueva-Meyer J, Mena I (1993). Single photon emission computed tomography in dementia: relationship of perfusion to cognitive deficits. J Geriatr.Psychiatry Neurol. 6: 144-151. http://www.ncbi.nlm.nih.gov/pubmed/8397758

Golan H, Kremer J, Freedman M, Ichise M (1996). Usefulness of follow-up regional cerebral blood flow measurements by single-photon emission computed tomography in the differential diagnosis of dementia. J Neuroimaging 6: 23-28.  http://www.ncbi.nlm.nih.gov/pubmed/8555659

Hanada K, Hosono M, Kudo T, Hitomi Y, Yagyu Y, Kirime E, Komeya Y, Tsujii N, Hitomi K, Nishimura Y (2006). Regional cerebral blood flow in the assessment of major depression and Alzheimer’s disease in the early elderly. Nucl Med Commun. 27: 535-541. http://www.ncbi.nlm.nih.gov/pubmed/16710109

Hanyu H, Abe S, Arai H, Asano T, Iwamoto T, Takasaki M (1993). Diagnostic accuracy of single photon emission computed tomography in Alzheimer’s disease. Gerontology 39: 260-266. http://www.ncbi.nlm.nih.gov/pubmed/8314092

Huang C, Wahlund LO, Svensson L, Winblad B, Julin P (2002). Cingulate cortex hypoperfusion predicts Alzheimer’s disease in mild cognitive impairment. BMC Neurology 2:9. http://www.ncbi.nlm.nih.gov/pubmed/12227833

Ishii, K. (2014). Imaging diagnosis of dementia. Nihon Rinsho. 72(4):681-6. http://www.ncbi.nlm.nih.gov/pubmed/24796097

Ishiwata A, Sakayori O, Minoshima S, Mizumura S, Kitamura S, Katayama Y (2006). Preclinical evidence of Alzheimer changes in progressive mild cognitive impairment: a qualitative and quantitative SPECT study. Acta Neurol.Scand 114: 91-96. http://www.ncbi.nlm.nih.gov/pubmed/16867030

Jobst KA, Barnetson LP, Shepstone BJ (1998). Accurate 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. http://www.ncbi.nlm.nih.gov/pubmed/9785148

Johnson KA, Moran EK, Becker JA, Blacker D, Fischman AJ, Albert MS (2007). Single photon emission computed tomography perfusion differences in mild cognitive impairment. J Neurol.Neurosurg.Psychiatry 78: 240-247. http://www.ncbi.nlm.nih.gov/pubmed/17056633

Kogure D, Matsuda H, Ohnishi T, Asada T, Uno M, Kunihiro T, Nakano S, Takasaki M (2000). Longitudinal evaluation of early Alzheimer’s disease using brain perfusion SPECT. J Nucl Med 41: 1155-1162. http://www.ncbi.nlm.nih.gov/pubmed/10914904

Matsuda H (2007). Role of Neuroimaging in Alzheimer’s Disease, with Emphasis on Brain Perfusion SPECT. J Nucl Med. http://www.ncbi.nlm.nih.gov/pubmed/17631544

McKeith IG, Burn DJ, Ballard CG, Collerton D, Jaros E, Morris CM, McLaren A, Perry EK, Perry R, Piggott MA, O’Brien JT (2003). Dementia with Lewy bodies. Semin.Clin Neuropsychiatry 8: 46-57. http://www.ncbi.nlm.nih.gov/pubmed/12567332

O’brien JT (2007). Role of imaging techniques in the diagnosis of dementia. Br.J.Radiol. 80 Spec No 2: S71-S77.  http://www.ncbi.nlm.nih.gov/pubmed/17135460

O’Brien JT, Firbank MJ, Davison C, Barnett N, et al. (2014). 18F-FDG PET and perfusion SPECT in the diagnosis of Alzheimer and Lewy body dementias. J Nucl Med. 55(12):1959-65. http://www.ncbi.nlm.nih.gov/pubmed/25453043

Osimani A, Ichise M, Chung DG, Pogue JM, Freedman M (1994). SPECT for differential diagnosis of dementia and correlation of rCBF with cognitive impairment. Can.J Neurol.Sci. 21: 104-111. http://www.ncbi.nlm.nih.gov/pubmed/8087734

Pulli, B, Chen, JW (2014). Imaging Neuroinflammation – from Bench to Bedside. J Clin Cell Immunol. 5. pii: 226. http://omicsonline.org/open-access/imaging-neuroinflammation-from-bench-to-bedside-2155-9899.1000226.php?aid=27597

Santra A, Sinha GK, Neogi R, Thukral RK. (2014). (99m)Tc-hexamethyl propyleneamine oxime brain perfusion single photon emission computed tomography in characterization of dementia: an initial experience in Indian clinical practice. World J Nucl Med. 13(2):120-7.  http://www.ncbi.nlm.nih.gov/pubmed/25191127

Starkstein SE, Migliorelli R, Tesón A, Sabe L, Vázquez S, Turjanski M, Robinson RG, Leiguarda R (1994). Specificity of changes in cerebral blood flow in patients with frontal lobe dementia. Journal of Neurology, Neurosurgery, and Psychiatry 57: 790-796.http://www.ncbi.nlm.nih.gov/pubmed/8021663

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