radiology of Alzheimer's disease
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Epidemiology
- women with comparable clinical & cognitive measures with mwn have
- higher beta-amyloid deposition
- lower FDG glucose metabolism
- lower MRI gray & white matter volumes compared to the male group
- menopause accentuates these differences between men & women
- hormone replacement therapy mitigates these differences
Radiology
- neuroimaging: MRI preferable to CT
- the American Academy of Neurology affirms neuroimaging is appropriate in the routine initial evaluation of patients with dementia[24]
- computed tomography (CT)
- magnetic resonance imaging (MRI)
- more sensitive than CT to small vessel disease
- functional MRI may be able to detect changes in predementia phase (see FAD3)
- cortical atrophy, parietal, temporal & frontal cortex
- enlargement of lateral ventricles
- thinning of cortical regions spanning the temporal, parietal, & frontal heteromodal association cortices[4][6]
- diminished hippocampal volume adjusted for intracranial volume is a marker for Alzheimer's pathology[7]
- CSF Abeta [1-42] is the earliest marker[7]
- functional magnetic resonance imaging (fMRI)
- impaired grid cell activity (entorhinal cortex) with elevated hippocampal activity identified by fMRI in people age >= 30 years heterozygous for apoE4[8]
- apoE4 heterozygotes demonstrated deficits in test of spatial navigation[8]
- impaired grid cell activity (entorhinal cortex) with elevated hippocampal activity identified by fMRI in people age >= 30 years heterozygous for apoE4[8]
- positron-emission tomography (PET)[1][2]
- sensitivity > specificity
- may show parietal-temporal hypometabolism, a non-specific finding as also occurs in frontotemporal dementia[5]
- 11-C Pittsburgh compound B shows fibrillar amyloid
- imaging for amyloid & tau may be able to identify patients with mild cognitive impairment
- binding of 18F T807 in the brain during PET scanning correlates with Braak staging for Alzheimer's disease
- 18F T807 binding is minimal or localized to the medial temporal lobe in the cognitively normal elderly
- elevated neocortical 18F T807 binding, particularly in the inferior temporal gyrus is associated with cognitive impairment[9] see (18F T807)
- four patterns of 18F FTP tau PET[19]
- limbic-predominant pattern
- medial temporal lobe-sparing pattern
- posterior temporal pattern resembling atypical clinical variants of AD
- lateral temporal pattern resembling atypical clinical variants of AD
- 18F FTP tau PET predicts AD pathology[16]
- predicts location of neurodegeneration 1 year in advance[16]
- 18F FTP tau PET predicts cognitive decline in FAD3 due to PSEN1 E280A mutation[11]
- [18F] Flortaucipir PET in vivo in patient with PSEN1 T116N mutation predicts post-mortem tau pathology[15]
- tau PET predicts cognitive change better than amyloid PET & MRI[20]
- tau PET may support prognosis in preclinical & prodromal stages of AD
- tau PET outperforms amyloid PET or brain MRI in predicting conversion of mild cognitive impairment to dementia[26]
- increased 18F flortaucipir (FTP) tau PET levels associated with declines in all cognitive domains
- amyloid PiB Centiloid values assume less importance in predicting cognitive decline as tau levels increase[23]
- heterogeneous cortical tau PET patterns found inpatients with preclinical AD[22]
- amyloid PET using [18F]-florbetapir
- high sensitivity (0.91) & specificity (0.92) for distinguishing AD from non-AD[17]
- not cost-effective[10]
- both amyloid-positive & amyloid-negative results associated with changes in diagnosis & treatment[12]
- age of symptom onset in sporadic AD correlated with the age an individual reaches a tipping point in amyloid accumulation[21]
- 11C-UCB-J-PET imaging (SV2A) may provide a direct measure of synaptic density[13]
- microtubule-associated protein tau aggregation measured with 18F FTP tau PET & neurodegeneration measured with MRI are closely associated with cognitive decline in Alzheimer's disease[25]
- SPECT not able to distinguish AD from FTD better than neuropsychiatric evaluation[3]
- do not order dopamine transporter SPECT or PET[14]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Small GW et al, PET of brain amyloid and tau in mild cognitive impairment. N Engl J Med 2006, 355:2652 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17182990
- ↑ 2.0 2.1 Edison P, Archer HA, Hinz R, Hammers A, Pavese N, Tai YF, Hotton G, Cutler D, Fox N, Kennedy A, Rossor M, Brooks DJ. Amyloid, hypometabolism, and cognition in Alzheimer disease: an [11C]PIB and [18F]FDG PET study. Neurology. 2007 Feb 13;68(7):501-8. Epub 2006 Oct 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17065593
- ↑ 3.0 3.1 McNeill R et al, Accuracy of single-photon emission computed tomography in differentiating frontotemporal dementia for Alzheimer's disease. J Neurol Neurosurg Psychiatry 2007, 78:350 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17158559
- ↑ 4.0 4.1 Bakkour A et al. The cortical signature of prodromal AD: Regional thinning predicts mild AD dementia. Neurology 2009 Mar 24; 72:1048. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19109536
- ↑ 5.0 5.1 Womack KB et al. Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. Arch Neurol 2011 Mar; 68:329. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21059987
- ↑ 6.0 6.1 Dickerson BC et al. Alzheimer-signature MRI biomarker predicts AD dementia in cognitively normal adults. Neurology 2011 Apr 19; 76:1395. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21490323
- ↑ 7.0 7.1 7.2 Jack CR Jr et al. Evidence for ordering of Alzheimer disease biomarkers. Arch Neurol 2011 Dec; 68:1526. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21825215
- ↑ 8.0 8.1 8.2 Kunz L et al. Reduced grid-cell-like representations in adults at genetic risk for Alzheimer's disease. Science 2015 Oct 23; 350:430. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26494756
- ↑ 9.0 9.1 Johnson KA, Schultz A, Betensky RA et al. Tau positron emission tomographic imaging in aging and early Alzheimer's disease. Ann Neurol 2016 Jan; 79:110 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26505746 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/ana.24546/abstract
- ↑ 10.0 10.1 Boccardi M, Altomare D, Ferrari C et al. Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The Incremental Diagnostic Value of Amyloid PET With [18F]- Florbetapir (INDIA-FBP) study. JAMA Neurol 2016 Oct 31; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27802513 <Internet> http://jamanetwork.com/journals/jamaneurology/article-abstract/2578330
- ↑ 11.0 11.1 George J Tau PET Predicts Decline in Autosomal-Dominant Alzheimer's. Whether findings apply to late-onset Alzheimer's disease is unclear. MedPage Today. Feb 12, 2018 https://www.medpagetoday.com/neurology/alzheimersdisease/71105
Quiroz YT, Sperling RA, Norton DJ et al Association Between Amyloid and Tau Accumulation in Young Adults With Autosomal Dominant Alzheimer Disease. JAMA Neurol. Published online Feb 12, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435558 https://jamanetwork.com/journals/jamaneurology/fullarticle/2671402
McDade E, Bateman RJ Tau Positron Emission Tomography in Autosomal Dominant Alzheimer Disease. Small Windows, Big Picture. JAMA Neurol. Published online Feb 12, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435570 https://jamanetwork.com/journals/jamaneurology/fullarticle/2671395 - ↑ 12.0 12.1 George J, Solomon HA, Caputo D Amyloid PET Changes Diagnosis, Treatment. Dutch study may boost prospects for insurance, Medicare coverage. MedPage Today. June 11, 2018 https://www.medpagetoday.com/neurology/alzheimersdisease/73412
de Wilde A, van der Flier WM, Pelkmans W et al Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort: The ABIDE Project. JAMA Neurol. 2018 Jun 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29889941
Salloway S Improving Evaluation of Patients With Cognitive Impairment With Amyloid Positron Emission Tomography. JAMA Neurol. 2018 Jun 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29889928 - ↑ 13.0 13.1 Chen MK, Mecca AP, Naganawa M et al Assessing Synaptic Density in Alzheimer Disease With Synaptic Vesicle Glycoprotein 2A Positron Emission Tomographic Imaging. JAMA Neurol. Published online July 16, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30014145 https://jamanetwork.com/journals/jamaneurology/fullarticle/2687472
Mormino EC, Jagust WJ. A New Tool for Clinical Neuroscience - Synaptic Imaging. JAMA Neurol. Published online July 16, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30014142 https://jamanetwork.com/journals/jamaneurology/fullarticle/2687466 - ↑ 14.0 14.1 Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 15.0 15.1 Smith R, Wibom M, Pawlik D, Englund E, Hansson O. Correlation of In Vivo [18F]Flortaucipir With Postmortem Alzheimer Disease Tau Pathology. JAMA Neurol. Published online December 3, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30508025 https://jamanetwork.com/journals/jamaneurology/fullarticle/2716833
- ↑ 16.0 16.1 16.2 George J Alzheimer's s Brain Atrophy Predicted by Tau PET - Study identifies location of neurodegeneration a year in advance MedPage Today. Jan 2, 2020 https://www.medpagetoday.com/neurology/alzheimersdisease/84188
La Joie R, Visani AV, Baker SL et al Prospective longitudinal atrophy in Alzheimer's disease correlates with the intensity and topography of baseline tau-PET. Science Translational Medicine 01 Jan 2020: 12(524): eaau5732 Not yet indexed in PubMe https://stm.sciencemag.org/content/12/524/eaau5732 - ↑ 17.0 17.1 Fink HA, Linskens EJ, Silverman PC et al Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia: A systematic review. Ann Intern Med 2020 May 19; 172:669. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32340038 https://www.acpjournals.org/doi/10.7326/M19-3888
- ↑ George J Alzheimer's May Develop Differently in Women - Brain changes appear years earlier in women than in men, imaging shows. MedPage Today June 24, 2020 https://www.medpagetoday.com/neurology/alzheimersdisease/87246
Rahman A, Schelbaum E, Hoffman K et al Sex-driven modifiers of Alzheimer risk. A multimodality brain imaging study. Neurology. June 24, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32580974 https://n.neurology.org/content/early/2020/06/24/WNL.0000000000009781 - ↑ 19.0 19.1 Vogel JW, Young AL, Oxtoby NP et al Four distinct trajectories of tau deposition identified in Alzheimer's disease. Nature Medicine. 2021. April 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33927414 https://www.nature.com/articles/s41591-021-01309-6
- ↑ 20.0 20.1 Ossenkoppele R, Smith R, Mattsson-Carlgren N et al Accuracy of Tau Positron Emission Tomography as a Prognostic Marker in Preclinical and Prodromal Alzheimer Disease. A Head-to-Head Comparison Against Amyloid Positron Emission Tomography and Magnetic Resonance Imaging. JAMA Neurol. Published online June 28, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34180956 https://jamanetwork.com/journals/jamaneurology/fullarticle/2781465
- ↑ 21.0 21.1 George J Amyloid Tipping Point Helps Predict Alzheimer's Dementia Onset. Algorithm requires only one PET scan and age. MedPage Today September 20, 2021 https://www.medpagetoday.com/neurology/alzheimersdisease/94605
Schindler S, Li Y, Buckles VD et al Predicting Symptom Onset in Sporadic Alzheimer Disease With Amyloid PET. Neurology. 2021. September 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34504028 https://n.neurology.org/content/early/2021/09/09/WNL.0000000000012775 - ↑ 22.0 22.1 Young CB, Winer JR, Younes K et al Divergent Cortical Tau Positron Emission Tomography Patterns Among Patients With Preclinical Alzheimer Disease. JAMA Neurol. Published online April 18, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35435938 https://jamanetwork.com/journals/jamaneurology/fullarticle/2790807
- ↑ 23.0 23.1 23.2 23.3 23.4 Farrell ME, Papp KV, Buckley RF et al. Association of emerging beta-amyloid and tau pathology with early cognitive changes in clinically normal older adults. Neurology 2022 Apr 12; 98:e1512. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35338074 PMCID: PMC9012271 (available on 2023-04-12) https://n.neurology.org/content/98/15/e1512
- ↑ 24.0 24.1 NEJM Knowledge+ Question of the week. Feb 14, 2022 https://knowledgeplus.nejm.org/question-of-week/1614/
Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and Management of Dementia: Review JAMA. 2019 Oct 22;322(16):1589-1599 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31638686 PMCID: PMC7462122 Free PMC article https://jamanetwork.com/journals/jama/fullarticle/2753376 - ↑ 25.0 25.1 Singleton EH et al Dynamic associations between tau aggregation, atrophy, and cognitive decline in Alzheimer's disease. medRxiv. 2024. July 21 Not indexed in PubMed https://www.medrxiv.org/content/10.1101/2024.07.20.24310441v1.full
- ↑ 26.0 26.1 Groot C, Smith R, Collij LE et al. Tau positron emission tomography for predicting dementia in individuals with mild cognitive impairment. JAMA Neurol 2024 Aug; 81:845-856 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38857029 PMCID: PMC11165418 Free PMC article https://jamanetwork.com/journals/jamaneurology/fullarticle/2819811