imaging in dementia: options for clinical practice 2014 2015+ john a. bertelson, md clinical chief...

Imaging in Imaging in Dementia:Dementia:

Options for Clinical Practice Options for Clinical Practice 2014 2015+2014 2015+

John A. Bertelson, MDJohn A. Bertelson, MD

Clinical Chief of Neurology, Seton Brain and Spine Clinical Chief of Neurology, Seton Brain and Spine InstituteInstitute

Assistant Professor of Medicine, Dell Medical Assistant Professor of Medicine, Dell Medical School, UT AustinSchool, UT Austin

Clinical Assistant Professor of Psychology, UT Clinical Assistant Professor of Psychology, UT AustinAustin

DisclosuresDisclosures

NoneNone

OutlineOutline Early ImagingEarly Imaging

Indications for Imaging in DementiaIndications for Imaging in Dementia

Imaging TechniquesImaging Techniques MRIMRI PETPET

Imaging of Alzheimer’s DiseaseImaging of Alzheimer’s Disease

Future DirectionsFuture Directions

Early Imaging ModalityEarly Imaging Modality

What am I?What am I? Initially described in Initially described in

1918 1918 11

Low resolutionLow resolution High morbidity, High morbidity,

including:including: Meningeal irritation, 6 hrs:Meningeal irritation, 6 hrs:

HeadacheHeadache NauseaNausea EmesisEmesis

Elevation in BPElevation in BP Became obsolete in 1971Became obsolete in 1971

1: AJNR 2012

Early Dementia ImagingEarly Dementia Imaging


1918 1918 11





1: AJNR 20122: http://www.isradiology.org/tropical_deseases/tmcr/chapter45/imaging.htm

2

Early Dementia ImagingEarly Dementia Imaging


1918 1918 11





PneumoencephalographyPneumoencephalography

1: AJNR 20122: http://www.isradiology.org/tropical_deseases/tmcr/chapter45/imaging.htm

2

Pneumoencephalogram: Pneumoencephalogram: “dementia paralytica”“dementia paralytica”

Hydrocephalus “ex vacuo” pattern with diffuse widening of the cortical sulci

Ciudad Sanitaria Provincial, Madrid SpainJNNP 1979

Modern ImagingModern Imaging

Traditional Role for Traditional Role for Neuroimaging in DementiaNeuroimaging in Dementia

IndicationIndication: Rule out reversible process : Rule out reversible process

Quality Standards Subcommittee of the AAN, 1994:Quality Standards Subcommittee of the AAN, 1994:

““Neuroimaging should be considered in every patient with Neuroimaging should be considered in every patient with dementia”dementia”

“… “… potentially treatable disorders that can otherwise be potentially treatable disorders that can otherwise be missed, such as tumors, subdural hematomas, missed, such as tumors, subdural hematomas, hydrocephalus, and strokes.”hydrocephalus, and strokes.”

“… “… there is no consensus on the need for such studies in there is no consensus on the need for such studies in the evaluation of patients with the insidious onset of the evaluation of patients with the insidious onset of dementia after age 60 without focal signs or symptoms, dementia after age 60 without focal signs or symptoms, seizures, or gait disturbances.”seizures, or gait disturbances.”

Alter M, 1994

Evolution of Indications for Evolution of Indications for Neuroimaging in DementiaNeuroimaging in Dementia

From: Bertelson and Ajtai, 2014

Entit

yYear Recommendations

AAN 1994 Neuroimaging is not routinely recommended

CCC

D1999

Neuroimaging (head CT) is recommended only in select

situations

AAN 2001

Structural neuroimaging (noncontrast CT or MRI) is

appropriate in the routine initial evaluation of patients with

dementia

EFNS 2007

Structural imaging is recommended in every patient

suspected of dementia:

-Noncontrast CT can identify surgically treatable lesions and

vascular disease.

-To increase specificity, MRI should be used.

EFNS 2012

Structural imaging (CT or MRI) is recommended in the

routine evaluation of every patient with dementia, to

exclude secondary causes of dementia.

Key: AAN: American Academy of Neurology CCD: Canadian Consensus Conference on Dementia EFNS: European Federation of Neurological Subspecialties

Reversible Causes of DementiaReversible Causes of DementiaCopenhagen Memory ClinicCopenhagen Memory Clinic

Potentially reversible etiologies for cognitive symptomsIn 1000 memory clinic patients

Hejl A 2002

4-5%

Neuroimaging in DementiaNeuroimaging in Dementia

Imaging Imaging ModalitiesModalities

Magnetic Resonance ImagingMagnetic Resonance Imaging

Positron Emission Positron Emission TomographyTomography

Magnetic Resonance Magnetic Resonance Imaging (MRI)Imaging (MRI)

Minimum MRI Minimum MRI Sequences for Dementia Sequences for Dementia

EvaluationEvaluation Multiplanar ImagingMultiplanar Imaging

Axial, coronal, sagittalAxial, coronal, sagittal

Multiple ModalitiesMultiple Modalities T1W, T2W, FLAIR, DWIT1W, T2W, FLAIR, DWI

Screening for Abnormal Blood ProductsScreening for Abnormal Blood Products GRE or SWIGRE or SWI

Contrast-Enhanced (select situations)Contrast-Enhanced (select situations)

Other MR ModalitiesOther MR Modalities Volumetric MRIVolumetric MRI

CSF flow studiesCSF flow studies

MR spectroscopyMR spectroscopy

fMRIfMRI

Diffusion tensor (DTI)Diffusion tensor (DTI)

MR perfusionMR perfusion

Other MR ModalitiesOther MR Modalities Volumetric MRIVolumetric MRI

CSF flow studiesCSF flow studies

MR spectroscopyMR spectroscopy

fMRIfMRI

Diffusion tensor (DTI)Diffusion tensor (DTI)

MR perfusionMR perfusion

Semi-routinely Semi-routinely utilized for clinical utilized for clinical assessment of assessment of dementiadementia

Rapidly progressive Rapidly progressive dementiadementia

““Hockey stick” signHockey stick” sign DWI hyperintensity in DWI hyperintensity in

the bilateral medial the bilateral medial thalami and pulvinarthalami and pulvinar

Variant Creutzfeldt-Variant Creutzfeldt-Jakob Disease (vCJD)Jakob Disease (vCJD)


Positron Positron Emission Emission

Tomography Tomography (PET)(PET)

FDG PET Medicare CoverageFDG PET Medicare CoverageDementia and Neurodegenerative Dementia and Neurodegenerative

DiseasesDiseases

Effective 9/15/2004,Effective 9/15/2004,

““An FDG PET scan is considered reasonable An FDG PET scan is considered reasonable and necessary in patients with:and necessary in patients with:

a recent diagnosis of dementia,a recent diagnosis of dementia,

documented cognitive decline of at least 6 documented cognitive decline of at least 6 months, months,

meet diagnostic criteria for both AD and FTD.” meet diagnostic criteria for both AD and FTD.”

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_Part4.pdf

FDG PET Medicare CoverageFDG PET Medicare CoverageDementia and Neurodegenerative Dementia and Neurodegenerative

DiseasesDiseases Additional prerequisites include:Additional prerequisites include:

Comprehensive evaluation already completed, Comprehensive evaluation already completed, including brain CT or MRIincluding brain CT or MRI

Evaluation by “a physician experienced in the Evaluation by “a physician experienced in the diagnosis and assessment of dementia”diagnosis and assessment of dementia”

Evaluation is indeterminate and FDG PET is Evaluation is indeterminate and FDG PET is reasonably expected to clarify the diagnosis reasonably expected to clarify the diagnosis between FTD and ADbetween FTD and AD

SPECT or PET have SPECT or PET have notnot already been obtained in already been obtained in the past 12 months AND significant clinical the past 12 months AND significant clinical changes have occurredchanges have occurred

FDG PETFDG PET

ADAD

FTDFTD PPAPPA


Parkinson-plus syndromeParkinson-plus syndromeAtrophicmidbrain

Normalmidbrain

Reduced APmidbrain diameter


Parkinson-plus syndromeParkinson-plus syndromeAtrophicmidbrain

Normalmidbrain

Reduced APmidbrain diameter

Progressive Supranuclear Palsy

Alzheimer’s Alzheimer’s Disease (AD)Disease (AD)

Alzheimer’s DiseaseAlzheimer’s Disease

The most common cause of The most common cause of dementiadementia

Affects over 5 million Americans Affects over 5 million Americans

6th leading cause of death for 6th leading cause of death for people in the USpeople in the US

Affects 1 in 9 age 65 and older,Affects 1 in 9 age 65 and older,

1 in 3 over age 851 in 3 over age 85

About 10% of people have early About 10% of people have early onset which affects people under onset which affects people under age 65age 65

Histopathologic Hallmarks of ADHistopathologic Hallmarks of AD

Major histopathologic hallmarks includeMajor histopathologic hallmarks include Amyloid-Amyloid- plaques plaques Neurofibrillary tanglesNeurofibrillary tangles Neuronal and synaptic lossNeuronal and synaptic loss

AP = amyloid plaques.NFT = neurofibrillary tangles.Courtesy of Albert Enz, PhD, Novartis Pharmaceuticals Corporation.

AP NFT

Model of the Dynamic Model of the Dynamic Biomarkers of Alzheimer’s Biomarkers of Alzheimer’s

DiseaseDisease

Sperling RA, 2011

NIA-AA Diagnostic Criteria for NIA-AA Diagnostic Criteria for Dementia due to Alzheimer’s Dementia due to Alzheimer’s

DiseaseDisease Probable AD dementia Probable AD dementia

Possible AD dementia Possible AD dementia

Pathophysiologically Pathophysiologically proved AD dementiaproved AD dementia

Dementia unlikely to be Dementia unlikely to be due to ADdue to AD

McKhann GM, 2011

NIA-AA Diagnostic Criteria for NIA-AA Diagnostic Criteria for Dementia due to Alzheimer’s Dementia due to Alzheimer’s

DiseaseDisease Probable AD dementia Probable AD dementia

w/ evidence of the AD w/ evidence of the AD pathophysiological pathophysiological processprocess

Possible AD dementia Possible AD dementia w/ evidence of the AD w/ evidence of the AD

pathophysiological pathophysiological processprocess

Pathophysiologically Pathophysiologically proved AD dementiaproved AD dementia

Dementia unlikely to be Dementia unlikely to be due to ADdue to AD

““To improve the To improve the certainty that the certainty that the basis of the clinical basis of the clinical dementia syndrome dementia syndrome is the AD is the AD pathophysiological pathophysiological process”process”

McKhann GM, 2011

Biomarker

Biomarker

AD Biomarkers AD Biomarkers NIA-AA Criteria (2011)NIA-AA Criteria (2011)

Brain Aß Brain Aß amyloidosisamyloidosis PIB/florbetapir-PETPIB/florbetapir-PET

↓ ↓ CSF Aß-42CSF Aß-42

Neuronal injuryNeuronal injury FDG-PETFDG-PET

↑ ↑ CSF-tauCSF-tau

MRI atrophyMRI atrophy Medial temporal Medial temporal

lobeslobes ParalimbicParalimbic Temporoparietal Temporoparietal

cortexcortex

Imaging Findings in ADImaging Findings in AD MRIMRI

Early: “Normal” or medial temporal atrophyEarly: “Normal” or medial temporal atrophy Late: Generalized atrophyLate: Generalized atrophy

FDG PETFDG PET Early: Hypometabolism in the temporal/parietal regions Early: Hypometabolism in the temporal/parietal regions Late: Generalized hypometabolism (with sparing of Late: Generalized hypometabolism (with sparing of

primary sensorimotor cortex)primary sensorimotor cortex)

Amyloid PETAmyloid PET All stages: Generalized cortical amyloid depositionAll stages: Generalized cortical amyloid deposition Amyloid binding may also occur with normal agingAmyloid binding may also occur with normal aging

MRI and ADMRI and AD

MRI and AD: AtrophyMRI and AD: Atrophy

Coronal MRI can demonstrate progressive medial temporal and generalized atrophy in patients with AD

Automated volumetric MRI Automated volumetric MRI analysisanalysis

Hippocampal Volume Hippocampal Volume Eval.Eval.

NeuroQuant®, CorTechs NeuroQuant®, CorTechs LabsLabs

Commercially availableCommercially available

Reported:Reported: Volumes of hippocampi (HV) Volumes of hippocampi (HV)

and inferior lateral ventricle and inferior lateral ventricle (ILV)(ILV)

Volumes as % of intracranial Volumes as % of intracranial volumevolume

Normative %, based on age Normative %, based on age and genderand gender

Inferior Lateral Vent.

Hippocampus

Volumetric MRI Analysis- Volumetric MRI Analysis- NeuroQuant®NeuroQuant®

http://www.cortechs.net/products/neuroquant.php

Progressive Cognitive Progressive Cognitive DeclineDeclineT=0 years T=3 years T=8 years

Progressive Cognitive Progressive Cognitive DeclineDeclineT=0 years T=3 years T=8 years

PRIMARY

PROGRESSIVE

APHASIA

““PET” and PET” and DementiaDementia

FDG PETFDG PET

Amyloid PETAmyloid PET

FDG PET in ADFDG PET in AD

Profoundly diminished [18F]FDG uptake in the temporoparietal and parietal regions bilaterally (arrows), seen on (A) axial and (B) parasagittal images


Pittsburgh Compound-B Pittsburgh Compound-B (PIB)(PIB) Radiolabeled thioflavin Radiolabeled thioflavin

derivativederivative

[N-methyl-(11)C]2-(4’-[N-methyl-(11)C]2-(4’-methylaminophenyl)-6-methylaminophenyl)-6-hydroxybenzothiazolehydroxybenzothiazole

Selectively binds to amyloid Selectively binds to amyloid plaque and cerebrovascular plaque and cerebrovascular amyloidamyloid

Significant retention seen Significant retention seen in:in:

90+% AD patients90+% AD patients 60% patients with MCI60% patients with MCI 30% “normal” elderly30% “normal” elderly

Very short half life: 20 Very short half life: 20 minutesminutes

Amyloid Imaging:Amyloid Imaging:Pittsburgh Compound-B PETPittsburgh Compound-B PET

Mathis J Med Chem 2003;46(13)Applied Neurology, Nov. 2005 (suppl)

Mosconi J Alzheimer’s Dis 2010

T1W-MRI PIB- PET

Con

trol

AD

Commercially Available Commercially Available Amyloid-binding Amyloid-binding RadionucleotidesRadionucleotides

Florbetapir (Amyvid) Florbetapir (Amyvid) 11

Marketed in US by Eli LillyMarketed in US by Eli Lilly Approved by FDA, not covered by CMS for Approved by FDA, not covered by CMS for

routine use routine use 22

Half life 110 minutesHalf life 110 minutes

Additional FDA-approved radionucleotides Additional FDA-approved radionucleotides 33

Florbetaben (Neuraceq, Piramal Imaging)Florbetaben (Neuraceq, Piramal Imaging) Flutemetamol (Vizamyl, GE Healthcare)Flutemetamol (Vizamyl, GE Healthcare)

1: Florbetapir, package insert2: CMS Memo (CAG-00431N)3: Alzforum, downloaded 8.5.14

But…But…

AAẞẞ burden as assessed by burden as assessed by positron emission positron emission

tomography(PET) does tomography(PET) does notnot strongly correlate with strongly correlate with

cognitive impairment in AD cognitive impairment in AD patientspatients

Tau ImagingTau Imaging

Human postmortem studies have Human postmortem studies have shown that it is the density of NFTs shown that it is the density of NFTs and not of Aand not of Aẞẞ insoluble plaques that insoluble plaques that strongly correlates with strongly correlates with neurodegeneration and cognitive neurodegeneration and cognitive deficits.deficits.

Villemagne 2014

Tau ImagingTau Imaging

PhosphoproteinPhosphoprotein 6 isoforms6 isoforms

Stabilizes microtubulesStabilizes microtubules Cytoskeletal supportCytoskeletal support Intracellular transport (organelles, Intracellular transport (organelles,

neurotransmitters, etc)neurotransmitters, etc)

Associated with AD, PSP, CBGD, CTE, Associated with AD, PSP, CBGD, CTE, and several variants of FTD.and several variants of FTD.

Neurofibrillary Tangles

.

AD and the Brain

NIA/ADEAR

Progression of tau Progression of tau deposition in ADdeposition in AD

Braack and Braak (I-VI), and Delacourte staging (S1-10)

Villemagne 2015

Tau TracersTau Tracers

Villemagne 2014

AD hemibrain sectionsAD hemibrain sectionsTau and Amyloid imagingTau and Amyloid imaging

Tau ImmunohistochemistryTau Immunohistochemistry

Villemagne 2014

MRI and tau/aMRI and tau/aẞ ẞ PETPET

Villemagne 2015

Other Degenerative Other Degenerative DementiasDementias

Frontotemporal dementia (FTD)Frontotemporal dementia (FTD) Vascular dementia (VAD)Vascular dementia (VAD) Chronic traumatic encephalopathy Chronic traumatic encephalopathy

(CTE)(CTE) Lewy Body dementia (LBD)Lewy Body dementia (LBD) Parkinson’s disease dementia (PDD)Parkinson’s disease dementia (PDD) EtcEtc

What’s next??What’s next??

Wider utilization of biomarkers to:Wider utilization of biomarkers to: Clarify the diagnosisClarify the diagnosis Monitor response to disease modifying agentsMonitor response to disease modifying agents

Greater implementation of multimodal imagingGreater implementation of multimodal imaging

LimitationsLimitations CostCost Access to advanced imagingAccess to advanced imaging Inadequacy of response to disease modifying agentsInadequacy of response to disease modifying agents

Clinical, genetic, and pathological Clinical, genetic, and pathological spectrum of misfolded proteins in spectrum of misfolded proteins in

neurodegenerative diseaseneurodegenerative disease

Villemagne 2015

Multimodal Imaging- tau Multimodal Imaging- tau and Aand Aẞẞ

Tau -/ATau -/Aẞẞ - -

Tau +/ATau +/Aẞẞ + +

Tau -/ATau -/Aẞẞ + +

Tau +/ATau +/Aẞẞ - -

Normal aging, depression, Normal aging, depression, medsmeds

Alzheimer’s disease, Alzheimer’s disease, AD/LBDAD/LBD

Premorbid AD, normal Premorbid AD, normal agingaging

CTE, FTD, MSA > ADCTE, FTD, MSA > AD

What should I do What should I do todaytoday??????

I want to work up a patient with cognitive I want to work up a patient with cognitive symptoms. What imaging modality should I symptoms. What imaging modality should I order?order?

““I'm sorry, my responses are limited. You must ask the I'm sorry, my responses are limited. You must ask the right question.”right question.”

Hologram of Dr. Lanning (James Cromwell) to Det. Spooner Hologram of Dr. Lanning (James Cromwell) to Det. Spooner (Will Smith):(Will Smith):

From: From: I, RobotI, Robot Film released by 20Film released by 20thth Century Fox in 2004 Century Fox in 2004 Based on a series of short stories by Isaac AsimovBased on a series of short stories by Isaac Asimov

I want to work up a patient with cognitive I want to work up a patient with cognitive symptoms. What imaging modality should symptoms. What imaging modality should I order?I order?

What is the clinical suspicion(s)?What is the clinical suspicion(s)?

What is the local access to advanced imaging What is the local access to advanced imaging techniques?techniques?

Do patient comorbidities suggest a wider DDx?Do patient comorbidities suggest a wider DDx?

Are there any patient-specific limitations to Are there any patient-specific limitations to imaging (foreign body, tolerance of prolonged imaging (foreign body, tolerance of prolonged scan times, body habitus, etc)?scan times, body habitus, etc)?

““That, detective, is the right question”That, detective, is the right question”

Dr. Lanning to Det. Spooner Dr. Lanning to Det. Spooner

From: From: I, RobotI, Robot

Thank YouThank You

ReferencesReferences

Villemagne, VL et al. Tau imaging: Villemagne, VL et al. Tau imaging: early progress and future directions. early progress and future directions. Lancet Neurology 14 :1(2015) 114-Lancet Neurology 14 :1(2015) 114-24.24.

Villemagne VL and Okamura N. In Villemagne VL and Okamura N. In vivo tau imaging: Obstacles and vivo tau imaging: Obstacles and progress. Alzheimer’s and Dementia progress. Alzheimer’s and Dementia 10(2014) S254-64.10(2014) S254-64.

ReferencesReferences Alter, M et al (Quality Standards Subcommittee of the AAN). Practice parameter for diagnosis and Alter, M et al (Quality Standards Subcommittee of the AAN). Practice parameter for diagnosis and

evaluation of dementia. Neurology 1994; 44:2203-6.evaluation of dementia. Neurology 1994; 44:2203-6.

Knopman DS et al. Practice Parameter: diagnosis of dementia (an evidence-based review). Knopman DS et al. Practice Parameter: diagnosis of dementia (an evidence-based review). Neurology 2001; 56:1143-53.Neurology 2001; 56:1143-53.

Kalkonde YV et al. Difference between clinical subspecialties in the outpatient evaluation and Kalkonde YV et al. Difference between clinical subspecialties in the outpatient evaluation and treatment of dementia in an academic medical center. Dement Geriatr Cogn Disord 2010; 29:38-treatment of dementia in an academic medical center. Dement Geriatr Cogn Disord 2010; 29:38-36.36.

Hejl A et al. Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neuro Hejl A et al. Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neuro Neurosurg Psychiatry 2002; 73(4): 390-4.Neurosurg Psychiatry 2002; 73(4): 390-4.

Jack CR Jr, Albert M, Knopman D, McKhann G, Sperling R, Carrillo M, et al. Introduction to the Jack CR Jr, Albert M, Knopman D, McKhann G, Sperling R, Carrillo M, et al. Introduction to the revised criteria for the diagnosis of Alzheimer’s disease: National Institute on Aging and the revised criteria for the diagnosis of Alzheimer’s disease: National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:257-62.Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:257-62.

McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:263-69.and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:263-69.

Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM, et al. Towards defining the Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM, et al. Towards defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:280-92.and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:280-92.

Albert M, DeKosky ST, Dickson D, Dubois B, Feldman H, Fox NC, et al. The diagnosis of mild Albert M, DeKosky ST, Dickson D, Dubois B, Feldman H, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: report of the National Institute on Aging and the cognitive impairment due to Alzheimer’s disease: report of the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:270-9.Alzheimer’s Association workgroup. Alzheimers Dement 2011;7:270-9.

ReferencesReferences Borghesani PR et al. Neuroimaging in the clinical diagnosis of dementia: Borghesani PR et al. Neuroimaging in the clinical diagnosis of dementia:

observations from a memory disorders clinic. Journal of the American observations from a memory disorders clinic. Journal of the American Geriatrics Society 2010; 58(8): 1453-8.Geriatrics Society 2010; 58(8): 1453-8.

Heister D et al. Predicting MCI outcome with clinically available MRI and Heister D et al. Predicting MCI outcome with clinically available MRI and CSF biomarkers. Neurology 2011; 77:1619-28.CSF biomarkers. Neurology 2011; 77:1619-28.

Dickerson BC et al. Alzheimer-signature MRI biomarker predicts AD Dickerson BC et al. Alzheimer-signature MRI biomarker predicts AD dementia in cognitively normal adults. Neurology 2011; 76: 1395-402.dementia in cognitively normal adults. Neurology 2011; 76: 1395-402.

Dickerson BC et al. MRI cortical thickness biomarker predicts AD-like Dickerson BC et al. MRI cortical thickness biomarker predicts AD-like CSF and cognitive decline in normal adults. Neurology 2012; 78: 84-90.CSF and cognitive decline in normal adults. Neurology 2012; 78: 84-90.

Petersen RC. New clinical criteria for the Alzheimer’s Disease Spectrum. Petersen RC. New clinical criteria for the Alzheimer’s Disease Spectrum. Minnesota Medicine 2012.Minnesota Medicine 2012.

Price DL et al. “Investigation of acoustic noise on 15 MRI scanners from Price DL et al. “Investigation of acoustic noise on 15 MRI scanners from 0.2T to 3T.” J Magn Reson Imaging 2001; 13(2):288-93.0.2T to 3T.” J Magn Reson Imaging 2001; 13(2):288-93.

ReferencesReferences Rabinovici GD, Rosen HJ, etal. Amyloid vs. FDG-PET in the differential diagnosis of AD and FTLD. Rabinovici GD, Rosen HJ, etal. Amyloid vs. FDG-PET in the differential diagnosis of AD and FTLD.

Neurology 2011; 77:2034-42.Neurology 2011; 77:2034-42.

Suárez J et al. Characterizing radiology reports in patients with frontotemporal dementia. Suárez J et al. Characterizing radiology reports in patients with frontotemporal dementia. Neurology 2009; 73(13): 1073-4.Neurology 2009; 73(13): 1073-4.

Kerholz K et al. “Positron emission tomography imaging in dementia.” British Journal of Radiology Kerholz K et al. “Positron emission tomography imaging in dementia.” British Journal of Radiology 2007; 80:S160-7.2007; 80:S160-7.

Mosconi L et al. “Pre-clinical detection of Alzheimer’s disease using FDG-PET with or without Mosconi L et al. “Pre-clinical detection of Alzheimer’s disease using FDG-PET with or without amyloid imaging.” J Alzheimers Dis. 2010; 20(3): 843-54.amyloid imaging.” J Alzheimers Dis. 2010; 20(3): 843-54.

Laino C Two radioactive tracers detect amyloid, may aid in AD diagnosis. Neurology Today 2012; Laino C Two radioactive tracers detect amyloid, may aid in AD diagnosis. Neurology Today 2012; 12(10): 16-7.12(10): 16-7.

Li TQ and Wahlund LO. The search for neuroimaging biomarkers of Alzheimer's disease with Li TQ and Wahlund LO. The search for neuroimaging biomarkers of Alzheimer's disease with advanced MRI techniques. Acta Radiologica. 2011; Vol. 52 (2): 211-22.advanced MRI techniques. Acta Radiologica. 2011; Vol. 52 (2): 211-22.

Gorno-Tempini ML et al. “Classification of primary progressive aphasia and its variants.” Gorno-Tempini ML et al. “Classification of primary progressive aphasia and its variants.” Neurology 2011; 76:1006-14. Neurology 2011; 76:1006-14.

Snowden JS et al. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. Snowden JS et al. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. J Neurol Neurosurg Psychiatry 2001; 70: 323-32.J Neurol Neurosurg Psychiatry 2001; 70: 323-32.

imaging in dementia: options for clinical practice 2014 2015+ john a. bertelson, md clinical chief...

Documents

early dementia imaging

dementia neuroimaging

dementia indications

modern imaging slide

early imaging modality

insidious onset of dementia

ut austin slide

meningeal irritation