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Differential Diagnosis Between Alzheimer’s and Frontotemporal Disease by the Posterior Cingulate Sign

¹ Nuclear Medicine Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
² Department of Psychiatry and Academic Computing Service, University of Texas Southwestern Medical Center, Dallas, Texas

This was a study to evaluate the posterior cingulate sign in differential diagnosis between Alzheimer’s and frontotemporal disease. The impending availability of effective treatment for Alzheimer’s disease makes this differential diagnosis important. Methods: Images of 20 patients with clinically confirmed or autopsy-proven (10 patients) Alzheimer’s disease and 20 patients with clinically confirmed or autopsy-proven (7 patients) frontotemporal disease were compared with the consolidated images of 20 elderly healthy control subjects. The ^99mTc-hexamethylpropyleneamine oxime SPECT data on brain blood flow from each patient were compared with the consolidated control image using statistical parametric mapping. Results: Sixteen of 20 patients with Alzheimer’s disease showed the posterior cingulate sign in the form of significant blood flow reductions; 1 of 20 patients with frontotemporal disease showed the posterior cingulate sign. That patient’s illness has evolved into Alzheimer’s disease. The remaining 19 patients were negative for the posterior cingulate sign. Conclusion: When present, the posterior cingulate sign indicates the presence of Alzheimer’s disease; it is apparently absent in frontotemporal disease, thus serving as a differential diagnostic sign. It was absent in 3 patients with proven tangle-predominant Alzheimer’s disease.

Key Words: posterior cingulate sign • Alzheimer’s disease • frontotemporal disease • SPECT brain blood flow

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