Summary
In mild or atypical cases of Alzheimer’s disease (AD) the differential diagnosis to other dementing diseases, such as vascular dementia (VD), may pose a difficult problem. Beside computed tomography (CT) and magnetic resonance imaging (MRI), functional neuroimaging by positron emission tomography (PET) support the clinical diagnosis by visualizing cerebral function. PET of 18F-2-fluoro-2-deoxy-D-glucose (FDG) for measurement of regional cerebral glucose metabolism (rCMRG1) has shown a typical metabolic pattern in patients with probable AD: hypometabolism in temporoparietal and frontal association areas, but relative recessing of primary cortical areas, basal ganglia and cerebellum. In VD a different pattern is seen. It consists of scattered areas with reduction of rCMRGl typically extending over cortical and subcortical structures. Severity of dementia is correlated with rCMRGl reduction in the temporoparietal association cortex, irrespective of the cause of dementia. Also the total volume of hypometabolic regions is related to severity of dementia but did not differ between AD and VD, even in patients with small lacunar infarction. This indicates that the total volume of functional tissue loss is more important, since it also includes the effects of incompletely infarcted tissue and morphologically intact but deafferented cortex. The characteristic metabolic pattern has a high diagnostic accuracy for the discrimination between probable AD, normals and VD, even in patients with mild cognitive impairment. Under clinical and therapeutic aspects the analysis of longitudinal changes of rCMRGl has shown that neuropsychological and metabolic changes are closely related in both, AD and VD.
Keywords
- Vascular Dementia
- Metabolic Ratio
- Vascular Dementia Patient
- Regional Cerebral Glucose Metabolism
- HMPAO SPECT
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. edn. American Psychiatric Association, Washington DC
Benson DF, Kuhl DE, Hawkins RA, Phelps ME, Cummings JL, Tsai SY (1983) The fluordeoxyglucose 18F scan in Alzheimer’s disease and multi-infarct dementia. Arch Neurol 40: 711–714
Breitner JCS, Silverman JM, Mohs RC, Davis KL (1988) Familial aggregation in Alzheimer’s disease: comparison od risk among relatives of early-and late-onset cases, and among male and female relatives in successive generations. Neurology 38: 207–212
Chase TN, Foster NL, Mansi L (1983) Alzheimer’s disease and the parietal lobe. Lancet ii: 225
Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R (1992) Criteria for the diagnosis of ischemic vascular dementia proposed by the state of California Alzheimer’s disease diagnostic and treatment centers. Neurology 42: 473–480
DeCarli C, Kaye JA, Horwitz B, Rapoport SI (1990) Critical analysis of the use of computer assisted transverse axial tomography to study human brain in aging and dementia of the Alzheimer type. Neurology 40: 872–883
Duara R, Grady C, Haxby J, Sundaram M, Cutler NR, Heston L, Moore A, Schlageter N, Larson S, Rapoport SI (1986) Positron emmission tomography in Alzheimer’s disease. Neurology 36: 879–887
Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental State: a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 12: 189–198
Foster NL, Chase TN, Fedio P, Patronas NJ, Brooks RA, DiChiro G (1983) Alzheimer’s disease: focal cortical changes shown by positron emission tomography. Neurology (Cleveland) 33: 961–965
Frackowiak RSJ, Pozzilli C, Legg NJ, du Boulay GH, Marshall J, Lenzi GL, Jones T (1981) Regional cerebral oxygen supply and utilization in dementia. Brain 104: 753–778
Friedland RP, Budinger TF, Ganz E, Yano Y, Mathis CA, Koss B, Ober BA, Huesman RH, Derenzo SE (1983) Regional cerebral metabolic alterations in dementia of the Alzheimer’s type: positron emission tomography with (18F)fluordeoxyglucose. J Comput Assist Tomogr 7: 5590–598
Gemmel HG, Sharp PF, Besson JAO, Crawford JR, Ebmeier KP, Davidson J, Smith FW (1987) Differential diagnosis in dementia using cerebral blood flow agent TC-99m HM-PAO: a SPECT study. J Comput Assist Tomogr 11: 398–402
Gemmell HG, Sharp PF, Besson JAO, Ebmeier KP, Smith FW (1988) A comparison of TC-99m HM-PAO and 1–123 IMP cerebral SPECT images in Alzheimer’s disease and multi-infarct dementia. Eur J Nucl Med 14: 463–466
Gemmel HG, Evans NTS, Besson JAO, Roeda D, Davidson J, Dodd MG, Sharp PF, Smith FW, Crawford JR, Newton RH, Kulkarni V, Mallard JR (1990) Regional cerebral blood flow imaging: a quantitative comparison of Technetium-99m-HMPAO SPECT with C15O2 PET. J Nucl Med 31: 1595–1600
Gibbs JM, Frackowiak RSJ, Legg NJ (1986) Regional cerebral blood flow and oxygen metabolism in dementia due to vascular disease. Gerontology 32 [Suppl 1]: 84–86
Grady CL, Haxby JV, Horwitz B, Berg G, Rapoport SI (1987) Neuropsychological and cerebral metabolic function in early vs late onset dementia of the Alzheimer type. Neuropsychologia 25: 807–816
Grady CL, Haxby JV, Horwitz B, Sundaram M, Berg G, Schapiro M, Friedland RP, Rapoport SI (1988) Longitudinal study of the early neuropsychological and cerebral changes in dementia of the Alzheimer type. J Clin Exp Neuropsychol 10: 576–596
Hachinski VC, Iliff LD, Zilhka E, DuBoulay GH, McAllister VL, Marshall J, Russell RWR, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32: 632–637
Haxby JV, Grady CL, Duara R, Schlageter N, Berg G, Rapoport SI (1986) Neocortical abnormalities precede nonmemory cognitive defects in early Alzheimer’s type dementia. Arch Neurol 43: 882–885
Haxby JV, Grady CL, Koss E, Horwitz B, Heston L, Schapiro M, Friedland RP, Rapoport SI (1990) Longitudinal study of cerebral metabolic asymmetries and associated neuropsychological patterns in early dementia of the Alzheimer type. Arch Neurol 47: 753–760
Heiss WD, Ilsen HW, Wagner R, Pawlik G, Wienhard K, Eriksson L (1983) Remote functional depression of glucose metabolism in stroke and its alteration by activating drugs. In: Heiss WD, Phelps ME (eds) Positron emission tomography of the brain. Springer, Berlin Heidelberg New York Tokyo, pp 162–168
Heiss WD, Hebold I, Klinkhammer P, Ziffling P, Szelies B, Pawlik G, Herholz K (1988) Effect of piracetam on cerebral glucose metabolism in Alzheimer’s disease as measured by positron emission tomography. J Cereb Blood Flow Metab 8: 613–617
Heiss WD, Kessler J, Mielke R, Szelies B, Herholz K (1994) Long-term effects of Phosphatidylserine, Pyritinol, and cognitive training in Alzheimer’s disease. A neuropsychological, EEG, and PET investigation. Dementia 5: 88–98
Herholz K, Adams R, Kessler J, Szelies B, Grond M, Heiss WD (1990) Criteria for the diagnosis of Alzheimer’s disease with positron emission tomography. Dementia 1: 156–164
Heston LL, Mastri AR, Anderson VE, White J (1981) Dementia of the Alzheimer type. Clinical genetics, natural history and associated conditions. Arch Gen Psychiatry 38: 1085–1090
Jagust WJ, Friedland RP, Budinger TF, Koss E, Ober B (1988) Longitudinal studies of regional cerebral metabolism in Alzheimer’s disease. Neurology 38: 909–912
Kamo H, McGeer P, Harrop R, McGeer E, Calne D, Martin W, Pate B (1987) Positron emission tomography and histopathology in Pick’s disease. Neurology 37: 439
Kase CS (1991) Epidemiology of multi-infarct dementia. Alz Dis Assoc Disord 5: 71–76
Kennedy AM, Newman S, Clegg F, Tyrrell P, Warrington EK, Roques P, Hardy J, Rossor MN, Frackowiak RSJ (1992) Imaging in dementia: longitudinal studies using positron emission tomography. Neurobiol Aging 13: S13
Kessler J, Herholz K, Heiss WD (1991) Impaired metabolic activation in Alzheimer’s disease: a PET study during continous visual recognition. Neuropsychologia 29: 229–243
Klinkhammer P, Szelies B, Heiss WD (1990) Effect of phosphatidylserine on cerebral glucose metabolism in Alzheimer’s disease. Dementia 1: 197–201
Kraepelin E (1910) Psychiatrie, ein Lehrbuch für Studierende und Ärzte, 8th edn, vol II/1. Barth, Leipzig
Kuhl DE, Phelps ME, Kowell AP, Metter EJ, Selin C, Winter J (1980) Effects of stroke on local cerebral metabolism and perfusion: mapping by emission computed tomography of 18FDG and 13NH3. Ann Neurol 8: 47–60
Kuhl D, Phelps M, Markham C (1982) Cerebral metabolism and atrophy in Huntington’s disease determined by 18-FDG and computed tomographic scan. Ann Neurol 12: 425–434
Kuhl DE, Metter EJ, Riege WH, Hawkings RA, Mazziotta JC, Phelps DE, Kling AS (1983) Local cerebral glucose utilization in elderly patients with depression, multiple infarct dementia and Alzheimer’s disease. J Cereb Blood Flow Metab 3: S494–S495
Kuhl D, Metter E, Benson F, Ashford JW, Riege WH, Fujikawa DG, Markham CH, Mazziotta JC, Maltese A, Dorsey DA (1985) Similarities of cerebral glucose metabolism in Alzheimer’s and Parkinson’s dementia. J Cereb Blood Flow Metab 5: 169–170
Kuwert T, Lange HW, Langen KJ, Herzog H, Aulich A, Feinendegen LE (1990) Cortical and subcortical glucose consumption measured by PET in patients with Huntington’s disease. Brain 113: 1405–1423
Mann DMA, Yates PO, Marcyniuk B (1984) Alzheimer’s presenile dementia, senile dementia of Alzheimer type and Down’s syndrome in middle age from an age related continuum of pathological changes. Neuropathol Appl Neurobiol 10: 185–207
McGeer PL, Kamo H, Harrop R, Li DK, Tuokko H, McGeer EG, Adam MJ, Ammann W, Beattie BL, Calne DB (1986) Positron emission tomography in patients with clinical diagnosed Alzheimer’s disease. Can Med Assoc J 134: 597–607
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 19: 939–944
Messa C, Perani D, Lucignani G, Zenorini A, Zito F, Rizzo G, Grassi F, Del Sole A, Franceschi M, Gilardi MC, Fazio F (1994) High-resolution technetium-99m-HMPAO SPECT in patients with probable Alzheimer’s disease: comparison with fluorine-18-FDG PET. J Nucl Med 35: 210–216
Mielke M, Ghaemi J, Kessler B, Kittner B, Szelies B, Herholz K, Heiss WD (1998) Propentofylline enhances cerebral metabolic response to auditory memory stimulation in Alzheimer’s disease. J Neurol Sci (in press)
Mielke R, Herholz K, Grand M, Kessler J, Heiss WD (1992) Differences of regional cerebral glucose metabolism between presenile and senile dementia of Alzheimer type. Neurobiol Aging 13: 93–98
Mielke R, Pietrzyk U, Jacobs A, Fink GR, Ichimiya A, Kessler J, Herholz K, Heiss WD (1994) HMPAO SPET and FDG PET in Alzheimer’s disease and vascular dementia: comparison of perfusion and metabolic pattern. Eur J Nucl Med 21: 1052–1060
Mielke R, Herholz K, Grand M, Kessler J, Heiss WD (1994) Clinical deterioration in probable Alzheimer’s disease correlates with progressive metabolic impairment of association areas. Dementia 5: 36–41
Mielke R, Jacobs A, Kessler J, Pietrzyk U, Herholz K, Heiss WD (1995) Diagnostic accuracy of FDG PET and HMPAO SPECT for the differentiation between Alzheimer’s disease and vascular dementia depends on severity of disease. J Neurol 241: 35
Mielke R, Schröder R, Fink G, Kessler J, Herholz K, Heiss WD (1996) Regional cerebral glucose metabolism and postmortem pathology in Alzheimer’s disease. Acta Neuropathol 91: 174–179
Mielke R, Ghaemi M, Kittner B, Kessler J, Szelies B, Herholz K, Heiss WD (1996) Propentofylline improves regional cerebral glucose metabolism and neuropsy-chological performance in vascular dementia. J Neurol Sci 141: 59–64
Morris JC, McKeel Jr DW, Fulling K, Torack RM, Berg L (1988) Validation of clinical diagnostic criteria for Alzheimer’s disease. Ann Neurol 24: 17–22
Nordberg A, Lilja A, Lundqvist H, Hartvig P, Amberla K, Viitanen M, Warpman U, Johansson M, Hellstrom-Lindahl E, Bjurling P (1992) Tacrine restores cholinergic nicotinic receptors and glucose-metabolism in Alzheimer patients as visualized by positron emission tomography. Neurobiol Aging 13: 747–758
Podreka I, Suess E, Goldenberg G, Steiner M, Brücke T, Müller CH, Lang W, Neirinckx RD, Deecke L (1987) Initial experience with Technetium-99m HM-PAO brain SPECT. J Nucl Med 28: 1657–1666
Rapoport SI, Hatanpää K, Brady DR, Chandrasekaran K (1996) Brain energy metabolism, cognitive function and down-regulated oxidative phosphorylation in Alzheimer’s disease. Neurodegeneration 5: 473–476
Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozzo JM, Brun A, Hofman A, Moody DM, O’Brien MD, Yamaguchi T, Grafman J, Drayer BP, Bennett DA, Fisher M, Ogata J, Kokmen E, Bermejo F, Wolf PA, Gorelick PB, Bick KL, Pajeau AK, Bell MA, DeCarli C, Culebras A, Korczyn AD, Bogousslavsky J, Hartmann A, Scheinberg P (1993) Vascular dementia: diagnostic criteria for research studies. Neurology 43: 250–260
Rossor MN, Iversen LL, Reynolds GP, Mountjoy CQ, Roth M (1984) Neurochemical characteristics of early and late onset type of Alzheimer’s disease. Br Med J 288: 961–964
Roth MN (1986) The association of clinical and neurobiological findings and its bearing on the classification and aetiology of Alzheimer’s disease. Br Med Bull 42: 42–50
Sacquegna T, DeCarolis P, Daidone R, Dondi M (1988) Single-photon emission tomography with technetium Tc 99m hexamethylpropylene amine oxime in Binswanger’s disease. Arch Neurol 45: 603–604
Small GW. Kuhl DE, Riege WH, Fujikawa DG, Ashford JW, Metter EJ, Mazziotta JC (1989) Cerebral glucose metabolic patterns in Alzheimer’s disease. Effect of gender and age at dementia onset. Arch Gen Psychiat 46: 527–532
StGeorge-Hyslop PH, Haines JL, Farrer LA, Polinsky R, Broeckhoven C, Goate A, McLachlan DRC, Orr H, Bruni AC, Sorbi S, Rainero I, Foncin JF, Pollen D, Cantu JM, Tupler R, Voskresenskaya N, Mayeux R, Growdon J, Fried VA, Myers RH, Nee L, Backhovens H, Martin JJ, Rossor M, Owen MJ, Mullan M, Percy ME, Karlinsky H, Rich S, Heston L, Montesi M, Mortilla M, Nacmias N, Gusella JF, Hardy JA (1990) Genetic linkage studies suggest that Alzheimer’s disease is not a single homogenous disorder. Nature 347: 194–197
Szelies B, Herholz K, Pawlik G, Beil C, Wienhard K, Heiss WD (1986) Zerebraler Glukosestoffwechsel bei praeseniler Demenz vom Alzheimer Typ — Verlaufskontrolle unter Therapie mit muskarinergem Cholinagonisten. Fortschr Neurol Psychiat 11: 364–373
Szelies B, Karenberg A (1986) Störungen des Glukosestoffwechsels bei Pickscher Erkrankung. Fortschr Neurol Psychiat 54: 393–397
Tomlinson BE, Blessed G, Roth M (1968) Observations on the brains of non-demented old people. J Neurol Sci 7: 331–356
Tomlinson BE, Blessed G, Roth M (1970) Observations on the brains of demented old people. J Neurol Sci 11: 205–242
Tune L, Brandt J, Frost JJ, Harris G, Mayberg H, Steele C, Burns A, Sapp J, Folstein MF, Wagner HN (1991) Physostigmine in Alzheimer’s disease — effects on cognitive-functioning, cerebral glucose-metabolism analyzed by positron emission tomography and cerebral blood flow analyzed by single photon-emission tomography. Acta Psychiatr Scand 93 [Suppl 366]: 61–65
Weinstein HC, Haan J, van Royen EO, Derix MMA, Lanser JBK, van der Zant F, Dunnewold RJW, van Kroonenburgh MJPG, Pauwels EKJ, van der Velde EA, Hijdra A, Buruma OJS (1991) SPECT in the diagnosis of Alzheimer’s disease and multi-infarct dementia. Clin Neurol Neurosurg 93: 39–43
Weltgesundheitsorganisation (1991) Dilling H, Mombour W, Schmidt MH (eds) Internationale Klassifikation psychischer Störungen ICD 10 Kp V (F). Klinischdiagnostische Leitlinien. Huber, Bern
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1998 Springer-Verlag Wien
About this paper
Cite this paper
Mielke, R., Heiss, WD. (1998). Positron emission tomography for diagnosis of Alzheimer’s disease and vascular dementia. In: Jellinger, K., Fazekas, F., Windisch, M. (eds) Ageing and Dementia. Journal of Neural Transmission. Supplementa, vol 53. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6467-9_21
Download citation
DOI: https://doi.org/10.1007/978-3-7091-6467-9_21
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-83114-4
Online ISBN: 978-3-7091-6467-9
eBook Packages: Springer Book Archive