Dementia

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Slide 1 :

Dementia Dr Peter J Nestor peter.nestor@mrc-cbu.cam.ac.uk

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Imaging challenging patients

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Focal lesions to the mesial temporal lobe cause amnesia Amnesia is the first feature of Alzheimer’s disease Neurofibrillary tangle (t) pathology occurs earliest and most severely in the mesial temporal lobe

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MRI in established AD Healthy elderly AD Hippocampal atrophy

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Differing patterns of temporal atrophy in Alzheimer’s disease and semantic dementia C. J. Galton, MRCP(UK);, K. Patterson, PhD;, K. Graham, PhD;, M.A. Lambon-Ralph, PhD;, G. Williams, PhD;, N. Antoun, FRCR, FRCP;, B.J. Sahakian, PhD and J.R. Hodges, MD, FRCP Neurology 2001 57: 216-225

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glucose glucose-6-phosphate FDG FDG-6-phosphate Metabolic pathways of glucose and 18Fluorodeoxyglucose blood vessel 18FDG: a PET tracer analogue of glucose Brain cells Energy

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The image Healthy brain areas need glucose and thus appear bright on the scan Damaged brain areas are not working and therefore do not pick up glucose

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Alzheimer’s disease Co-registration Spatial normalisation to standard template Smoothing Statistics

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Very mild Alzheimer’s -Isolated memory impairment Posterior cingulate hypometabolism

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Retrosplenial cortex is the first area universally affected Nestor et al, Eur J Neurosci 2003

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60 year old male, recent onset memory impairment, MMSE = 30/30

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Anatomy Cingulum bundle

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Method Regions of interest traced onto 3T volumetric MRI. FDG-PET co-registered onto MRI CMRglc calculated Normalised to cerebellum 3-compartment partial volume correction

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Co-registration

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Nestor et al, Ann Neurol, 2003

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Alzheimer’s disease and positron emission tomography Pathology Neuronal loss Amyloid deposition ACh activity loss NFT (t) Marker [18F]FDG [11C]PIB [11C]PMP In development

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