Dementia
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Population Covered By The Guidance
This pathway provides guidance on the imaging investigation of adult patients with cognitive decline, once systemic causes have been excluded.
Date reviewed: September 2014
Date of next review: May 2023
Published: December 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Teaching Points
Teaching Points
- Dementia is a disorder that is characterised by impairment of memory and at least one other cognitive domain (aphasia, apraxia, agnosia or executive functioning). There must be a decline from previous level of function that is severe enough to interfere with daily function and independence
- There are many causes of dementia, though Alzheimer’s disease and Vascular Dementia are the commonest. There are approximately 36 million people with dementia worldwide 1
- Initial assessment of a patient thought to be dementing should include a systematic search for a reversible cause
- Imaging has a role in assessing for tumours, haematomas and hydrocephalus which may be treated. These may be visualised on contrast enhanced CT of the brain
- MRI, SPECT and PET modalities have a role in certain circumstances, after consultation with a specialist
References
References
Date of literature search: June 2014
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Wortmann M. Dementia: a global health priority - highlights from an ADI and World Health Organization report. Alzheimers Res Ther. 2012;4(5):40. (Review article). View the reference
- Practice parameter for diagnosis and evaluation of dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1994;44(11):2203-6. (Consensus statement). View the reference
- McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ARDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology. 1984;34(7):939-44. View the reference
- 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-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):263-9. (Guideline document). View the reference
- Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270-9. (Guideline document). View the reference
- Jack CR, Jr., Albert MS, Knopman DS, McKhann GM, Sperling RA, Carrillo MC, et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):257-62. (Review article)
- Hyman BT, Phelps CH, Beach TG, Bigio EH, Cairns NJ, Carrillo MC, et al. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement. 2012;8(1):1-13. (Guideline document). View the reference
- Villemagne VL, Burnham S, Bourgeat P, Brown B, Ellis KA, Salvado O, et al. Amyloid beta deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study Lancet Neurol. 2013;12(4):357-67. (Level I evidence). View the reference
- Jack CR, Jr., Knopman DS, Weigand SD, Wiste HJ, Vemuri P, Lowe V, et al. An operational approach to National Institute on Aging-Alzheimer's Association criteria for preclinical Alzheimer disease. Ann Neurol. 2012;71(6):765-75. (Guidelines document). View the reference
- Jack CR, Jr., Knopman DS, Jagust WJ, Petersen RC, Weiner MW, Aisen PS, et al. Tracking pathophysiological processes in Alzheimer's disease: an updated hypothetical model of dynamic biomarkers. Lancet Neurol. 2013;12(2):207-16. (Review article). View the reference
- Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1143-53. (Level I evidence). View the reference
- Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6(8):734-46. (Review article). View the reference
- Hort J, O'Brien JT, Gainotti G, Pirttila T, Popescu BO, Rektorova I, et al. EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol. 2010;17(10):1236-48. (Evidence Based Guidelines). View the reference
- Factora R, Luciano M. Normal pressure hydrocephalus: diagnosis and new approaches to treatment. Clin Geriatr Med. 2006;22(3):645-57. (Review article). View the reference
- Bradley WG, Jr., Whittemore AR, Kortman KE, Watanabe AS, Homyak M, Teresi LM, et al. Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus. Radiology. 1991;178(2):459-66. (Level III evidence). View the reference
- Scheltens P. Early diagnosis of dementia: neuroimaging. J Neurol. 1999;246(1):16-20. (Review article). View the reference
- Small GW, Leiter F. Neuroimaging for diagnosis of dementia. J Clin Psychiatry. 1998;59 Suppl 11:4-7. (Review article). View the reference
- Jobst KA, Hindley NJ, King E, Smith AD. The diagnosis of Alzheimer's disease: a question of image? J Clin Psychiatry. 1994;55 Suppl:22-31. (Level II/III evidence). View the reference
- Jobst KA, Smith AD, Szatmari M, Molyneux A, Esiri ME, King E, et al. Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet. 1992;340(8829):1179-83. (Level IV evidence). View the reference
- de Leon MJ, George AE, Stylopoulos LA, Smith G, Miller DC. Early marker for Alzheimer's disease: the atrophic hippocampus. Lancet. 1989;2(8664):672-3. (Level III evidence). View the reference
- Jagust WJ, Eberling JL. MRI, CT, SPECT, PET: their use in diagnosing dementia. Geriatrics. 1991;46(2):28-35. (Review article). View the reference
- Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. Ont Health Technol Assess Ser. 2014;14(2):1-67. (Level II evidence). View the reference
- Jack CR, Jr., Petersen RC, O'Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer's disease. Neurology. 1992;42(1):183-8. (Level III evidence). View the reference
- Pantel J, Schroder J, Schad LR, Friedlinger M, Knopp MV, Schmitt R, et al. Quantitative magnetic resonance imaging and neuropsychological functions in dementia of the Alzheimer type. Psychol Med. 1997;27(1):221-9. (Level III evidence). View the reference
- Vanneste J, Augustijn P, Tan WF, Dirven C. Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry. 1993;56(3):251-6. (Level III evidence). View the reference
- Daniela P, Orazio S, Alessandro P, Mariano NF, Leonardo I, Pasquale Anthony DR, et al. A survey of FDG- and amyloid-PET imaging in dementia and GRADE analysis. Biomed Res Int. 2014;2014:785039. (Level II evidence). View the reference
- Marcus C, Mena E, Subramaniam RM. Brain PET in the diagnosis of Alzheimer's disease. Clin Nucl Med. 2014;39(10):e413-22; quiz e23-6. (Review article)
- Bloudek LM, Spackman DE, Blankenburg M, Sullivan SD. Review and meta-analysis of biomarkers and diagnostic imaging in Alzheimer's disease. J Alzheimers Dis. 2011;26(4):627-45. (Level I evidence)
- Ishii K. PET Approaches for diagnosis of dementia. AJNR Am J Neuroradiol. 2014;35(11):2030-8. (Review article). View the reference
- Ng S, Villemagne VL, Berlangieri S, Lee ST, Cherk M, Gong SJ, et al. Visual assessment versus quantitative assessment of 11C-PIB PET and 18F-FDG PET for detection of Alzheimer's disease. J Nucl Med. 2007;48(4):547-52. (Level III evidence). View the reference
- Zhang S, Han D, Tan X, Feng J, Guo Y, Ding Y. Diagnostic accuracy of 18 F-FDG and 11 C-PIB-PET for prediction of short-term conversion to Alzheimer's disease in subjects with mild cognitive impairment. Int J Clin Pract. 2012;66(2):185-98. (Level I evidence)
- Rabinovici GD, Rosen HJ, Alkalay A, Kornak J, Furst AJ, Agarwal N, et al. Amyloid vs FDG-PET in the differential diagnosis of AD and FTLD. Neurology. 2011;77(23):2034-42. (Level II evidence). View the reference
- Vandenberghe R, Adamczuk K, Van Laere K. The interest of amyloid PET imaging in the diagnosis of Alzheimer's disease. Curr Opin Neurol. 2013;26(6):646-55. (Review article). View the reference
- Okello A, Koivunen J, Edison P, Archer HA, Turkheimer FE, Nagren K, et al. Conversion of amyloid positive and negative MCI to AD over 3 years: an 11C-PIB PET study. Neurology. 2009;73(10):754-60. (Level II evidence). View the reference
- Davison CM, O'Brien JT. A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. Int J Geriatr Psychiatry. 2014;29(6):551-61. (Review article). View the reference
- Yeo JM, Lim X, Khan Z, Pal S. Systematic review of the diagnostic utility of SPECT imaging in dementia. Eur Arch Psychiatry Clin Neurosci. 2013;263(7):539-52. (Level I evidence). View the reference
- Larsson A, Arlig A, Bergh AC, Bilting M, Jacobsson L, Stephensen H, et al. Quantitative SPECT cisternography in normal pressure hydrocephalus. Acta Neurol Scand. 1994;90(3):190-6. (Level II evidence). View the reference
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Information for Consumers
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