Pathological aging of the brain: an overview

Area of Science:

• Neurology
• Radiology
• Geriatrics

Background:

• The global elderly population is rapidly expanding, leading to an anticipated rise in dementia cases.
• Alzheimer disease (AD) is the most prevalent cause of dementia, often co-occurring with cerebrovascular pathology.

Purpose of the Study:

• To highlight the role of characteristic magnetic resonance (MR) imaging findings in identifying different dementia-causing diseases.
• To emphasize the importance of specific neuroimaging techniques for early and accurate dementia diagnosis.

Main Methods:

• Utilizing axial T2-weighted images (T2-WI), FLAIR/proton density-weighted images, and gradient-echo T2*-weighted images for cerebrovascular pathology detection.
• Employing high-resolution T1-weighted coronal images for medial temporal lobe atrophy assessment.
• Considering Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) for potential diagnostic value.

Main Results:

• Specific MR imaging protocols are crucial for detecting cerebrovascular disease and brain atrophy patterns associated with dementia.
• Advanced imaging techniques like functional MR and serial volumetric studies show promise in identifying subtle abnormalities.
• SPECT and PET imaging, particularly with new radioligands for AD pathology, may offer added diagnostic benefits.

Conclusions:

• Characteristic MR imaging findings are vital for differentiating dementia etiologies.
• Integrating advanced imaging techniques with clinical evaluation can lead to more rigorous and earlier dementia diagnosis.
• Future advancements in functional imaging and radioligands are expected to enhance diagnostic accuracy, potentially matching neuropathology.