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Neuroimaging for differentiating vascular from Alzheimer's dementias
J S Meyer1, T Shirai, H Akiyama
1Cerebral Blood Flow Laboratories, Veterans Administration Medical Center, and Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Cerebrovascular and Brain Metabolism Reviews
|January 1, 1996
Summary
Neuroimaging techniques can differentiate vascular dementia (VAD) from Alzheimer type dementia (DAT). Differences in cerebral blood flow and metabolism, along with the acetazolamide test, aid in diagnosis.
Area of Science:
- Neurology
- Radiology
Background:
- Vascular dementia (VAD) and Alzheimer type dementia (DAT) are common elderly dementias.
- Lacunar VAD with silent strokes can be misdiagnosed as DAT.
- Accurate differentiation is crucial for effective treatment.
Purpose of the Study:
- To describe advances in differentiating VAD from DAT using clinical and neuroimaging features.
- To highlight the diagnostic utility of cerebral blood flow (CBF) and metabolism (CMR) imaging.
- To present the acetazolamide test as a method for assessing cerebral vasomotor capacitance.
Main Methods:
- Comparison of clinical and neuroimaging features of VAD and DAT.
- Brain mapping of cerebral blood flow (CBF) and cerebral metabolic rate (CMR).
- Utilizing the noninvasive acetazolamide test with xenon contrast CT scanning.
Main Results:
- VAD shows multifocal, subcortical infarcts on CBF/CMR maps, distinct from DAT's diffuse cortical reductions.
- The acetazolamide test reveals increased vasodilator reserve in DAT.
- VAD exhibits an absent or blunted vasodilator reserve, clearly distinguishing it from DAT.
Conclusions:
- Neuroimaging, particularly CBF and CMR mapping, is vital for diagnosing VAD versus DAT.
- The acetazolamide test provides a dramatic and effective method for differentiating these dementias.
- Understanding these differences aids in establishing the correct diagnosis for elderly patients.