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Despite the fact that the diagnosis of dementia is mainly based on clinical criteria, the role of neuroimaging is still expanding. Among other imaging techniques, magnetic resonance imaging (MRI) plays a core role in assisting with the differentiation between various dementia syndromes and excluding other underlying pathologies that cause dementia,...
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... four-step global cortical atrophy (GCA) scale proposed by Pasquier ranges from 0 = no atrophy to 3 = knife-blade atrophy (illustrated in Fig. 1; [1]). GCA 0 represents a normal volume of the gyri and a normal width of the sulci; GCA 1 indicates mild atrophy with a still-normal volume of the gyri but some open sulci; GCA 2 describes moderate brain atrophy with a reduction of gyri volume and a moderate enlargement of the sulci; and GCA 3 illustrates severe atrophy with severely ...
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... imaging features are characterized by periventricular white matter hyperintensities, which can range from punctate to confluent (Fazekas 1-3), cortical/subcortical ischemic/postischemic lesions, lacunar infarcts, enlarged Virchow-Robin spaces, and/or microbleeds (see Fig. 10) [11,12]. ...
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... imaging features are characterized by periventricular white matter hyperintensities, which can range from punctate to confluent (Fazekas 1-3), cortical/subcortical ischemic/postischemic lesions, lacunar infarcts, enlarged Virchow-Robin spaces, and/or microbleeds (see Fig. 10) ...
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... from amyloid deposits in the walls of blood vessels. Cerebral amyloid angiopathy is common in Alzheimer's K Neuroimaging in dementia dementia. A 75-year-old patient presenting with extensive confluent periventricular white matter hyperintensities (white arrow, a, b), as well as a lacune in the left thalamus (black arrow) on axial Flair images Fig. 11 Cerebral amyloid angiopathy. A 60-year-old female patient with cerebral amyloid angiopathy who presented with superficial hemosiderosis, particularly frontal and occipital (the latter marked with a circle), as well as multiple microbleeds (black arrow) representing hemosiderin deposits on axial susceptibility-weighted images (a). There ...
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... is notable for diffuse, progressive white matter hyperintensities, microbleeds located in the cortical gray-white matter junction, superficial hemosiderosis, as well as acute intraparenchymal bleeding or post-hemorrhagic parenchymal defects (illustrated in Fig. 11) ...
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... special subgroup of vascular disease is CADASIL, which is a hereditary vasculopathy based on mutations in the NOTCH3 gene [16,17]. Patients with CADASIL show extensive white matter hyperintensities, lacunar infarctions, and hemorrhage mainly in the insulae and the anterior temporal lobes (illustrated in Fig. 12) ...
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... who suffer from the behavioral variant of frontotemporal dementia show typically asymmetrical frontal and temporal cortical atrophy, with a gradient of the imaging findings from anterior to posterior, and a widening of the orbitofrontal sulci as one of the first signs of disease manifestation (see Fig. 13). Consequently, also the frontal horns of the lateral ventricles are widened disproportionately in the course of the disease. Atrophy also includes the insula, the anteNeuroimaging in dementia rior cingulate, the amygdala, the thalamus, and the striatum ...
Citations
... Comparison with conventional biomarkers, namely CSF amyloid-β, ptau, and t-tau levels, and amyloid, tau, and FDG PET, should be pursued in future studies. Age-specific cutoff values were comprehensively considered using large-scale data from previous studies [21,22,34,[56][57][58], which were heterogeneous. In previous studies, age thresholds for the MTA score were considered at 75 or 80 years [22,56,57]; however, Korean [21] and Chinese [58] studies described younger and more precise age ranges. ...
... Age-specific cutoff values were comprehensively considered using large-scale data from previous studies [21,22,34,[56][57][58], which were heterogeneous. In previous studies, age thresholds for the MTA score were considered at 75 or 80 years [22,56,57]; however, Korean [21] and Chinese [58] studies described younger and more precise age ranges. In particular, the government's public health policy on dementia in Korea was systematically implemented in 2008 [59] based on the prominent public health care system [60] that could affect the careful observation of clinicians and the attention of elderly people. ...
Background
Application of visual scoring scales for regional atrophy in Alzheimer’s disease (AD) in clinical settings is limited by their high time cost and low intra/inter-rater agreement.
Objective
To provide automated atrophy scoring using objective volume driven from deep-learning segmentation methods for AD subtype classification using magnetic resonance imaging (MRI).
Methods
We enrolled 3,959 participants (1,732 cognitively normal [CN], 1594 with mild cognitive impairment [MCI], and 633 with AD). The occupancy indices for each regional volume were calculated by dividing each volume by the size of the lateral and inferior ventricular volumes. MR images from 355 participants (119 CN, 119 MCI, and 117 AD) from three different centers were used for validation. Two neuroradiologists performed visual assessments of the medial temporal, posterior, and global cortical atrophy scores in the frontal lobe using T1-weighted MR images. Images were also analyzed using the deep learning-based segmentation software, Neurophet AQUA. Cutoff values for the three scores were determined using the data distribution according to age. The scoring results were compared for consistency and reliability.
Results
Four volumetric-driven scoring results showed a high correlation with the visual scoring results for AD, MCI, and CN. The overall agreement with human raters was weak-to-moderate for atrophy scoring in CN participants, and good-to-almost perfect in AD and MCI participants. AD subtyping by automated scores also showed usefulness as a research tool.
Conclusions
Determining AD subtypes using automated atrophy scoring for late-MCI and AD could be useful in clinical settings or multicenter studies with large datasets.
... The qualitative assessment of the MTA score was based on the degree of atrophy in the choroid fissure, temporal horn, and hippocampal volume from the coronal plane, as described by Frisoni et al. 17 . MTA 0 was characterized with normal choroid fissure, temporal horn, and hippocampal volume, MTA 1 was characterized with slight widened choroid fissure, MTA 2 was characterized with moderate widened choroid fissure, slight enlargement of temporal horn, and mild decrement of hippocampal volume, MTA 3 was characterized by markedly widened choroid fissure, moderate enlargement of temporal horn, and moderate decrement of hippocampal volume, and MTA 4 was characterized by markedly widened choroid fissure, markedly enlargement of temporal horn, and markedly decrement of hippocampal volume 18,19 . ...
... The Koedam score's qualitative assessment was assesed on the degree of parietal atrophy from the sagittal plane, as outlined by Koedam et al. 20 . Koedam score 0 showed normal sulci and no present atrophy of the precuneus while Koedam score 1, 2, and 3 showed mild, moderate, and severe widening of the sulci and atrophy of the precuneus, respectively 19 . Koedam score 0 indicated no cortical atrophy, Koedam score 1 was characterized with mild parietal cortical atrophy with slight widening of the posterior cingulate and parieto-occipital sulcus, Koedam score 2 showed moderate parietal cortical atrophy with significant widening of sulci, and Koedam score 3 was characterized with severe parietal atrophy ("knife blade" atrophy) 21 . ...
Although medial temporal atrophy (MTA) and parietal atrophy (Koedam score) have been used to diagnose Alzheimer’s disease (AD), early detection of other dementia types remains elusive. The study aims to investigate the association between these brain imaging markers and cognitive function in dementia. This cross-sectional study collected data from the Memory Clinic of Dr. Sardjito General Hospital Yogyakarta, Indonesia from January 2020 until December 2022. The cut-off value of MTA and Koedam score was set with Receiver Operating Curve. Multivariate analysis was performed to investigate the association between MTA and Koedam score with cognitive function. Of 61 patients, 22.95% had probable AD, 59.01% vascular dementia, and 18.03% mixed dementia. Correlation test showed that MTA and Koedam score were negatively associated with Montreal Cognitive Assessment-Indonesian Version (MoCA-INA) score. MTA score ≥ 3 (AUC 0.69) and Koedam score ≥ 2 (AUC 0.67) were independently associated with higher risk of poor cognitive function (OR 13.54, 95% CI 1.77–103.43, p = 0.01 and OR 5.52, 95% CI 1.08–28.19, p = 0.04). Higher MTA and Koedam score indicate worse cognitive function in dementia. Future study is needed to delineate these findings as prognostic markers of dementia severity.
... Imaging biomarkers can play an important role in increasing the certainty of the dementia diagnosis. 15,16 Depending on the modalities, imaging biomarkers trace structural, functional, and molecular changes in the brain. 16,17 Magnetic resonance imaging (MRI) is a widely used tool that can assist in identifying dementia types and their underlying pathologies. ...
... 16,17 Magnetic resonance imaging (MRI) is a widely used tool that can assist in identifying dementia types and their underlying pathologies. 15 Dementia causes regional atrophy in gray matter (GM) and white matter (WM) of the brain, which can be detected using structural MRI techniques. 18,19 Previous studies reported patterns of this structural alteration in AD and VaD. ...
Alzheimer’s disease (AD) is the most common type of dementia, and AD individuals often present significant cerebrovascular disease (CVD) symptomology. AD with significant levels of CVD is frequently labeled mixed dementia (or sometimes AD-CVD), and the differentiation of these two neuropathologies (AD, AD-CVD) from each other is challenging, especially at early stages. In this study, we compared the gray matter (GM) and white matter (WM) volumes in AD (n = 83) and AD-CVD (n = 37) individuals compared with those of cognitively healthy controls (n = 85) using voxel-based morphometry (VBM) of their MRI scans. The control individuals, matched for age and sex with our two dementia groups, were taken from the ADNI. The VBM analysis showed widespread patterns of significantly lower GM and WM volume in both dementia groups compared to the control group (P < .05, family-wise error corrected). While comparing with AD-CVD, the AD group mainly demonstrated a trend of lower volumes in the GM of the left putamen and right hippocampus and WM of the right thalamus (uncorrected P < .005 with cluster threshold, K = 10). The AD-CVD group relative to AD tended to present lower GM and WM volumes, mainly in the cerebellar lobules and right brainstem regions, respectively (uncorrected P < .005 with cluster threshold, K = 10). Although finding a discriminatory feature in structural MRI data between AD and AD-CVD neuropathologies is challenging, these results provide preliminary evidence that demands further investigation in a larger sample size.
... Although diagnostic evaluations are primarily performed based on clinical criteria, the role of neuroimaging has also expanded significantly [18]. Advanced neuroimaging techniques, such as diffusion tensor imaging (DTI), functional MRI (fMRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT), have been shown to provide valuable information in the diagnosis of dementia. ...
Dementia is a debilitating neurological condition that is characterized by persistent cognitive decline. It is a global health challenge, with a rapidly increasing prevalence due to an increasing aging population. Although definitive diagnosis of various conditions of dementia is only possible by autopsy, clinical diagnosis can be performed by a specialist. The diagnostic process has evolved with recent breakthroughs in diagnostic tools, such as advanced imaging techniques and biomarkers. These tools facilitate early and accurate identification of the condition. Early diagnosis is vital, as it enables timely interventions to improve the quality of life for affected individuals. Treatment strategies for dementia encompass both pharmacological and non-pharmacological approaches. Non-pharmacological treatments include cognitive training and lifestyle modifications. Among pharmacological treatments, acetyl-cholinesterase inhibitors including donepezil, rivastigmine, and galantamine can be used in various doses based on the severity of the disease. Apart from these, N-methyl-D-aspartate receptor antagonists such as memantine can also be used. Furthermore, personalized treatments have also gained significant attention in dementia treatment. Interdisciplinary care, involving healthcare professionals, social workers, and support networks, is crucial for comprehensive and holistic dementia management.
... They should not be confused with dilated perivascular spaces (PVS), i.e., spaces filled with CSF that surround perforating arterioles and venules as they pass through the parenchyma out from the subarachnoid space. Dilated PVS is typically formed by volume loss in the surrounding tissue, with a predisposition for the BG [9,42,43]. Both are considered cSVD manifestations. ...
... The degree of MTA can be assessed using the Scheltens scale (Table 3) on coronal planes perpendicular to the long axis of the HC [42]. Figure 3 shows the Scheltens scale, which focuses on three MTL features: the choroid fissure, the temporal horn width, and the HC height. ...
Dementia is a syndrome characterized by multidomain acquired chronic cognitive impairment that has a profound impact on daily life. Neurogenerative diseases such as Alzheimer's disease or nondegenerative diseases such as vascular dementia are considered to cause dementia. The need for further diagnostic improvement originates from the prevalence of these conditions, especially in developed countries with a predominance of the elderly population. Today, the diagnosis and follow-up of all neurodegenerative diseases cannot be performed without radiological imaging, primarily magnetic resonance imaging (MRI). The introduction of 3T MRI and its modern techniques, such as arterial spin labeling, has enabled better visualization of morphologic changes in dementia. For better diagnosis and follow-up in patients with dementia, various semiquantitative scales have been designed to improve the accuracy of assessment and decrease interobserver variability. Moreover, there is a growing need for MRI in the assessment of novel therapies and their side effects. To better apply MRI findings in the diagnosis of both already developed dementia and its early stages, the aim of this paper is to review the available literature and summarize the specific MRI changes.
... Through use of cerebrospinal fluid and imaging biomarkers, ADrelated changes can be detected early in cognitively normal older individuals [6]. For example, brain atrophy on structural magnetic resonance imaging (MRI) in a characteristic pattern involving the medial temporal lobes, paralimbic and temporoparietal cortices, has been associated with AD-related neurodegeneration [7][8][9]. Observational longitudinal studies have also suggested that differences in gray matter (GM) can be predictive of conversion of mild cognitive impairment (MCI) to AD [10]. ...
Cognitive impairment is a rapidly growing public health problem. As there is no curative treatment for dementia, the proactive management of modifiable risk factors and the identification of early biomarkers indicative of the cognitive decline are of great importance. Although nutrition is one of the most extensively studied lifestyle factor in relation to cognitive health, its association with brain magnetic resonance imaging (MRI) biomarkers is not well established. In the present work, we review available studies relating dietary or nutrient patterns with brain MRI biomarkers in dementia-free adults. Greater adherence to the Mediterranean diet has been associated with the preservation of structural connectivity and less brain atrophy in adults without dementia. In addition, specific nutrient patterns, characterized by a high intake of antioxidant vitamins, polyphenols and unsaturated fatty acids, have been related to larger brain volume. Although the results are encouraging regarding the role of dietary and nutrient patterns on imaging biomarkers, more well-designed observational longitudinal studies and clinical trials are needed in order to confirm potentially causal relationships and better understand underlying mechanisms.
Women have an over 50% greater risk of dementia than men, which is a main topic of much research. This review aims to investigate the impact of a woman’s reproductive history on dementia risk. The consequences of stillbirth are long-term health and psychosocial problems for women. Because of the awareness of an endangered pregnancy, many parents experience deep anxiety and stress in subsequent pregnancies. There are contradictory conclusions from research about abortion and the risk of dementia correlation. When it comes to the late age of first birth, which is said to be above 35 years old, it was observed that older mothers have a decreased risk of dementia compared to those who gave birth in their 20s; however, being a child of the older mother is connected with a higher risk of developing dementia. Using hormonal contraception can result in decreased risk of dementia as estrogen stimulates microglia-related Aβ removal and reduces tau hyperphosphorylation. The influence of postmenopausal hormonal therapy and the duration of the reproductive period on developing dementia remains unclear. Although female disorders like endometriosis and polycystic ovary syndrome are reported to increase the risk of dementia, the research on this topic is very limited, especially when it comes to endometriosis, and needs further investigation. Interestingly, there is no conclusion on whether hypertensive disorders of pregnancy increase the risk of dementia, but most articles seem to confirm this theory.
