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Neuropsychological tests and [99mTc]-HM PAO SPECT in the diagnosis of Alzheimer's dementia

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Abstract

Twenty-three patients with Alzheimer's dementia (AD) in relatively early stages and 40 patients with other cognitive disorders of vascular or degenerative aetiology underwent neuropsychological examination and [99mTc]-HM PAO single photon emission computed tomography (SPECT). In contrast to the commonly accepted notion of a posterior temporoparietal reduction of tracer uptake as the typical SPECT pattern of AD, the most consistent feature found in the SPECT images of our AD patients was a hippocampal uptake deficit, associated with a variable degree of temporal, parietal and frontal deficit (extending from the posterior to the anterior regions), according to the severity of the disease. These results support the theory of AD as a “hippocampal dementia”, at least in the early stages. Neuropsychological tests were found to be somewhat more specific and more accurate than SPECT in distinguishing AD from non-AD cases.

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References

  1. American Psychiatric Association (1987) Diagnostic and statistic manual of mental disorders, 3rd edn revised. American Psychiatric Association, Washington, DC, pp 103–107

    Google Scholar 

  2. Ball MJ, Fisman M, Hachinski V, et al (1985) A new definition of Alzheimer's disease: a hippocampal dementia. Lancet I: 14–16

    Google Scholar 

  3. Battistin L, Pizzolato G, Dam M, Ponza I, Borsato N, Zando PL, Ferlin G (1990) Regional cerebral blood flow study with 99m Tc-propyleneamine oxime single photon emission computed tomography in Alzheimer's and multi-infarct dementia. Eur Neurol 30: 296–301

    PubMed  Google Scholar 

  4. Bergman H, Chertkow H, Stern J, et al (1992) HM-PAO (Ceretec) brain scanning in the diagnosis of Alzheimer's disease. Neurobiol Aging 13 [Suppl 1]: S17

    Google Scholar 

  5. Brun A, Englund E (1987) Regional pattern of degeneration in Alzheimer's disease. Neuronal loss and histopathological grading. Histopathology 5: 549–564

    Google Scholar 

  6. Burns A, Philpot M, Costa D, Ell P, Levy R (1989) The investigation of Alzheimer's disease with single photon emission tomography. J Neurol Neurosurg Psychiatry 52: 248–253

    PubMed  Google Scholar 

  7. Caltagirone C, Gainotti G, Masullo C, Miceli G (1979) Validity of some neuropsychological tests in the assessment of mental deterioration. Acta Psychiatr Scand 60: 50–56

    PubMed  Google Scholar 

  8. Costa DC, Ell PJ, Burns A, Philpot M, Levy R (1988) CBF tomograms with 99m Tc-HM-PAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease: initial results. J Cereb Blood Flow Metab 8 [Suppl 1]: 109–115

    PubMed  Google Scholar 

  9. De Leon MJ, George AE, Stylopoulos LA, Smith G, Miller DC (1989) Early marker for Alzheimer's disease: the atrophic hippocampus. Lancet II: 672–673

    Google Scholar 

  10. Deutsch G, Tweedy JR (1987) Cerebral blood flow in severity-matched Alzheimer and multi-infarct patients. Neurology 37: 431–438

    PubMed  Google Scholar 

  11. Eagger S, Syed GMS, Burns A, Barrett JJ, Levy R (1992) Morphologic (CT) and functional (rCBF-SPECT) correlates in Alzheimer's disease. Nucl Med Communi 13: 644–647

    Google Scholar 

  12. Folstein MF, Folstein SE, McHugh PR (1975) ‘Mini-mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198

    PubMed  Google Scholar 

  13. Foster NL, Chase TN, Fedio P, et al (1983) Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology 33: 961–965

    PubMed  Google Scholar 

  14. Frlich L, Eilles C, Ihl R, Maurer K, Lancjik M (1989) Stage-dependent reductions of regional cerebral blood flow measured by HMPAO-SPECT in dementia of Alzheimer type. Psychiatry Res 29: 347–350

    PubMed  Google Scholar 

  15. Gainotti G, Marra C (1994) Some aspects of memory disorders clearly distinguish dementia of the Alzheimer's type from depressive pseudo-dementia. J Clin Exp Neuropsychol 16: 65–78

    PubMed  Google Scholar 

  16. Geaney D, Soper N, Shepstone B, Cowen P (1990) The effect of central cholinergic stimulation on regional cerebral blood flow in Alzheimer's disease studied by single photon emission tomography. Lancet 335: 1484–1487

    PubMed  Google Scholar 

  17. Gemmel HG, Sharp PF, Besson JAO, Crawford JR, Ebmeier KP, Davidson J, Smith FW (1987) Differential diagnosis in dementia using the cerebral blood flow agent 99m Tc HM-PAO: a SPECT study. J Comput Assist Tomogr 11: 398–402

    PubMed  Google Scholar 

  18. Gemmel HG, Sharp PF, Besson JAO, Ebmeier KP, Smith FW (1988) A comparison of Tc-99m HM-PAO and I-123 IMP cerebral SPECT images in Alzheimer's disease and multi-infarct dementia. Eur J Nucl Med 14: 463–466

    PubMed  Google Scholar 

  19. Giordano A, Calcagni ML, Di Fazio P, Della Corte F, Barelli A, Pennisi M, Sada E, Colombo S, Galli G (1991) Brain SPECT (99m Tc-HMPAO) and DSPECT (133Xenon) using a new fast rotating 28 slices cerebral tomograph. In Schmidt HAE, Hofer R (eds) Nuclear medicine: nuclear medicine in research and practice, European Nuclear Medicine Congress, Vienna, 1–5 September 1991. Schattauer, Stuttgart, pp 6–8

    Google Scholar 

  20. Habert M, Spampinato U, Mas J, Bourdel MC, Ziegler M, Recondo J de, Askienazy S, Rondot P (1991) 99m Tc-HM-PAO SPECT and cognitive impairment in Parkinson's disease: a comparison with dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry 54: 787–792

    PubMed  Google Scholar 

  21. Hachinski VC, Ilif LD, Zihka E, Du Boulay GH, McAllister VL, Marshall J, Ross Russel RW, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32: 632–637

    PubMed  Google Scholar 

  22. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17: 427–442

    PubMed  Google Scholar 

  23. Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A (1992) The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium 99m-HMPAO SPECT. J Nucl Med 33: 181–185

    PubMed  Google Scholar 

  24. Hunter R, McLuskie R, Wyper D, et al (1989) The pattern of function-related regional cerebral blood flow investigated by single photon emission tomography with 99m Tc-HMPAO in patients with presenile Alzheimer's disease and Korsakoff's psychosis. Psychol Med 19: 847–855

    PubMed  Google Scholar 

  25. Jagust WJ, Buginger TF, Reed BR (1987) The diagnosis of dementia with single photon emission computed tomography. Arch Neurol 44: 258–262

    PubMed  Google Scholar 

  26. Jobst KA, Smith AD, Szatmari M, et al (1992) Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet 340: 1179–1183

    PubMed  Google Scholar 

  27. Johnson KA, Mueller SP, Walshe TM, English RJ, Holman BL (1987) Cerebral perfusion imaging in Alzheimer's disease: use of single photon emission computed tomography and iofetamine hydrochloride I-123. Arch Neurol 44: 165–168

    PubMed  Google Scholar 

  28. Johnson KA, Holman BL, Mueller SP, et al (1988) Single photon emission computed tomography in Alzheimer's disease: abnormal I-123-iofetamine uptake reflects dementia severity. Arch Neurol 45: 392–396

    PubMed  Google Scholar 

  29. Kushner M, Tobin M, Alavi A, et al (1987) Cerebellar glucose consumption in normal and pathological states using fluorine-FDG and PET. J Nucl Med 28: 1667–1670

    PubMed  Google Scholar 

  30. Lantos P (1990) Ageing and dementias. In: Weller R (ed) Nervous system, muscle and eyes, 3rd edn, vol 4. Churchill Livingstone, Edinburgh

    Google Scholar 

  31. Maher ER, Lees AJ (1986) The clinical features and natural history of the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology 36: 1005–1008

    PubMed  Google Scholar 

  32. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services task force on Alzheimer's disease. Neurology 34: 939–994

    PubMed  Google Scholar 

  33. Montaldi D, Brooks D, McColl J, Wyper D, Patterson J, Barron E, McCulloch J (1990) Measurements of regional cerebral blood flow and cognitive performance in Alzheimer's disease. J Neurol Neurosurg Psychiatry 53: 33–38

    PubMed  Google Scholar 

  34. Neary D, Snowden JS, Shield RA, Burjan AWI, Northen B, MacDermott N, Prescott MC, Testa HJ (1987) Single photon emission tomography using 99m Tc-HM-PAO. J Neurol Neurosurg Psychiatry 50: 1101–1109

    PubMed  Google Scholar 

  35. O'Brien JT, Eagger S, Syed GMS, Sahakian BJ, Levy R (1992) A study of regional blood flow and cognitive performance in Alzheimer's disease. J Neurol Neurosurg Psychiatry 55: 1182–1187

    PubMed  Google Scholar 

  36. Perani D, Di Piero V, Vallar G, Cappa S, Messa C, Bottini G, Berti A, Passafiume D, Scarlato G, Gerundini P, Lenzi GL, Fazio F (1988) Technetium-99m HM-PAO-SPECT study of regional cerebral perfusion in early Alzheimer's disease. J Nucl Med 29: 1507–1514

    Google Scholar 

  37. Risberg J (1985) Application of the nontraumatic xenon 133 method in neuropsychiatry. In: Hartman A, Hoyer S (eds) Cerebral blood flow and metabolism measurement. Springer, Berlin Heidelberg New York, pp 385–390

    Google Scholar 

  38. Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 55: 967–972

    PubMed  Google Scholar 

  39. Scheltens P, Launer LJ, Weinstein HC, Barkhof F, Jonker C (1994) The value of MRI and SPECT in the early diagnosis of Alzheimer's disease. Neurology 44 [Suppl 2]: 179

    PubMed  Google Scholar 

  40. Seab JP, Jagust WJ, Wong STS, et al (1988) Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease. Magn Reson Med 8: 200–208

    PubMed  Google Scholar 

  41. Sharp P, Gemmel H, Cherryman G, Besson J, Crawford J, Smith F (1986) Application of iodine-123-labelled isopropylamphetamine imaging to the study of dementia. J Nucl Med 27: 761–768

    PubMed  Google Scholar 

  42. Steele JC, Richardson JC, Olszewski J (1964) Progressive supranuclear palsy. Arch Neurol 10: 333–359

    PubMed  Google Scholar 

  43. Tierney MC, Fisher RH, Lewis AJ, et al (1988) The NINCS-ADRDA work group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology 38: 359–364

    PubMed  Google Scholar 

  44. Waldemar G, Bruhn P, Kristensen M, Johnsen A, Paulson O B, Lassen N A (1994) Heterogeneity of neocortical cerebral blood flow deficits in dementia of the Alzheimer type: a [99mTc]-d,l-HMPAO SPECT study. J Neurol Neurosurg Psychiatry 57: 285–295

    PubMed  Google Scholar 

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Villa, G., Cappa, A., Tavolozza, M. et al. Neuropsychological tests and [99mTc]-HM PAO SPECT in the diagnosis of Alzheimer's dementia. J Neurol 242, 359–366 (1995). https://doi.org/10.1007/BF00868390

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  • DOI: https://doi.org/10.1007/BF00868390

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