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Dementia

Danial K. Hallam¹, Noriko Salamon‐Muramaya²

¹University of Washington, Seattle, Washington
²Northwestern University, Chicago, Illinois

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A5.3

DOI:

10.1002/0471142719.mia0503s06

Online Posting Date:

November, 2002

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Abstract

This unit presents specific protocols intended to maximize the contribution of MRI to the clinical evaluation of dementia. Each protocol has, as its foundation, a whole-brain screen designed to evaluate for treatable causes of dementia. Reflecting the frequent overlap of vascular disease with dementing illness, the screening protocol also serves as an optimal evaluation of the patient with suspected vascular dementia. Additional sequences or modifications are then used to answer specific clinical questions. The parameters given here are derived from experience at 1.5 T and may need to be altered slightly depending on the field strength and the equipment manufacturer.

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Unit Introduction
Basic Protocol 1: Vascular Dementia
Basic Protocol 2: Alzheimer's Disease
Basic Protocol 3: Huntington's Disease
Basic Protocol 4: Parkinson's Disease
Commentary
Bibliography
Figures
Tables

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Figures

Figure A5.3.1

A coronal T₁-weighted image demonstrates disproportionate atrophy of mesial temporal lobe structures, most notably the hippocampus (hi). Parahippocampal gyrus is also marked (PHG).

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Figure A5.3.2

An off-midline sagittal T₁-weighted image allows visualization of long axis of hippocampus (along arrowheads). Oblique coronal T₁-weighted images are positioned perpendicular to the hippocampal long axis.

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Figure A5.3.3

Coronal T₁-weighted images of two Huntington's patients, (A) and (B), demonstrating caudatal atrophy seen with advanced disease. In the normal, the caudate head bulges into the lateral aspect of the anterior horn of the lateral ventricles. Atrophy of the caudate head results in loss of the usual medially oriented convex margin, which may become flattened or with increasing atrophy, concave. Reproduced from D.H. Yock (1995) with permission from Mosby.

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Figure A5.3.4

Conventional T₂-weighted spin echo demonstrates narrowing and smudging of pars compacta (arrow) in Parkinson's Disease. The pars reticulata (black arrowhead) of the substantia nigra exhibits low signal secondary to mineralization. The red nucleus (white arrowhead) is similarly recognized.

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Figure A5.3.5

Patient with progressive supranuclear palsy. Characteristic focal marked atrophy of the superior colliculi (black arrows) and periaqueductal region (white arrowheads) is present.

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Figure A5.3.6

Patient with striatonigral degeneration. T₂-weighted coronal image demonstrates slit-like signal void in putamen (large arrows) resulting from iron depostion. In this case, some high signal was also seen adjacent to the patient's left putamen (small arrows).

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Figure A5.3.7

Profound atrophy of pons and cerebellum demonstrated by T₂-weighted transverse (A) and T₁-weighted sagittal, midline (B) and para-midline (C) in this patient with olivopontocerebellar degeneration as a component of multiple system atrophy.

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Literature Cited

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Key References
	Shellock and Kanal, 1996. See above.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.
	Terry, R.D., Katzman, R., and Bick, K.L. 1999. Alzheimer Disease, 2nd Edition. Lippincott Williams & Wilkins, Philadelphia.
A current review of the major aspects of Alzheimer's disease including clinical, epidemiologic, structural, imaging, chemical, genetic, and molecular.