Dementia

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Dementia

• Dr Peter J Nestor
• peter.nestor_at_mrc-cbu.cam.ac.uk

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Imaging challenging patients
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Focal lesions to the mesial temporal lobe cause
amnesiaAmnesia is the first feature of
Alzheimers diseaseNeurofibrillary tangle (t)
pathology occurs earliest and most severely in
the mesial temporal lobe
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MRI in established AD
Hippocampal atrophy
Healthy elderly
AD
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Differing patterns of temporal atrophy in
Alzheimers disease and semantic dementia C. J.
Galton, MRCP(UK), K. Patterson, PhD, K. Graham,
PhD, M.A. Lambon-Ralph, PhD, G. Williams, PhD,
N. Antoun, FRCR, FRCP, B.J. Sahakian, PhD and
J.R. Hodges, MD, FRCP Neurology 2001 57 216-225
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18FDG a PET tracer analogue of glucose
glucose-6-phosphate
glucose
Energy
FDG-6-phosphate
FDG
blood vessel
Brain cells
Metabolic pathways of glucose and
18Fluorodeoxyglucose
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The image
Healthy brain areas need glucose and thus appear
bright on the scan
Damaged brain areas are not working and therefore
do not pick up glucose
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Alzheimers disease
Co-registration
Spatial normalisation to standard template
Smoothing
Statistics
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Very mild Alzheimers-Isolated memory impairment
Posterior cingulate hypometabolism
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Retrosplenial cortex is the first area
universally affected
Nestor et al, Eur J Neurosci 2003
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(No Transcript)
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60 year old male, recent onset memory impairment,
MMSE 30/30
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Anatomy
Cingulum bundle
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Method

• Regions of interest traced onto 3T volumetric
  MRI.
• FDG-PET co-registered onto MRI
• CMRglc calculated
• Normalised to cerebellum
• 3-compartment partial volume correction

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Co-registration
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Nestor et al, Ann Neurol, 2003
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Alzheimers disease and positron emission
tomography

• Pathology
• Neuronal loss
• Amyloid deposition
• ACh activity loss
• NFT (t)

• Marker
• 18FFDG
• 11CPIB
• 11CPMP
• In development