Chuppa Rustom – PET and Dementias

8/2/2019 Chuppa Rustom PET and Dementias

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Chuppa Rustom PET and

Dementias

Dr. Shemin Mehta

3rd year DNB RadiologyDr. Balabhai Nanavati Hospital


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Dementia The Indian Perspective

In 2010, there are 3.7 million Indians withdementia and the total societal cost isabout 14,700 crore

The cost of taking care of a person withdementia is about Rs. 43,000/- annually

While the numbers are expected to double

by 2030, costs would increase three times Early detection allows early initiation of

therapy to slow decline


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Diagnosis

Dementia diagnosis is essentially clinical falsenegative in 50-90%

Laboratory investigations play a supportive role

Structural imaging in the form of CT and MRI isinadequate in early stages, as well as havinglow sensitivity and specificity

Functional imaging, i.e. PET is more sensitiveand allows further disease characterization


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When to conduct a dementiaevaluation

Patient/family concerns

Functional impairment (driving, self-care)

Changes in personality & behaviour

Persistent cognitive deficit after deliriumclears

Abrupt change in cognitive, emotional or

neurologic status Depression associated with reversible

dementia (50% irreversible after 5 years)


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Patterns

Alzheimers Disease posterior cingulate,parietal and temporal cortices frontalinvolvement as AD progresses

Frontotemporal Dementia frontotemporal

abnormality with preserved posteriorfunctioning D/D from AD

Vascular Dementia patchy hypometabolicpattern in cortical & subcorticalregions

Dementia with Lewy Bodies parietal, temporaldeficits with frontal involvement as diseaseprogresses (similar to AD) along with occipitalhypometabolism


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Case 1

70/M

C/o forgetfulness,decreasedcomprehension, lack of

responsiveness

Insidious onset ofsymptoms

CT - Moderate cerebralatrophy, prominence ofsylvian fissures


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MRI and MRS

Multiple bilaterallacunar infarcts

Mild cerebral and

cerebellar atrophy Periventricular white

matter ischemia

MRS reduced NAA,mI and Chometabolic disorder


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PET-CT findings, Evaluation withScenium

Hypometabolismbilateral temporo-parietal, frontal

regions, bothhippocampi,amygdala, mesialtemporal lobe

Occipital regionslargely unaffected

Alzheimers disease


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Case 2

77/M

H/o socialdisinhibition,

aggressiveness CT moderate

atrophic changes,mild periventricularischemia


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Frontotemporal deficit

Preserved posteriorfunctioning

Frontotemporaldementia (FTD)


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Case 3

61/F

C/o decreased

attention and

decreased cognition CT temporoparietal

atrophy, moderateperiventricularischemia


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Parietal and temporaldeficits

Marked occipitalhypometabolism

Preserved frontalmetabolism

Lewy Body Dementia


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PET Present Status

Adds to clinical picture improves diagnosticaccuracy

Dementia diagnosis sensitivity with PET 91.5

+/- 3.5%, sensitivity without PET 66 +/- 17% To differentiate AD from FTD

Early identification of patients who will developAD and other dementias

Sensitive to AD-like hypometabolic changes innon-dementedpersons with APOE-4 risk forAD


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PET Present Status

Predicts cognitive decline in patients with APOE-4, normal elderly and persons with mild memoryimpairment

Predicts progression from Mild CognitiveImpairment (MCI) to dementia

Sensitive to preclinicalcognitive changes inpatients with high cognitive reserve

Normal study reassures worried well Role in Age-Associated Memory Impairment

(AAMI)


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Future Trends

F18-FDDNP tovisualise neurofibrillarytangles and senileplaques in AD; amyloid

labelling to followneuropathologic evolutionof AD in living subjects

F18-MPPF selectiveprobe for serotonin 1A

receptors as an index ofhippocampal neuronalloss early detection andmonitoring of dementias


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Future Trends

Newer compoundslike F18-FDOPA andothers to study

dopamine synthesis,dopamine transporterand vesiculartransporter in

Parkinsons disease


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Future Trends

C11-PK11195 aperipheral BZDreceptor agent

shows increaseduptake in AD, PD,multisystem atrophy,MND may correlate

with disease severityand mark diseaseonset


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References

PET in the Evaluation of Alzheimers

Disease and Related Disorders DanielSilverman

The Dementia India Report 2010

Documents

Chuppa Rustom – PET and Dementias