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Alzheimer Disease
Akiva Mintz, MD, PhD, MHA, CFA; Bryan J. Neth, BS
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Alzheimer disease (AD)
          • Progressive neurodegenerative brain disease generally characterized by impairments in episodic memory and other cognitive domains
          • Likely related to β-amyloid (βA) and tau aggregation leading to synaptic dysfunction, neuronal/glial cell death
          • Role of imaging
            • Early detection of preclinical AD
            • Diagnosis of AD with clinical presentation and other biomarkers
            • Differential diagnosis between AD and other causes of dementia
        • Mild cognitive impairment (MCI)
          • Clinical symptoms of memory &/or other cognitive problems greater than normal for age and education
          • Increased risk of conversion to AD, but not all progress to full dementia
          • Annual conversion rate from MCI to dementia ~ 5-10%
        • Pre-AD or pre-clinical AD
          • Stage of disease process where series of pathologic events occurs in brain (e.g., βA plaque deposition) but prior to onset of significant clinically detectable symptoms

      IMAGING

      • General Features

        • Nuclear Medicine Findings

          • MR Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Key Imaging Findings

                          Selected References

                          1. Jagust W: Imaging the evolution and pathophysiology of Alzheimer disease. Nat Rev Neurosci. 19(11):687-700, 2018
                          2. Alzheimer's Association Report 2018 Alzheimer's disease facts and figures. https://www.sciencedirect.com/science/article/pii/S1552526018300414?via%3Dihub. Published May 2018. Accessed December 2019
                          3. Rice L et al: The diagnostic value of FDG and amyloid PET in Alzheimer's disease-A systematic review. Eur J Radiol. 94:16-24, 2017
                          4. Weidman DA et al: Added value and limitations of amyloid-PET imaging: review and analysis of selected cases of mild cognitive impairment and dementia. Neurocase. 23(1):41-51, 2017
                          5. SNMMI Procedure Standard-EANM Practice Guideline for Amyloid PET. http://snmmi.files.cms-plus.com/ACNM/Documents/SNMMI-EANM%20Standard%20for%20Amyloid%20PET%20Imaging%20of%20the%20Brain%20.pdf. Published January 2016. Accessed December 2019
                          6. Johnson KA et al: Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association. Alzheimers Dement. 9(1):e-1-16, 2013
                          7. Hyman BT et al: National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement. 8(1):1-13, 2012
                          8. Herholz K et al: Clinical amyloid imaging in Alzheimer's disease. Lancet Neurol. 10(7):667-70, 2011
                          9. McKhann GM et al: The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7(3):263-9, 2011
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              TERMINOLOGY

                              • Definitions

                                • Alzheimer disease (AD)
                                  • Progressive neurodegenerative brain disease generally characterized by impairments in episodic memory and other cognitive domains
                                  • Likely related to β-amyloid (βA) and tau aggregation leading to synaptic dysfunction, neuronal/glial cell death
                                  • Role of imaging
                                    • Early detection of preclinical AD
                                    • Diagnosis of AD with clinical presentation and other biomarkers
                                    • Differential diagnosis between AD and other causes of dementia
                                • Mild cognitive impairment (MCI)
                                  • Clinical symptoms of memory &/or other cognitive problems greater than normal for age and education
                                  • Increased risk of conversion to AD, but not all progress to full dementia
                                  • Annual conversion rate from MCI to dementia ~ 5-10%
                                • Pre-AD or pre-clinical AD
                                  • Stage of disease process where series of pathologic events occurs in brain (e.g., βA plaque deposition) but prior to onset of significant clinically detectable symptoms

                              IMAGING

                              • General Features

                                • Nuclear Medicine Findings

                                  • MR Findings

                                    • Imaging Recommendations

                                      DIFFERENTIAL DIAGNOSIS

                                        PATHOLOGY

                                        • General Features

                                          CLINICAL ISSUES

                                          • Presentation

                                            • Demographics

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Key Imaging Findings

                                                  Selected References

                                                  1. Jagust W: Imaging the evolution and pathophysiology of Alzheimer disease. Nat Rev Neurosci. 19(11):687-700, 2018
                                                  2. Alzheimer's Association Report 2018 Alzheimer's disease facts and figures. https://www.sciencedirect.com/science/article/pii/S1552526018300414?via%3Dihub. Published May 2018. Accessed December 2019
                                                  3. Rice L et al: The diagnostic value of FDG and amyloid PET in Alzheimer's disease-A systematic review. Eur J Radiol. 94:16-24, 2017
                                                  4. Weidman DA et al: Added value and limitations of amyloid-PET imaging: review and analysis of selected cases of mild cognitive impairment and dementia. Neurocase. 23(1):41-51, 2017
                                                  5. SNMMI Procedure Standard-EANM Practice Guideline for Amyloid PET. http://snmmi.files.cms-plus.com/ACNM/Documents/SNMMI-EANM%20Standard%20for%20Amyloid%20PET%20Imaging%20of%20the%20Brain%20.pdf. Published January 2016. Accessed December 2019
                                                  6. Johnson KA et al: Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association. Alzheimers Dement. 9(1):e-1-16, 2013
                                                  7. Hyman BT et al: National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement. 8(1):1-13, 2012
                                                  8. Herholz K et al: Clinical amyloid imaging in Alzheimer's disease. Lancet Neurol. 10(7):667-70, 2011
                                                  9. McKhann GM et al: The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7(3):263-9, 2011