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Alzheimer Disease
Santhosh Gaddikeri, MD; Miral D. Jhaveri, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Alzheimer disease (AD)
            • Synonyms

              • Senile/presenile dementia of Alzheimer type
            • Definitions

              • AD dementia is progressive neurodegenerative condition characterized by progressive cognitive decline, memory impairment, and adverse impact on activities of daily living
              • National Institute on Aging and Alzheimer's Association (NIA-AA) 2011 workgroup recommendations
                • Phases of AD pathophysiological processes
                  • Preclinical AD
                  • Mild cognitive impairment (MCI) in AD
                  • AD dementia
              • AD is pathologic process reflected in specific postmortem histopathologic criteria, which is frequently but not necessarily associated with characteristic dementia syndrome
              • Probable AD dementia: Clinical syndrome meeting core clinical criteria specified in NIA-AA workgroup report
              • Possible AD dementia: Clinical syndrome meeting core clinical criteria for AD dementia in terms of nature of cognitive deficits for AD dementia, but either 1) has sudden onset of impairment or demonstrates insufficient historical detail or objective documentation of progression, or 2) has mixed etiological presentation due to evidence of vascular or Lewy body pathology
              • MCI: Clinical syndrome meeting published core clinical criteria for MCI; generally agreed core features include 1) concern for change in cognition, 2) impairment in one or more cognitive domains, and 3) preservation of independence in functional activities, but 4) not demented

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Chandra A et al: Applications of amyloid, tau, and neuroinflammation PET imaging to Alzheimer's disease and mild cognitive impairment. Hum Brain Mapp. ePub, 2019
                                            2. Huang Q et al: Three-dimensional pseudocontinuous arterial spin labeling and susceptibility-weighted imaging associated with clinical progression in amnestic mild cognitive impairment and Alzheimer's disease. Medicine (Baltimore). 98(23):e15972, 2019
                                            3. Matsuda H et al: Neuroimaging of Alzheimer's disease: focus on amyloid and tau PET. Jpn J Radiol. ePub, 2019
                                            4. Rabinovici GD et al: Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA. 321(13):1286-1294, 2019
                                            5. Triviño-Ibáñez EM et al: Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria. Medicine (Baltimore). 98(29):e16509, 2019
                                            6. Veitch DP et al: Understanding disease progression and improving Alzheimer's disease clinical trials: Recent highlights from the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement. 15(1):106-152, 2019
                                            7. Femminella GD et al: Imaging and Molecular Mechanisms of Alzheimer's Disease: A Review. Int J Mol Sci. 19(12), 2018
                                            8. Morley JE et al: Alzheimer Disease. Clin Geriatr Med. 34(4):591-601, 2018
                                            9. Xia C et al: Multimodal PET Imaging of Amyloid and Tau Pathology in Alzheimer Disease and Non-Alzheimer Disease Dementias. PET Clin. 12(3):351-359, 2017
                                            10. Brown RK et al: Brain PET in suspected dementia: patterns of altered FDG metabolism. Radiographics. 34(3):684-701, 2014
                                            11. Nasrallah IM et al: Multimodality imaging of Alzheimer disease and other neurodegenerative dementias. J Nucl Med. 55(12):2003-11, 2014
                                            12. Ishii K: PET Approaches for Diagnosis of Dementia. AJNR Am J Neuroradiol. Epub ahead of print, 2013
                                            13. Petrella JR: Neuroimaging and the search for a cure for Alzheimer disease. Radiology. 269(3):671-91, 2013
                                            14. Croisile B et al: [The new 2011 recommendations of the National Institute on Aging and the Alzheimer's Association on diagnostic guidelines for Alzheimer's disease: Preclinal stages, mild cognitive impairment, and dementia.] Rev Neurol (Paris). 168(6-7):471-82, 2012
                                            15. Jack CR Jr: Alzheimer disease: new concepts on its neurobiology and the clinical role imaging will play. Radiology. 263(2):344-61, 2012
                                            16. Albert MS et al: The diagnosis of mild cognitive impairment 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):270-9, 2011
                                            17. 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
                                            18. Shen Q et al: Volumetric and visual rating of magnetic resonance imaging scans in the diagnosis of amnestic mild cognitive impairment and Alzheimer's disease. Alzheimers Dement. 7(4):e101-8, 2011
                                            19. Sperling RA et al: Toward defining the preclinical stages of 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):280-92, 2011
                                            20. Dai W et al: Mild cognitive impairment and alzheimer disease: patterns of altered cerebral blood flow at MR imaging. Radiology. 250(3):856-66, 2009
                                            21. McEvoy LK et al: Alzheimer disease: quantitative structural neuroimaging for detection and prediction of clinical and structural changes in mild cognitive impairment. Radiology. 251(1):195-205, 2009
                                            22. Duara R et al: Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology. 71(24):1986-92, 2008
                                            23. Petrella JR et al: Cortical deactivation in mild cognitive impairment: high-field-strength functional MR imaging. Radiology. 2007 Oct;245(1):224-35. Erratum in: Radiology. 246(1):338, 2008
                                            24. Norfray JF et al: Alzheimer's disease: neuropathologic findings and recent advances in imaging. AJR Am J Roentgenol. 182(1):3-13, 2004
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Alzheimer disease (AD)
                                                      • Synonyms

                                                        • Senile/presenile dementia of Alzheimer type
                                                      • Definitions

                                                        • AD dementia is progressive neurodegenerative condition characterized by progressive cognitive decline, memory impairment, and adverse impact on activities of daily living
                                                        • National Institute on Aging and Alzheimer's Association (NIA-AA) 2011 workgroup recommendations
                                                          • Phases of AD pathophysiological processes
                                                            • Preclinical AD
                                                            • Mild cognitive impairment (MCI) in AD
                                                            • AD dementia
                                                        • AD is pathologic process reflected in specific postmortem histopathologic criteria, which is frequently but not necessarily associated with characteristic dementia syndrome
                                                        • Probable AD dementia: Clinical syndrome meeting core clinical criteria specified in NIA-AA workgroup report
                                                        • Possible AD dementia: Clinical syndrome meeting core clinical criteria for AD dementia in terms of nature of cognitive deficits for AD dementia, but either 1) has sudden onset of impairment or demonstrates insufficient historical detail or objective documentation of progression, or 2) has mixed etiological presentation due to evidence of vascular or Lewy body pathology
                                                        • MCI: Clinical syndrome meeting published core clinical criteria for MCI; generally agreed core features include 1) concern for change in cognition, 2) impairment in one or more cognitive domains, and 3) preservation of independence in functional activities, but 4) not demented

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Chandra A et al: Applications of amyloid, tau, and neuroinflammation PET imaging to Alzheimer's disease and mild cognitive impairment. Hum Brain Mapp. ePub, 2019
                                                                                      2. Huang Q et al: Three-dimensional pseudocontinuous arterial spin labeling and susceptibility-weighted imaging associated with clinical progression in amnestic mild cognitive impairment and Alzheimer's disease. Medicine (Baltimore). 98(23):e15972, 2019
                                                                                      3. Matsuda H et al: Neuroimaging of Alzheimer's disease: focus on amyloid and tau PET. Jpn J Radiol. ePub, 2019
                                                                                      4. Rabinovici GD et al: Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA. 321(13):1286-1294, 2019
                                                                                      5. Triviño-Ibáñez EM et al: Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria. Medicine (Baltimore). 98(29):e16509, 2019
                                                                                      6. Veitch DP et al: Understanding disease progression and improving Alzheimer's disease clinical trials: Recent highlights from the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement. 15(1):106-152, 2019
                                                                                      7. Femminella GD et al: Imaging and Molecular Mechanisms of Alzheimer's Disease: A Review. Int J Mol Sci. 19(12), 2018
                                                                                      8. Morley JE et al: Alzheimer Disease. Clin Geriatr Med. 34(4):591-601, 2018
                                                                                      9. Xia C et al: Multimodal PET Imaging of Amyloid and Tau Pathology in Alzheimer Disease and Non-Alzheimer Disease Dementias. PET Clin. 12(3):351-359, 2017
                                                                                      10. Brown RK et al: Brain PET in suspected dementia: patterns of altered FDG metabolism. Radiographics. 34(3):684-701, 2014
                                                                                      11. Nasrallah IM et al: Multimodality imaging of Alzheimer disease and other neurodegenerative dementias. J Nucl Med. 55(12):2003-11, 2014
                                                                                      12. Ishii K: PET Approaches for Diagnosis of Dementia. AJNR Am J Neuroradiol. Epub ahead of print, 2013
                                                                                      13. Petrella JR: Neuroimaging and the search for a cure for Alzheimer disease. Radiology. 269(3):671-91, 2013
                                                                                      14. Croisile B et al: [The new 2011 recommendations of the National Institute on Aging and the Alzheimer's Association on diagnostic guidelines for Alzheimer's disease: Preclinal stages, mild cognitive impairment, and dementia.] Rev Neurol (Paris). 168(6-7):471-82, 2012
                                                                                      15. Jack CR Jr: Alzheimer disease: new concepts on its neurobiology and the clinical role imaging will play. Radiology. 263(2):344-61, 2012
                                                                                      16. Albert MS et al: The diagnosis of mild cognitive impairment 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):270-9, 2011
                                                                                      17. 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
                                                                                      18. Shen Q et al: Volumetric and visual rating of magnetic resonance imaging scans in the diagnosis of amnestic mild cognitive impairment and Alzheimer's disease. Alzheimers Dement. 7(4):e101-8, 2011
                                                                                      19. Sperling RA et al: Toward defining the preclinical stages of 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):280-92, 2011
                                                                                      20. Dai W et al: Mild cognitive impairment and alzheimer disease: patterns of altered cerebral blood flow at MR imaging. Radiology. 250(3):856-66, 2009
                                                                                      21. McEvoy LK et al: Alzheimer disease: quantitative structural neuroimaging for detection and prediction of clinical and structural changes in mild cognitive impairment. Radiology. 251(1):195-205, 2009
                                                                                      22. Duara R et al: Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology. 71(24):1986-92, 2008
                                                                                      23. Petrella JR et al: Cortical deactivation in mild cognitive impairment: high-field-strength functional MR imaging. Radiology. 2007 Oct;245(1):224-35. Erratum in: Radiology. 246(1):338, 2008
                                                                                      24. Norfray JF et al: Alzheimer's disease: neuropathologic findings and recent advances in imaging. AJR Am J Roentgenol. 182(1):3-13, 2004