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Imaging in dementia

University of Aberdeen, Department of Radiology, Lilian Sutton Building, Foresterhill, Aberdeen AB25 2ZD, UK

• Alzheimer's disease (AD) is the most common primary dementia
  
• AD causes posterior temporo-parietal defects on metabolic imaging with rCBF SPECT or FDG PET
  
• Structural brain imaging with MRI is a sensitive and specific method of diagnosing AD but requires volumetric assessment of medial temporal lobe structures
  
• In a patient with dementia, abnormal FP-CIT SPECT distinguishes dementia with Lewy bodies from AD
  
• Cerebrovascular disease is a common cause of dementia and may co-exist with other causes of dementia. It is most sensitively demonstrated on MRI but CT can also be used
  
• Current SIGN and NICE guidelines recommend structural brain imaging, preferably with MRI, in all new dementia patients but without health economic justification
  

This article reviews the role of imaging in patients with dementia, the typical appearances of different types of dementia on structural and functional imaging modalities and the implications of current guidelines for radiologists and imaging departments. The relative roles of structural and functional brain imaging in Alzheimer's disease, dementia with Lewy bodies, frontotemporal dementias and vascular dementia are discussed, and the usefulness of different modalities in routine clinical practice presented. Current guidelines for imaging in dementia recommend that structural imaging is performed in all patients in order to exclude significant intracranial abnormalities that may present with cognitive impairment, as well as to aid in establishing the subtype. Because there are currently no effective treatments for dementing illnesses, the cost of imaging in dementia is difficult to justify on health economic grounds. This is likely to change in the near future.