Skip to main content
Top
Published in: Insights into Imaging 1/2017

Open Access 01-02-2017 | Pictorial Review

Imaging biomarkers of dementia: recommended visual rating scales with teaching cases

Published in: Insights into Imaging | Issue 1/2017

Login to get access

Abstract

The diagnostic work up of dementia may benefit from structured reporting of CT and/or MRI and the use of standardised visual rating scales. We advocate a more widespread use of standardised scales as part of the workflow in clinical and research evaluation of dementia. We propose routine clinical use of rating scales for medial temporal atrophy (MTA), global cortical atrophy (GCA) and white matter hyperintensities (WMH). These scales can be used for evaluation of both CT and MRI and are efficient in routine imaging assessment in dementia, and may improve the accuracy of diagnosis. Our review provides detailed imaging examples of rating increments in each of these scales and a separate teaching file. The radiologist should relate visual ratings to the clinical assessment and other biomarkers to assist the clinician in the diagnostic decision.

Teaching points

Clinical dementia diagnostics would benefit from structured radiological reporting.
Standardised rating scales should be used in dementia assessment.
It is important to relate imaging findings to the clinically suspected diagnosis.
Appendix
Available only for authorised users
Literature
1.
go back to reference Harper L, Fumagalli GG, Barkhof F et al (2016) MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Brain J Neurol. doi:10.1093/brain/aww005 Harper L, Fumagalli GG, Barkhof F et al (2016) MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Brain J Neurol. doi:10.​1093/​brain/​aww005
2.
go back to reference Wahlund L-O, Westman E, Van Westen D et al (2013) Structural brain imaging may improve diagnostics in dementia. Lakartidningen 110:2116–2118PubMed Wahlund L-O, Westman E, Van Westen D et al (2013) Structural brain imaging may improve diagnostics in dementia. Lakartidningen 110:2116–2118PubMed
3.
go back to reference American Psychiatric Association, American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, ArlingtonCrossRef American Psychiatric Association, American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, ArlingtonCrossRef
4.
go back to reference Glenner GG, Wong CW (1984) Alzheimer’s disease: initial report of the purification and characterization of a novel cerebrovascular amyloid protein. Biochem Biophys Res Commun 120:885–890CrossRefPubMed Glenner GG, Wong CW (1984) Alzheimer’s disease: initial report of the purification and characterization of a novel cerebrovascular amyloid protein. Biochem Biophys Res Commun 120:885–890CrossRefPubMed
5.
go back to reference Masters CL, Simms G, Weinman NA et al (1985) Amyloid plaque core protein in Alzheimer disease and Down syndrome. Proc Natl Acad Sci U S A 82:4245–4249CrossRefPubMedPubMedCentral Masters CL, Simms G, Weinman NA et al (1985) Amyloid plaque core protein in Alzheimer disease and Down syndrome. Proc Natl Acad Sci U S A 82:4245–4249CrossRefPubMedPubMedCentral
6.
go back to reference Goedert M, Spillantini MG, Crowther RA (1991) Tau proteins and neurofibrillary degeneration. Brain Pathol Zurich Switz 1:279–286CrossRef Goedert M, Spillantini MG, Crowther RA (1991) Tau proteins and neurofibrillary degeneration. Brain Pathol Zurich Switz 1:279–286CrossRef
7.
go back to reference Braak E, Griffing K, Arai K et al (1999) Neuropathology of Alzheimer’s disease: what is new since A. Alzheimer? Eur Arch Psychiatry Clin Neurosci 3:14–22CrossRef Braak E, Griffing K, Arai K et al (1999) Neuropathology of Alzheimer’s disease: what is new since A. Alzheimer? Eur Arch Psychiatry Clin Neurosci 3:14–22CrossRef
8.
go back to reference Westman E, Simmons A, Muehlboeck J-S et al (2011) AddNeuroMed and ADNI: similar patterns of Alzheimer’s atrophy and automated MRI classification accuracy in Europe and North America. NeuroImage 58:818–828CrossRefPubMed Westman E, Simmons A, Muehlboeck J-S et al (2011) AddNeuroMed and ADNI: similar patterns of Alzheimer’s atrophy and automated MRI classification accuracy in Europe and North America. NeuroImage 58:818–828CrossRefPubMed
10.
go back to reference den Heijer T, van der Lijn F, Koudstaal PJ et al (2010) A 10-year follow-up of hippocampal volume on magnetic resonance imaging in early dementia and cognitive decline. Brain J Neurol 133:1163–1172CrossRef den Heijer T, van der Lijn F, Koudstaal PJ et al (2010) A 10-year follow-up of hippocampal volume on magnetic resonance imaging in early dementia and cognitive decline. Brain J Neurol 133:1163–1172CrossRef
12.
go back to reference Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9:689–701CrossRefPubMed Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9:689–701CrossRefPubMed
13.
go back to reference Wallin A, Nordlund A, Jonsson M et al (2015) The Gothenburg MCI study: design and distribution of Alzheimer’s disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab. doi:10.1038/jcbfm.2015.147 Wallin A, Nordlund A, Jonsson M et al (2015) The Gothenburg MCI study: design and distribution of Alzheimer’s disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab. doi:10.​1038/​jcbfm.​2015.​147
15.
go back to reference Vann Jones SA, O’Brien JT (2014) The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 44:673–683CrossRefPubMed Vann Jones SA, O’Brien JT (2014) The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 44:673–683CrossRefPubMed
16.
go back to reference Dubois B, Feldman HH, Jacova C et al (2014) Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. Lancet Neurol 13:614–629CrossRefPubMed Dubois B, Feldman HH, Jacova C et al (2014) Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. Lancet Neurol 13:614–629CrossRefPubMed
18.
go back to reference Burton EJ, Barber R, Mukaetova-Ladinska EB et al (2009) Medial temporal lobe atrophy on MRI differentiates Alzheimer’s disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain 132:195–203CrossRefPubMed Burton EJ, Barber R, Mukaetova-Ladinska EB et al (2009) Medial temporal lobe atrophy on MRI differentiates Alzheimer’s disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain 132:195–203CrossRefPubMed
19.
go back to reference Harper L, Barkhof F, Fox NC, Schott JM (2015) Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2014-310090 Harper L, Barkhof F, Fox NC, Schott JM (2015) Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. J Neurol Neurosurg Psychiatry. doi:10.​1136/​jnnp-2014-310090
20.
go back to reference Scheltens P, Launer LJ, Barkhof F et al (1995) Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol 242:557–560CrossRefPubMed Scheltens P, Launer LJ, Barkhof F et al (1995) Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol 242:557–560CrossRefPubMed
21.
go back to reference Scheltens P, Leys D, Barkhof F et al (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 55:967–972CrossRefPubMedPubMedCentral Scheltens P, Leys D, Barkhof F et al (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 55:967–972CrossRefPubMedPubMedCentral
22.
go back to reference Dubois B, Feldman HH, Jacova C et al (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 6:734–746CrossRefPubMed Dubois B, Feldman HH, Jacova C et al (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 6:734–746CrossRefPubMed
23.
go back to reference Cavallin L, Bronge L, Zhang Y et al (1987) (2012) Comparison between visual assessment of MTA and hippocampal volumes in an elderly, non-demented population. Acta Radiol Stockh Swed 53:573–579 Cavallin L, Bronge L, Zhang Y et al (1987) (2012) Comparison between visual assessment of MTA and hippocampal volumes in an elderly, non-demented population. Acta Radiol Stockh Swed 53:573–579
24.
go back to reference Pereira JB, Cavallin L, Spulber G et al (2014) Influence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut-offs. J Intern Med 275:317–330CrossRefPubMed Pereira JB, Cavallin L, Spulber G et al (2014) Influence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut-offs. J Intern Med 275:317–330CrossRefPubMed
25.
go back to reference Ferreira D, Cavallin L, Larsson E-M et al (2015) Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer’s disease and mild cognitive impairment. J Intern Med 278:277–290CrossRefPubMed Ferreira D, Cavallin L, Larsson E-M et al (2015) Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer’s disease and mild cognitive impairment. J Intern Med 278:277–290CrossRefPubMed
26.
go back to reference Wattjes MP, Henneman WJP, van der Flier WM et al (2009) Diagnostic imaging of patients in a memory clinic: comparison of MR imaging and 64-detector row CT. Radiology 253:174–183CrossRefPubMed Wattjes MP, Henneman WJP, van der Flier WM et al (2009) Diagnostic imaging of patients in a memory clinic: comparison of MR imaging and 64-detector row CT. Radiology 253:174–183CrossRefPubMed
27.
go back to reference Westman E, Cavallin L, Muehlboeck J-S et al (2011) Sensitivity and specificity of medial temporal lobe visual ratings and multivariate regional MRI classification in Alzheimer’s disease. PLoS One 6:e22506CrossRefPubMedPubMedCentral Westman E, Cavallin L, Muehlboeck J-S et al (2011) Sensitivity and specificity of medial temporal lobe visual ratings and multivariate regional MRI classification in Alzheimer’s disease. PLoS One 6:e22506CrossRefPubMedPubMedCentral
28.
go back to reference Cavallin L, Løken K, Engedal K et al (1987) (2012) Overtime reliability of medial temporal lobe atrophy rating in a clinical setting. Acta Radiol Stockh Swed 53:318–323 Cavallin L, Løken K, Engedal K et al (1987) (2012) Overtime reliability of medial temporal lobe atrophy rating in a clinical setting. Acta Radiol Stockh Swed 53:318–323
29.
go back to reference Pasquier F, Leys D, Weerts JG et al (1996) Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts. Eur Neurol 36:268–272CrossRefPubMed Pasquier F, Leys D, Weerts JG et al (1996) Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts. Eur Neurol 36:268–272CrossRefPubMed
30.
go back to reference Ferreira D, Cavallin L, Granberg T, et al. (2015) Quantitative validation of a visual rating scale for frontal atrophy: associations with clinical status, APOE e4, CSF biomarkers and cognition. Eur Radiol 1–14. doi:10.1007/s00330-015-4101-9 Ferreira D, Cavallin L, Granberg T, et al. (2015) Quantitative validation of a visual rating scale for frontal atrophy: associations with clinical status, APOE e4, CSF biomarkers and cognition. Eur Radiol 1–14. doi:10.​1007/​s00330-015-4101-9
31.
go back to reference McKhann GM, Knopman DS, Chertkow H et al (2011) 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 7:263–269CrossRefPubMedPubMedCentral McKhann GM, Knopman DS, Chertkow H et al (2011) 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 7:263–269CrossRefPubMedPubMedCentral
32.
go back to reference Barkhof F, Fox NC, Bastos-Leite AJ, Scheltens P (2011) Neuroimaging in Dementia. Springer Berlin Heidelberg, BerlinCrossRef Barkhof F, Fox NC, Bastos-Leite AJ, Scheltens P (2011) Neuroimaging in Dementia. Springer Berlin Heidelberg, BerlinCrossRef
33.
go back to reference Wahlund LO, Barkhof F, Fazekas F et al (2001) A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke J Cereb Circ 32:1318–1322CrossRef Wahlund LO, Barkhof F, Fazekas F et al (2001) A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke J Cereb Circ 32:1318–1322CrossRef
34.
go back to reference Koedam ELGE, Lehmann M, van der Flier WM et al (2011) Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 21:2618–2625CrossRefPubMedPubMedCentral Koedam ELGE, Lehmann M, van der Flier WM et al (2011) Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 21:2618–2625CrossRefPubMedPubMedCentral
Metadata
Title
Imaging biomarkers of dementia: recommended visual rating scales with teaching cases
Publication date
01-02-2017
Published in
Insights into Imaging / Issue 1/2017
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-016-0521-6

Other articles of this Issue 1/2017

Insights into Imaging 1/2017 Go to the issue