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P2‐062: Periventricular and deep white matter subcortical hypo‐intensities in Alzheimer's disease and normals
Author(s) -
Ramirez Joel,
Black Sandra E.
Publication year - 2008
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2008.05.1135
Subject(s) - hyperintensity , white matter , lesion , magnetic resonance imaging , dementia , lateral ventricles , medicine , pathology , cardiology , disease , radiology
Tc-99m-ECD for basal metabolism, injected in a quiet, dark room. Perfusion stimulants were acetazolamide 500 mg IV, nitroglycerin 0.6 -0.2 mg sublingual, omega 3 unsaturated acid ethyl esters (Lovaza) 10 gram oral, or Mona Vie (acai fruit juice) 100 ml oral. Cerebral Perfusion and Metabolic indices (CMi, CPi) for each patient, including 20 with low likelihood of disease, were calculated from the SPECT images. Patients were studied in the course of neurologic and neuroendocrine practice after complaints of cognitive impairment. Therapies included acetyl-cholinesterase inhibitors, Namenda, Lovaza, nonbranded fish oils, antihypertensives, statins and amantadine (for traumatic brain injury). Results: Brain SPECT defined three patterns: 1) CMi (5 -2)% CPi (normal if 49% CMi 71%) ; 2) CMi (5 -2)% CPi; 3) CMi (5 -2)% CPi. Therapeutic responses in 6 to 18 months among 20 -5 patients in each group were best (60% improved) for group 3, intermediate (30% improved) for group 2 and worst ( 10% improved) for group 1. Diagnoses included multiple causes of mild cognitive impairment in 80% and dementia in 20%. Over 70% of dementias were mixed, predominant types: vascular in 40%, Alzheimer’s in 30%, probable Lewy body in 15%, fronto-temporal in 5%, traumatic brain injury in 5% and miscellaneous in 5%. Conclusions: Stimulated perfusion is normally slightly increased over basal metabolism as defined by brain SPECT. Patients with decreased cerebral flow reserve (perfusion deficits) respond more readily to widely available therapy than those with predominant metabolic deficits and more intact flow reserve which characterize early neurodegenerative diseases. Patients with similar, fixed deficits in perfusion and metabolism (nonresponsive to perfusion stimulants) include advanced neurodegenerative and vascular dementias which have the worst prognosis.