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SPECT can be helpful in understanding and treating dementia
As the population ages, the incidence of dementia in the U.S. will become an even more common problem and take up an even larger percentage of the health care budget. With the advent of new medications that slow the course of some dementing processes, diagnostic tools that help in the early differential diagnosis of dementia is essential.
The SPECT pattern for Alzheimer's Disease is typically bilateral hypoperfusion in the parietal and temporal regions of the brain with frontal lobe hypoperfusion occurring later in the illness. Multi-infarct dementia is characterized by multiple areas of decreased perfusion. HIV dementia is typically seen by decreased patchy uptake across the cortex. Frontal lobe dementias (as the name indicates) are often characterized by very poor frontal lobe perfusion. Psuedodementia (another condition, such as depression, that clinically appears like dementia) will not have a typical dementia pattern and may be more like a depression pattern.
Here are several examples of how SPECT can be useful in the evaluation and treatment of dementia-like presentations.
Frank in his 70s - Alzheimer’s Disease
bilateral decreased parietal and temporal lobe activity
top-down
underside
When Frank, a wealthy, well-educated man, entered his seventies, he began to grow forgetful. At first it was over small things, but as time went on the lapses of memory progressed to the point where he often forgot essential facts of his life: where he lived, his wife's name and even his own name. His wife and children, not understanding the change in behavior, were aggravated with his absent-mindedness and often angry at him for it. Frank's SPECT study showed a marked suppression across the entire brain, but especially in the frontal lobes, the parietal lobes and temporal lobes. This was a classic Alzheimer's disease pattern. By showing the family these images and pointing out the physiological cause of Frank's forgetfulness, in living images, I helped them understand that he was not trying to be annoying, but had a serious medical problem.
Consequently, instead of blaming him for his memory lapses, they began to show compassion towards him, and they developed strategies to deal more effectively with the problems of living with a person who has Alzheimer's Disease. In addition, I placed Frank on new experimental treatments for Alzheimer's Disease that seemed to slow the progression of the illness.
Ralph 92 yr.old - Alzheimer's Disease
Here is a scan of a 92 year old man with Alzheimer's Disease who had become forgetful, frequently lost away from home, forgot how to do simple things such as dress himself and began getting aggressive with his wife. Notice the extensive frontal lobe involvement.
top down
under side
notice marked overall suppression, especially in the parietal
lobes (arrows left images) and temporal lobes (arrows right image)
Reproduced with permission from Amen Clinics.
Medical Disclaimer: The information on this web site is for general informational purposes only. It is not a substitute for a medical evaluation. If you feel that medical interventions are necessary, please check with your physician.