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Clinical utility of MRI and SPECT in the diagnosis of cognitive impairment referred to memory clinic

Published online by Cambridge University Press:  07 September 2017

John Guinane Open the ORCID record for John Guinane [Opens in a new window]  and
Boon Lung Ng
John Guinane*
Affiliation:
Department of Geriatric Medicine, Barwon Health, Geelong, Victoria, Australia
Boon Lung Ng
Affiliation:
Department of Geriatric Medicine, Barwon Health, Geelong, Victoria, Australia
*
Correspondence should be addressed to: John Guinane, Department of Geriatric Medicine, Barwon Health, Ryrie Street, Geelong 3220, Victoria, Australia. Phone: +613 4215 5200. Email: [email protected].
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Abstract

Background:

Despite of their limited availability and potential for significant variation between and within each modality, this is the first study to prospectively measure the clinical utility of MRI and/or SPECT brain scanning in addition to the routine diagnostic workup of patients presenting to memory clinic.

Methods:

A single center study was conducted over a convenience of 12-month sampling period. For each patient referred for MRI and/or SPECT scanning, the primary geriatrician or psychogeriatrician was asked to assign an initial diagnosis. The initial diagnosis was then compared with the final consensus diagnosis after any scans or neuropsychology testing had been completed.

Results:

During the 12-month study period, 66 patients (26%) were referred for scans out of a total of 253 patients included in the study. There were 16/44 (36%) positive MRI outcomes and 13/35 (37%) positive SPECT outcomes. The diagnosis changed consistent with the MRI scan findings in 11/44 (25%) and changed consistent with the SPECT scan findings in 9/35 (26%). Potentially reversible pathology was identified in a single patient, 1/50 (2%), via an MRI scan that suggested normal pressure hydrocephalus. The number needed to test for one positive outcome was 3.8 (95% CI 2.0–23.3), 6.0 (95% CI NA), and 1.7 (95% CI 1.3–2.5) for MRI only, SPECT only, and MRI and SPECT together, respectively.

Conclusions:

The clinical utility of MRI and/or SPECT scanning in this study may be broadly superior to the available international evidence, and further research is needed to identify predictors of positive scan outcomes.

Keywords

cognitive impairmentdementiamagnetic resonance imaging (MRI)single photon emission computed tomography (SPECT)diagnosis and classification
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 5: Issue Theme: Brain Imaging , May 2018 , pp. 611 - 617
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Armstrong, B. et al. (2007). Challenges in health and health care for Australia. Medical Journal of Australia, 187, 485–489.Google Scholar
Birks, J. S. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews, CD005593.Google Scholar
Boelaarts, L., Scheltens, P. and de Jonghe, J. (2014). Using magnetic resonance imaging in diagnosing dementia: a Dutch outpatient memory clinics survey. Dementia and Geriatric Cognitive Disorders, 38, 281–285.Google Scholar
Borghesani, P. R. et al. (2010). Neuroimaging in the clinical diagnosis of dementia: observations from a memory disorders clinic. Journal of the American Geriatrics Society, 58, 1453–1458.Google Scholar
Brækhus, A. et al. (2011). The memory clinic–outpatient assessment when dementia is suspected. Tidsskrift for den Norske Lægeforening: Tidsskrift for Praktisk Medicin, ny række, 131, 2254–2257.Google Scholar
Brodaty, H., Seeher, K. and Gibson, L. (2012). Dementia time to death: a systematic literature review on survival time and years of life lost in people with dementia. International Psychogeriatrics, 24, 1034–1045.CrossRefGoogle Scholar
Chaudhry, P. et al. (2007). Characteristics and reversibility of dementia in normal pressure hydrocephalus. Behavioural Neurology, 18, 149–158.Google Scholar
Chui, H. and Zhang, Q. (1997). Evaluation of dementia: a systematic study of the usefulness of the American academy of neurology's practice parameters. Neurology, 49, 925–935.CrossRefGoogle ScholarPubMed
Frisoni, G. B. et al. (2010). The clinical use of structural MRI in Alzheimer disease. Nature Reviews Neurology, 6, 67–77.Google Scholar
Geroldi, C. et al. (2008). The added value of neuropsychologic tests and structural imaging for the etiologic diagnosis of dementia in italian expert centers. Alzheimer Disease and Associated Disorders, 22, 309– 320.Google Scholar
Hejl, A., Høgh, P. and Waldemar, G. (2002). Potentially reversible conditions in 1000 consecutive memory clinic patients. Journal of Neurology, Neurosurgery, and Psychiatry, 73, 390–394.Google Scholar
Meijs, A. P. et al. (2015). How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?. Age and Ageing, 44, 72–77.Google Scholar
Scheltens, P. et al. (2011). How golden is the gold standard of neuropathology in dementia?. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 7, 486– 489.Google Scholar
Skene, L. (2002). Dementia. Legal issues in consent. Australian Family Physician, 31, 329–332.Google Scholar
Yokoyama, S. et al. (2014). Imaging discrepancies between magnetic resonance imaging and brain perfusion single-photon emission computed tomography in the diagnosis of Alzheimer's disease, and verification with amyloid positron emission tomography. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 14, 110–117.Google Scholar