Shifting paradigms in dementia toward stratification of diagnosis and treatment using MRI

Wiesje M. Van Der Flier*, Frederik Barkhof, Philip Scheltens

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

Abstract

Atrophy and cerebrovascular disease are the two most important magnetic resonance imaging (MRI) characteristics in the evaluation of dementia. On MRI, atrophy is the primary hallmark of neurodegenerative dementias including Alzheimer's disease (AD), while vascular dementia is characterized by the presence of ischemic vascular damage, such as territorial infarcts, lacunes, and white matter hyperintensities. Evidence is accumulating that vascular factors play an important role in the development of cognitive decline at old age and clinical AD. In the present article we present results of four recent MRI studies suggesting the additional involvement of small vessel disease in neurodegenerative disorders. Atrophy in the medial temporal lobe, as typically observed in AD, and small vessel disease often coincide. In terms of clinical significance, their effectsmay even be synergistic. The strict distinction between AD and vascular dementia is often artificial, as most patients suffer from both disorders to some extent. For the future,we see an important role for MRI in identifying those different compartments, regardless of clinical classification. Treatment could be directed by (and evaluated through) MRI patterns, rather than a diagnostic label.

Original languageEnglish
Title of host publicationImaging and the Aging Brain
PublisherBlackwell Publishing Inc.
Pages215-224
Number of pages10
ISBN (Print)1573316598, 9781573316590
DOIs
Publication statusPublished - 1 Jan 2007

Publication series

NameAnnals of the New York Academy of Sciences
Volume1097
ISSN (Print)0077-8923
ISSN (Electronic)1749-6632

Cite this

Van Der Flier, W. M., Barkhof, F., & Scheltens, P. (2007). Shifting paradigms in dementia toward stratification of diagnosis and treatment using MRI. In Imaging and the Aging Brain (pp. 215-224). (Annals of the New York Academy of Sciences; Vol. 1097). Blackwell Publishing Inc.. https://doi.org/10.1196/annals.1379.013