Toney Lauren Kay, McCue Tim J, Minoshima Satoshi, Lewis David H
Department of Nuclear Medicine, University of Washington, Seattle, WA, USA.
Hosp Pract (1995). 2011 Aug;39(3):149-60. doi: 10.3810/hp.2011.08.590.
Dementia is a clinical syndrome with diverse presentation, a challenging differential diagnosis, and time-sensitive therapy. The most common cause of dementia in patients aged > 65 years is Alzheimer's disease, which now affects 4 million people in the United States, but is often underrecognized, especially in the inpatient population. The hospitalist may have the opportunity to evaluate a patient's initial presentation of dementia. Addressing the inpatient's dementia symptoms can improve overall care and outcomes, so it is imperative that the hospitalist is abreast of recent developments in the dementia workup. The focus of this article is to overview how nuclear medicine imaging of the brain can aid in this process, with perfusion single-photon emission computed tomography (SPECT) and fludeoxyglucose F 18 ((18)F-FDG) positron emission tomography (PET) as the 2 most common modalities. Our discussion focuses on Alzheimer's disease, as this the most common etiology of dementia in patients aged > 65 years; however, we also touch on the other common neurodegenerative dementias (eg, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia) for completeness. We begin with a summary of the most recent published guidelines for each of these neurodegenerative diseases, and then expand on the role that nuclear imaging plays in each. We provide a basic overview of the principles of these nuclear medicine techniques, and then illustrate findings in perfusion SPECT and (18)F-FDG PET for typical patterns of dementia, with emphasis on evidence regarding diagnostic accuracy of each modality, in comparison with accepted gold standards. Finally, we outline some future research topics within the field of nuclear medicine in dementia, including amyloid plaque imaging and dopamine transporter imaging.
痴呆是一种临床表现多样、鉴别诊断具有挑战性且治疗具有时间敏感性的临床综合征。65岁以上患者中最常见的痴呆病因是阿尔茨海默病，目前在美国有400万人受其影响，但往往未得到充分认识，尤其是在住院患者中。住院医师可能有机会评估患者痴呆的初始表现。处理住院患者的痴呆症状可改善整体护理和治疗结果，因此住院医师必须了解痴呆检查的最新进展。本文的重点是概述脑核医学成像如何有助于这一过程，其中灌注单光子发射计算机断层扫描（SPECT）和氟脱氧葡萄糖F 18（（18）F-FDG）正电子发射断层扫描（PET）是两种最常见的方式。我们的讨论聚焦于阿尔茨海默病，因为它是65岁以上患者中最常见的痴呆病因；然而，为了全面起见，我们也会涉及其他常见的神经退行性痴呆（如路易体痴呆、血管性痴呆和额颞叶痴呆）。我们首先总结这些神经退行性疾病各自最新发布的指南，然后详述核成像在每种疾病中所起的作用。我们提供这些核医学技术原理的基本概述，然后说明灌注SPECT和（18）F-FDG PET在典型痴呆模式中的表现，重点是与公认的金标准相比，每种方式的诊断准确性证据。最后，我们概述痴呆领域核医学的一些未来研究主题，包括淀粉样斑块成像和多巴胺转运体成像。
