Abstract
Biomarkers are playing a progressively leading role in both clinical practice and scientific research in dementia. Although amyloid and tau biomarkers have gained ground in the clinical community in recent years, neurodegeneration biomarkers continue to play a key role due to their ability to identify different patterns of brain involvement that sign the transition between asymptomatic and symptomatic stages of the disease with high sensitivity and specificity. Both 18F-FDG positron emission tomography (PET) and perfusion single photon emission computed tomography (SPECT) have proved useful to reveal the functional alterations underlying various neurodegenerative diseases. Although the focus of nuclear neuroimaging has shifted to PET, the lower cost and wider availability of SPECT make it a still valid alternative for the study of patients with dementia. This review discusses the principles of both techniques, compares their diagnostic performance for the diagnosis of neurodegenerative diseases and highlights the role of SPECT to characterize patients from low- and middle-income countries, where special care of additional costs is particularly needed to meet the new recommendations for the diagnosis and characterization of patients with dementia.
Highlights
Functional brain imaging includes a set of techniques that reveal biochemical, physiological, or electrical properties of the central nervous system
single photon emission computed tomography (SPECT) and positron emission tomography (PET) are nuclear medicine techniques that use radiopharmaceuticals for the evaluation of different functional phenomena, today there is a plethora of tracers that allow the study of many molecular events in the brain
Some authors like Nagata et al state that the information provided by SPECT/PET is useful in the differential diagnosis between vascular dementia (VD), Alzheimer’s disease (AD) and mixed dementia and should be taken into account in the diagnostic guidelines [61]
Summary
Functional brain imaging includes a set of techniques that reveal biochemical, physiological, or electrical properties of the central nervous system. The most developed of these techniques are single photon emission tomography (SPECT), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Magnetic resonance spectroscopy (MRS) is another functional technique that has clinical utility mostly in the evaluation of brain tumors, it does not have yet defined clinical applications in dementia. SPECT and PET are nuclear medicine techniques that use radiopharmaceuticals for the evaluation of different functional phenomena (classically brain perfusion for SPECT or metabolism for PET), today there is a plethora of tracers that allow the study of many molecular events in the brain
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