Abstract
Dementia is defined as chronic deterioration of intellectual function and cognitive skills significant enough to interfere with the ability to perform daily activities. Recent advances in the treatment of dementia have renewed interest in the use of various neuroimaging techniques that can assist in the diagnosis and differentiation of various subtypes. Neuroimaging and computational techniques have helped the radiological community to monitor disease progression of various neurodegenerative conditions presenting with dementia, such as Alzheimer disease, frontotemporal lobe dementia (FTLD), progressive supranuclear palsy (PSP) and multisystem atrophy-cerebellar variant (MSA-C), and their response to newer therapies. Prompt identification of treatable or reversible forms of dementia, such as tumours, subdural haemorrhage and intracranial dAVF, is crucial for the effective management of these conditions. It is also prudent to recognize the imaging spectrum of metabolic, infective and autoimmune diseases with rapidly progressing dementia, such as methanol toxicity, central pontine myelinolysis (CPM), delayed post hypoxic leukoencephalopathy (DPHL), HIV, Creutzfeldt-Jakob Disease (CJD), Sjogren's syndrome, multiple sclerosis (MS), radiation necrosis and Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), which are difficult to treat and often require palliative care. This pictorial review emphasizes various non-Alzheimer’s dementia entities and discusses their imaging highlights.Teaching Points• Non Alzheimer’s dementia constitutes a broad spectrum of conditions.• Neuroimaging plays an important role in differentiating treatable from irreversible dementia.• Neuroimaging is often non-specific in early stages of neurodegenerative conditions with dementia.• Neuroimaging plays an important role in the multimodal approach towards management of dementia.
Highlights
Dementia is a disorder characterized by global impairment in cognition, social and occupational functioning severe enough to interfere with daily functioning and quality of life
Three common forms of ischemic lesions can result in Vascular dementia (VaD): 1) Large artery infarcts involving the cortex and subcortical regions due to thromboembolic occlusion of major intracranial arteries; 2) Small artery infarctions or lacunes attributed to arteriolosclerosis involving the penetrating arteries and affecting the thalamus, basal ganglia, internal capsule, brain stem and cerebellum; 3) Periventricular white matter disease resulting from chronic subcortical ischemia of small arteries affecting the neurons, oligodedrocytes and astrocytes
It can manifest as steroidresponsive treatable dementia, which is caused by angiitis or nonvasculitic autoimmune inflammatory meningoencephalitis (NAIM)
Summary
Dementia is a disorder characterized by global impairment in cognition, social and occupational functioning severe enough to interfere with daily functioning and quality of life. There are various other nonAlzheimer conditions, which may present with cognitive impairments and can be divided into the broad categories of neurodegenerative, inflammatory/infective, metabolic/ genetic and miscellaneous This pictorial review emphasizes the role of neuroimaging in evaluating various causes of nonAlzheimer’s dementia. Three common forms of ischemic lesions can result in VaD: 1) Large artery infarcts involving the cortex and subcortical regions due to thromboembolic occlusion of major intracranial arteries; 2) Small artery infarctions or lacunes attributed to arteriolosclerosis involving the penetrating arteries and affecting the thalamus, basal ganglia, internal capsule, brain stem and cerebellum; 3) Periventricular white matter disease resulting from chronic subcortical ischemia of small arteries affecting the neurons, oligodedrocytes and astrocytes. Cortical lesions tend to be sudden onset with more focal neurodeficits, whereas subcortical lacunar infarcts and white matter disease have more gradual or stepwise decline of cognitive functions. There are no uniform diagnostic criteria; a combination of clinical and neuropsychological assessment with neuroimaging inputs may help in the diagnosis and management of patients with VaD
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