Abstract
PurposeThe purpose of this study was to investigate how structural imaging findings of medial temporal lobe atrophy (MTA), posterior cortical atrophy (PCA), global cortical atrophy (GCA), white matter changes (WMC), and Evans’ index/width of lateral ventricles (EI/WLV) are reported in the primary care diagnostic work-up of patients with subjective cognitive decline or mild cognitive impairment.MethodsWe included 197 patients referred to a non-enhanced computed tomography (NECT) as part of the diagnostic work-up. We compared the frequencies of reported findings in radiology reports written by neuroradiologists and general radiologists with actual pathological findings in a second view done by a single neuroradiologist using the MTA, PCA, GCA, WMC, and EI/WLV visual rating scales. Structural findings were also compared to cognitive tests.ResultsWe found that MTA and PCA were clearly underreported by both neuroradiologists and general radiologists. The presence of GCA and WMC was also underreported among general radiologists. Only MTA showed a clear association with cognitive test results.ConclusionsWe believe that the use of visual rating scales should be put into clinical practice to increase the yield of clinical NECT exams in the investigation of cognitive impairment. Special emphasis should be put on reporting MTA.
Highlights
Dementia is a clinical condition caused by a spectrum of diseases where Alzheimer’s disease (AD) is the most common among elderly [1, 2]
We retrospectively identified 250 eligible patients who had performed a non-enhanced computed tomography (NECT) 12 months prior to the BioFINDER imaging baseline
43 had not performed NECT as part of a memory impairment diagnostic work-up and referrals were missing for 10 patients leaving 197 patients who were included in the study
Summary
Dementia is a clinical condition caused by a spectrum of diseases where Alzheimer’s disease (AD) is the most common among elderly [1, 2]. Alzheimer’s disease has an insidious onset with progressive memory impairment and a prodromal phase starting decades before clinical onset, a phase often. Patients with MCI have an increased risk of later developing AD but early stages of AD and MCI can be difficult to separate [3]. The incidence of dementia is predicted to increase in the 20 to 30 years and validation of new therapies requires early identification of patients. Structural neuroimaging, i.e., computed tomography (CT) or magnetic resonance imaging (MRI), is used to exclude potentially treatable causes of dementia and identifying structural findings that may support the suspected diagnosis [1, 5, 6].
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