![]() ![]() 17-19 It is projected that the prevalence will nearly quadruple over the next 50 years, by which time approximately 1 in 45 Americans will be affected with this disease. In the future, the introduction of new therapies, for example the anti-amyloid drugs 16 for Alzheimer disease (AD), will reinforce the need of a more rigorous and early diagnosis, given the expectation that the earlier a specific therapy can be started, the more effective it will be in preventing or slowing disease progression.Īlzheimer disease is the most common cause of dementia, with prevalence rates higher than 40% at the age of 85 and a total annual cost approaching 70 billion dollars in the United States of America. 11 Moreover, the recognition of conditions that may precede dementia, such as mild cognitive impairment (MCI) or vascular cognitive impairment (VCI), 12-15 which may be more amenable to intervention, also raise the importance of an earlier diagnosis. 6 Additionally, there is an increasing urge for an early and more accurate diagnosis of dementia, given the current availability of therapies, such as cholinesterase inhibitors, that for the most frequent dementias, 7-10 improve or stabilize cognition, treat behavioral symptoms, and delay institutionalization. ![]() 5 From the diagnostic point of view, structural neuroimaging with either a noncontrast computed tomography (CT) or magnetic resonance (MR) imaging is already recommended for the initial evaluation of patients with dementia, 2 and is increasingly being used to support the clinical diagnosis beyond the traditional exclusionary approach. Since dementia is a growing health problem 4,5 with an enormous impact on society, measures should be taken to restructure the diagnostic algorithms and rehabilitation support. ▪ the essential feature of dementia is impairment in short and long term memory, associated with impairment in abstract thinking, impaired judgment, other disturbances of higher cortical function, or personality change… severe enough to interfere significantly with work or usual social activities… Pathological aging manual#The definition of dementia recommended by the American Academy of Neurology 2 as proposed in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-IIIR) 3 states: ![]() In this review, we will focus on dementia, the most severe consequence of pathologic brain aging. As a consequence of the aged population, an increase in neurologic illnesses is expected, such as neurodegenerative dementias, cerebrovascular disease (CVD), and movement disorders. The number of elderly people is increasing rapidly, and this tendency will continue in the near future. Pathological aging serial#New functional MR techniques and serial volumetric imaging studies to identify subtle brain abnormalities may also provide surrogate markers for pathologic processes that occur in diseases causing dementia and, in conjunction with clinical evaluation, may enable a more rigorous and early diagnosis, approaching the accuracy of neuropathology. Single photon emission computed tomography and positron emission tomography may have added value in the diagnosis of dementia and may become more important in the future, due to the development of radioligands for in vivo detection of AD pathology. Structural neuroimaging in dementia is focused on detection of brain atrophy, especially in the medial temporal lobe, for which coronal high resolution T1-weighted images perpendicular to the long axis of the temporal lobe are extremely important. The MR imaging protocol should include axial T2-weighted images (T2-WI), axial fluid-attenuated inversion recovery (FLAIR) or proton density-weighted images, and axial gradient-echo T2*-weighted images, for the detection of cerebrovascular pathology. Characteristic magnetic resonance (MR) imaging findings can contribute to the identification of different diseases causing dementia. Vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are the most frequent causes after AD, but a large proportion of patients have a combination of degenerative and vascular brain pathology. Alzheimer disease (AD) is the most common cause of dementia. The number of elderly people is increasing rapidly and, therefore, an increase in neurodegenerative and cerebrovascular disorders causing dementia is expected. ![]()
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