Regional Cerebral Blood Flow Single Photon Emission Computed Tomography for detection of Frontotemporal dementia in people with suspected dementia

Archer, Hilary; Smailagic, Nadjija; John, Christeena; Holmes, Robin; Takwoingi, Yemisi; Coulthard, Elizabeth; Cullum, Sarah

doi:10.1002/14651858.cd010896.pub2

Cited by 22 publications

(14 citation statements)

References 73 publications

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“…A change to regional blood flow on SPECT is another red flag for underlying brain pathology. However, SPECT reporting is not standardised between centres and its specificity for dementia is only around 73% 33 34. Some centres use fludeoxyglucose positron-emission tomography during a work-up for dementia, which is more sensitive and specific than SPECT 23.…”

Section: Investigationsmentioning

confidence: 99%

Functional cognitive disorder: what is it and what to do about it?

et al. 2015

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To err is human, and it is normal to make minor cognitive errors from time to time. Some people experience persistent subjective cognitive difficulties that cause distress and functional impairment, with no underlying structural, neurodegenerative, toxic or metabolic cause. This is considered a form of functional disorder. In this article, we review functional cognitive disorder and outline its core clinical features. Patients with this are typically of working age and have a source of psychological distress, such as chronic pain, work stress or family difficulties. Its distinction from incipient dementia is difficult and usually requires interval follow-up. Pointers towards possible dementia include abnormal neuroimaging or loss of insight. Many patients accept a functional cognitive disorder diagnosis and willingly engage with psychological therapies but there is no defined optimal treatment. Functional cognitive disorder is common but under-studied; future research priorities include the development of clear diagnostic criteria and robust trials of therapeutic strategies.

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Section: Investigationsmentioning

confidence: 99%

Functional cognitive disorder: what is it and what to do about it?

et al. 2015

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“…Whilst the SPECT scan is widely requested for the diagnosis of FTD, the clinical evidence for its use is still lacking [28]. This type of investigation was the only FTD-specific nonclinical benchmark identified in the study and its overall performance was positive, albeit with a substantial number of occasions where its negative findings severely delayed the diagnosis.…”

Section: The Art and Power Of A Request Formmentioning

confidence: 98%

“…However, there is a mixed picture in the literature concerning these scans, with their considerable limitations [26,27]. A recent meta-analysis revealed that there is currently insufficient evidence to recommend the use of SPECT scans in routine practice [28]. EEG may be helpful [29][30][31] but it is not usually employed in a dementia clinic.…”

Section: The Variability and Inaccuracy Of The Diagnostic Criteriamentioning

confidence: 99%

Diagnostic accuracy of frontotemporal dementia. An artificial intelligence-powered study of symptoms, imaging and clinical judgement

Brzezicki

Kobetić

Neumann³

et al. 2019

Advances in Medical Sciences

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PURPOSE Frontotemporal dementia (FTD) is a neurodegenerative disorder associated with a poor prognosis and a substantial reduction in quality of life. The rate of misdiagnosis of FTD is very high, with patients often waiting for years without a firm diagnosis. This study investigates the current state of the misdiagnosis of FTD using a novel artificial intelligencebased algorithm. PATIENTS & METHODS An artificial intelligence algorithm has been developed to retrospectively analyse the patient journeys of 47 individuals diagnosed with FTD (age range 52-80). The algorithm analysed the efficiency of patient pathways by utilizing a reward signal of-1 to +1 to assess the symptoms, imaging techniques, and clinical judgement in both behavioural and language variants of the disease. RESULTS On average, every patient was subjected to 4.93 investigations, of which 67.4% were radiological scans. From first presentation it took on average 939 days for a firm diagnosis. The mean time between appointments was 204 days, and the average patient had their diagnosis altered 7.37 times during their journey. The algorithm proposed improvements by evaluating the interventions that resulted in a decreased reward signal to both the individual and the population as a whole. CONCLUSIONS The study proves that the algorithm can efficiently guide clinical practice and improve the accuracy of the diagnosis of FTD whilst making the process of auditing faster and more economically viable.

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“…Another method for functional imaging is perfusion SPECT, which also requires the intravenous injection of a radiolabeled tracer molecule, but instead is a measure of cerebral blood flow (CBF). The radiotracers most commonly used are 99m technetium-hexamethylpropylenamine oxime ( 99m Tc-HMPAO) or 99m technetium-ethyl-cysteinate dimer ( 99m Tc-ECD) (Archer et al, 2015).…”

Section: Imaging Techniques To Diagnose Ftdmentioning

confidence: 99%

The Use of Biomarkers and Genetic Screening to Diagnose Frontotemporal Dementia: Evidence and Clinical Implications

2019

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Within the wide range of neurodegenerative brain diseases, the differential diagnosis of frontotemporal dementia (FTD) frequently poses a challenge. Often, signs and symptoms are not characteristic of the disease and may instead reflect atypical presentations. Consequently, the use of disease biomarkers is of importance to correctly identify the patients. Here, we describe how neuropsychological characteristics, neuroimaging and neurochemical biomarkers and screening for causal gene mutations can be used to differentiate FTD from other neurodegenerative diseases as well as to distinguish between FTD subtypes. Summarizing current evidence, we propose a stepwise approach in the diagnostic evaluation. Clinical consensus criteria that take into account a full neuropsychological examination have relatively good accuracy (sensitivity [se] 75–95%, specificity [sp] 82–95%) to diagnose FTD, although misdiagnosis (mostly AD) is common. Structural brain MRI (se 70–94%, sp 89–99%) and FDG PET (se 47–90%, sp 68–98%) or SPECT (se 36–100%, sp 41–100%) brain scans greatly increase diagnostic accuracy, showing greater involvement of frontal and anterior temporal lobes, with sparing of hippocampi and medial temporal lobes. If these results are inconclusive, we suggest detecting amyloid and tau cerebrospinal fluid (CSF) biomarkers that can indicate the presence of AD with good accuracy (se 74–100%, sp 82–97%). The use of P-tau 181 and the Aβ 1 – 42 /Aβ 1 – 40 ratio significantly increases the accuracy of correctly identifying FTD vs. AD. Alternatively, an amyloid brain PET scan can be performed to differentiate FTD from AD. When autosomal dominant inheritance is suspected, or in early onset dementia, mutation screening of causal genes is indicated and may also be offered to at-risk family members. We have summarized genotype–phenotype correlations for several genes that are known to cause familial frontotemporal lobar degeneration, which is the neuropathological substrate of FTD. The genes most commonly associated with this disease ( C9orf72, MAPT, GRN, TBK1 ) are discussed, as well as some less frequent ones ( CHMP2B, VCP ). Several other techniques, such as diffusion tensor imaging, tau PET imaging and measuring serum neurofilament levels, show promise for future implementation as diagnostic biomarkers.

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Regional Cerebral Blood Flow Single Photon Emission Computed Tomography for detection of Frontotemporal dementia in people with suspected dementia

Cited by 22 publications

References 73 publications

Functional cognitive disorder: what is it and what to do about it?

Functional cognitive disorder: what is it and what to do about it?

Diagnostic accuracy of frontotemporal dementia. An artificial intelligence-powered study of symptoms, imaging and clinical judgement

The Use of Biomarkers and Genetic Screening to Diagnose Frontotemporal Dementia: Evidence and Clinical Implications

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