ABSTRACT

Dementia is the progressive decline and loss of cognitive functions such as orientation, memory, perception, attention, and judgement that cause worsening in daily activities. There are many reasons causing dementia, but the most common one is Alzheimer’s disease. The clinical diagnosis of dementia can be challenging especially in the early stages of disease. Early and accurate diagnosis of the disease has great importance because treatment is more effective when the medication is started before the irreversible brain damage. Although there are tests for exclusion of certain causes of dementia, results can rarely lead to definitive diagnosis. For this reason, imaging tools are playing an increasingly important role in the workup of dementia patients. Imaging can be performed by various methods such as structural-anatomical, cerebral blood flow, cerebral glucose metabolism, neurochemical, or molecular imaging. In chronological order, computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) are the commonly used imaging techniques in dementia diagnosis. In many neurodegenerative disorders, significant brain function alterations can be detected by SPECT or PET even when structural images with CT or MRI reveal no specific abnormalities. By the development of new tracers, PET is becoming a commonly used imaging tool in the diagnosis and differential diagnosis of dementia. PET imaging can be performed by using tracers indicating cerebral glucose metabolism, neuropathology (amyloid β plaques, neurofibrillary tangles), and neurotransmitter activity (cholinergic, serotoninergic, dopaminergic). Brain 2-[fluorine-18]fluoro-2-deoxy-d-glucose (F-18) FDG PET is a minimally invasive diagnostic imaging procedure used to evaluate cerebral glucose metabolism which provides an index of local synaptic activity and the dominant biochemical maintenance processes in dementia. Cerebral glucose hypometabolism on FDG-PET is a downstream marker of neuronal injury and neurodegeneration. Except cerebral glucose metabolism, pathological protein deposits such amyloid and tau, neurotransmitter activity alterations and existing neuroinflammation can also be detected by various PET tracers. The use of nuclear medicine techniques alone or combined with MRI can lead to accurate diagnosis of various subtypes of dementia especially with overlapping clinical symptoms. Early and accurate diagnosis can also facilitate early and effective treatment options which prevent high treatment costs of advanced disease. In conclusion, by the development of new PET tracers, nuclear medicine imaging will continue to play an important role in dementia both now and in the future.