Comparative assessment of cerebral perfusion and metabolism in patients with Alzheimer’s disease and vascular cognitive disorders

Abstract

BACKGROUND: The high medical and social significance of the problem determines the necessity of the earliest nosological diagnostics of the cognitive disorders. Functional neuroimaging methods such as single-photon emission computed tomography and positron emission tomography play an important role in the early differential diagnosis, allowing to estimate perfusion and metabolism of the cerebral tissue.

AIM: To perform a comparative analysis of perfusion and metabolic abnormalities in different cerebral structures of patients with Alzheimer’s disease and vascular cognitive disorders in small cerebral vessels disease.

MATERIALS AND METHODS: Single-photon emission computed tomography was performed in 13 patients with Alzheimer’s disease and in 21 patients with vascular cognitive disorders; positron emission tomography with 18F-FDG was performed in 17 patients with Alzheimer’s disease and in 15 patients with vascular cognitive disorders.

RESULTS: Patterns of perfusion and metabolic abnormalities differ in patients with Alzheimer’s disease and vascular cognitive disorders. In patients with vascular cognitive disorders due to cerebral small vessels disease, a distinctive feature was a combination of hypoperfusion in subcortical structures, especially in the caudate nucleus and thalamus, with hypoperfusion in the deep parts of the frontal lobe. In Alzheimer’s disease, bilateral pronounced perfusion abnormalities in the parietal and temporal cortex were the most characteristic. Patterns of metabolic disturbances were similar to patterns of perfusion disturbances in different variants of cognitive disorders, but metabolic disturbances were more widespread. Рositron emission tomography was more informative in diagnosing patients with Alzheimer’s disease compared to single photon emission computed tomography. More pronounced perfusion and metabolic disorders were observed in patients with more severe cognitive disorders. Perfusion disturbances in the area of subcortical structures can be considered as an early marker of cognitive impairment development in patients with small vessel disease.

CONCLUSION: Single photon emission computed tomography has sufficient sensitivity and specificity when examining patients with vascular cognitive disorders, while positron emission tomography is more preferable when examining patients with Alzheimer-type dementia.

Keywords

Alzheimer’s disease / small vessel disease / dementia / Alzheimer-type dementia / metabolism / neuroimaging / single photon emission computed tomography / perfusion / positron emission tomography / vascular cognitive disorders / vascular dementia

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