| Theme |
Cognitive impairment and dialysis therapy |
| Title |
Diagnostic imaging for cognitive decline in hemodialysis patients |
| Author |
Shigeki Hirano |
Department of Neurology, Chiba University Graduate School of Medicine / Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology |
| Author |
Tetsuya Suhara |
Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology |
| [ Summary ] |
Neuroimaging should be considered as a diagnostic tool when hemodialysis patients present with cognitive decline. Among the differential diagnoses related to cognitive impairment, posterior reversible encephalopathy syndrome (PRES) and Wernicke's encephalopathy may be efficaciously diagnosed through use of brain MRIs. Forms of dementia such as vascular dementia (VaD), Alzheimer's disease (AD), and dementia with Lewy bodies (DLB), may have differential diagnoses for patients with cognitive decline because of their high prevalence in elderly patients. Brain MRIs and perfusion images, together with statistical parametric analyses, may be employed to effectively discriminate between these disorders. In cases of VaD, MRIs reveal ischemic lesions and corresponding regional hypoperfusion. In cases involving AD, mesial temporal atrophy as indicated by MRIs and parietal hypoperfusion there are characteristic features. In cases involving DLB, perfusion images indicate reduced occipital perfusion. A statistical parametric imaging approach can be applied to these imaging modalities and they may be used as rigorous diagnostic tools. Underlying pathologies may overlap, and may indicate the need for types of disease specific imaging such as, amyloid imaging, dopamine transporter imaging or cardiac sympathetic imaging as forms of adjunct testing. Imaging tests play pivotal roles in diagnosing patients with dementia and may also serve to indicate biomarkers. |