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• W2054869425 abstract "Dementia has several aetiologies. Common to them all is that they lead to dysfunction of cerebral neurons and thereby to clinical symptoms, and that they disturb cerebral blood flow and metabolism. The causes of dementia may be divided into three categories: degenerative, e.g., Alzheimer's disease (AD), vascular dementias, and dementia due to other causes, e.g., sequela of head trauma. It is well known that advanced dementia irrespective of cause is accompanied by marked changes in cerebral perfusion and metabolism. In most instances the changes in perfusion and metabolism seem to be coupled. More controversial are the questions: 1) To which extent can measurements of CBF be used in the early diagnosis of dementia? and 2) Can CBF measurements be used to distinguish between different types of dementia, especially between vascular dementia and AD? The neural damage in a dementing disease may lead to tissue atrophy as well as to reduction in flow and metabolism. Of major interest is whether an observed flow reduction reflects only tissue loss (less tissue and thus lower total flow in the voxel) or reflects a true reduction of flow in the remaining tissue. With the classical inert gas clearance techniques, Kety Schmidt's original method and Lassen and Ingvar's later method using intraarterial injection of tracer, the measurements yield a direct value of perfusion per gram tissue. Thus, these measurements would be independent of any tissue loss and directly reflect flow in remaining tissue. In contrast, with the more modern tomographic methods the measurements depend heavily on the amount of tracer taken up in the tissue. Thus, in any given voxel the uptake will be proportional to the fraction of tissue present, the so-called partial volume effect. In dementia with atrophy the partial volume correction becomes essential if the aim is to calculate true flow in the remaining tissue. Though the evidence is not conclusive, it seems as if there is a flow and metabolism reduction in addition to the partial volume loss. Vascular dementia typically refers to dementia of vascular origin apart from sequela of major stroke. It might either be caused by multiple small ischemic lesions, potentially with infarction, or to more widespread and diffuse hypoperfusion leading to threatening ischemia. In threatening cerebral ischemia the circulation is often sufficient or only marginally reduced but with daily fluctuation of blood pressure insufficient perfusion may occur if there is no autoregulatory reserve. Also, vasodilatory stimuli like moderate accumulation of carbon dioxide might result in an adverse effect leading to insufficient perfusion in the threatened areas. Such abnormalities would be expected to distinguish vascular dementia from AD. There are many reports of such threatening ischemia, but most studies have been in smaller selected patient groups with signs of insufficient perfusion. In conclusion studies of cerebral blood flow and metabolism in dementing diseases have given us valuable information about pathophysiology. But at present it remains unclear to which extent flow measurement can be used more broadly in the clinical evaluation of patients with memory disturbances and dementing diseases." @default.
• W2054869425 created "2016-06-24" @default.
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• W2054869425 date "2005-08-01" @default.
• W2054869425 modified "2023-09-25" @default.
• W2054869425 title "CBF as a diagnostic tool in dementias: Revision required?" @default.
• W2054869425 doi "https://doi.org/10.1038/sj.jcbfm.9591524.0702" @default.
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