Ärzte Zeitung online, 22.11.2008

Second Step in Diagnostic Work-up for Dementia is CT or MRI

40 percent of dementia patients do not have Alzheimer's disease. The cause of the symptoms may be a normal pressure hydrocephalus.

All patients with dementia symptoms should undergo an imaging examination of the head at least once, radiologists at the x-ray congress in Berlin stressed.

"Of course an imaging study of the head is not the first step in the diagnostic work-up of dementia, but it is definitely the second," said Professor Michael Forsting, a radiologist at the Department of Diagnostic and Interventional Radiology and Neuroradiology at the University Hospital in the German town of Essen. Around four out of ten patients with dementia symptoms do not have Alzheimer's, but dementia with a different cause, Prof. Forsting added. It is possible to treat the causes in at least some of these patients.

Forsting mentioned two main variants of dementia. "Typically, patients with normal pressure hydrocephalus have gait disorders and incontinence problems, in addition to the symptoms of dementia," he said. In these patients CT or MRI reveals very characteristic, dilated ventricles. "In such cases dementia can be delayed by a simple ventricular shunt." Gait disorders and incontinence disappear after this. "It is a minimally invasive intervention and the patients are home again after a few days."

The second cause of dementia which can only be definitively clarified with radiological measures is subdural haematoma. In these cases the symptoms develop relatively quickly. "Typically, other family members report that grandpa has been getting confused lately," says Forsting. Scans then often show bilateral haematomas. Here, too, the symptoms can be reduced if the haematomas are aspirated, he says.

He adds that an imaging procedure can also be helpful in vascular dementia due to arterial hypertension. There is no neurosurgical treatment for this, but at least the compliance of hypertensive patients can be influenced very positively by imaging that shows fine white scars, Forsting says. "People who see that their own brain is already damaged are much more likely to take their tablets than a person who has only been told about what can happen in theory," he confidently states. (gvg)

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