Structural Neuroimaging: Brain Atrophy

Neuroimaging in Alzheimer’s disease (AD) has moved beyond the stage where it was used purely to exclude other disease processes. Structural brain magnetic resonance imaging (MRI) is useful to assess hippocampal atrophy on coronal slices; clinicians can use a simple visual rating scale, which can help to confirm the diagnosis of AD. Another useful indication for neuroimaging is to assess the contribution of cerebrovascular disease (CBVD) to the clinical syndrome of dementia. It has become clear in recent years that the most common situation in the general population is the combination of AD and CBVD. A neuroimaging procedure (CT scan or, preferably, MRI) can detect silent CBVD, which would modify management of modifiable risk factors. The recent Canadian Consensus on Dementia recognized this indication.