Dementia
affects at least 5% of people over 65 in the UK and USA, and incidence
is increasing.
In diagnosing
dementia type, two studies found concordances of just 3% and 29%
respectively for the diagnosis, via a range of protocols, of vascular
dementia (VaD), generally considered to be one of the two commonest
types, the other being Alzheimer’s disease (AD).
Millions of
dollars are spent annually on dementia research in the USA alone,
but much of this involves often-crude animal models. In
vitro models cannot represent the whole person or whole brain,
and clinical trials still rely largely on clinical diagnostic protocols
for selecting and classifying participants and analysing outcomes.
Thus it is
perhaps unsurprising that progress in finding causes and treatments
is slow. The main current treatments for AD are acetylcholinesterase
(AChE) inhibitors, which can only provide modest, short-term symptomatic
relief and do not work for all AD patients.
This review
examines the potential of the medical imaging of normal and diseased
human brains in vivo to provide insights into the development
and progression of these devastating and costly diseases.
Conclusions:
Imaging has great potential to enhance our understanding of the
development and progression of disease and response to treatment
in dementia research, and is a promising candidate to replace post-mortem
examination as a gold standard for dementia diagnosis.
Imaging may
help us to complete the picture of dementia causation by drawing
together the pathological strands detectable by the various modalities,
enabling prevention and treatment at an early stage and, it is hoped,
averting a dementia epidemic threatened by demographic changes and
the possible exacerbating contribution of environmental pollution.
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