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¹H MR spectroscopy in common dementias

From the Departments of Diagnostic Radiology (Drs. Kantarci and Jack), Neurology (Drs. Petersen, Boeve, and Knopman), Health Sciences Research (Dr. Petersen), Clinical Epidemiology (Drs. O’Brien and Edland, S.D. Weigand), Psychiatry and Psychology (Drs. Smith and Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic, Rochester, MN, and Departments of Neurology (Dr. Tang-Wai) and Psychiatry and Psychology (Dr. Ferman), Mayo Clinic, Jacksonville, FL.

Address correspondence and reprint requests to Dr. C.R. Jack, Jr., Mayo Clinic 200 First St. SW, Rochester, MN 55905; e-mail: jack.clifford{at}mayo.edu

Objective: To determine the ¹H MR spectroscopic (MRS) findings and intergroup differences among common dementias: Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration (FTLD).

Methods: The authors consecutively recruited 206 normal elderly subjects and 121 patients with AD, 41 with FTLD, 20 with DLB, and 8 with VaD. The ¹H MRS metabolite ratio changes in common dementias were evaluated with respect to normal and also differences among the common dementias.

Results: N-Acetylaspartate (NAA)/creatine (Cr) was lower than normal in patients with AD, FTLD, and VaD. Myo-inositol (mI)/Cr was higher than normal in patients with AD and FTLD. Choline (Cho)/Cr was higher than normal in patients with AD, FTLD, and DLB. There were no metabolite differences between patients with AD and FTLD or between patients with DLB and VaD. NAA/Cr was lower in patients with AD and FTLD than DLB. MI/Cr was higher in patients with AD and FTLD than VaD. MI/Cr was also higher in patients with FTLD than DLB.

Conclusions: NAA/Cr levels are decreased in dementias that are characterized by neuron loss, such as AD, FTLD, and VaD. MI/Cr levels are elevated in dementias that are pathologically characterized by gliosis, such as AD and FTLD. Cho/Cr levels are elevated in dementias that are characterized by a profound cholinergic deficit, such as AD and DLB.

Received August 28, 2003. Accepted in final form June 15, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the October 26 issue to find the title link for this article.

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