Memory Problems and Dementia

Alzheimer’s disease accounts for 60-80% of dementia cases. Approximately 5.2 million people in the U.S have already been diagnosed, and that number is expected to nearly triple by the year 2050! Its signature brain pattern is low activity (blood flow) in the posterior cingulate gyrus, parietal lobes and temporal lobes. In later stages of Alzheimer’s, the low activity often extends into other areas of the brain, including the frontal lobes.
Research has shown that SPECT imaging can identify the abnormally low blood flow pattern of Alzheimer’s disease up to 9 years before the onset of noticeable symptoms. This capacity of SPECT imaging is particularly valuable for people with a family history of Alzheimer’s disease.

Common Symptoms in Alzheimer’s Disease:

• Memory loss
• Problems with numbers
• Difficulty performing familiar tasks
• Problems constructing things
• Difficulty following directions
• Getting lost
• Confusion with time, date or location
• Difficulty interpreting what is seen
• Struggling with vocabulary or verbal expression
• Judgment problems
• Changes in mood or personality

Frontal-temporal lobe dementia is a neurodegenerative disease that affects the function of the frontal and temporal lobes, as its name suggests. This disease causes decreased blood flow and low activity in these important areas of the brain that are in charge of thinking, behaving and memory.

It’s estimated that 10-15% of people with dementia have this type. People with frontal-temporal lobe dementia often develop it in their 50s and 60s, although earlier onset is possible. Sometimes this type of dementia is incorrectly diagnosed as late onset bipolar disorder because some of the symptoms look similar. It’s so important to know what is really going on by looking at the brain. The SPECT images for these two disorders are vastly different.

Common Symptoms in Frontal-Temporal Lobe Dementia:

• Inappropriate behavior
• Loss of restraint/increased impulsivity
• Problems with language or speech
• Memory loss
• Cognitive difficulties
• Apathy
• Personality changes
• Language problems

Alcohol Related Dementia is caused by excessive use or abuse of alcohol. Alcohol is toxic to the brain, thus heavy long-term use impairs brain function over time, making the brain vulnerable to a degenerative process. With SPECT imaging, we will typically see a widespread pattern of low blood flow in the brain. It is also thought that vitamin deficiencies (especially a lack of thiamine), which are commonly found in alcoholics, play an important role in alcohol related dementia.

Common Symptoms of Alcohol Related Dementia:

• Balance problems
• Memory problems
• Difficulty learning new things
• Clouded thinking
• Disorganization
• Social problems
• Loss of motivation or initiative
• Hallucinations
• Confabulation (making things up)
• Language problems
• Moodiness
• Personality changes

It is estimated that 10% of dementia patients are suffering from vascular dementia. This type of dementia occurs as a result of diseases and conditions that inflame or damage blood vessels and consequently restrict blood flow in the brain. These include:

• High blood pressure
• Arthrosclerosis (hardening of the arteries)
• High cholesterol
• Diabetes
• Obesity
• Cerebral vascular (blood vessel) disease and stroke
• Lupus erythematosus
• Untreated obstructive sleep apnea
• Brain infections
• Traumatic brain injury
• Untreated depression
• Cigarette smoking

With stroke, a person may develop dementia symptoms right afterward, depending on the area that has been damaged; however, symptoms can also develop over time as a result of the artery disease affecting the brain. A person who has “mini strokes”—also known as TIAs that cause multiple small blockages in the brain—may also be vulnerable to vascular dementia.

Symptoms of vascular dementia can vary depending on which areas of the brain are most affected by the disease and may include several of the following:

• Thinking problems
• Confusion
• Poor reasoning and planning skills
• Difficulty with decision making
• Memory problems
• Poor concentration
• Difficulty with word finding
• Difficulty in social situations
• Uncontrollable laughing or crying
• Restlessness or agitation
• Difficulty walking
• Urinary urgency or incontinence

SPECT imaging will reveal areas of low blood flow, although the specific pattern for each person will vary based on the brain areas affected by the vascular dementia.

Normal Pressure Hydrocephalus (NPH) is caused by an abnormal build-up of fluid in the brain, causing the ventricles to enlarge and press on areas of the brain involved with walking, bladder control and cognitive processes. NPH causes symptoms that can mimic those seen in Alzheimer’s disease and Parkinson’s disease, so people suffering with NPH are often misdiagnosed. A SPECT scan can be extremely helpful in differentiating NPH from actual dementia so that a person can get the urgent medical attention and correct treatment needed for this potentially debilitating condition. If identified and treated early (before brain damage has occurred), the dementia symptoms of NPH often can be reversed.

Common Symptoms of Normal Pressure Hydrocephalus:

• Difficulty with walking
• Slowed movements
• Loss of bladder control
• Memory problems
• Difficulty making decisions and planning
• Personality changes
• Behavior problems
• Apathy

Pseudodementia is a condition in which a patient has another disorder—such as depression —yet has symptoms that mimic dementia (i.e. memory problems and behavior changes), but does not actually have dementia. The role of SPECT imaging is important for revealing the underlying cause of symptoms, since the treatment for depression (as in this example) is very different than that for dementia.