Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Neurobiological Correlates       Metabolism in Imaging       Imaging Modalities       Diagnostic Specificity       Early Detection       Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Posttest         Accreditation     Reference List     Acknowledgements		Neuroimaging in Dementia Scott A. Small, M.D. Diagnostic Specificity   There are three domains of clinical utility for which we hope to apply imaging techniques: diagnostic specificity, early detection, and mapping the clinical course of disease.   We know from a number of epidemiological studies that we have very high sensitivity in diagnosis of Alzheimer's dementia and that our diagnostic failure is in specificity. In other words, we are not very good at diagnosing a non-Alzheimer's cause of dementia such as Lewy-body dementia, vascular dementia, and CJD.   In fact, if you blindly assign the diagnosis of Alzheimer's disease to anyone who walks into your clinic with dementia, you will have 100-percent sensitivity but your specificity will suffer. Our goal is to use imaging to improve our diagnostic specificity by both improving our techniques to capture Alzheimer's disease, and by being very precise in defining the features of other dementias.   There are different neuropsychological profiles that map to different brain areas and large-scale patterns of brain function. We know that Alzheimer's affects the hippocampus first. Some studies show that Lewy-body dementia involves the occipital cortex, perhaps substantiating the predominant visual hallucinations. Frontotemporal dementia affects the frontal lobes. Some studies suggest that the cortical basal ganglionic degeneration that affects the frontal lobes might also affect the premotor cortex. The goal is to create a pattern-recognition scheme that allows us to associate patterns of dysfunction with disease.   When a patient presents with dementia, all of the techniques I have mentioned will be helpful, because dementia affects large-scale areas of the brain. By the time someone has dementia, there are multiple neuropathological correlates, including cell loss and others. Diagnostic specificity will likely involve a combination of all of these techniques.     PREVIOUS | NEXT