The role of neuroimaging in geriatric psychiatry
Purpose of review: This article reviews some of the key neuroimaging advances that have occurred over the past year, of relevance to Alzheimer's disease and late-life depression. As the number of elderly in the population continues to grow, the prevalence of these two diseases will rise correspondingly. Earlier and more accurate diagnoses will be essential to providing the best care and treatment. Neuroimaging contributes to all aspects of the therapeutic process, from diagnosis to treatment, and its role will only continue to grow. Recent findings: In Alzheimer's disease, neuroimaging advances offer great promise in early diagnosis, disease monitoring and drug development. Magnetic resonance imaging, positron emission tomography and functional magnetic resonance imaging studies have revealed hippocampal and entorhinal cortex abnormalities in early dementia as well as in patients with mild cognitive impairment. Serial imaging techniques, such as voxel compression mapping or spectroscopy, can be used to monitor dementia progression, estimate longitudinal change rates, or used in combination to enhance specificity and sensitivity. Techniques to image amyloid as well as the acetylcholinesterase enzyme have been studied in clinical samples. In late-life depression, neuroimaging advances have offered insights into pathophysiology and identified a subtype, vascular depression, characterized by white matter ischemic changes. The impact of such vascular changes on cognitive and therapeutic outcomes of late-life depression is being studied in a large prospective trial. Summary: Significant progress has been made in our ability to incorporate neuroimaging into medical management of psychiatric diseases; but research must continue to help neuroimaging fulfill its potential.
Townsend, BA; Petrella, JR; Doraiswamy, PM
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