My husband has been diagnosed with MCI. He had an MRI last January and another in November. Both reports said he had moderate cerebral atrophy. They said a few other things, but nothing specific about where the atrophy was. Can an MRI lead to a diagnosis of a specific type of dementia? If so, what would the report be likely to say?
It is my understanding the an MRI shows damage that is already done, but not necessarily why/what caused it. My husband's first MRI did specify where the damage was, but the first neurologist said the shrinking/atrophy was normal for a 53 year old and could have been caused by excessive drinking in college!!!! When the same MRI was reviewed along with his neuropysch testing, the 2nd neurologist clearly thought there was some sort of dementia. THEN, the 3rd neurologist ordered a PETscan, because she says that is better at showing WHY the damage is occuring, not just that it has occurred. That's when we got the AD diagnosis, although my husband has a PETscan every year, because he has extensive frontal lobe damage, so they think AD but have still not ruled out FTD entirely. He also has MRIs as part of the Elan clinical trial, but we don't see those results, and that is apparently to be sure he doesn't have brain swelling as a result of the infusions. His neurologist thinks the PETscans are much more conclusive than MRIs, but they are more expensive. This is the first year he'll have one after qualifying for medicare, so we'll see if medicare pays----my private insurance did pay almost all of the cost last year.
Janet, When my DH had the MRI it showed he had had a small stroke and several mini strokes. I don't know if it showed plaques had formed on the brain cells but they dx'd him as in the first stages of AD. That was in September of 2007. He was put on Aricept and I think it helped but he may getting worse now.
Thanks texasmom. That's helpful. My understanding is that Medicare doesn't usually pay for a PET scan. That's why my husband hasn't had one. I think I read somewhere that they will pay if it's necessary to know what kind of dementia he has. So maybe they will pay for your husband's.
Does anyone know anything about getting Medicare to pay for Pet scans?
Haven't checked in for a while but have been following you all.
Texasmom, my DH is also doing the Elan study. He had his first infusion last week of December. Jan 1 was the cut off for new clients so the neuro got him in under the wire. DH is only having MRI's but no PEt scans. He is also APOE4 carrier so his dose is a little different. I feel he is slightly worse but it could be my imagination. DH also had the atrophy show up last 2-3 years also with MCI DX about 3 years ago. Neuro says they can't see plaques on a scan. He likened it to seeing the beach from outer space but you can distinquish the grains of sand.
Over the past 8 years my husband has had 5 MRI which none really showed a diagnoses. He also had a PET Scan a couple years ago, also didn't do anything to help with a diagnoses. Then in July last year he had another PET Scan that diagnosed him with FTD.
My DH had an MRI when we first noticed some memory problems in 2005. The PCP called and said it just showed normal aging of the brain with no acute abnormality. I asked for a copy of the report.
It said mild cortical and central atrophy is present and there are some mild chronic ischemic changes in the periventricular and subcortical region. No hemorrhage, mass or mass effect to suggest an acute abnormality. Normal flow voids are present in the internal carotid artery and in the basilar artery. After administration of contract there is no abnormal enhancement.
Most of that is Greek to me but 3 years later, January 2008, at the memory clinic, he was diagnosed with moderate AD. No MRI, PET scan or any test was done at that time, just a physical checkup and the MMSE. Would it have helped to put him on Aricept and Namenda back then? - just don't know.
jodij---Good news is that husband has had no side effects from infusions, and the staff treats him like a king so he loves participating! Bad news is that we've seen no improvement, and we recently found out that he's been getting the "real thing" since he started in fall of '06, which sort of confirms my thought that his may be a little more FTD than AD. He really declined on his neurophysch testing between Feb. '07 and Feb. '08, so much that his neurologist had more testing done in April '08, but then he seemed to stabilize, but my daughters and I (and our parttime caregiver) have seen a real nosedive since this past fall. His next neuropsych testing is next month, so I suspect we'll see more decline. I look at the Elan study as hope for the future, not necessarily for my husband, although as I've said several times on this website, participating in the study has resulted in all the top neurologists in Houston knowing us on a first name basis, so that's been a plus for us.
Kadee---our neurologist made an interesting comment last year about Petscans. She said they are only beneficial if you have qualified doctors to read them, and only recently did she think the doctors who read them in Houston knew what they were doing, AND that she only trusts 1-2 of them. Other spouses in my early-onset support group have heard the same comment from their spouse's doctors. If getting good Petscan readings here is a problem, I can only imagine what it's like outside the major metropolitan areas.
My DH was only dx'd with FTD after a PET Scan w/dye. MRI just showed normal shrinkage with aging. Please log on to the University of California Memory and Aging Center: memory.ucsf.edu/ftd. This is part of their Department of Neurology. You can pull up their primer on diagnostics, etc. It is very informative. You may find your answers there. M
MRI, CT (CAT), and PET scans can be used to help diagnose the disorder that is causing dementia symptoms.
MRI and CT scans do "structural" imaging. They can identify brain lesions (tumors), cerebral infarctions, subdural or extradural haematomas, cerebral abscesses and hydrocephalus, lobar cerebral atrophy, cerebrovascular disease and cortical atrophy.
MRI provides better images of intracranial structures than CT, especially cerebral white matter, and is more sensitive at picking up vascular lesions than CT. MRI is therefore particularly useful in identifying vascular dementia. Also, MRI scans may show knife-edge focal atrophy of frontal and/or temporal areas that is often asymmetrical indicating FTD, although trying to make a diagnosis of FTD is much trickier than a diagnosis of VaD.
An MRI scan takes longer than a CT scan, and an MRI may also not be readily available in emergency situations. It also cannot be used when a patient has a cardiac pacemaker or metallic intracranial aneurysm clips.
CT scans are often used in emergency situations, to take a quick look for problems that need immediate treatment, such as hemorrhagic stroke. Noncontrast CT is used as a routine to primarily exclude brain lesions and identify cerebrovascular disease.
While an MRI scan will show atrophy (shrinkage) of the brain, it will not show you why that shrinkage took place. Atrophy of the hippocampus and medial temporal lobe are consistent with AD, but cannot be used to diagnose AD definitively. If vascular lesions are not apparent, VaD is ruled out.
PET scans image metabolic activity and blood flow, rather than structure. They can also detect certain types of cerebral receptors, if the right type of radioactive label is used. (The analysis involves the injection of radiolabeled material, and it is the radiolabel that is imaged.) The material most commonly used during diagnosis of AD is glucose -- PET scans that use this material reflect the areas of the brain with abnormal glucose metabolism.
Again, the PET scan provides supportive evidence that the problem is AD, but not a definitive diagnosis.
However, other types of materials are under development that will, theoretically, help image other types of brain function. Some researchers have claimed success at imaging plaques and tangles. This approach may lead to a better diagnosis for AD, but is not yet in clinical use.
As for getting insurance to pay for a PET scan ... the doctor has to claim that it's for something that can be approved. If I recall correctly, my husband's doctor said she wanted to diagnosis the reason for dizziness, but I could have that wrong. She did not say it was for AD, because she knew the insurance would not cover that.
Thanks for all the info Sunshyne, as always you are a wealth of knowledge.
Jodij, My husband also got his first infusion in the Elan study in December. We haven't noticed any change one way or the other and I he will be getting the extra PET Scans. (There are only 4 I believe.) Although we don't get to see the results, I believe that we are entitled to at least a verbal report of what the tests show.? Maybe someone else knows more about this?
Texasmoms neurologists makes a good point as my husbands' first neuro read the MRI completely differently than his current neuro. I don't know much about the insurance coverage issue, I just bunt and hope for the best.
Thanks for the information Sunshyne. It is really helpful. I guess I'm like Charlotte on another discussion. I want a definite diagnosis - it is Alzheimer's or it isn't - not of this MCI stuff! It might turn into something else, or it might not.
Ah, but at least it might not. What I wouldn't give for MCI stuff right now.
I know what you mean, Janet, sometimes it seems as if anything is better than not knowing. But when you do know ... not knowing can start looking a lot better. Nuts.