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9 - MRS in neurodegenerative disease

Published online by Cambridge University Press:  04 August 2010

Peter B. Barker ,
Alberto Bizzi ,
Nicola De Stefano ,
Rao Gullapalli  and
Doris D. M. Lin
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Alberto Bizzi
Affiliation:
Istituto Neurologico Carlo Besta, Milan
Nicola De Stefano
Affiliation:
Università degli Studi, Siena
Rao Gullapalli
Affiliation:
University of Maryland, Baltimore
Doris D. M. Lin
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Key points

  • Despite the relatively common occurrence of neurodegenerative diseases, MRS is lightly used in these conditions, most likely because of lack of sensitivity and overlap of spectral findings in different disorders.

  • MRS usually shows decreased levels of NAA in dementia.

  • Dementias associated with gliosis (e.g. Alzheimer's) also have increased myo-inositol (mI).

  • mI/NAA ratios correlate with clinical severity and histopathological involvement in Alzheimer's disease.

  • mI/NAA ratios, and regional variations in metabolite levels, may be helpful in the differential diagnosis of different dementias (Alzheimer, vascular, frontotemporal, Lewy body).

  • Parkinson's disease does not seem to be associated with any metabolic disorders, although other Parkinsonian disorders (e.g. multiple system atrophy) may show reduced NAA in the basal ganglia.

  • Metabolic changes in Huntington's disease are unclear; some studies have reported elevated lactate levels in the basal ganglia, but others have not.

  • Prion diseases are characterized by decreased NAA levels.

  • In amyotrophic lateral sclerosis (ALS), upper motor neuron NAA decreases may be helpful in establishing a diagnosis.

Introduction

Neurodegenerative diseases include a very wide group of disorders affecting the central nervous system (CNS). Many of these disorders arise from the combined effects of genetic predisposition and environmental factors. This results in reduced cognition (e.g. Alzheimer's disease, dementia with Lewy bodies, and vascular dementia), motor system performance (e.g. amyotrophic lateral sclerosis), or both (e.g. Parkinson's disease and prion diseases).

Type
Chapter
Information
Clinical MR Spectroscopy
Techniques and Applications
 , pp. 144 - 160
Publisher: Cambridge University Press
Print publication year: 2009

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