Structural imaging in cognitive impairment and the dementias: an update

PURPOSE OF REVIEW: The purpose of this review is to explore and summarize recent advances in the structural imaging of cognitive impairment and the dementias. The focus is practical, covering issues that bear relevance to clinical practice or diagnosis. Findings in mild cognitive impairment, a state preceding but not necessarily leading to dementia, are discussed. Data from dementias other than Alzheimer's disease are reviewed at some length before outlining some novel issues in Alzheimer's disease imaging. RECENT FINDINGS: A number of studies have proposed some medial temporal atrophy in mild cognitive impairment, and this may have some clinical value in predicting conversion to dementia. Data on other regions have also been proposed to predict conversion, but a number of studies on these regions have yielded entirely conflicting results. Data are also accumulating on the medial temporal lobe and other regions in non-Alzheimer's dementias. SUMMARY: The medial temporal lobe is still the region of interest when studying mild cognitive impairment and Alzheimer's disease. Medial temporal atrophy, or lack thereof, may be of some diagnostic value even in non-Alzheimer's dementias. Medial temporal atrophy, however, is not an Alzheimer's disease-specific feature. One potential approach to improve the radiological diagnosis of dementia is mapping a number of regions in order to define patterns of atrophy. At present, however, the scarcity of existing data prevents unambiguous conclusions on this issue.