Cognitive Impairment: Assessment With Brain Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy
J Clin Psychiatry 2003;64(3):235-242
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: In vivo proton magnetic resonance
spectroscopy is a safe and noninvasive tool that can be used to
study aspects of brain chemistry and metabolism. This study was
designed to evaluate its role in routine application to reveal
the diagnostic reasons for cognitive impairment.
Method: 37 Alzheimer's disease patients
(NINCDS-ADRDA criteria), 31 patients with subcortical ischemic
vascular dementia (Chui et al. criteria), and 13 subjects with
subjective cognitive impairment (DSM-IV criteria) were included
in this retrospective study. Magnetic resonance images were used
for atrophy rating; additionally, proton magnetic resonance
spectroscopy was performed.
Results: Significantly reduced N-acetylaspartate
levels (p < .05) were found in both patients with Alzheimer's
disease and patients with subcortical ischemic vascular dementia
compared to the group with subjective memory complaints. The
ratios of N-acetylaspartate/creatine and
N-acetylaspartate/myo-inositol were significantly lower in
Alzheimer's disease patients compared to patients with vascular
dementia (p = .012) or patients with subjective memory impairment
(p = .002). N-acetylaspartate/creatine and
N-acetylaspartate/myo-inositol ratios were positively correlated
to the degree of cerebral atrophy. Disoriented patients displayed
a low N-acetylaspartate/creatine ratio. In contrast, we were not
able to relate concurrent psychotic or behavioral symptoms to any
Conclusion: This study indicates that proton
magnetic resonance spectroscopy parameters could provide
additional information in differentiating between Alzheimer's
disease, subcortical ischemic vascular dementia, and subjective
cognitive impairment. Therefore, this method can contribute to
the routine diagnosis of dementia. Psychiatric and behavioral
symptoms associated with dementia or due to a major psychiatric
disorder cannot be related to changes in the measured proton
magnetic resonance spectroscopy parameters.