Diagnostik der SDAT mittels HMPAO-SPECT und Serumvitamin-B₁₂-Spiegel

Zusammenfassung

Die alleinige klinische Abklärung dementieller Zustandsbilder, so auch der senilen Demenz vom Alzheimertyp (SDAT), ist schwierig. Durch die Kombination von ^99mTc-HMPAO-Gehirn-SPECT und Serumvitamin-B₁₂-Bestimmung erwarteten wir eine Beschleunigung und Verbesserung der Diagnostik der SDAT. Von 116 Patienten, die in 4 Gruppen, entsprechend ihrem ^99mTc-HMPAO-Verteilungsmuster eingeteilt worden waren, konnten bei 17 klinisch sehr wahrscheinlichen SDAT-Patienten bei 15 Auffälligkeiten mit Hinweis auf SDAT im Gehirn SPECT gefunden werden. Ein Teil der Patienten wies einen niedrig-normalen bzw. pathologisch niedrigen Vitamin-B₁₂-Spiegel auf. Andere Untersuchungen würden durch die Kombination von Gehirn-SPECT und Serumvitamin-B₁₂-Bestimmung nicht überflüssig werden, obwohl beide Untersuchungen Informationen lieferten, die die Zuordnung zur Diagnose SDAT erleichterten. Die zusätzliche Serumvitamin-B₁₂-Bestimmung stellt keinen wesentlichen Mehraufwand dar.

Summary

It is quite difficult to confirm the diagnosis of demential disorders, including senile dementia of the Alzheimer type (SDAT) by clinical means only. Through the combination of ^99mTc-HMPAO brain SPECT and serum vitamin B₁₂ determination it was hoped to speed up and improve the diagnosis of SDAT. 116 patients who had been divided into four groups according to their defect pattern in the ^99mTc-HMPAO brain SPECT 17 very probably had SDAT; of these 15 showed a defect-pattern with brain SPECT which could be associated to SDAT. The majority of SDAT patients had serum vitamin B₁₂ levels in the lower normal range or pathologically below that range. Both investigations contributed to establishing the SDAT diagnosis without replacing other investigations. The determination of serum vitamin B₁₂ does not require any major additional effort.

Schlüsselwörter

SDAT - ^99mTc-HMPAO SPECT - Vitamin B₁₂

Keywords

SDAT - ^99mTc-HMPAO SPECT - vitamin B₁₂

• Literatur

• 1 Berberich A, Buell U, Eilles A. et al. ^99mTc Hexamethylpropyleneamine oxine (HMPAO) SPECT in cerebrovascular disease (CVD). A comparison to transmission CT. J Nucl Med 1986; 27: 888.
• 2 Bonte FJ, Horn J, Tintner R. et al. Single photon tomography in Alzheimer’s disease and the dementias. Sem Nucl Med 1990; 20: 34252.
• 3 Cole MG, Prchal JF. Low serum vitamin B)₂ in Alzheimer-type dementia. Age-Ageing 1984; 13 (Suppl. 02) 101-5.
• 4 Deisenhammer E, Reisecker F, Leblhuber F. et al. Single photon emission computed tomography (SPECT) and X-ray CT in patients with dementia. Psych Research 1989; 29: 443-5.
• 5 Deisenhammer E, Reisecker F, Leblhuber H. et al. Single-Photon-Emissions-Computer-tomographie bei der Differentialdiagnose der Demenz. Dtsch Med Wschr 1989; 114: 1639-44.
• 6 Dierchx RA, Appel B, Saerens J. et al. ^99mTc HMPAO brain SPECT in dementia due to transitory obstructive hydrocephalus. Clin Nucl Med 1993; 18: 245-6.
• 7 Fazekas F, Alavi A, Chawluk JL. et al. Comparison of CT, MR, and PET in Alzheimer’s dementia and normal aging. J Nucl Med 1989; 30: 1607-15.
• 8 Feistel H. SPECT in der Gehirndiagnostik. Nuklearmediziner 1991; 5 (Suppl. 14) 306-23.
• 9 Gemmel HG, Sharp PF, Besson JAO. et al. A comparison of ^99mTc HMPAO and J-IMP cerebral SPECT images in Alzheimer’s disease and multi-infarct dementia. Eur J Nucl Med 1988; 14: 463-6.
• 10 Grünwald F, Broich K, Hartmann A. et al. Nuklearmedizinische Diagnostik der Demenz vom Alzheimer-Typ. Dtsch Med Wschr 1988; 113: 208-12.
• 11 Grünwald F, Horn R, Rieker O. et al. HMPAO-SPECT bei Demenz vom Alzheimer-Typ und major depression mit mnesti-schen Störungen. Nucl-Med 1993; 32: 128-33.
• 12 Grünwald F, Zierz S, Broich K. et al. HMPAO-SPECT imaging resembling Aiz-heimer-type dementia in mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS). J Nucl Med 1990; 31: 1740-2.
• 13 Habert MO, Spampinto U, Mas JL. et al. A comparative technetium ^99m-hexamethyl-propylene amine oxime SPECT study in different types of dementia. Eur J Nucl Med 1991; 18: 3-11.
• 14 Holman BL, Johnson KA, Gerada B. et al. The scintigraphic appearance of Alzheimer’s disease: a prospective study using ^99mTc-HMPAO SPECT. J Nucl Med 1992; 33: 181-5.
• 15 Kao CH, Wang PY, Wang SJ. et al. Regional cerebral blood flow of Alzheimer’s diseaselike pattern in young patients with Down’s syndrome detected by ^99mTc HMPAO brain SPECT. Nucl Med Commun 1993; 14: 47-51.
• 16 Karnaze DS, Carmel R. Low serum cobala-min levels in primary degenerative dementia. Arch Intern Med 1987; 147: 429-31.
• 17 Lang C, Herholz K, Huk W. et al. Die diagnostische Differenzierung dementieller Erkrankungen durch moderne bildgebende Verfahren. Fortschr Neurol Psychiat 1990; 58: 380-98.
• 18 McCaddon A, Kelly CL. Alzheimer’s disease: A “cobalaminergic” hypothesis. Med Hypotheses 1992; 37: 161-5.
• 19 Murden RA. The diagnosis of Alzheimer’s disease. Adv Exp Med Biol 1990; 282: 59-64.
• 20 Neary D, Snowden JS, Shields RA. et al. Single photon emission tomography using ^99mTc-HMPAO in the investigation of dementia. J Neurol Neurosurg Psych 1987; 50: 1101-9.
• 21 Nijst TQ, Wevers RA, Schoonderwaldt HC. et al. Vitamin B₁₂ and folate concentrations in serum and cerebrospinal fluid of neurological patients with special reference to multiple sclerosis and dementia. J Neurol Neurosurg Psychiat 1990; 53: 951-4.
• 22 Perani D, Di Piero V, Vallar G. et al. Techne-tium-^99m-HMPAO SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J Nucl Med 1988; 29: 1507-14.
• 23 Podreka I. HMPAO in clinical practice. Nucl Med Commun 1987; 8: 559-72.
• 24 Regland B, Gottfries CG, Oreland L. Vitamin B₁₂ induced reduction of platelet monoamine oxidase activity in patients with dementia and pernicious anemia. Eur Arch Psych Clin Neurosci 1991; 240: 288-9.
• 25 Reisecker F, Költringer P, Lind P. et al. Neu-roimaging bei einem Fall von progressiver Paralyse. Neuropsych 1990; 4: 123-5.
• 26 Smith FW, Gemmell HG, Sharp PF. The use of ^99mTc-HMPAO for the diagnosis of dementia. Nucl Med Commun 1987; 8: 525-33.
• 27 Spampinato U, Habert MO, Mas JL. et al. ^99mTc HMPAO SPECT and cognitive impairment in Parkinson’s disease: a comparison with dementia of the Alzheimer type. J Neurology Neurosurg Psychiatry 1991; 54: 787-92.
• 28 Weinstein HC, Haan J, van Royen EO. et al. SPECT in the diagnosis of Alzheimer’s disease and multi-infarct-dementia. Clin Neurol Neurosurg 1991; 91: 39-43.