Skip to main content Accessibility help
×
Home

Electroencephalography and single photon emission computed tomography in dementia: a comparative study

  • E. P. Sloan (a1), G. W. Fenton (a1), N. S. J. Kennedy (a1) and J. M. MacLennan (a1)

Synopsis

A series of elderly patients with dementia of Alzheimer type (AD), multi-infarct dementia (MID) and functional (non-organic) psychiatric illness (major depressive disorder) were selected according to DSM-III-R criteria and received: a battery of cognitive tests, EEG and Single Photon Emission Computed Tomography (SPECT) using 99mTc HMPAO. The EEG and SPECT scans were examined independently of the clinical data. The former were divided into two abnormal categories, those showing AD type change and vascular change respectively, and a normal group. The SPECT scans were classified as follows: a SPECT rCBF pattern showing bilateral temporoparietal perfusion deficits (AD type); those showing single focal perfusion deficits or multiple areas of low perfusion in the cerebral cortex suggestive of ischaemic change (vascular type SPECT picture); a mixed AD/MID pattern; and those with normal scan findings. There were significant associations between clinical diagnosis, EEG rating and SPECT rCBF pattern, approximately three-quarters of AD and MID patients having the predicted EEG and scan changes. Normal EEG recordings were more common in the MID patients. The two tests agreed in about two-thirds of cases, with no consistent pattern apparent in the cases with divergent findings. Each test misclassified a minority of dementia patients, but in only one patient were both investigations normal. Almost half of the so called ‘functionally ill’ patients had abnormal rCBF changes, showing mainly vascular changes while one-fifth had abnormal EEGs.

Copyright

Corresponding author

1 Address for correspondence: Professor George W. Fenton, Department of Psychiatry, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY.

References

Hide All
Abou-Saleh, M. T. (1990). Brain imaging in psychiatry. British Journal of Psychiatry 157, Suppl. 9, 7101.
Bench, C. J., Friston, K. J., Brown, R. G., Scott, L. C., Frackowiak, R. S. J. & Dolan, R. J. (1992). The anatomy of melancholia – focal abnormalities of cerebral blood flow in major depression. Psychological Medicine 22, 607615.
Berger, H. (1932). Über das Elektrenkephalogramm des Menschen. Fünfte Mitteilung. Archiv für Psychiatrie und Nervenkfrankheiten 98, 231254.
Burns, A., Philpot, M., Costa, D. C., Ell, P. J. & Levy, R. (1989). The investigation of Alzheimer's disease with single photon emission tomography. Journal of Neurology, Neurosurgery and Psychiatry 52, 248253.
Busse, E. W. (1983). Electroencephalography. In Alzheimer's Disease (ed. Reisberg, B.), pp. 231236. Free Press: New York.
Constantinidis, J., Krassoievitch, M. & Tissot, R. (1969). Corrélations entre les perturbations electroencéphalographiques et les lésions anatomohistologiques dans les démences. Encéphale 58, 1952.
Duara, R. (1990). Utilisation of positron emission tomography for research and clinical applications in dementia. In Positron Emission Tomography in Dementia. Frontiers of Clinical Neuroscience (ed. Duara, R.), 10, 112. Wiley-Liss: New York.
Erkinjuntti, T., Larsen, R., Sulkava, R., Ketonen, L., Laaksonen, R., & Palo, J. (1988). EEG in the differential diagnosis in between Alzheimer's disease and vascular dementia. Acta Neurologica Scandinavica 77, 3643.
Fenton, G. W. (1994). Electroencephalography. In The Psychiatry of Old Age. An International Textbook (ed. Copeland, J., Blazer, D. and Abou-Saleh, M.), pp. 459466.
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.
Friedland, R. P. & Jagust, W. J. (1990). Positron and single photon emission tomography in the differential diagnosis of dementia. In Positron Emission Tomography in Dementia. Frontiers of Clinical Science 10, 161177. Wiley-Liss: New York.
Gemmell, H. G., Sharp, P. F., Besson, J. A. O., Crawford, J. R., Ebmeier, K. P., Davidson, J. & Smith, F. W. (1987). Differential diagnosis in dementia using the cerebral blood flow agent 99m TC HM-PAO: a SPECT study. Journal of Computer Assisted Tomography 11, 398402.
Holman, B. L. & Devous Sr, M. D. (1992). Functional brain SPECT: the emergence of a powerful clinical method. Journal of Nuclear Medicine 33, 18881904.
House, A. (1987). Depression after stroke. British Medical Journal 294, 7678.
Jagust, W. J., Budinger, T. F. & Reed, B. R. (1987). The diagnosis of dementia with single photon emission computed tomography. Archives of Neurology 44, 258262.
Kendrick, D. C. (1985). The Kendrick Cognitive Test for the Elderly. NFER Nelson: Windsor.
McKeith, I. G., Bartholomew, P. H., Irvine, E. M., Cook, J., Adams, R. & Simpson, A. E. S. (1993). Single photon emission computerised tomography in elderly patients with Alzheimer's disease and multi-infarct dementia. British Journal of Psychiatry 163, 579603.
Mena, I., Villanueva-Meyer, J. & Darcourt, J. (1990). SPECT studies in Alzheimer type dementia patients. In Alzheimer Disease. Current Research in Early Diagnosis (ed. Becker, R. E. and Giacobini, E.), pp. 339353. Taylor & Francis: New York.
Morris, P. I. P., Robinson, R. G., Raphael, B., Samuels, J. & Mollow, P. (1992). The relationship between risk factors for affective disorder and poststroke depression in hospitalised stroke patients. Australian and New Zealand Journal of Psychiatry 26, 208217.
Neary, D., Snowden, J., Sheilds, R. A., Burian, A. W. I., Northen, B., Macdermott, N., Prestcott, M. C. & Testa, H. J. (1987). Single photon emission tomography using 99m Tc-HM-PAO in the investigation of dementia. Journal of Neurology, Neurosurgery and Psychiatry 50, 11011109.
Neary, D., Snowden, J. S., Northen, B. & Goulding, P. (1988). Dementia of frontal lobe type. Journal of Neurology, Neurosurgery and Psychiatry 51, 353361.
Nelson, H. E. (1982). The National Adult Reading Test (NART) – Test Manual. NFER-Nelson: Windsor.
Obrist, W. D. (1976). Problems of ageing. In Handbook of Electroencephalography and Clinical Neurophysiology, pp. 273292. Elsevier: Amsterdam.
Parks, R. W., Becker, R. E., Dodrill, K. L., Bennett, B. A., Crockett, D. J., Hurwitz, T. A., McGeer, P. L. & McGeer, E. G. (1990). Positron emission tomography and neuropsychological studies in dementia. In Alzheimer Disease. Current Research in Early Diagnosis (ed. Becker, R. E. and Giacobini, E.), pp. 315327. Taylor and Francis: New York.
Pattie, A. H. & Gilleard, G. J. (1979). Manual of Clifton Assessment Procedures for the Elderly (CAPE). Hodder & Stoughton: London.
Pedley, T. S. & Miller, J. A. (1983). Clinical neurophysiology and ageing and dementia. In The Dementias (ed. Mayeux, R. and Rosen, W. G.), pp. 3149.
Perani, D., Di Piero, V. & Valler, G. (1988). Technetium – 99m HMPAO SPECT study of regional cerebral perfusion in early Alzheimer's disease. Journal of Nuclear Medicine 29, 15071514.
Philpot, M. R., Costa, D. C., Burns, A., Levy, R. & Ell, P. J. (1991). Single photon emission tomography in Alzheimer's disease. A longitudinal study of changes in relative regional cerebral blood flow. International Journal of Geriatric Psychiatry 6, 767774.
Roberts, M. A., McGeorge, A. L. & Caird, F. I. (1978). Electroencephalography and computerised tomography in vascular and non-vascular dementia in old age. Journal of Neurology, Neurosurgery and Psychiatry 41, 903906.
Robinson, R. G. & Starkstein, S. E. (1990). Current research in affective disorders following stroke. Journal of Neuropsychiatry 2, 114.
Sloan, E. P. & Fenton, G. W. (1992). EEG power spectra in geriatric psychiatry: a longitudinal study. Electroencephalography and Clinical Neurophysiology 86, 361367.
Soininen, H., Partanen, V. J., Puranen, M. & Riekkinen, P. J. (1982). EEG and computed tomography in the investigation of patients with senile dementia. Journal of Neurology Neurosurgery and Psychiatry 45, 711714.
Soininen, H., Riekkinen, P., Partanen, V. J., Paakkonen, A., Helkala, E. L. & Laulumaa, V. (1990). EEG in the diagnosis of early Alzheimer disease. In Alzheimer Disease. Current Research and Early Diagnosis (ed. Becker, R. E. and Giacobini, E.), pp. 159169. Taylor & Francis: New York.
Striano, S., Vacca, G., Bilo, L. & Meo, R. (1981). The electroencephalogram in dementia. Differential diagnostic value in Alzheimer's disease, senile dementia and multi-infarct dementia. Acta Neurologica (Napoli) 36, 727734.
Wechsler, D. (1955). Manual for the Wechsler Adult Intelligence Scale. The Psychological Corporation: New York.
Zubenko, G. S., Sullivan, P., Nelson, J. P, Belle, S. H., Huff, J. & Wolf, G. L. (1990). Brain imaging abnormalities of late life. Archives of Neurology 47, 11071111.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed