Alzheimer Disease and the Role Imaging Will Play

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 2.25
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 1.25
Neurological: 1.25

Nuclear Medicine Technology: 3.25
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.25
Other Imaging Procedures: 2.25

Radiography: 1.00
Patient Care: 1.00
Patient Interactions and Management: 1.00

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Neurological, Vascular, and Lymphatic Sections: 3.25

Sonography: 1.00
Patient Care: 1.00
Patient Interactions and Management: 1.00

Outline

1. Introduction
2. Demographics and Public Health Impact
3. Clinical Course of the Disease
4. Genetics and Molecular Pathways: The Amyloid Cascade Hypothesis
5. Pathologic Features and Their Relationship to Clinical Symptoms
6. AD Biomarkers
7. Temporal Ordering of AD Biomarkers
8. Modifiers of Clinical Expression: Cognitive Reserve and Genetics
9. Modifiers of Clinical Expression: Coexistent Age-related Brain Abnormality
10. Diffusion, Perfusion, Spectroscopy, and Functional MR Imaging
    1. Diffusion Imaging
    2. Perfusion Imaging
    3. Hydrogen 1 MR Spectroscopy
    4. Functional MR Imaging
11. Applications of Imaging Biomarkers: New Diagnostic Criteria for AD
12. Applications of Imaging Biomarkers: Clinical Trials
    1. Subject Inclusion
    2. Subject Exclusion
    3. Stratification, Enrichment, and Covariates
    4. Outcome
13. Need for Standardization of Imaging

Objectives

Upon completion of this course, students will:

1. identify the features of Alzheimer disease that make it an unprecedented public health problem
2. understand the definition of dementia
3. identify the age group at increased risk for death from Alzheimer disease
4. understand the annual rate of conversion from mild cognitive impairment to Alzheimer disease
5. identify the percentage of individuals that will convert to dementia after a diagnosis of MCI
6. recognize the genetic risk factors for Alzheimer disease
7. understand the function of the apolipoprotein E gene in cholesterol metabolism
8. recognize the negative effects from the presence of the APOE ε4 allele
9. recognize the positive effect from the presence of the APOE ε2 allele
10. understand the role of Aβ in familial Alzheimer disease
11. understand the role of Aβ in late onset sporadic Alzheimer disease
12. identify Aβ as the target of the majority of clinical trials on disease modification
13. identify the neuritic plaque as the hallmark Aβ peptide deposit in Alzheimer disease
14. understand the use of the term “biomarker” in Alzheimer disease investigation
15. understand the role of cerebrospinal fluid analytes in Alzheimer disease investigation
16. understand the correlation between a clinical diagnosis of Alzheimer disease and amyloid imaging studies
17. recognize the physiologic features that are associated with greater amyloid PET binding in cognitively normal late-middle-aged to elderly subject
18. recognize the neurologic conditions that may exhibit elevated levels of tau in CSF
19. identify the typical uptake pattern on FDG PET imaging that is consistent with Alzheimer disease
20. identify the physical half-life of the oxygen-15 isotope used in PET imaging
21. recognize the various PET imaging agents used to image Aβ accumulation in the brain
22. identify the imaging features of the PET imaging agent ¹⁸F-FDDNP
23. understand the link between cognitive impairment and neurodegeneration
24. understand the term “cognitive reserve” and its application
25. recognize the comorbid brain pathologic conditions that are most commonly found at autopsy in elderly subjects with a diagnosis of Alzheimer disease
26. identify cardiovascular disease as the second most common pathologic contributor to dementia in elderly persons after Alzheimer disease
27. identify microinfarction as the most common vascular lesion found in community autopsy studies
28. recognize the brain regions that exhibit characteristic decreased blood flow on perfusion imaging in the presence of Alzheimer disease
29. identify the imaging techniques currently being used to assess cerebral blood flow in the presence of Alzheimer disease
30. recognize the metabolites that are consistently abnormal in hydrogen-1 MR spectroscopy in the presence of Alzheimer disease
31. understand the use of hydrogen-1 as the isotope target of MR imaging and spectroscopy
32. identify the compounds that are not detectable by hydrogen-1 MR spectroscopy
33. compare the techniques currently being used to acquire perfusion images in the presence of Alzheimer disease
34. identify the three currently recognized phases of Alzheimer disease
35. understand the role of anatomic MR imaging for exclusionary purposes in Alzheimer disease therapeutic trials
36. recognize the target of current available treatments for Alzheimer disease
37. understand the coverage criteria established by CMS for FDG PET imaging of Alzheimer disease
38. identify other diseases that cause dementia that must be included in the differential diagnosis with Alzheimer disease
39. identify the imaging requirements that must be satisfied for CMS coverage of FDG PET imaging of Alzheimer disease
40. understand the coverage criteria established by CMS for Aβ PET imaging of Alzheimer disease