chapter  10
Structural brain imaging
ByRobert Barber and John T. O’Brien
Pages 15

From a clinical-orientated perspective, the ability to visualize the structure of the live brain directly means MRI and CT scans play a central role in diagnosis, providing both positive and negative predictive information. Traditionally, imaging in dementia was applied to ‘rule out’ pathologies that may be responsible for cognitive impairment, including the so-called treatable or reversible causes. Increasingly, the application of imaging recognizes dementia subtypes have characteristic changes that can be identied at various stages of the illness. is shi to use imaging to ‘rule in’ these changes can increase diagnostic accuracy and condence, and is increasingly becoming a part of the new clinical diagnostic criteria for dementia subtypes. Reecting this change, structural imaging is now regarded as a core investigation in the clinical assessment of patients with possible dementia: a practice endorsed by international consensus guidelines for the assessment of those suspected of suering from dementia (see Table 10.1). Indeed, expectations are growing and imaging can be central to helping individuals and their families understand and adjust to the diagnosis of dementia. To optimize the benets of imaging, clinicians should know how best to incorporate these techniques into their practice, including how to interpret their ndings in the wider context of global clinical presentation and communicate their relevance to patients and carers.