Evaluation of brain perfusion in specific Brodmann areas in Frontotemporal dementia and Alzheimer disease using automated 3-D voxel based analysis

Introduction. Brain perfusion studies with single-photon emission computed tomography (SPECT) have been applied in demented patients to provide better discrimination between frontotemporal dementia (FTD) and Alzheimer's disease (AD). Aim. To assess the perfusion of specific Brodmann (Br) areas of the brain cortex in FTD and AD patients, using NeuroGam processing program to provide 3D voxel-by-voxel cerebral SPECT analysis. Material and methods. We studied 34 consecutive patients. We used the established criteria for the diagnosis of dementia and the specific established criteria for the diagnosis of FTD and AD. All the patients had a neuropsychological evaluation with a battery of tests including the mini-mental state examination (MMSE). Twenty-six patients (16 males, 10 females, mean age 68.76 +/- 6.51 years, education 11.81 +/- 4.25 years, MMSE 16.69 +/- 9.89) received the diagnosis of FTD and 8 patients (all females, mean age 71.25 +/- 10.48 years, education 10 +/- 4.6 years, MMSE 12.5 +/-3.89) the diagnosis of AD. All the patients underwent a brain SPECT. We applied the NeuroGam Software for the evaluation of brain perfusion in specific Br areas in the left (L) and right (R) hemispheres. Results. Statistically significant hypoperfusion in FTD compared to AD patients, was found in the following Br areas: 11L (p < 0.0001), 11R, 20L, 20R, 32L, 38L, 38R, 44L (p < 0.001), 32R, 36L, 36R, 45L, 45R, 47R (p < 0.01), 9L, 21L, 39R, 44R, 46R, 47L (p < 0.05). On the contrary, AD patients presented significant (p < 0.05) hypoperfusion in 7R and 39R Br areas. Conclusion. NeuroGam processing program of brain perfusion SPECT could result in enhanced accuracy for the differential diagnosis between AD and FTD patients.