The role of transcranial sonography in differentiation of dementia subtypes: an introduction of a new diagnostic method

Neurological Sciences volume 42, pages275–283(2021)Cite this article

Abstract

Purpose

Transcranial sonography (TCS) is increasingly used for the diagnosis of neurodegenerative disorders. We assessed the role of third ventricle width (TVW), midbrain area (MA), and midbrain circumference (MC) by TCS for diagnosis and differentiation of dementia.

Methods

A cross-sectional study was designed in 59 patients with dementia including 19 patients with Alzheimer’s disease (AD), 10 Dementia with Lewy bodies (DLB), 23 Frontotemporal dementia (FTD) and 7 Vascular dementia (VaD), and 22 normal-cognition individuals. Both case and control groups were matched by age, sex, and educational level. The dementia patients were divided into two subgroups: cortical-dominant dementia (CDD) including AD and FTD; and subcortical-dominant dementia (SDD) including DLB and VaD. TCS was performed through a temporal window, in which the size of TVW and midbrain was measured by trans-thalamic and trans-mesencephalic planes, respectively.

Results

The mean TVW was 0.85 ± 0.3 cm and 0.66 ± 0.2 cm in dementia patients and the control group, respectively (p < 0.01). The MA/MC were smaller in dementia patients compared with the control group (p < 0.05 and p < 0.01). The TVW in CDD (p = 0.003) and SDD (p = 0.027), but only MA/MC in SDD (p < 0.05), was statistically different compared with the control group.

Conclusion

The measurement of TVW and midbrain size by TCS can be used for diagnosis and differentiation of dementia. Patients with CDD and SDD have larger TVW than the control group, whereas patients with SDD have smaller midbrain sizes.

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References

  1. 1.

    (2014) The appropriate use of neuroimaging in the diagnostic work-up of dementia: an evidence-based analysis. Ont Health Technol Assess Ser 14(1):1–64

  2. 2.

    De Riva V, Galloni E, Marcon M, Di Dionisio L, Deluca C, Meligrana L et al (2013) Analysis of combined CSF biomarkers in AD diagnosis. Clin Lab 60(4):629–634

    Google Scholar 

  3. 3.

    Pasi M, Poggesi A, Pantoni L (2011) The use of CT in dementia. Int Psychogeriatr 23(S2):S6–S12

    Article  Google Scholar 

  4. 4.

    Davison CM, O'Brien JT (2014) A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. International journal of geriatric psychiatry 29(6):551–561

    Article  Google Scholar 

  5. 5.

    van der Flier WM, Scheltens P (2005) Epidemiology and risk factors of dementia. J Neurol Neurosurg Psychiatry 76(suppl 5):v2–v7

    Article  Google Scholar 

  6. 6.

    Walter U (2009) Imaging of the brain: where is transcranial sonography superior to magnet resonance imaging? Fortschr Neurol Psychiatr 77:S39–S41

    Article  Google Scholar 

  7. 7.

    Monaco D, Berg D, Thomas A, Di Stefano V, Barbone F, Vitale M, Ferrante C, Bonanni L, Di Nicola M, Garzarella T, Marchionno LP (2018) The predictive power of transcranial sonography in movement disorders: a longitudinal cohort study. Neurol Sci 39(11):1887–1894

    Article  Google Scholar 

  8. 8.

    Mosavi A, Zamani B, Rouhani MJCD (2015) Midbrain area measurement by transcranial sonography for discrimination Parkinson disease from progressive supranuclear palsy (PSP): P16. 39

  9. 9.

    Walter U, Dressler D, Probst T, Wolters A, Abu-Mugheisib M, Wittstock M, Benecke R (2007) Transcranial brain sonography findings in discriminating between parkinsonism and idiopathic Parkinson disease. Arch Neurol 64(11):1635–1640

    Article  Google Scholar 

  10. 10.

    Berg D, Godau J, Walter U (2008) Transcranial sonography in movement disorders. The Lancet Neurology. 7(11):1044–1055

    Article  Google Scholar 

  11. 11.

    Svetel M, Mijajlović M, Tomić A, Kresojević N, Pekmezović T, Kostić VS (2012) Transcranial sonography in Wilson’s disease. Parkinsonism Relat Disord 18(3):234–238

    Article  Google Scholar 

  12. 12.

    Rohani M, Almasi M, Yousefpour F, Zamani B, Shahidi GJBG (2017) Echogenicity of lentiform nucleus in different types of idiopathic dystonia. 10:8–11

  13. 13.

    Walter U, Horowski S, Benecke R, Zettl UK (2007) Transcranial brain sonography findings related to neuropsychological impairment in multiple sclerosis. J Neurol 254(2):II49–II52

    PubMed  Google Scholar 

  14. 14.

    Berg D, Mäurer M, Warmuth-Metz M, Rieckmann P, Becker G (2000) The correlation between ventricular diameter measured by transcranial sonography and clinical disability and cognitive dysfunction in patients with multiple sclerosis. Arch Neurol 57(9):1289–1292

    CAS  Article  Google Scholar 

  15. 15.

    Yaldizli Ö, Kastrup O, Obermann M, Esser S, Wilhelm H, Ley C, Forsting M, Maschke M (2006) Transcranial sonography of the third ventricle and cognitive dysfunction in HIV patients. J Neurol 253(9):1185–1188

    Article  Google Scholar 

  16. 16.

    Walter U, Dressler D, Wolters A, Wittstock M, Benecke R (2006) Sonographic discrimination of dementia with Lewy bodies and Parkinson’s disease with dementia. J Neurol 253(4):448–454

    Article  Google Scholar 

  17. 17.

    Wollenweber FA, Schomburg R, Probst M, Schneider V, Hiry T, Ochsenfeld A, Mueller M, Dillmann U, Fassbender K, Behnke S (2011) Width of the third ventricle assessed by transcranial sonography can monitor brain atrophy in a time-and cost-effective manner-results from a longitudinal study on 500 subjects. Psychiatry Res Neuroimaging 191(3):212–216

    Article  Google Scholar 

  18. 18.

    Lee JE, Park B, Song SK, Sohn YH, Park HJ, Lee PH (2010) A comparison of gray and white matter density in patients with Parkinson’s disease dementia and dementia with Lewy bodies using voxel-based morphometry. Mov Disord 25(1):28–34

    Article  Google Scholar 

  19. 19.

    Lancu I, Olmer A (2006) The minimental state examination--an up-to-date review. Harefuah. 145(9):687–690 701

    PubMed  Google Scholar 

  20. 20.

    Dubois B, Feldman HH, Jacova C, DeKosky ST, Barberger-Gateau P, Cummings J et al (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS–ADRDA criteria. The Lancet Neurology 6(8):734–746

    Article  Google Scholar 

  21. 21.

    McKeith IG (2006) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis 9(3 Supplement):417–423

    Article  Google Scholar 

  22. 22.

    Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu J, Garcia JA et al (1993) Vascular dementia diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 43(2):250

    Article  Google Scholar 

  23. 23.

    Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EGP, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL (2011) Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 134(9):2456–2477

    Article  Google Scholar 

  24. 24.

    Gorno-Tempini M, Hillis A, Weintraub S, Kertesz A, Mendez M, Cappa SE et al (2011) Classification of primary progressive aphasia and its variants. Neurology. 76(11):1006–1014

    Article  Google Scholar 

  25. 25.

    Sahuquillo P, Tembl JI, Parkhutik V, Vázquez JF, Sastre I, Lago A (2013) The study of deep brain structures by transcranial duplex sonography and imaging resonance correlation. Ultrasound Med Biol 39(2):226–232

    Article  Google Scholar 

  26. 26.

    Turner MA, Moran NF, Kopelman MD (2002) Subcortical dementia. Br J Psychiatry 180(2):148–151

    Article  Google Scholar 

  27. 27.

    Suri S, Topiwala A, Mackay CE, Ebmeier KP, Filippini N (2014) Using structural and diffusion magnetic resonance imaging to differentiate the dementias. Current neurology and neuroscience reports 14(9):1–14

    Article  Google Scholar 

  28. 28.

    Zerfass R, Geiger-Kabisch C, Sattel H, Besthorn C, Hentschel F (1995) Brain atrophy in normal ageing and Alzheimer’s disease. Volumetric discrimination and clinical correlations. Br J Psychiatry 167(6):739–746

    Article  Google Scholar 

  29. 29.

    Albert M, Naeser MA, Levine HL, Garvey AJ (1984) Ventricular size in patients with presenile dementia of the Alzheimer’s type. Arch Neurol 41(12):1258–1263

    CAS  Article  Google Scholar 

  30. 30.

    Barber R, Ballard C, McKeith I, Gholkar A, O’Brien J (2000) MRI volumetric study of dementia with Lewy bodies: a comparison with AD and vascular dementia. Neurology. 54(6):1304–1309

    CAS  Article  Google Scholar 

  31. 31.

    Nakatsuka T, Imabayashi E, Matsuda H, Sakakibara R, Inaoka T, Terada H (2013) Discrimination of dementia with Lewy bodies from Alzheimer’s disease using voxel-based morphometry of white matter by statistical parametric mapping 8 plus diffeomorphic anatomic registration through exponentiated Lie algebra. Neuroradiology. 55(5):559–566

    Article  Google Scholar 

  32. 32.

    Leite AJB, van der Flier WM, van Straaten EC, Scheltens P, Barkhof F (2006) Infratentorial abnormalities in vascular dementia. Stroke. 37(1):105–110

    Article  Google Scholar 

  33. 33.

    Sung Y-H, Park K-H, Lee Y-B, Park H-M, Shin DJ, Park J-S, Oh MS, Ma HI, Yu KH, Kang SY, Kim YJ, Lee BC (2009) Midbrain atrophy in subcortical ischemic vascular dementia. J Neurol 256(12):1997–2002

    Article  Google Scholar 

  34. 34.

    Pantel J, Schröder J, Essig M, Jauss M, Schneider G, Eysenbach K, von Kummer R, Baudendistel K, Schad LR, Knopp MV (1998) In vivo quantification of brain volumes in subcortical vascular dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord 9(6):309–316

    CAS  Article  Google Scholar 

  35. 35.

    Cardenas VA, Boxer AL, Chao LL, Gorno-Tempini ML, Miller BL, Weiner MW, Studholme C (2007) Deformation-based morphometry reveals brain atrophy in frontotemporal dementia. Arch Neurol 64(6):873–877

    Article  Google Scholar 

  36. 36.

    Yang Y, Schmitt HP (2001) Frontotemporal dementia: evidence for impairment of ascending serotoninergic but not noradrenergic innervation. Acta Neuropathol 101(3):256–270

    CAS  Article  Google Scholar 

  37. 37.

    Sastre-Bataller I, Vázquez JF, Martínez-Torres I, Sahuquillo P, Rubio-Agustí I, Burguera JA, Ferrer JM, Valero C, Tembl JI (2013) Mesencephalic area measured by transcranial sonography in the differential diagnosis of parkinsonism. Parkinsonism Relat Disord 19(8):732–736

    Article  Google Scholar 

  38. 38.

    Kim JY, Kim ST, Jeon SH, Lee WY (2007) Midbrain transcranial sonography in Korean patients with Parkinson’s disease. Mov Disord 22(13):1922–1926

    Article  Google Scholar 

  39. 39.

    Morra JH, Tu Z, Apostolova LG, Green AE, Avedissian C, Madsen SK, Parikshak N, Hua X, Toga AW, Jack CR Jr, Schuff N, Weiner MW, Thompson PM, and the Alzheimer's Disease Neuroimaging Initiative (2009) Automated 3D mapping of hippocampal atrophy and its clinical correlates in 400 subjects with Alzheimer’s disease, mild cognitive impairment, and elderly controls. Hum Brain Mapp 30(9):2766–2788

    Article  Google Scholar 

  40. 40.

    Jack C, Petersen RC, Xu Y, O'Brien PC, Smith GE, Ivnik RJ et al (1998) Rate of medial temporal lobe atrophy in typical aging and Alzheimer’s disease. Neurology. 51(4):993–999

    Article  Google Scholar 

  41. 41.

    Hernández N, Escrivá A, Jordà J (2007) Study of the diameter of the third ventricle with transcranial sonography. Neurologia (Barcelona, Spain) 22(8):507–510

    Google Scholar 

  42. 42.

    Seidel G, Gerriets T, Kaps M, Hutzelmann A (1995) Evaluation of the ventricular system in adults by transcranial duplex sonography. J Neuroimaging 5(2):105–108

    CAS  Article  Google Scholar 

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Acknowledgments

This research was presented as a residency thesis in Tehran University of medical science. We are thankful to our colleagues in Dementia clinic of Hazrat-e-Rasool hospital who provided expertise that greatly assisted the research, especially Dr. Fahimeh Haji-Akhoundi, and also, we thank Dr. Siavash Adibeyk, Dr. Nima Mohsenzadeh, and Dr. Neda Gharahi greatly for their friendly collaboration in this research. We would also like to show our gratitude to Dr. Gholamali Shahidi and Dr. Amir Hassan Habibi for comments that greatly improved the manuscript.

Funding

This study was resulted from a residency thesis which was recorded by number 1773 date 2014/3/6 at Tehran University of medical science research committee. There was no other funding to this study.

Author information

Affiliations

  1. Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St, Valiasr St, Tehran, Iran

    Mostafa Almasi-Dooghaee & Babak Zamani

  2. Department of Neurology, Hazrat-e-Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Rohani

  3. Faculty of Medicine, Islamic Azad University Tehran Medical Branch, Tehran, Iran

    Atefeh Imani

  4. Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran

    Shabnam Nadjafi

Authors
  1. Mostafa Almasi-Dooghaee
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  2. Mohammad Rohani
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  3. Atefeh Imani
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  4. Shabnam Nadjafi
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  5. Babak Zamani
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Contributions

Five authors were contributed in this manuscript. Dr. Mostafa Almasi-Dooghaee is the first author and both Dr. Babak Zamani and Dr. Mostafa Almasi-Dooghaee are the corresponding author, equally. All of the authors are agree with authorship rules. Dr. Babak Zamani and Dr. Mohammad Rohani play the important role in referring the patients. The diagnosis of dementia and its type and performing the transcranial sonography were performed by Dr. Babak Zamani and Dr. Mostafa Almasi-Dooghaee. The collecting and analysis of the data and writing of the manuscript were handled by Dr. Mostafa Almasi-Dooghaee, Dr. Atefeh Imani, and Dr. Shabnam Nadjafi.

Corresponding author

Correspondence to Mostafa Almasi-Dooghaee.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All procedures performed in this study were in accordance with the ethical standards of the Tehran university of Medical science.

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Almasi-Dooghaee, M., Rohani, M., Imani, A. et al. The role of transcranial sonography in differentiation of dementia subtypes: an introduction of a new diagnostic method. Neurol Sci 42, 275–283 (2021). https://doi.org/10.1007/s10072-020-04566-4

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Keywords

  • Transcranial sonography
  • Third ventricle
  • Midbrain
  • Dementia
  • Cortical dementia
  • Subcortical dementia