For the diagnosis of many dementing disorders, imaging is considered important. Magnetic resonance imaging (MRI) for example is often used to demonstrate medial temporal lobe atrophy in Alzheimer’s disease. However, only for the diagnosis of vascular dementia (VaD), imaging is truly indispensable, and an essential requirement in for example the NINDS-AIREN criteria.
Imaging abnormalities that may support the diagnosis of VaD include strategic (dominant hemisphere) large vessel disease and widespread small vessel damage to the subcortical white matter changes (WMC). The NINDS-AIREN criteria are often used for inclusion of patients into trials of VaD, although operational definitions have not been developed, and there probably exists significant interobserver variability in the application of these criteria.
When imaging is used, several elements need consideration: choice of imaging modality, scanning protocol, image analysis, and central coordination. These issues will be discussed now, and suggestions for implementation provided.
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