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Recursos imagiológicos na Doença de Alzheimer
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Abstract(s)
A Doença de Alzheimer (DA) é a principal causa de demência a nível mundial.
Atualmente a DA e as outras demências constituem um forte desafio para a saúde
pública. Neste sentido são necessárias medidas de prevenção e de melhoria na prestação
de cuidados de saúde aos indivíduos com DA. Com uma prevalência crescente, estimase que em 2018, em Portugal, 150000 indivíduos tinham demência. Atualmente,
acredita-se que a fisiopatologia da DA está amplamente relacionada com a acumulação
anormal de placas beta amiloide e de tranças neurofibrilares a nível cerebral. Com base
no conhecimento atual da fisiopatologia da DA, desenvolveram-se métodos
imagiológicos e bioquímicos.
A presente dissertação tem como objetivo desenvolver a temática dos exames
complementares imagiológicos que atualmente permitem e auxiliam no diagnóstico da
DA.
Esta monografia foi elaborada com base em revisões bibliográficas, em livros de
neurologia recentes, em normas e planos de autores institucionais. As revisões
bibliográficas foram pesquisadas na base de dados Pubmed num período entre janeiro e
fevereiro de 2025 empregando os seguintes termos, muitas vezes em conjunto:
“Alzheimer’s disease”, “ERICA score”, “dementia”, “alois alzheimer”, “complications”,
“MRI”, “PET”, “neurocognitive disorder”, “Amyloid”, “Tau”, “neuropathology”, “ADNI”,
“Spectroscopy “e “biomarkers”. Para o ponto 3 - Neuroimagem e a Doença de Alzheimer
aplicou-se uma restrição temporal de 01 de janeiro 2024 a 30 de janeiro de 2025 para a
inclusão da bibliografia.
A ressonância magnética (RM) e tomografia por emissão de positrões (PET) são
as principais técnicas imagiológicas usadas para um diagnóstico, estadiamento,
prognóstico e mesmo identificação de co-patologias. Ao nível da RM estrutural continuase a investir no seu desenvolvimento e melhoria de escalas já existentes usadas no
estadiamento, no entanto pode ser uma técnica que num futuro próximo seja utilizada
no diagnóstico patológico através de uma avaliação volumétrica precisa da morfologia
do lobo temporal médio. A RM funcional cerebral, segundo os últimos estudos, apresenta
correlação entre padrões de atividade neuronal alterados e a presença de biomarcadores.
Apesar da necessidade de mais estudos, pode ser útil na deteção precoce de DA numa
fase assintomática. O uso de radiofármacos específicos tanto para proteínas amiloides
como proteínas tau hiperfosforiladas para PET, é uma das técnicas que num período
próximo será aplicada para o diagnóstico de DA. São vários os estudos que integram
diferentes radiofármacos de modo a comprovar a sua utilidade, vantagens e
desvantagens perante os já aprovados. A inovação e procura de outras técnicas para diagnóstico de DA é constante como por exemplo, a utilização da inteligência artificial
no processamento de dados obtidos por algoritmos computacionais que analisam
imagens PET, bem como outras técnicas não invasivas que avaliam a atividade cerebral
através da monitorização de parâmetros fisiológicos associados à ocorrência de DA.
Embora a ciência que acompanha o diagnóstico atempado e tratamento da DA
não pare de evoluir, ainda são vários os desafios vigentes. Uma das perspetivas futuras
para a neuroimagem é a integração de múltiplas técnicas e a sua interpretação baseada
em inteligência artificial, permitindo uma abordagem personalizada tal como a
continuação do desenvolvimento de novas e melhores terapias.
Alzheimer’s Disease (AD) is the leading cause of dementia worldwide. Currently, AD and other dementias represent a significant challenge for public health. In this regard, preventive measures and improvements in healthcare services for individuals with AD are necessary. With an increasing prevalence, it was estimated that in 2018, in Portugal, 150,000 individuals had dementia. At present, it is believed that the pathophysiology of AD is largely related to the abnormal accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain. Based on this current understanding of AD pathophysiology, there has been a development of imaging and biochemical methods. The objective of this dissertation is to explore the role of complementary imaging exams that currently assist in the diagnosis of AD. This monography was developed based on literature reviews, recent neurology books, and guidelines from institutional authors. The literature research was conducted using the PubMed database between January and February 2025, employing the following terms, often in combination: "Alzheimer’s disease," "ERICA score," "dementia," "Alois Alzheimer," "complications," "MRI," "PET," "neurocognitive disorder," "amyloid," "tau," "neuropathology," "ADNI," "spectroscopy," and "biomarkers." For Section 3 (Neuroimaging and Alzheimer’s Disease), a temporal restriction was applied, including only literature published between January 1, 2024, and January 30, 2025. Magnetic resonance imaging (MRI) and Positron emission tomography (PET) are the primary imaging techniques used for diagnosis, staging, prognosis, and even the identification of co-pathologies. In the field of structural MRI, ongoing research aims to enhance existing scales used for staging; however, in the near future, this technique may be employed for pathological diagnosis through precise volumetric assessment of medial temporal lobe morphology. According to recent studies, functional MRI (fMRI) demonstrates a correlation between altered neuronal activity patterns and the presence of biomarkers. Although further studies are needed, this method may be useful in the early detection of AD in its asymptomatic phase. The use of specific radiopharmaceuticals for both amyloid and hyperphosphorylated tau proteins in PET imaging, is an emerging technique expected to be widely applied for AD diagnosis in the near future. Numerous studies are integrating different radiopharmaceuticals to evaluate their utility, advantages, and disadvantages compared to those already approved. Innovation and the pursuit of new diagnostic techniques for AD are continuous. For instance, artificial intelligence (AI) is being applied to process PET imaging data using computational algorithms, and other non-invasive techniques are being explored to assess brain activity by monitoring physiological parameters associated with AD onset. Although scientific advance in the early diagnosis and treatment of AD continues to progress, several challenges remain. One of the future perspectives in neuroimaging is the integration of multiple imaging techniques, combined with AI-based interpretation, allowing for a personalized approach and the continued development of new and improved therapies.
Alzheimer’s Disease (AD) is the leading cause of dementia worldwide. Currently, AD and other dementias represent a significant challenge for public health. In this regard, preventive measures and improvements in healthcare services for individuals with AD are necessary. With an increasing prevalence, it was estimated that in 2018, in Portugal, 150,000 individuals had dementia. At present, it is believed that the pathophysiology of AD is largely related to the abnormal accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain. Based on this current understanding of AD pathophysiology, there has been a development of imaging and biochemical methods. The objective of this dissertation is to explore the role of complementary imaging exams that currently assist in the diagnosis of AD. This monography was developed based on literature reviews, recent neurology books, and guidelines from institutional authors. The literature research was conducted using the PubMed database between January and February 2025, employing the following terms, often in combination: "Alzheimer’s disease," "ERICA score," "dementia," "Alois Alzheimer," "complications," "MRI," "PET," "neurocognitive disorder," "amyloid," "tau," "neuropathology," "ADNI," "spectroscopy," and "biomarkers." For Section 3 (Neuroimaging and Alzheimer’s Disease), a temporal restriction was applied, including only literature published between January 1, 2024, and January 30, 2025. Magnetic resonance imaging (MRI) and Positron emission tomography (PET) are the primary imaging techniques used for diagnosis, staging, prognosis, and even the identification of co-pathologies. In the field of structural MRI, ongoing research aims to enhance existing scales used for staging; however, in the near future, this technique may be employed for pathological diagnosis through precise volumetric assessment of medial temporal lobe morphology. According to recent studies, functional MRI (fMRI) demonstrates a correlation between altered neuronal activity patterns and the presence of biomarkers. Although further studies are needed, this method may be useful in the early detection of AD in its asymptomatic phase. The use of specific radiopharmaceuticals for both amyloid and hyperphosphorylated tau proteins in PET imaging, is an emerging technique expected to be widely applied for AD diagnosis in the near future. Numerous studies are integrating different radiopharmaceuticals to evaluate their utility, advantages, and disadvantages compared to those already approved. Innovation and the pursuit of new diagnostic techniques for AD are continuous. For instance, artificial intelligence (AI) is being applied to process PET imaging data using computational algorithms, and other non-invasive techniques are being explored to assess brain activity by monitoring physiological parameters associated with AD onset. Although scientific advance in the early diagnosis and treatment of AD continues to progress, several challenges remain. One of the future perspectives in neuroimaging is the integration of multiple imaging techniques, combined with AI-based interpretation, allowing for a personalized approach and the continued development of new and improved therapies.
Description
Keywords
Biomarcadores Demência Doença de Alzheimer Espetroscopia Imagiologia Neuroimagiologia Ressonância Magnética Tomografia Computorizada Tomografia de
Emissão de Positrões