Background: The use of imaging markers for the diagnosis of predementia and early dementia
stages of Alzheimer's disease (AD) has widely been explored in research settings and specialized
care. The use of these markers in primary care has yet to be established.
Objective: Summarize current evidence for the usefulness of imaging markers for AD in primary compared
to specialized care settings.
Method: Selective overview of the literature, and pilot data on the use of MRI-based hippocampus and
basal forebrain volumetry for the discrimination of AD dementia and mild cognitive impairment (MCI)
cases from healthy controls in 58 cases from a primary care cohort and 58 matched cases from a memory
Results: Molecular imaging marker of amyloid pathology, and volumetric markers of regional and
whole brain atrophy support the diagnosis of AD dementia and MCI due to AD, and contribute to confidence
in the differential diagnosis of AD and non-AD related dementias in specialized care. Limited
evidence from the literature and our primary care cohort suggests that the diagnostic accuracy of volumetric
imaging markers may be similar in the dementia stage of AD, but may be inferior for cases with
MCI in primary compared with specialized care.
Conclusion: Evidence is still widely lacking on the use of imaging markers for early and differential
diagnosis of AD dementia, and detection of prodromal AD in primary care. Further progress to fill this
gap will depend on the availability of international multimodal data from well-defined primary care cohorts.