Mild cognitive impairment (MCI) is a relatively recent term that is used to describe patients who have memory impairment insufficient to interfere with daily life and do not meet the criteria for a dementia diagnosis. However, more than half of patients with MCI will progress to dementia within five years and so this may be seen as a significant risk factor for dementia7


. Alzheimer’s disease is the most common cause of dementia8 and is the result of neuronal cell loss caused by


neurofibrillary tangles due to the presence of tau protein and plaques caused by extracellular -amyloid (A) deposition. Vascular dementia is caused by vascular disease associated with hypertension, diabetes mellitus and smoking that causes reduction or blockage of cerebral perfusion9


. The result is single or multiple cortical and/or subcortical infarcts. Dementia with Lewy bodies is caused by intracellular pathological aggregations of alpha synuclein, that lead


to neuronal cell loss resulting in non-specific global and sub-cortical volume loss with relative preservation of the hippocampi9


. Dementia with Lewy bodies is on a continuum with Parkinson’s disease and is differentiated by


neuropsychiatric disturbances occurring before, or shortly after, motor symptoms become apparent. Parkinson’s disease typically presents with motor symptoms for at least 12 months prior to any symptoms of dementia developing9 Fronto-temporal dementia is caused by degeneration of the fronto-temporal lobes indicated by atrophy of the


.


frontal and temporal lobes of the brain. This is the result of neuronal cell loss in these regions caused by pathological aggregation of tau protein9


Clinical diagnosis of dementia Clinical assessment of patients presenting with memory problems to determine if they have dementia, is currently undertaken using memory tests, the most commonly used being the mini mental state examination (MMSE)14


.


The literature suggests that there is a time lag of at least a decade between the start of the pathological process for Alzheimer’s disease and clinical symptoms being present and that some experiencing dementia will never show clinical symptoms8


.


. Clinical assessment alone is suggested to have sensitivity and specificity of 76-81% and 56-70% respectively, but this is in patients who have usually presented in the later stages of dementia8,11


Whilst anatomical imaging, as described previously, is useful to rule out structural causes of memory impairment, there


are no other diagnostics that are currently utilised, possibly due to lack of funding and an evidence base, to assist clinicians in providing earlier diagnoses of dementia.


Current treatment of dementia Current treatment of dementia is provided to reduce symptoms of the disease, but does nothing to modify the pathological processes involved and therefore does not provide a curative option15


diagnosed with Alzheimer’s disease may be harmful to those with fronto-temporal dementia, so ensuring the appropriate diagnosis is vitally important15


.


Diagnostic imaging that aids the earlier detection of the pathological processes associated with dementia, could provide information about which patients will benefit from which treatment, and earlier treatment could slow the progression of the disease and allow the patient to have a more independent life for longer. This could also reduce the burden on the health service, therefore appropriate funding of PET-CT imaging services may ultimately reduce cost in the long-term.


-27- . Fronto-temporal dementia broadly has two main sub-groups – a behaviour-led syndrome (personality changes and alterations in social conduct) and a language-led syndrome (primary progressive aphasia)13 .


. The drugs provided to patients


Only 44% of people with dementia in England, Wales and Northern Ireland receive a diagnosis


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