Applying Quantitative Neuroimaging With Neuroreader® in Geriatric Psychiatry

By Cyrus A. Raji, MD, PhD, and David A. Merrill, MD, PhD

Published in Today’s Geriatric Medicine, Vol. 9, No. 5, p.16

Quantitative MRI volumetry using Neuroreader enables clinicians in geriatric psychiatry to detect early neurodegenerative changes, improve differential diagnosis, and track treatment effects over time. By objectively measuring brain structures such as the hippocampus, volumetric MRI helps distinguish Alzheimer’s disease from conditions with overlapping symptoms, including depression, vascular dementia, and traumatic brain injury.

The Role of Quantitative MRI in Alzheimer’s Diagnosis

Alzheimer’s disease (AD) is the most common cause of dementia, affecting more than 5 million Americans, with prevalence expected to rise as the population ages. While AD is incurable, several other conditions — including late-life depression, vascular dementia, and traumatic brain injury — can mimic its clinical presentation.

Traditional brain imaging has historically been used to rule out alternative diagnoses such as tumors or stroke. In contrast, quantitative MRI volumetry allows clinicians to measure the volume of specific brain regions and detect subtle atrophy patterns associated with Alzheimer’s disease and other neurological disorders.

Neuroreader®: Rapid and Clinically Relevant Volumetric Analysis

Neuroreader® is an FDA-cleared, automated brain volumetric analysis software designed for clinical use.

Key capabilities include:

• Validated accuracy comparable to gold-standard anatomical hippocampal tracings
• Hippocampal volume measurement in under 5 minutes
• Quantification of up to 45 brain regions in under 10 minutes
• Detection of atrophy patterns not visible on standard visual MRI interpretation

By integrating Neuroreader® into routine MRI workflows, clinicians gain objective data that supports more accurate diagnosis and personalized treatment planning.

Case Study 1: Alcohol-Related Cerebellar Atrophy Misdiagnosed as Alzheimer’s Disease

A 62-year-old man presented with progressive memory complaints and concern for Alzheimer’s disease.

Findings

• Conventional MRI: No visible abnormalities
• Neuroreader® analysis: Normal hippocampal volumes with abnormally low cerebellar volume

Clinical Correlation

Further history revealed chronic alcohol use, averaging one bottle of wine nightly for 15 years.

Outcome

After alcohol cessation, the patient demonstrated cognitive improvement, confirming that quantitative MRI clarified the diagnosis and prevented an Alzheimer’s misdiagnosis.

Case Study 2: Former Football Player With Suspected Chronic Traumatic Encephalopathy

A 51-year-old former athlete with repeated head trauma presented with worsening attention and cognitive symptoms.

Longitudinal Neuroreader® Findings (4-year interval):

• 14% gray matter loss, most prominent in the brainstem and ventral diencephalon
• Stable to increased hippocampal volume (+5.2%), potentially associated with aerobic exercise and omega-3 dietary changes

Interpretation

Volumetric MRI findings were consistent with possible chronic traumatic encephalopathy (CTE) while also demonstrating measurable neuroprotective effects linked to lifestyle interventions.

Clinical Applications in Geriatric Psychiatry

At UCLA’s Cognitive Health Clinic, directed by Dr. David Merrill, quantitative MRI is incorporated into a comprehensive assessment that includes neuropsychological testing, genomic-guided pharmacology, and quantitative EEG.

Clinical benefits include:

• Early detection of neurodegenerative changes, potentially years before symptom onset
• Improved differentiation between Alzheimer’s disease, depression, vascular dementia, and traumatic brain injury
• Longitudinal monitoring of treatment-related brain volume changes

Why Brain Volume Is a Vital Sign

Brain volume serves as a measurable biomarker of neuronal health:

• Decreasing volume is associated with neurodegeneration
• Stable or increasing volume may reflect protective factors such as exercise, nutrition, and neurotrophic support

Volumetric MRI enables clinicians to track these changes over time, similar to monitoring other clinical vital signs.

Future Directions in Quantitative Neuroimaging

• Preventive neuroradiology to identify patients at risk before clinical decline
• Expanded collaboration between radiologists, psychiatrists, and neurologists
• Use of MRI volumetrics as outcome measures in clinical trials evaluating lifestyle and pharmacologic interventions

With growing systematic review evidence supporting volumetric imaging, the primary challenge lies in broader clinical adoption.

Key Takeaways

• Neuroreader® provides fast, validated quantitative brain volumetrics for clinical practice
• Volumetric MRI improves diagnostic accuracy in geriatric psychiatry and neurology
• Objective brain volume measurements support treatment selection and monitoring
• Quantitative MRI is noninvasive, cost-effective, and reimbursable
• Lifestyle-related brain changes can be measured and tracked over time

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