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

The Role of Quantitative MRI in Alzheimer’s Diagnosis

Alzheimer’s disease (AD) is the leading cause of dementia, currently affecting over 5 million Americans, with cases expected to rise dramatically as the population ages. While AD is incurable, other conditions such as late-life depression, vascular dementia, and traumatic brain injury can mimic its symptoms, often leading to misdiagnosis and delayed treatment.

Traditional brain imaging has been used primarily to exclude other conditions (e.g., tumors, strokes). However, quantitative MRI volumetry with Neuroreader®, an FDA-cleared software, allows clinicians to measure the size of brain structures like the hippocampus and detect subtle atrophy patterns linked to AD and other disorders.

Neuroreader®: Rapid, Accurate Volumetric Analysis

• Validated accuracy: Matches gold-standard anatomical tracings of the hippocampus .
• Efficiency: Computes hippocampal volumes in under 5 minutes, and up to 45 brain regions in <10 minutes.
• Clinical relevance: Identifies patterns of brain atrophy invisible to standard radiology reads.

By integrating this tool, clinicians gain objective data to differentiate AD from other causes of memory loss and to guide personalized treatment plans.

Case Study 1: Alcohol-Related Cerebellar Atrophy Misdiagnosed as AD

A 62-year-old man presented with progressive memory loss and feared he had AD.

• MRI scan: No visible abnormalities.
• Neuroreader® analysis: Normal hippocampal volumes, but abnormally low cerebellar volume.
• Clinical correlation: Patient revealed heavy alcohol use (1 bottle of wine nightly for 15 years).
• Outcome: After stopping alcohol, cognition improved.

This case shows how quantitative MRI clarified the diagnosis, preventing an AD misdiagnosis and guiding effective intervention.

Case Study 2: Football Player With Suspected CTE

A 51-year-old former athlete with repeated head trauma experienced worsening attention issues.

• Longitudinal Neuroreader® scans (4 years apart):
  • 14% gray matter loss, especially in the brainstem and ventral diencephalon.
  • Stable to increasing hippocampal volume (+5.2%), likely linked to lifestyle changes (aerobic exercise, omega-3 diet).
• Interpretation: Findings suggest possible chronic traumatic encephalopathy (CTE), while also highlighting protective effects of lifestyle on hippocampal health.

Volumetric imaging not only revealed disease-related atrophy but also tracked positive changes linked to lifestyle interventions.

Clinical Applications in Geriatric Psychiatry

At UCLA’s Cognitive Health Clinic (CHC), directed by Dr. David Merrill, quantitative MRI is integrated into a multimodal assessment alongside neuropsychological testing, genomic-guided pharmacology, and quantitative EEG. Key benefits include:

• Early detection: Atrophy visible up to 10 years before AD symptoms .
• Differential diagnosis: Distinguishes AD from depression, vascular dementia, and TBI.
• Treatment tracking: Identifies brain volume changes related to lifestyle, medications, or cognitive training.
• Cost-effectiveness:
  • MRI with Neuroreader®: ~$437 + $70 software (reimbursable under CPT 76377).
  • PET scan: ~$3,000.
  • Avoids contrast agents and radiation.

Why Brain Volume Is a Vital Sign

Brain volume acts as a biomarker of neuronal health:

• Decreasing volume = neurodegeneration (e.g., Alzheimer’s).
• Stable/increasing volume = protective factors (exercise, nutrition, neurotrophic support).

Volumetric MRI with Neuroreader® provides clinicians with quantifiable data that can be tracked over time, much like monitoring blood pressure or cholesterol.

Future Directions

• Preventive neuroradiology: Identifying at-risk patients before cognitive decline.
• Multidisciplinary care: Collaboration between radiologists, psychiatrists, and neurologists.
• Clinical trials: Using MRI volumetrics to measure treatment efficacy (e.g., exercise, diet, medications).

With systematic review evidence supporting volumetric imaging , the challenge lies not in validation but in clinical adoption.

Key Takeaways

• Neuroreader® delivers fast, validated brain volumetrics that enhance geriatric psychiatry and neurology.
• It helps distinguish Alzheimer’s from other cognitive disorders and guides treatment decisions.
• MRI volumetry is a cost-effective, noninvasive, and reimbursable tool.
• Lifestyle interventions (exercise, omega-3 diet) can be tracked using quantitative MRI, demonstrating measurable effects on brain health.

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