**6. Concluding remarks**

There is still a long way to go before AD can be fully understood and treated. With magnetic resonance technologies, it is possible to observe changes before cognitive decline begins. A lot of work has been done with structural imaging of gray and white matter, and changes are detectible in ApoE ε4 carriers decades before the onset of symptoms. More longitudinal studies need to be performed to determine which of these changes will specifically lead to AD. Functional studies offer a window of the changes that occur before neuronal atrophy, but the specific vascular causes behind the BOLD effect need to be further studied. Finally, chemical imaging can provide a glimpse of the changes occurring at the molecular level, and by further developing and standardizing these measures there is much that can be learned.

### **Author details**

Emily J. Mason1\*, Manus J. Donahue2 and Brandon A. Ally1

\*Address all correspondence to: emily.mason.1@vanderbilt.edu

1 Department of Neurology, Vanderbilt University, Nashville, TN, USA

2 Department of Radiology, Vanderbilt University, Nashville, TN, USA

#### **References**

some cases—and because the measurements are taken in a single voxel the subject must stay absolutely still throughout the scan. This is very difficult for young healthy subjects, and may be nearly impossible in older, demented subjects. Common sedation drugs such as propofol will change the levels of brain metabolites and should be avoided[72]. In premenopausal women GABA levels also vary depending on the stage of the menstrual

Typically, spectroscopy is done in the posterior cingulate or medial temporal cortices, but these are only affected by AD in late stages of the disease. It would be more helpful to study the smaller limbic areas that are affected sooner, but the voxel sizes typically used in spec‐ troscopy are larger than many of these areas [66]. Falini et al developed a technique to per‐ form spectroscopy across the entire brain and found that NAA levels are reduced in those with AD, however whole-brain spectroscopy is a non-specific marker [41,74]. These limita‐ tions will be overcome with higher field strength, advances in shimming algorithms, and

MRSi is a technique that uses spectroscopy but applies it to voxels across the entire brain. The concentration of the chemical of interest corresponds to the brightness or color of the voxel in the image produced. It can achieve high spatial resolution (up to 0.25 cm3

when optimized can produce a wealth of information [44,75]. This technique has largely been developed for breast cancer imaging, and can identify chemical "hot spots" that are of use when categorizing a tumor. It has great potential as a technique for understanding AD.

There is still a long way to go before AD can be fully understood and treated. With magnetic resonance technologies, it is possible to observe changes before cognitive decline begins. A lot of work has been done with structural imaging of gray and white matter, and changes are detectible in ApoE ε4 carriers decades before the onset of symptoms. More longitudinal studies need to be performed to determine which of these changes will specifically lead to AD. Functional studies offer a window of the changes that occur before neuronal atrophy, but the specific vascular causes behind the BOLD effect need to be further studied. Finally, chemical imaging can provide a glimpse of the changes occurring at the molecular level, and by further developing and standardizing these measures there is much that can be learned.

and Brandon A. Ally1

), and

cycle, and may introduce variability[73].

240 Understanding Alzheimer's Disease

**6. Concluding remarks**

**Author details**

Emily J. Mason1\*, Manus J. Donahue2

\*Address all correspondence to: emily.mason.1@vanderbilt.edu

improvements to computerized registration techniques [42,68].

**5.2. Magnetic Resonance Spectroscopy imaging (MRSi)**


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**Section 3**

**Therapy**

**Section 3**
