title: [Cognitive impairment: classification by proton magnetic resonance spectroscopy and the contributions of conventional magnetic resonance imaging].
abstract: OBJECTIVE
  To analyze the diagnostic accuracy of proton magnetic resonance spectroscopy (1H MRS) in patients with cognitive impairment and to establish the usefulness of complementary information provided by conventional magnetic resonance imaging (MRI).
  
  
  METHODS
  64 patients with cognitive impairment, including Alzheimer's disease (AD) (n=31), vascular dementia (n=6), mild cognitive impairment (MCI) (n=9), and major depression (n=18), were studied. All patients underwent cerebral MRI and single-volume 1H MRS using two echo times (TE, 31 and 136 ms) in the posterior cingulate gyrus and right temporal lobe. The metabolites analyzed were N-acetylaspartate (NAA), myo-Inositol (mI), choline (Ch), and creatine (Cr), and the ratios of Ch/Cr, mI/Cr, NAA/mI and NAA/Cr were calculated. In order to differentiate among the different types of cognitive impairment, the alterations in imaging and spectroscopy findings were graded from 0 to 4, as was the mean combination of the two, and then ROC curves were obtained.
  
  
  RESULTS
  Statistically significant differences were found between the spectra of patients with dementia (AD and vascular dementia) and those without dementia (MCI and depression) in the posterior cingulate gyrus. The NAA/mI ratio yielded the best area under the ROC curve, with the best sensitivity (82.5%) and specificity (72.7%) in the diagnosis of AD. The NAA/mI and mI/Cr quotients differentiated between the four degenerative pathologies causing the cognitive impairment. The combination of MRI and 1H MRS significantly improved the accuracy of the diagnosis of AD.
  
  
  CONCLUSIONS
  The metabolic differences found among patients with cognitive impairment using 1H MRS can be useful for differentiating AD, vascular dementia, MCI, and depression. The combination of spectroscopy and MRI findings is useful in the diagnosis of AD.
authors.affiliation: Departamento de Química-Física, Universidad de Valencia, España.
authors.forename: M C
authors.initials: MC
authors.lastname: Martínez-Bisbal
authors.forename: E
authors.initials: E
authors.lastname: Arana
authors.forename: L
authors.initials: L
authors.lastname: Martí-Bonmatí
authors.forename: B
authors.initials: B
authors.lastname: Martínez-Granados
authors.forename: B
authors.initials: B
authors.lastname: Celda
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000145:classification* / Q000175:diagnosis*; D003072:Cognition Disorders / Q000145:classification* / Q000175:diagnosis*; D015140:Dementia, Vascular / Q000145:classification* / Q000175:diagnosis*; D003866:Depressive Disorder / Q000145:classification* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results