Brain imaging and DXA reports in older patients
When an older person needs CT or MRI brain, how to read the report (atrophy pattern, white matter disease on the Fazekas scale, lacunes, microbleeds, subdurals, ventricles out of proportion), and how age-related spinal change distorts a DXA.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The 2016 Australian dementia guidelines recommend structural brain imaging (CT or MRI) in the diagnostic work-up, unless the result wouldn't change care, as in advanced dementia. MRI is preferred; CT is enough when MRI is unavailable, contraindicated or not tolerated.
- In delirium, scan when there are focal signs, a fall or head strike, anticoagulation, reduced consciousness, or no cause found. A routine CT in every delirious patient has a low yield.
- Some findings are expected with age. Read the report for pattern and severity: medial temporal atrophy out of proportion, confluent white matter disease, lobar microbleeds, ventricles too big for the sulci.
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Sources
- Neuroimaging standards for research into small vessel disease: advances since 2013 (STRIVE-2) (Duering M et al. Lancet Neurol 2023;22:602-18)Lancet Neurology, 2023
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (Fazekas F et al. AJR Am J Roentgenol 1987;149:351-6)American Journal of Roentgenology, 1987
- Atrophy of medial temporal lobes on MRI in probable Alzheimer's disease and normal ageing (Scheltens P et al. J Neurol Neurosurg Psychiatry 1992;55:967-72)Journal of Neurology, Neurosurgery and Psychiatry, 1992
- The Canadian CT Head Rule for patients with minor head injury (Stiell IG et al. Lancet 2001;357:1391-6)The Lancet, 2001
- DXA reporting updates: 2023 Official Positions of the International Society for Clinical Densitometry (Krueger D, Tanner SB, Szalat A et al. J Clin Densitom 2024;27(1):101437)International Society for Clinical Densitometry, 2023 (latest adult positions, checked November 2026)
- Donanemab: appropriate use recommendations (Rabinovici GD et al. J Prev Alzheimers Dis 2025;12(5):100150)Journal of Prevention of Alzheimer's Disease, 2025
- Osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of ageAU/NZRoyal Australian College of General Practitioners and Healthy Bones Australia, 3rd edition, update of the 2017 2nd edition (current November 2026)
- Clinical Practice Guidelines and Principles of Care for People with DementiaAU/NZNHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People, 2016 (Monash-led update consulted on 11 May to 6 July 2026; final not yet released)
- Updating the Clinical Practice Guidelines and Principles of Care for People with DementiaAU/NZMonash University, 2026 draft
- Leqembi (lecanemab) Australian product informationAU/NZTherapeutic Goods Administration, Version 1 (first approval 24 September 2025)
- Last updated
- 14 November 2026
What changed
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