Imaging Neurodegeneration: What Can Magnetic Resonance Spectroscopy Contribute?

With increased prevalence of neurodegenerative diseases with age and an aging society, neuroimaging for diagnosis, prognosis, and therapy monitoring in these diseases has become more important than ever. There is particularly a great need for robust biomarkers and surrogate markers of cerebral pathology that can facilitate development of effective treatments in these conditions. Many radionuclide and MRI modalities are currently used in clinical research, with some already accepted among diagnostic criteria for neurodegenerative diseases. Others are being evaluated for their potential to monitor the pathogenic events during neurodegeneration at multiple levels from the global network level down to the subcellular and molecular levels. This chapter places magnetic resonance spectroscopy (MRS) within the context of other imaging modalities for evaluating neurodegeneration and summarizes its unique role in simultaneously assessing multiple relevant pathophysiological events, including neuronal loss/dysfunction, gliosis, demyelination, impaired energetics, increased membrane turnover, demyelination, synaptic dysfunction, and oxidative stress. Finally, the steps that still need to be taken to facilitate wider utility of advanced MRS methodology are outlined.