From the Guidelines
Involutional changes on a CT head scan are a normal finding and do not require specific treatment, as they represent a normal aging process rather than a disease. These changes typically include widening of the brain's sulci, enlargement of the ventricles, and decreased brain volume, and are often seen in elderly patients 1. According to the American College of Radiology, a noncontrast head CT is the first-line neuroimaging test of choice for assessing altered mental status, and can help identify acute contributory findings, although the yield of such findings is generally low, ranging from 2% to 45% 1.
In patients with involutional changes, the focus should be on maintaining brain health through regular physical exercise, cognitive stimulation, healthy diet, adequate sleep, and management of cardiovascular risk factors, such as hypertension, diabetes, and high cholesterol 1. It is essential to note that some degree of brain atrophy occurs in everyone as they age, though the rate varies between individuals based on genetics, lifestyle factors, and medical conditions. If the involutional changes are more pronounced than expected for someone's age or are accompanied by cognitive symptoms, further evaluation may be warranted to rule out neurodegenerative conditions like Alzheimer's disease or other forms of dementia 1. Key factors that may indicate the need for further evaluation include history of trauma or falls, hypertension, anticoagulant use, headache, nausea or vomiting, older age, impaired consciousness or unresponsiveness, neurologic deficit, and history of malignancy 1.
Some important points to consider in the management of patients with involutional changes on CT head scan include:
- The reported detection of treatment-altering findings on head CT is very low in elderly patients with new onset delirium unless specific risk factors are present, such as focal neurologic deficit, history of recent falls or head injury, anticoagulation therapy, signs of elevated intracranial pressure, or significant deterioration of consciousness 1.
- Risk stratification tools have been proposed to maintain sensitivity while reducing CT utilization, but they have not been prospectively validated, and the determination of the need and benefit of brain imaging falls on the evaluating clinician’s judgement 1.
- Acute pathology that resulted in a change of management was detected in a small proportion of patients on head CT, highlighting the importance of careful patient selection and clinical evaluation 1.
From the Research
CT Head Showing "Involutional Changes"
- Involutional changes refer to the natural aging process of the brain, which can include changes such as cerebral atrophy and ventricular enlargement.
- These changes can be seen on CT scans of the head and are often associated with aging, but can also be related to various neurological conditions, including Alzheimer's disease.
- Studies have shown that certain medications, such as donepezil and memantine, can be effective in improving cognitive function and reducing behavioral and psychological symptoms in patients with Alzheimer's disease 2, 3, 4, 5.
- However, the provided studies do not directly address the topic of involutional changes on CT head scans, but rather focus on the treatment and management of Alzheimer's disease.
- There is no direct evidence in the provided studies to suggest that donepezil and memantine can reverse or halt involutional changes, but rather they may help to slow down cognitive decline and improve symptoms in patients with Alzheimer's disease.
Treatment of Alzheimer's Disease
- Donepezil and memantine are two commonly used medications for the treatment of Alzheimer's disease, and have been shown to be effective in improving cognitive function and reducing behavioral and psychological symptoms 2, 3, 4, 5.
- The combination of donepezil and memantine has been shown to be more effective than monotherapy in improving cognitive function and reducing hospital and emergency department visits 4.
- Cholinesterase inhibitors, such as donepezil, have also been shown to be effective in improving cognitive function in patients with vascular cognitive impairment 6.
Limitations
- The provided studies do not directly address the topic of involutional changes on CT head scans, and therefore do not provide evidence on the effectiveness of donepezil and memantine in reversing or halting these changes.
- Further research is needed to fully understand the effects of donepezil and memantine on involutional changes and to determine their potential role in the treatment and management of Alzheimer's disease.