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van Engelen MPE, Gossink FT, de Vijlder LS, Meursing JR, Scheltens P, Dols A, Pijnenburg YA. End Stage Clinical Features and Cause of Death of Behavioral Variant Frontotemporal Dementia and Young-Onset Alzheimer's Disease. J Alzheimers Dis 2020; 77:1169-1180. [PMID: 32925036 PMCID: PMC7683069 DOI: 10.3233/jad-200337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Limited literature exists regarding the clinical features of end stage behavioral variant frontotemporal dementia (bvFTD). This data is indispensable to inform and prepare family members as well as professional caregivers for the expected disease course and to anticipate with drug-based and non-pharmacological treatment strategies. OBJECTIVE The aim of the present study was to describe end stage bvFTD in a broad explorative manner and to subsequently evaluate similarities and dissimilarities with the end stage of the most prevalent form of young-onset dementia, Alzheimer's disease (yoAD). METHODS We analyzed medical files on patients, using a mixed model of qualitative and quantitative approaches. Included were previously deceased patients with probable bvFTD and probable yoAD. End stage was defined as the last 6 months prior to death. Primary outcome measures comprised somatic, neurological, and psychiatric symptoms and the secondary outcome measure was cause of death. RESULTS Out of 89 patients, a total of 30 patients were included (bvFTD; n = 12, yoAD; n = 18). Overall, the end stages of bvFTD and yoAD were characterized by a broad spectrum of clinical symptoms including severe autonomic dysfunction and an increased muscle tone. Patients with bvFTD displayed more mutism compared with yoAD while compulsiveness was only present in bvFTD. CONCLUSION Our study describes the full clinical spectrum of end stage bvFTD and yoAD. In this study, symptoms extend far beyond the initial behavioral and cognitive features. By taking both somatic, psychiatric, and neurological features into account, family members and professional caregivers may anticipate (non) pharmacological treatment.
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Affiliation(s)
- Marie-Paule E. van Engelen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Flora T. Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Lieke S. de Vijlder
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Jan R.A. Meursing
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Eldaief MC, Perez DL, Quimby M, Hochberg D, Touroutoglou A, Barrett LF, Dickerson BC. Atrophy in Distinct Corticolimbic Networks Subserving Socioaffective Behavior in Semantic Variant Primary Progressive Aphasia. Dement Geriatr Cogn Disord 2020; 49:589-597. [PMID: 33691310 PMCID: PMC8812818 DOI: 10.1159/000511341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although traditionally conceptualized as a language disorder, semantic variant primary progressive aphasia (svPPA) is often accompanied by significant behavioral and affective symptoms which considerably increase disease morbidity. Specifically, these neuropsychiatric symptoms are characterized by breaches in normative socioaffective function, for example, an inability to read social cues, excessive trusting of others, and decreased empathy. Our prior neuroimaging work identified 3 corticolimbic networks anchored in the amygdala, temporal pole, and frontoinsular cortex: an affiliation network, theorized to mediate social approach behavior; an aversion network, theorized to subserve the appraisal of social threat; and a perception network, theorized to mediate the detection of social cues. We hy-pothesized that degeneration of these networks could provide neuroanatomical substrates for socioaffective deficits in svPPA. METHODS We examined hypothesized relationships between subscores on the Social Impairment Rating Scale (SIRS) and atrophy in each of these 3 networks in a group of 16 svPPA patients (using matched cognitively normal controls as a reference). RESULTS Consistent with our predictions, the magnitude of atrophy in the affiliation network in svPPA patients correlated with the SIRS subscore of socioemotional detachment, while the magnitude of atrophy in the aversion network in svPPA patients correlated with the SIRS subscore of inappropriate trusting. We did not find the predicted association between perception network atrophy and the SIRS subscore of lack of attention to social cues. CONCLUSION These findings highlight specific socioaffective deficits in svPPA and provide a neuroanatomical basis for these impairments by linking them to networks commonly targeted in this disorder.
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Affiliation(s)
- Mark C. Eldaief
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Center for Brain Sciences, Harvard University, Cambridge, MA, USA
| | - David L. Perez
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Megan Quimby
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daisy Hochberg
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra Touroutoglou
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Lisa Feldman Barrett
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA,Division of Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Psychology, Northeastern University, Boston MA USA
| | - Bradford C. Dickerson
- Frontotemporal Disorders Unit and Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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53
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Bocchetta M, Iglesias JE, Neason M, Cash DM, Warren JD, Rohrer JD. Thalamic nuclei in frontotemporal dementia: Mediodorsal nucleus involvement is universal but pulvinar atrophy is unique to C9orf72. Hum Brain Mapp 2019; 41:1006-1016. [PMID: 31696638 PMCID: PMC7267940 DOI: 10.1002/hbm.24856] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Abstract
Thalamic atrophy is a common feature across all forms of FTD but little is known about specific nuclei involvement. We aimed to investigate in vivo atrophy of the thalamic nuclei across the FTD spectrum. A cohort of 402 FTD patients (age: mean(SD) 64.3(8.2) years; disease duration: 4.8(2.8) years) was compared with 104 age-matched controls (age: 62.5(10.4) years), using an automated segmentation of T1-weighted MRIs to extract volumes of 14 thalamic nuclei. Stratification was performed by clinical diagnosis (180 behavioural variant FTD (bvFTD), 85 semantic variant primary progressive aphasia (svPPA), 114 nonfluent variant PPA (nfvPPA), 15 PPA not otherwise specified (PPA-NOS), and 8 with associated motor neurone disease (FTD-MND), genetic diagnosis (27 MAPT, 28 C9orf72, 18 GRN), and pathological confirmation (37 tauopathy, 38 TDP-43opathy, 4 FUSopathy). The mediodorsal nucleus (MD) was the only nucleus affected in all FTD subgroups (16-33% smaller than controls). The laterodorsal nucleus was also particularly affected in genetic cases (28-38%), TDP-43 type A (47%), tau-CBD (44%), and FTD-MND (53%). The pulvinar was affected only in the C9orf72 group (16%). Both the lateral and medial geniculate nuclei were also affected in the genetic cases (10-20%), particularly the LGN in C9orf72 expansion carriers. Use of individual thalamic nuclei volumes provided higher accuracy in discriminating between FTD groups than the whole thalamic volume. The MD is the only structure affected across all FTD groups. Differential involvement of the thalamic nuclei among FTD forms is seen, with a unique pattern of atrophy in the pulvinar in C9orf72 expansion carriers.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Juan E Iglesias
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Mollie Neason
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.,Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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Sani TP, Bond RL, Marshall CR, Hardy CJ, Russell LL, Moore KM, Slattery CF, Paterson RW, Woollacott IO, Wendi IP, Crutch SJ, Schott JM, Rohrer JD, Eriksson SH, Dijk DJ, Warren JD. Sleep symptoms in syndromes of frontotemporal dementia and Alzheimer's disease: A proof-of-principle behavioural study. eNeurologicalSci 2019; 17:100212. [PMID: 31828228 PMCID: PMC6889070 DOI: 10.1016/j.ensci.2019.100212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
Sleep is a key concern in dementias but their sleep phenotypes are not well defined. We addressed this issue in major FTD and AD syndromes versus healthy older controls. We surveyed sleep duration, quality and disruptive events, and daytime somnolence. Sleep symptoms were frequent in FTD and AD and distinguished these diseases. Sleep disturbance is an important clinical issue across major FTD and AD syndromes.
Sleep disruption is a key clinical issue in the dementias but the sleep phenotypes of these diseases remain poorly characterised. Here we addressed this issue in a proof-of-principle study of 67 patients representing major syndromes of frontotemporal dementia (FTD) and Alzheimer’s disease (AD), in relation to 25 healthy older individuals. We collected reports on clinically-relevant sleep characteristics - time spent overnight in bed, sleep quality, excessive daytime somnolence and disruptive sleep events. Difficulty falling or staying asleep at night and excessive daytime somnolence were significantly more frequently reported for patients with both FTD and AD than healthy controls. On average, patients with FTD and AD retired earlier and patients with AD spent significantly longer in bed overnight than did healthy controls. Excessive daytime somnolence was significantly more frequent in the FTD group than the AD group; AD syndromic subgroups showed similar sleep symptom profiles while FTD subgroups showed more variable profiles. Sleep disturbance is a significant clinical issue in major FTD and AD variant syndromes and may be even more salient in FTD than AD. These preliminary findings warrant further systematic investigation with electrophysiological and neuroanatomical correlation in major proteinopathies.
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Affiliation(s)
- Tara P. Sani
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Neurology Department, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Rebecca L. Bond
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Charles R. Marshall
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Chris J.D. Hardy
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Lucy L. Russell
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Katrina M. Moore
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Catherine F. Slattery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ross W. Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ione O.C. Woollacott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Indra Putra Wendi
- Department of Chemistry and Biochemistry, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan D. Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sofia H. Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, UK
- Dementia Research Institute, UK
| | - Jason D. Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Corresponding author at: Dementia Research Centre, UCL Institute of Neurology, University College London, London WC1N 3BG, UK.
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Kovach CR, Putz M, Guslek B, McInnes R. Do Warmed Blankets Change Pain, Agitation, Mood or Analgesic Use Among Nursing Home Residents? Pain Manag Nurs 2019; 20:526-531. [PMID: 31526591 DOI: 10.1016/j.pmn.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/02/2019] [Accepted: 07/03/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain, agitation, and thermal discomfort are common symptoms of older adults residing in nursing homes. Nonpharmacologic interventions are recognized as a best practice strategy for people living in nursing homes because of their low adverse effect profile and increased evidence of effectiveness. Warmed blankets have not been empirically tested for use in long-term care. AIMS The purpose of this quality improvement project was to describe the use of warmed blankets in a nursing home setting and determine if use was associated with changes in pain, agitation, mood, or analgesic use. DESIGN A pretest posttest design was used along with a comparison of intact groups. SETTINGS The setting was one 160-bed skilled long-term care facility. PARTICIPANTS/SUBJECTS There were 141 residents eligible since they did not have a condition that could be worsened by superficial heat. METHODS Warmed blankets were unfolded and placed over residents with pain, agitation, or thermal discomfort. Short-term pain measures included use of the Revised FACES Pain Scale, the PAINAD (Pain Assessment in Advanced Dementia) scale, and the Brief Agitation Rating Scale. Long-term measures were taken from the electronic medical record. RESULTS Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the 1- month study period. There were statistically significant decreases in both pain level and agitation among baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and as-needed analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. CONCLUSIONS Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.
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Affiliation(s)
| | - Michelle Putz
- Research Office, Ovation Communities, Milwaukee, Wisconsin
| | - Barbara Guslek
- Research Office, Ovation Communities, Milwaukee, Wisconsin
| | - Robert McInnes
- Research Office, Ovation Communities, Milwaukee, Wisconsin
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56
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Ahmed RM, Landin-Romero R, Liang CT, Keogh JM, Henning E, Strikwerda-Brown C, Devenney EM, Hodges JR, Kiernan MC, Farooqi IS, Piguet O. Neural networks associated with body composition in frontotemporal dementia. Ann Clin Transl Neurol 2019; 6:1707-1717. [PMID: 31461580 PMCID: PMC6764740 DOI: 10.1002/acn3.50869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Frontotemporal dementia (FTD) is associated with complex changes in eating behavior and metabolism, which potentially affect disease pathogenesis and survival. It is currently not known if body composition changes and changes in fat deposition also exist in FTD, the relationship of these changes in eating behavior and appetite, and whether these changes are centrally mediated. Methods Body composition was measured in 28 people with behavioral‐variant frontotemporal dementia (bvFTD), 16 with Alzheimer’s disease (AD), and 19 healthy controls, using dual energy x‐ray absorptiometry. Changes in body composition were correlated to brain grey matter atrophy using voxel‐based morphometry on high‐resolution magnetic resonance imaging. Results Behavioral‐variant FTD was characterized by changes in body composition, with increased total fat mass, visceral adipose tissue area (VAT area), and android: gynoid ratio compared to control and AD participants (all P values < 0.05). Changes in body composition correlated to abnormal eating behavior and behavioral change (P < 0.01) and functional decline (P < 0.01). Changes in body composition also correlated to grey matter atrophy involving a distributed neural network that included the hippocampus, amygdala, nucleus accumbens, insula, cingulate, and cerebellum – structures known to be central to autonomic control – as well as the thalamus, putamen, accumbens, and caudate, which are involved in reward processing. Conclusions Changes in body composition and fat deposition extend the clinical phenomenology in bvFTD beyond cognition and behavior, with changes associated with changes in reward and autonomic processing suggesting that these deficits may be central in FTD
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Affiliation(s)
- Rebekah M Ahmed
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.,Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Ramon Landin-Romero
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, Australia
| | - Cheng T Liang
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, Australia
| | - Julia M Keogh
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Elana Henning
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Cherie Strikwerda-Brown
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, Australia
| | - Emma M Devenney
- Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - John R Hodges
- Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, Australia
| | - Matthew C Kiernan
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.,Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - I Sadaf Farooqi
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, Australia
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Johnen A, Bertoux M. Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond. Front Neurol 2019; 10:594. [PMID: 31231305 PMCID: PMC6568027 DOI: 10.3389/fneur.2019.00594] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.
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Affiliation(s)
- Andreas Johnen
- Section for Neuropsychology, Department of Neurology, University Hospital Münster, Münster, Germany
| | - Maxime Bertoux
- Univ Lille, Inserm UMR 1171 Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
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58
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Behavioural variant frontotemporal dementia: At the interface of interoception, emotion and social cognition? Cortex 2019; 115:335-340. [DOI: 10.1016/j.cortex.2017.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 08/01/2017] [Indexed: 01/30/2023]
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Hobson H, Brewer R, Catmur C, Bird G. The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. EMOTION REVIEW 2019. [DOI: 10.1177/1754073919838528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work & Counselling, University of Greenwich, UK
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway University of London, UK
| | - Caroline Catmur
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Convery R, Mead S, Rohrer JD. Review: Clinical, genetic and neuroimaging features of frontotemporal dementia. Neuropathol Appl Neurobiol 2019; 45:6-18. [DOI: 10.1111/nan.12535] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Affiliation(s)
- R. Convery
- Dementia Research Centre; Department of Neurodegenerative Disease; UCL Queen Square Institute of Neurology; London UK
| | - S. Mead
- UCL Institute of Prion Diseases; MRC Prion Unit at UCL; London UK
| | - J. D. Rohrer
- Dementia Research Centre; Department of Neurodegenerative Disease; UCL Queen Square Institute of Neurology; London UK
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Midorikawa A, Kumfor F, Leyton CE, Foxe D, Landin-Romero R, Hodges JR, Piguet O. Characterisation of "Positive" Behaviours in Primary Progressive Aphasias. Dement Geriatr Cogn Disord 2018; 44:119-128. [PMID: 28787730 DOI: 10.1159/000478852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Although some patients with primary progressive aphasia (PPA) exhibit novel or improved skills after the onset of dementia, these changes have yet to be quantified. Therefore, this study systematically explored and identified the emergence of positive behaviours after dementia onset. METHODS This study included 48 carers of patients with PPA: 12 nonfluent/agrammatic PPA (nfvPPA), 22 semantic variant PPA (svPPA), and 14 logopenic variant PPA (lvPPA). The presence and frequency of positive behaviour changes after dementia onset were established using the Hypersensory and Social/Emotional Scale (HSS). RESULTS Scores on Sensitivity to Details, Visuospatial Activities, and Music Activities differed significantly among the groups. More specifically, svPPA was associated with increased visuospatial activity, but only in the mild stage of the disease; nfvPPA was associated with increased visuospatial activity and decreased music activity, while lvPPA exhibited the reverse profile. CONCLUSIONS The results demonstrate that subsets of PPA patients show novel or increased positive behaviours following dementia onset, and differences among subtypes may be helpful for improving diagnostic accuracy. Additionally, harnessing these skills may improve the quality of life of both patients and carers.
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Affiliation(s)
- Akira Midorikawa
- Department of Psychology, Faculty of Letters, Chuo University, Tokyo, Japan
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Motzko-Soares ACP, Vizin RCL, Martins TMS, Hungaro ARO, Sato JR, Almeida MC, Carrettiero DC. Thermoregulatory profile of neurodegeneration-induced dementia of the Alzheimer's type using intracerebroventricular streptozotocin in rats. Acta Physiol (Oxf) 2018; 224:e13084. [PMID: 29719119 DOI: 10.1111/apha.13084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 01/18/2023]
Abstract
AIM Here, we have extensively investigated the relationship between thermoregulation and neurodegeneration-induced dementia of the Alzheimer's type using intracerebroventricular injections of streptozotocin (icv-STZ). METHODS Male Wistar rats were treated with bilateral injections of icv-STZ, and their thermoregulatory profiles (core body temperature, tail-skin temperature, cold and heat defence responses and thermal place preference) were evaluated. Spatial memory, locomotor activity, social interaction, brain ventricular volume, and Aβ1-42 and tau protein levels in the brain were analysed to characterize the effects of STZ on the brain and behaviour. RESULTS In addition to deficits in spatial memory, reduced social interaction and an increased brain ventricular volume, icv-STZ rats presented a pattern of hyperthermia, as demonstrated by an increased core body temperature. Hyperthermia was due to the activation of both autonomic heat conservation and behavioural cold avoidance, as STZ-treated rats presented tail-cutaneous vasoconstriction and an altered thermal preference. They also showed a distinct cold defence response when exposed to cold. CONCLUSION Our data bring evidence that icv-STZ in rats causes hyperthermia, with activation of both autonomic and behavioural thermoregulatory defence responses when challenged at colder temperatures, leading us to hypothesize that they are more efficient in preventing hypothermia. These data are relevant for a better understanding of neurodegenerative disease mechanisms.
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Affiliation(s)
- A. C. P. Motzko-Soares
- Graduate Program in Neuroscience and Cognition; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - R. C. L. Vizin
- Graduate Program in Neuroscience and Cognition; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - T. M. S. Martins
- Undergraduate Program in Science and Technology; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - A. R. O. Hungaro
- Undergraduate Program in Science and Technology; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - J. R. Sato
- Graduate Program in Neuroscience and Cognition; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
- Center for Mathematics Computation and Cognition (CMCC); Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - M. C. Almeida
- Graduate Program in Neuroscience and Cognition; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
- Center for Natural and Human Sciences (CCNH); Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
| | - D. C. Carrettiero
- Graduate Program in Neuroscience and Cognition; Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
- Center for Natural and Human Sciences (CCNH); Universidade Federal do ABC (UFABC); São Bernardo do Campo SP Brazil
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63
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Ahmed RM, Goldberg ZL, Kaizik C, Kiernan MC, Hodges JR, Piguet O, Irish M. Neural correlates of changes in sexual function in frontotemporal dementia: implications for reward and physiological functioning. J Neurol 2018; 265:2562-2572. [DOI: 10.1007/s00415-018-9024-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 01/31/2023]
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Marshall CR, Hardy CJD, Volkmer A, Russell LL, Bond RL, Fletcher PD, Clark CN, Mummery CJ, Schott JM, Rossor MN, Fox NC, Crutch SJ, Rohrer JD, Warren JD. Primary progressive aphasia: a clinical approach. J Neurol 2018; 265:1474-1490. [PMID: 29392464 PMCID: PMC5990560 DOI: 10.1007/s00415-018-8762-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Abstract
The primary progressive aphasias are a heterogeneous group of focal 'language-led' dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including 'clinical pearls' that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic 'roadmap'. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.
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Affiliation(s)
- Charles R Marshall
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Lucy L Russell
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Rebecca L Bond
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Phillip D Fletcher
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Camilla N Clark
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Catherine J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Martin N Rossor
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sebastian J Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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65
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Marshall CR, Hardy CJD, Allen M, Russell LL, Clark CN, Bond RL, Dick KM, Brotherhood EV, Rohrer JD, Kilner JM, Warren JD. Cardiac responses to viewing facial emotion differentiate frontotemporal dementias. Ann Clin Transl Neurol 2018; 5:687-696. [PMID: 29928652 PMCID: PMC5989744 DOI: 10.1002/acn3.563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/23/2018] [Accepted: 03/19/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To establish proof‐of‐principle for the use of heart rate responses as objective measures of degraded emotional reactivity across the frontotemporal dementia spectrum, and to demonstrate specific relationships between cardiac autonomic responses and anatomical patterns of neurodegeneration. Methods Thirty‐two patients representing all major frontotemporal dementia syndromes and 19 healthy older controls performed an emotion recognition task, viewing dynamic, naturalistic videos of facial emotions while ECG was recorded. Cardiac reactivity was indexed as the increase in interbeat interval at the onset of facial emotions. Gray matter associations of emotional reactivity were assessed using voxel‐based morphometry of patients’ brain MR images. Results Relative to healthy controls, all patient groups had impaired emotion identification, whereas cardiac reactivity was attenuated in those groups with predominant fronto‐insular atrophy (behavioral variant frontotemporal dementia and nonfluent primary progressive aphasia), but preserved in syndromes focused on the anterior temporal lobes (right temporal variant frontotemporal dementia and semantic variant primary progressive aphasia). Impaired cardiac reactivity correlated with gray matter atrophy in a fronto‐cingulo‐insular network that overlapped correlates of cognitive emotion processing. Interpretation Autonomic indices of emotional reactivity dissociate from emotion categorization ability, stratifying frontotemporal dementia syndromes and showing promise as novel biomarkers. Attenuated cardiac responses to the emotions of others suggest a core pathophysiological mechanism for emotional blunting and degraded interpersonal reactivity in these diseases.
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Affiliation(s)
- Charles R Marshall
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK.,Sobell Department of Motor Neuroscience and Movement Disorders Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Christopher J D Hardy
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Micah Allen
- Wellcome Trust Centre for Neuroimaging Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Lucy L Russell
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Camilla N Clark
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Rebecca L Bond
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Katrina M Dick
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Emilie V Brotherhood
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Jonathan D Rohrer
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - James M Kilner
- Sobell Department of Motor Neuroscience and Movement Disorders Institute of Neurology University College London Queen Square London WC1N 3BG UK
| | - Jason D Warren
- Dementia Research Centre Department of Neurodegenerative Disease Institute of Neurology University College London Queen Square London WC1N 3BG UK
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66
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Physiological changes in neurodegeneration - mechanistic insights and clinical utility. Nat Rev Neurol 2018; 14:259-271. [PMID: 29569624 DOI: 10.1038/nrneurol.2018.23] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The effects of neurodegenerative syndromes extend beyond cognitive function to involve key physiological processes, including eating and metabolism, autonomic nervous system function, sleep, and motor function. Changes in these physiological processes are present in several conditions, including frontotemporal dementia, amyotrophic lateral sclerosis, Alzheimer disease and the parkinsonian plus conditions. Key neural structures that mediate physiological changes across these conditions include neuroendocrine and hypothalamic pathways, reward pathways, motor systems and the autonomic nervous system. In this Review, we highlight the key changes in physiological processing in neurodegenerative syndromes and the similarities in these changes between different progressive neurodegenerative brain conditions. The changes and similarities between disorders might provide novel insights into the human neural correlates of physiological functioning. Given the evidence that physiological changes can arise early in the neurodegenerative process, these changes could provide biomarkers to aid in the early diagnosis of neurodegenerative diseases and in treatment trials.
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67
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Bocchetta M, Gordon E, Cardoso MJ, Modat M, Ourselin S, Warren JD, Rohrer JD. Thalamic atrophy in frontotemporal dementia - Not just a C9orf72 problem. Neuroimage Clin 2018; 18:675-681. [PMID: 29876259 PMCID: PMC5988457 DOI: 10.1016/j.nicl.2018.02.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/07/2018] [Accepted: 02/21/2018] [Indexed: 12/12/2022]
Abstract
Background Frontotemporal dementia (FTD) is a heterogeneous neurodegenerative disorder associated with frontal and temporal atrophy. Subcortical involvement has been described as well, with early thalamic atrophy most commonly associated with the C9orf72 expansion. However thalamic involvement has not been comprehensively investigated across the FTD spectrum. Methods We investigated thalamic volumes in a sample of 341 FTD patients (age: mean(standard deviation) 64.2(8.5) years; disease duration: 4.6(2.7) years) compared with 99 age-matched controls (age: 61.9(11.4) years). We performed a parcellation of T1 MRIs using an atlas propagation and label fusion approach to extract left and right thalamus volumes, which were corrected for total intracranial volumes. We assessed subgroups stratified by clinical diagnosis (141 behavioural variant FTD (bvFTD), 76 semantic dementia (SD), 103 progressive nonfluent aphasia (PNFA), 7 with associated motor neurone disease (FTD-MND) and 14 primary progressive aphasia not otherwise specified (PPA-NOS), genetic diagnosis (24 with MAPT, 24 with C9orf72, and 15 with GRN mutations), and pathological diagnosis (40 tauopathy, 61 TDP-43opathy, 3 FUSopathy). We assessed the diagnostic accuracy based on thalamic volume. Results Overall, FTD patients had smaller thalami than controls (8% difference in volume, p < 0.0005, ANCOVA). Stratifying by genetics, C9orf72 group had the smallest thalami (14% difference from controls, p < 0.0005). However, the thalami were also smaller than controls in the other genetic groups: GRN and MAPT groups showed a difference of 11% and 9% respectively (p < 0.0005). ROC analysis showed a relatively poor ability to separate C9orf72 from MAPT (AUC = 0.651, p = 0.073) and from GRN cases (AUC = 0.644, p = 0.133) using thalamic volume. All clinical subtypes had significantly smaller thalami than controls (p < 0.0005), with the FTD-MND group having the smallest (15%), followed by bvFTD (9%), PNFA (8%), PPA-NOS (7%), and lastly SD (5%). In the pathological groups, the TDP-43opathies had an 11% difference from controls, and tauopathies 9%, while the FUSopathies showed only 2% of difference from controls (p < 0.0005). GRN, PPA-NOS and SD were the subgroups showing the highest asymmetry in volumes. Conclusions The thalamus was most affected in C9orf72 genetically, TDP-43opathies pathologically and FTD-MND clinically. However, thalamic atrophy is a common feature across all FTD groups.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Elizabeth Gordon
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - M Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Marc Modat
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom.
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68
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Clark CN, Golden HL, McCallion O, Nicholas JM, Cohen MH, Slattery CF, Paterson RW, Fletcher PD, Mummery CJ, Rohrer JD, Crutch SJ, Warren JD. Music models aberrant rule decoding and reward valuation in dementia. Soc Cogn Affect Neurosci 2018; 13:192-202. [PMID: 29186630 PMCID: PMC5827340 DOI: 10.1093/scan/nsx140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/06/2017] [Accepted: 11/19/2017] [Indexed: 01/03/2023] Open
Abstract
Aberrant rule- and reward-based processes underpin abnormalities of socio-emotional behaviour in major dementias. However, these processes remain poorly characterized. Here we used music to probe rule decoding and reward valuation in patients with frontotemporal dementia (FTD) syndromes and Alzheimer's disease (AD) relative to healthy age-matched individuals. We created short melodies that were either harmonically resolved ('finished') or unresolved ('unfinished'); the task was to classify each melody as finished or unfinished (rule processing) and rate its subjective pleasantness (reward valuation). Results were adjusted for elementary pitch and executive processing; neuroanatomical correlates were assessed using voxel-based morphometry. Relative to healthy older controls, patients with behavioural variant FTD showed impairments of both musical rule decoding and reward valuation, while patients with semantic dementia showed impaired reward valuation but intact rule decoding, patients with AD showed impaired rule decoding but intact reward valuation and patients with progressive non-fluent aphasia performed comparably to healthy controls. Grey matter associations with task performance were identified in anterior temporal, medial and lateral orbitofrontal cortices, previously implicated in computing diverse biological and non-biological rules and rewards. The processing of musical rules and reward distils cognitive and neuroanatomical mechanisms relevant to complex socio-emotional dysfunction in major dementias.
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Affiliation(s)
- Camilla N Clark
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Hannah L Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Oliver McCallion
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Miriam H Cohen
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ross W Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Phillip D Fletcher
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Catherine J Mummery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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Midorikawa A, Leyton CE, Foxe D, Landin-Romero R, Hodges JR, Piguet O. All Is Not Lost: Positive Behaviors in Alzheimer's Disease and Behavioral-Variant Frontotemporal Dementia with Disease Severity. J Alzheimers Dis 2018; 54:549-58. [PMID: 27472884 PMCID: PMC5026134 DOI: 10.3233/jad-160440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Anecdotal evidence indicates that some patients with dementia exhibit novel or increased positive behaviors, such as painting or singing, after the disease onset. Due to the lack of objective measures, however, the frequency and nature of these changes has not been formally investigated. Objective: This study aimed to systematically identify changes in these behaviors in the two most common younger-onset dementia syndromes: Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD). Methods: Sixty-three caregivers of patients with dementia (32 caregivers of AD patients and 31 caregivers of bvFTD patients) participated in the study. Caregivers rated the presence and frequency of positive and negative behavior changes after the onset of dementia using the Hypersensory and Social/Emotional Scale (HSS) questionnaire, focusing on three domains: sensory processing, cognitive skills, and social/emotional processing. Six composites scores were obtained reflecting these three domains (two composite scores for each domain). Differences across scores and ratios of increased and decreased behaviors were analyzed between AD and bvFTD, at different disease severity levels. Results: After disease onset, significant changes in the sensory processing domain were observed across disease severity levels, particularly in AD. Composite scores of the other domains did not change significantly. Importantly, however, some novel or increased positive behaviors were present in between 10% (Music activities) and 70% (Hypersensitivity) of AD and bvFTD patients, regardless of disease severity. Conclusions: We provide the first systematic investigation of positive behaviors in AD and bvFTD. The newly developed HSS questionnaire is a valid measure to characterize changes and progression of positive behaviors in patients with dementia.
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Affiliation(s)
- Akira Midorikawa
- Department of Psychology, Faculty of Letters, Chuo University, Tokyo, Japan.,Neuroscience Research Australia, Sydney, Australia
| | - Cristian E Leyton
- Neuroscience Research Australia, Sydney, Australia.,Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.,Australia Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - David Foxe
- Neuroscience Research Australia, Sydney, Australia.,Australia Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Ramon Landin-Romero
- Neuroscience Research Australia, Sydney, Australia.,Australia Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia.,Australia Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia.,Australia Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,School of Medical Sciences, The University of New South Wales, Sydney, Australia
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70
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Motor signatures of emotional reactivity in frontotemporal dementia. Sci Rep 2018; 8:1030. [PMID: 29348485 PMCID: PMC5773553 DOI: 10.1038/s41598-018-19528-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
Automatic motor mimicry is essential to the normal processing of perceived emotion, and disrupted automatic imitation might underpin socio-emotional deficits in neurodegenerative diseases, particularly the frontotemporal dementias. However, the pathophysiology of emotional reactivity in these diseases has not been elucidated. We studied facial electromyographic responses during emotion identification on viewing videos of dynamic facial expressions in 37 patients representing canonical frontotemporal dementia syndromes versus 21 healthy older individuals. Neuroanatomical associations of emotional expression identification accuracy and facial muscle reactivity were assessed using voxel-based morphometry. Controls showed characteristic profiles of automatic imitation, and this response predicted correct emotion identification. Automatic imitation was reduced in the behavioural and right temporal variant groups, while the normal coupling between imitation and correct identification was lost in the right temporal and semantic variant groups. Grey matter correlates of emotion identification and imitation were delineated within a distributed network including primary visual and motor, prefrontal, insular, anterior temporal and temporo-occipital junctional areas, with common involvement of supplementary motor cortex across syndromes. Impaired emotional mimesis may be a core mechanism of disordered emotional signal understanding and reactivity in frontotemporal dementia, with implications for the development of novel physiological biomarkers of socio-emotional dysfunction in these diseases.
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71
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Almeida MC, Carrettiero DC. Hypothermia as a risk factor for Alzheimer disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:727-735. [PMID: 30459036 DOI: 10.1016/b978-0-444-64074-1.00044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alzheimer disease (AD), which is associated with chronic and progressive neurodegeneration, is the most prevalent cause of dementia linked to aging. Among the risk factors for AD, age stands as the greatest one, with the vast majority of people with AD being 65 years of age or older. Nevertheless, the pathophysiologic mechanisms underlying the link between aging and the development of AD, although not completely understood, might reveal important aspects for the understanding of this pathology. Thus, there is significant evidence that the impaired thermal homeostasis associated with normal aging leads to a variety of metabolic changes that could be associated with AD development. In this chapter, we assess the clinical and biochemical evidence implicating hypothermia as a risk factor for the development of AD and the impact of hypothermia on the two pathologic hallmarks of AD: accumulation of senile plaques of amyloid-beta and neurofibrillary tangles of aberrant hyperphosphorylated tau protein.
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Affiliation(s)
- Maria Camila Almeida
- Natural and Human Sciences Center, Federal University of ABC, São Bernardo do Campo, SP, Brazil.
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72
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Bud Craig AD. Central neural substrates involved in temperature discrimination, thermal pain, thermal comfort, and thermoregulatory behavior. HANDBOOK OF CLINICAL NEUROLOGY 2018; 156:317-338. [PMID: 30454598 DOI: 10.1016/b978-0-444-63912-7.00019-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A phylogenetically novel pathway that emerged with primate encephalization is described, which conveys high-fidelity cutaneous thermosensory activity in "labeled lines" to a somatotopic map in the dorsal posterior insular cortex. It originates in lamina I of the superficial dorsal horn and ascends by way of the lateral spinothalamic tract and a distinct region in posterolateral thalamus. It evolved from the homeostatic sensory activity that represents the physiologic (interoceptive) condition of the body and drives the central autonomic network, which underlies all affective feelings from the body. Accordingly, human discriminative thermal sensations are accompanied by thermally motivated behaviors and thermal feelings of comfort or discomfort (unless neutral), which evidence suggests are associated with activity in the insular, cingulate, and orbitofrontal cortices, respectively. Yet, the substrates for thermoregulatory behavior have not been established, and several strong candidates (including the hypothalamus and the bed nucleus of the stria terminalis) are discussed. Finally, the neural underpinnings for relationships between thermal affect and social feelings (warm-positive/cold-negative) are addressed, including the association of hyperthermia with clinical depression.
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Affiliation(s)
- Arthur D Bud Craig
- Atkinson Research Laboratory, Barrow Neurological Institute, Phoenix, AZ, United States.
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Perry DC, Datta S, Sturm VE, Wood KA, Zakrzewski J, Seeley WW, Miller BL, Kramer JH, Rosen HJ. Reward deficits in behavioural variant frontotemporal dementia include insensitivity to negative stimuli. Brain 2017; 140:3346-3356. [PMID: 29053832 DOI: 10.1093/brain/awx259] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
During reward processing individuals weigh positive and negative features of a stimulus to determine whether they will pursue or avoid it. Though patients with behavioural variant frontotemporal dementia display changes in their pursuit of rewards, such as food, alcohol, money, and sex, the basis for these shifts is not clearly established. In particular, it is unknown whether patients' behaviour results from excessive focus on rewards, insensitivity to punishment, or to dysfunction in a particular stage of reward processing, such as anticipation, consumption, or action selection. Our goal was to determine the nature of the reward deficit in behavioural variant frontotemporal dementia and its underlying anatomy. We devised a series of tasks involving pleasant, unpleasant, and neutral olfactory stimuli, designed to separate distinct phases of reward processing. In a group of 25 patients with behavioural variant frontotemporal dementia and 21 control subjects, diagnosis by valence interactions revealed that patients with behavioural variant frontotemporal dementia rated unpleasant odours as less aversive than did controls and displayed lower skin conductance responses when anticipating an upcoming aversive odour. Subjective pleasantness ratings and skin conductance responses did not differ between behavioural variant frontotemporal dementia and controls for pleasant or neutral smells. In a task designed to measure the effort subjects would expend to smell or avoid smelling a stimulus, patients with behavioural variant frontotemporal dementia were less motivated, and therefore less successful than control subjects, at avoiding what they preferred not to smell, but had equivalent success at obtaining stimuli they found rewarding. Voxel-based morphometry of patients with behavioural variant frontotemporal dementia revealed that the inability to subjectively differentiate the valence of pleasant and unpleasant odours correlated with atrophy in right ventral mid-insula and right amygdala. High pleasantness ratings of unpleasant stimuli correlated with left dorsal anterior insula and frontal pole atrophy. These findings indicate that insensitivity to negative information may be a key component of the reward-seeking behaviours in behavioural variant frontotemporal dementia, and may relate to degeneration of structures that are involved in representing the emotional salience of sensory information.
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Affiliation(s)
- David C Perry
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Samir Datta
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Virginia E Sturm
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristie A Wood
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Zakrzewski
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Van den Stock J, Stam D, De Winter F, Mantini D, Szmrecsanyi B, Van Laere K, Vandenberghe R, Vandenbulcke M. Moral processing deficit in behavioral variant frontotemporal dementia is associated with facial emotion recognition and brain changes in default mode and salience network areas. Brain Behav 2017; 7:e00843. [PMID: 29299378 PMCID: PMC5745238 DOI: 10.1002/brb3.843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/10/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Behavioral variant frontotemporal dementia (bvFTD) is associated with abnormal emotion recognition and moral processing. Methods We assessed emotion detection, discrimination, matching, selection, and categorization as well as judgments of nonmoral, moral impersonal, moral personal low- and high-conflict scenarios. Results bvFTD patients gave more utilitarian responses on low-conflict personal moral dilemmas. There was a significant correlation between a facial emotion processing measure derived through principal component analysis and utilitarian responses on low-conflict personal scenarios in the bvFTD group (controlling for MMSE-score and syntactic abilities). Voxel-based morphometric multiple regression analysis in the bvFTD group revealed a significant association between the proportion of utilitarian responses on personal low-conflict dilemmas and gray matter volume in ventromedial prefrontal areas (pheight < .0001). In addition, there was a correlation between utilitarian responses on low-conflict personal scenarios in the bvFTD group and resting-state fractional Amplitude of Low Frequency Fluctuations (fALFF) in the anterior insula (pheight < .005). Conclusions The results underscore the importance of emotions in moral cognition and suggest a common basis for deficits in both abilities, possibly related to reduced experience of emotional sensations. At the neural level abnormal moral cognition in bvFTD is related to structural integrity of the medial prefrontal cortex and functional characteristics of the anterior insula. The present findings provide a common basis for emotion recognition and moral reasoning and link them with areas in the default mode and salience network.
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Affiliation(s)
- Jan Van den Stock
- Laboratory for Translational NeuropsychiatryDepartment of NeurosciencesKU LeuvenLeuvenBelgium
- Department of Old Age PsychiatryUniversity Psychiatry CenterLeuvenBelgium
| | - Daphne Stam
- Laboratory for Translational NeuropsychiatryDepartment of NeurosciencesKU LeuvenLeuvenBelgium
| | - François‐Laurent De Winter
- Laboratory for Translational NeuropsychiatryDepartment of NeurosciencesKU LeuvenLeuvenBelgium
- Department of Old Age PsychiatryUniversity Psychiatry CenterLeuvenBelgium
| | - Dante Mantini
- Research Center for Movement Control and NeuroplasticityKU LeuvenLeuvenBelgium
- Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | | | - Koen Van Laere
- Nuclear Medicine and Molecular ImagingDepartment of Imaging and PathologyKU LeuvenLeuvenBelgium
| | - Rik Vandenberghe
- Laboratory for Cognitive NeurologyDepartment of NeurosciencesKU LeuvenLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Mathieu Vandenbulcke
- Laboratory for Translational NeuropsychiatryDepartment of NeurosciencesKU LeuvenLeuvenBelgium
- Department of Old Age PsychiatryUniversity Psychiatry CenterLeuvenBelgium
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75
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Marshall CR, Hardy CJD, Russell LL, Clark CN, Dick KM, Brotherhood EV, Bond RL, Mummery CJ, Schott JM, Rohrer JD, Kilner JM, Warren JD. Impaired Interoceptive Accuracy in Semantic Variant Primary Progressive Aphasia. Front Neurol 2017; 8:610. [PMID: 29201014 PMCID: PMC5696334 DOI: 10.3389/fneur.2017.00610] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022] Open
Abstract
Background Interoception (the perception of internal bodily sensations) is strongly linked to emotional experience and sensitivity to the emotions of others in healthy subjects. Interoceptive impairment may contribute to the profound socioemotional symptoms that characterize frontotemporal dementia (FTD) syndromes, but remains poorly defined. Methods Patients representing all major FTD syndromes and healthy age-matched controls performed a heartbeat counting task as a measure of interoceptive accuracy. In addition, patients had volumetric MRI for voxel-based morphometric analysis, and their caregivers completed a questionnaire assessing patients’ daily-life sensitivity to the emotions of others. Results Interoceptive accuracy was impaired in patients with semantic variant primary progressive aphasia relative to healthy age-matched individuals, but not in behavioral variant frontotemporal dementia and nonfluent variant primary progressive aphasia. Impaired interoceptive accuracy correlated with reduced daily-life emotional sensitivity across the patient cohort, and with atrophy of right insula, cingulate, and amygdala on voxel-based morphometry in the impaired semantic variant group, delineating a network previously shown to support interoceptive processing in the healthy brain. Conclusion Interoception is a promising novel paradigm for defining mechanisms of reduced emotional reactivity, empathy, and self-awareness in neurodegenerative syndromes and may yield objective measures for these complex symptoms.
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Affiliation(s)
- Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Camilla N Clark
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Katrina M Dick
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Rebecca L Bond
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Catherine J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
| | - James M Kilner
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, London, United Kingdom
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76
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Mann DMA, Snowden JS. Frontotemporal lobar degeneration: Pathogenesis, pathology and pathways to phenotype. Brain Pathol 2017; 27:723-736. [PMID: 28100023 DOI: 10.1111/bpa.12486] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Frontotemporal Lobar Degeneration (FTLD) is a clinically, pathologically and genetically heterogeneous group of disorders that affect principally the frontal and temporal lobes of the brain. There are three major associated clinical syndromes, behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SD) and progressive non-fluent aphasia (PNFA); three principal histologies, involving tau, TDP-43 and FUS proteins; and mutations in three major genes, MAPT, GRN and C9orf72, along with several other less common gene mutations. All three clinical syndromes can exist separately or in combination with Amyotrophic Lateral Sclerosis (ALS). SD is exclusively a TDP-43 proteinopathy, and PNFA may be so, with both showing tight clinical, histological and genetic inter-relationships. bvFTD is more of a challenge with overlapping histological and genetic features, involvement of any of the three aggregating proteins, and changes in any of the three major genes. However, when ALS is present, all cases show a clear histological phenotype with TDP-43 aggregated proteins, and familial forms are associated with expansions in C9orf72. TDP-43 and FUS are nuclear carrier proteins involved in the regulation of RNA metabolism, whereas tau protein - the product of MAPT - is responsible for the assembly/disassembly of microtubules, which are vital for intracellular transport. Mutations in TDP-43 and FUS genes are linked to clinical ALS rather than FTLD (with or without ALS), suggesting that clinical ALS may be a disorder of RNA metabolism. Conversely, the protein products of GRN and C9orf72, along with those of the other minor genes, appear to form part of the cellular protein degradation machinery. It is possible therefore that FTLD is a reflection of dysfunction within lysosomal/proteasomal systems resulting in failure to remove potentially neurotoxic (TDP-43 and tau) aggregates, which ultimately overwhelm capacity to function. Spread of aggregates along distinct pathways may account for the different clinical phenotypes, and patterns of progression of disease.
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Affiliation(s)
- David M A Mann
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Julie S Snowden
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
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77
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Pain in amyotrophic lateral sclerosis. Lancet Neurol 2017; 16:144-157. [DOI: 10.1016/s1474-4422(16)30358-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
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78
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Ahmed RM, Landin-Romero R, Collet TH, van der Klaauw AA, Devenney E, Henning E, Kiernan MC, Piguet O, Farooqi IS, Hodges JR. Energy expenditure in frontotemporal dementia: a behavioural and imaging study. Brain 2017; 140:171-183. [PMID: 27789521 PMCID: PMC5379863 DOI: 10.1093/brain/aww263] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 09/04/2016] [Indexed: 02/02/2023] Open
Abstract
SEE FINGER DOI101093/AWW312 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer's disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke's Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala, regions previously suggested to be involved exclusively in social and emotion processing in frontotemporal dementia. These neural correlates overlap the network involved in eating behaviour in frontotemporal dementia, suggesting a complex interaction between eating behaviour, autonomic function and energy homeostasis. As such the present study suggests that increased heart rate and autonomic changes are prevalent in behavioural variant frontotemporal dementia, and are associated with changes in energy expenditure. An understanding of these changes and neural correlates may have potential relevance to disease progression and prognosis.
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Affiliation(s)
- Rebekah M Ahmed
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia,Correspondence to: Dr Rebekah Ahmed, Brain and Mind Centre, University of Sydney 94 Mallett St Camperdown 2050, Australia E-mail:
| | - Ramon Landin-Romero
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia
| | - Tinh-Hai Collet
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Agatha A van der Klaauw
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Emma Devenney
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia
| | - Elana Henning
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Matthew C Kiernan
- 4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia
| | - Olivier Piguet
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia
| | - I Sadaf Farooqi
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - John R Hodges
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,Correspondence may also be addressed to: Professor John Hodges, e-mail:
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79
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Devenney EM, Landin-Romero R, Irish M, Hornberger M, Mioshi E, Halliday GM, Kiernan MC, Hodges JR. The neural correlates and clinical characteristics of psychosis in the frontotemporal dementia continuum and the C9orf72 expansion. Neuroimage Clin 2016; 13:439-445. [PMID: 28116236 PMCID: PMC5233794 DOI: 10.1016/j.nicl.2016.11.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/07/2016] [Accepted: 11/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This present study aims to address the gap in the literature regarding the severity and underlying neural correlates of psychotic symptoms in frontotemporal dementia with and without the C9orf72 gene expansion. METHODS Fifty-six patients with behavioural variant frontotemporal dementia (20 with concomitant amyotrophic lateral sclerosis) and 23 healthy controls underwent neuropsychological assessments, detailed clinical interview for assessment of psychosis symptoms, brain MRI and genetic testing. Carers underwent a clinical interview based upon the neuropsychiatric inventory. Patients were assessed at ForeFront, the Frontotemporal Dementia Research Group at Neuroscience Research Australia or at the Brain and Mind Centre, between January 2008 and December 2013. An index of psychosis was calculated, taking into account the degree and severity of psychosis in each case. Voxel-based morphometry analyses were used to explore relationships between the psychosis index and grey matter changes. RESULTS Thirty-four percent of frontotemporal dementia patients showed psychotic features. C9orf72 expansion cases were more likely to exhibit psychotic symptoms than non-carriers (64% vs. 26%; p = 0.006), which were also more severe (psychotic index 23.1 vs. 8.1; p = 0.002). Delusions comprised persecutory, somatic, jealous and grandiose types and were present in 57% of C9orf72 carriers and 19% of non-carriers (p = 0.006). Auditory, visual or tactile hallucinations were present in 36% of C9orf72 carriers and 17% of non-carriers (p = 0.13). Increased psychotic symptoms in C9orf72 expansion carriers correlated with atrophy in a distributed cortical and subcortical network that included discrete regions of the frontal, temporal and occipital cortices, as well as the thalamus, striatum and cerebellum. CONCLUSIONS This study underlines the need to consider and assess for psychotic symptoms in the frontotemporal dementia-amyotrophic lateral sclerosis continuum particularly in those with C9orf72 gene expansions. The network of brain regions identified in this study is strikingly similar to that identified in other psychotic disorders such as schizophrenia, which suggests that treatment strategies in psychiatry may be beneficial for the management of psychotic symptoms in frontotemporal dementia.
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Affiliation(s)
- Emma M Devenney
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
- Brain and Mind Research Institute, Camperdown, Sydney, NSW 2050, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW 2109, Australia
| | - Ramon Landin-Romero
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW 2109, Australia
| | - Muireann Irish
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Eneida Mioshi
- University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | - Glenda M. Halliday
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
| | - Matthew C. Kiernan
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
- Brain and Mind Research Institute, Camperdown, Sydney, NSW 2050, Australia
| | - John R. Hodges
- Neuroscience Research Australia, Barker Street, Sydney, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2031, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW 2109, Australia
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80
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Gan JJ, Lin A, Samimi MS, Mendez MF. Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia. PSYCHOSOMATICS 2016; 57:598-604. [DOI: 10.1016/j.psym.2016.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
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81
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Woollacott IOC, Rohrer JD. The clinical spectrum of sporadic and familial forms of frontotemporal dementia. J Neurochem 2016; 138 Suppl 1:6-31. [PMID: 27144467 DOI: 10.1111/jnc.13654] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/10/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Abstract
The term frontotemporal dementia (FTD) describes a clinically, genetically and pathologically diverse group of neurodegenerative disorders. Symptoms of FTD can present in individuals in their 20s through to their 90s, but the mean age at onset is in the sixth decade. The most common presentation is with a change in personality and impaired social conduct (behavioural variant FTD). Less frequently patients present with language problems (primary progressive aphasia). Both of these groups of patients can develop motor features consistent with either motor neuron disease (usually the amyotrophic lateral sclerosis variant) or parkinsonism (most commonly a progressive supranuclear palsy or corticobasal syndrome). In about a third of cases FTD is familial, with mutations in the progranulin, microtubule-associated protein tau and chromosome 9 open reading frame 72 genes being the major causes. Mutations in a number of other genes including TANK-binding kinase 1 are rare causes of familial FTD. This review aims to clarify the often confusing terminology of FTD, and outline the various clinical features and diagnostic criteria of sporadic and familial FTD syndromes. It will also discuss the current major challenges in FTD research and clinical practice, and potential areas for future research. This review clarifies the terminology of frontotemporal dementia (FTD) and summarizes the various clinical features and most recent diagnostic criteria of sporadic and familial FTD syndromes. It also discusses the current major challenges in FTD research and clinical practice, and highlights potential areas for future research.
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Affiliation(s)
- Ione O C Woollacott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
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82
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Oosterman JM, Zwakhalen S, Sampson EL, Kunz M. The use of facial expressions for pain assessment purposes in dementia: a narrative review. Neurodegener Dis Manag 2016; 6:119-31. [DOI: 10.2217/nmt-2015-0006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Facial expressions convey reliable nonverbal signals about pain and thus are very useful for assessing pain in patients with limited communicative ability, such as patients with dementia. In this review, we present an overview of the available pain observation tools and how they make use of facial expressions. Utility and reliability of facial expressions to measure pain in dementia are discussed, together with the effect of dementia severity on these facial expressions. Next, we present how behavioral alterations may overlap with facial expressions of pain, and may even influence the extent to which pain is facially expressed. The main focus is on disinhibition, apathy and emotional changes. Finally, an overview of theoretical considerations and practical implications is presented for assessing pain using facial expressions in clinical settings.
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Affiliation(s)
- Joukje M Oosterman
- Radboud University Nijmegen, Donders Institute for Brain, Cognition & Behaviour, Nijmegen, The Netherlands
| | - Sandra Zwakhalen
- Maastricht University, Department of Health Services Research, CAPHRI School for Public Health & Primary Care, Maastricht, The Netherlands
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London Medical School, London, UK
- North Middlesex University Hospital, Barnet Enfield & Haringey Mental Health Trust, London, UK
| | - Miriam Kunz
- University of Groningen, University Medical Center Groningen, Department of General Practice, Section Gerontology, Groningen, The Netherlands
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83
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A physiological signature of sound meaning in dementia. Cortex 2016; 77:13-23. [PMID: 26889604 PMCID: PMC4819950 DOI: 10.1016/j.cortex.2016.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/18/2015] [Accepted: 01/09/2016] [Indexed: 11/20/2022]
Abstract
The meaning of sensory objects is often behaviourally and biologically salient and decoding of semantic salience is potentially vulnerable in dementia. However, it remains unclear how sensory semantic processing is linked to physiological mechanisms for coding object salience and how that linkage is affected by neurodegenerative diseases. Here we addressed this issue using the paradigm of complex sounds. We used pupillometry to compare physiological responses to real versus synthetic nonverbal sounds in patients with canonical dementia syndromes (behavioural variant frontotemporal dementia – bvFTD, semantic dementia – SD; progressive nonfluent aphasia – PNFA; typical Alzheimer's disease – AD) relative to healthy older individuals. Nonverbal auditory semantic competence was assessed using a novel within-modality sound classification task and neuroanatomical associations of pupillary responses were assessed using voxel-based morphometry (VBM) of patients' brain MR images. After taking affective stimulus factors into account, patients with SD and AD showed significantly increased pupil responses to real versus synthetic sounds relative to healthy controls. The bvFTD, SD and AD groups had a nonverbal auditory semantic deficit relative to healthy controls and nonverbal auditory semantic performance was inversely correlated with the magnitude of the enhanced pupil response to real versus synthetic sounds across the patient cohort. A region of interest analysis demonstrated neuroanatomical associations of overall pupil reactivity and differential pupil reactivity to sound semantic content in superior colliculus and left anterior temporal cortex respectively. Our findings suggest that autonomic coding of auditory semantic ambiguity in the setting of a damaged semantic system may constitute a novel physiological signature of neurodegenerative diseases.
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84
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Loss in Executive Functioning Best Explains Changes in Pain Responsiveness in Patients with Dementia-Related Cognitive Decline. Behav Neurol 2015; 2015:878157. [PMID: 26788018 PMCID: PMC4691599 DOI: 10.1155/2015/878157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/30/2015] [Indexed: 11/18/2022] Open
Abstract
There is ample evidence that dementia changes the processing of pain. However, it is not known whether this change in pain processing is related to the general decline in cognitive functioning or whether it may be related to specific domains of cognitive functioning. With the present study we tried to answer this question. We assessed different cognitive domains (orientation, memory, abstract thinking/executive function, aphasia and apraxia, and information processing speed) in 70 older patients with cognitive impairment (mild cognitive impairment up to moderate degrees of dementia). Pain responsiveness was assessed by measuring the nociceptive flexion reflex (NFR) threshold and facial responses to noxious electrical stimulation. Using regression analyses, we assessed which domain of cognitive functioning best predicted variance in pain responsiveness. Variance in pain responsiveness (NFR and facial expressions) was best explained by those items assessing executive functioning even when controlling for overall cognitive performance and memory functioning. The close association between executive functioning and pain responsiveness suggests that dementia-related neurodegeneration in prefrontal areas might result not only in reduced executive functioning but also in a loss of pain inhibitory potency, rendering the patient more vulnerable to pain. Our findings also suggest that pain assessment in dementia should be regularly completed by tests of cognitive functions.
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