51
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Ulugut Erkoyun H, Groot C, Heilbron R, Nelissen A, van Rossum J, Jutten R, Koene T, van der Flier WM, Wattjes MP, Scheltens P, Ossenkoppele R, Barkhof F, Pijnenburg Y. A clinical-radiological framework of the right temporal variant of frontotemporal dementia. Brain 2021; 143:2831-2843. [PMID: 32830218 PMCID: PMC9172625 DOI: 10.1093/brain/awaa225] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/12/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
The concept of the right temporal variant of frontotemporal dementia (rtvFTD) is still equivocal. The syndrome accompanying predominant right anterior temporal atrophy has previously been described as memory loss, prosopagnosia, getting lost and behavioural changes. Accurate detection is challenging, as the clinical syndrome might be confused with either behavioural variant FTD (bvFTD) or Alzheimer’s disease. Furthermore, based on neuroimaging features, the syndrome has been considered a right-sided variant of semantic variant primary progressive aphasia (svPPA). Therefore, we aimed to demarcate the clinical and neuropsychological characteristics of rtvFTD versus svPPA, bvFTD and Alzheimer’s disease. Moreover, we aimed to compare its neuroimaging profile against svPPA, which is associated with predominant left anterior temporal atrophy. Of 619 subjects with a clinical diagnosis of frontotemporal dementia or primary progressive aphasia, we included 70 subjects with a negative amyloid status in whom predominant right temporal lobar atrophy was identified based on blinded visual assessment of their initial brain MRI scans. Clinical symptoms were assessed retrospectively and compared with age- and sex-matched patients with svPPA (n = 70), bvFTD (n = 70) and Alzheimer’s disease (n = 70). Prosopagnosia, episodic memory impairment and behavioural changes such as disinhibition, apathy, compulsiveness and loss of empathy were the most common initial symptoms, whereas during the disease course, patients developed language problems such as word-finding difficulties and anomia. Distinctive symptoms of rtvFTD compared to the other groups included depression, somatic complaints, and motor/mental slowness. Aside from right temporal atrophy, the imaging pattern showed volume loss of the right ventral frontal area and the left temporal lobe, which represented a close mirror image of svPPA. Atrophy of the bilateral temporal poles and the fusiform gyrus were associated with prosopagnosia in rtvFTD. Our results highlight that rtvFTD has a unique clinical presentation. Since current diagnostic criteria do not cover specific symptoms of the rtvFTD, we propose a diagnostic tree to be used to define diagnostic criteria and call for an international validation.
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Affiliation(s)
- Hulya Ulugut Erkoyun
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Colin Groot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ronja Heilbron
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Nelissen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonathan van Rossum
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Roos Jutten
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ted Koene
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,UCL Institutes of Neurology and Healthcare Engineering, University College London, UK
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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52
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Ulugut Erkoyun H, van der Lee SJ, Nijmeijer B, van Spaendonk R, Nelissen A, Scarioni M, Dijkstra A, Samancı B, Gürvit H, Yıldırım Z, Tepgeç F, Bilgic B, Barkhof F, Rozemuller A, van der Flier WM, Scheltens P, Cohn-Hokke P, Pijnenburg Y. The Right Temporal Variant of Frontotemporal Dementia Is Not Genetically Sporadic: A Case Series. J Alzheimers Dis 2021; 79:1195-1201. [PMID: 33427744 PMCID: PMC7990443 DOI: 10.3233/jad-201191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Right temporal variant frontotemporal dementia (rtvFTD) has been generally considered as a right sided variant of semantic variant primary progressive aphasia (svPPA), which is a genetically sporadic disorder. Recently, we have shown that rtvFTD has a unique clinical syndrome compared to svPPA and behavioral variant frontotemporal dementia. Objective: We challenge the assumption that rtvFTD is a sporadic, non-familial variant of FTD by identifying potential autosomal dominant inheritance and related genes in rtvFTD. Methods: We collected all subjects with a diagnosis of FTD or primary progressive aphasia who had undergone genetic screening (n = 284) and subsequently who had a genetic variant (n = 48) with a diagnosis of rtvFTD (n = 6) in 2 specialized memory clinics. Results: Genetic variants in FTD related genes were found in 33% of genetically screened rtvFTD cases; including MAPT (n = 4), GRN (n = 1), and TARDBP (n = 1) genes, whereas only one svPPA case had a genetic variant in our combined cohorts. Additionally, 4 out of 6 rtvFTD subjects had a strong family history for dementia. Conclusion: Our results demonstrate that rtvFTD, unlike svPPA, is not a pure sporadic, but a heterogeneous potential genetic variant of FTD, and screening for genetic causes for FTD should be performed in patients with rtvFTD.
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Affiliation(s)
- Hulya Ulugut Erkoyun
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sven J van der Lee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Nijmeijer
- Department of Clinical Genetics, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rosalina van Spaendonk
- Genome diagnostics, Department of Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Nelissen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marta Scarioni
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anke Dijkstra
- Alzheimer Center Amsterdam, Department of Pathology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bedia Samancı
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zerrin Yıldırım
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Tepgeç
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Frederik Barkhof
- Alzheimer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,UCL Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Annemieke Rozemuller
- Alzheimer Center Amsterdam, Department of Pathology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Alzheimer Center Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Petra Cohn-Hokke
- Department of Clinical Genetics, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Caso F, Agosta F, Magnani G, Cardamone R, Borghesani V, Miller Z, Riva N, La Joie R, Coppola G, Grinberg LT, Seeley WW, Miller BL, Gorno-Tempini ML, Filippi M. Temporal variant of frontotemporal dementia in C9orf72 repeat expansion carriers: two case studies. Brain Imaging Behav 2021; 14:336-345. [PMID: 32180125 DOI: 10.1007/s11682-019-00253-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The temporal variant of frontotemporal dementia (tv-FTD) is a progressive neurodegenerative disease with a complex clinical picture mainly characterized by behavioral and language disorders. In this work, we describe clinical, genetic, neuroanatomical and neuropathological (only in one case) features of two patients with tv-FTD carrying C9orf72 repeat expansion. The first patient (AB) presented with a 1-year disease duration showing focal right anterior temporal lobe (ATL) atrophy on magnetic resonance imaging (MRI). The second patient (BC) came to medical attention 13 years after disease onset and showed a prominent bilateral ATL involvement. Both patients showed naming deficits, impairment in identifying known faces and proper names, and personality changes with new onset behavioral rigidity, and progressing language difficulties to single-word and sentence comprehension difficulties. They were classified as tv-FTD. Clinical, cognitive and MRI follow-up were performed. As cognitive impairment progressed, MRI atrophy worsened in ATL and frontotemporal areas in both patients. Both cases had clear family histories of neurological and/or psychiatric disease. Genetic testing revealed a C9orf72 hexanucleotide repeat expansion in both cases. BC passed away after 15 years of disease and autopsy showed the expected TDP-type B pathology. These genetic cases of tv-FTD highlight the susceptibility of ATL to C9orf72-related pathology and emphasize the importance of genetical testing in FTD-spectrum disorders, regardless of the clinical phenotype.
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Affiliation(s)
- Francesca Caso
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Zachary Miller
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Nilo Riva
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Renaud La Joie
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Giovanni Coppola
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurophysiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
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54
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Ghosh A. Language Breakdown in Primary Progressive Aphasias. Ann Indian Acad Neurol 2020; 23:S67-S72. [PMID: 33343129 PMCID: PMC7731691 DOI: 10.4103/aian.aian_715_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022] Open
Abstract
Dementias with predominant language involvement, called primary progressive aphasias provide us with unique insight into systematic breakdown of language in neurodegenerative diseases and the structures and networks involved. Clinical and neuroimaging models quite distinct from those seen in stroke aphasias have evolved. In this short overview, we will discuss the cognitive processes involved in expressive and receptive verbal communication and how these processes are affected in the different variants of primary progressive aphasia producing distinctive clinical patterns. We will also discuss the brain's language network and how different components of the network break down in each of the primary progressive aphasia variants.
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Affiliation(s)
- Amitabha Ghosh
- Department of Neurology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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55
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Pozueta A, Lage C, García-Martínez M, Kazimierczak M, Bravo M, López-García S, Riancho J, González-Suarez A, Vázquez-Higuera JL, de Arcocha-Torres M, Banzo I, Jiménez-Bonilla J, Berciano J, Rodríguez-Rodríguez E, Sánchez-Juan P. Cognitive and Behavioral Profiles of Left and Right Semantic Dementia: Differential Diagnosis with Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease. J Alzheimers Dis 2020; 72:1129-1144. [PMID: 31683488 DOI: 10.3233/jad-190877] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Semantic dementia (SD) is a subtype of frontotemporal dementia (FTD) characterized by semantic memory loss and preserved abilities of other cognitive functions. The clinical manifestations of SD require a differential diagnosis with Alzheimer's disease (AD), especially those with early onset, and behavioral variant FTD (bvFTD). OBJECTIVE The present study aimed to compare cognitive performances and neuropsychiatric symptoms in a population of AD, bvFTD, and left and right SD defined with the support of molecular imaging (amyloid and 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography) and assessed the accuracy of different neuropsychological markers in distinguishing these neurodegenerative diseases. METHODS Eighty-seven participants (32 AD, 20 bvFTD, and 35 SD (17 Left-SD and 18 Right-SD) completed a comprehensive neuropsychological battery that included memory, language, attention and executive functions, visuospatial function, visuoconstructional skills, and tasks designed specifically to evaluate prosopagnosia and facial emotions recognition. The Neuropsychiatric Inventory was administered to assess neuropsychiatric symptoms. RESULTS An episodic memory test that included semantic cues, a visuospatial test (both impaired in AD), a naming test and a prosopagnosia task (both impaired in SD) were the four most valuable cognitive metrics for the differential diagnosis between groups. Several behavioral abnormalities were differentially present, of which aggression, self-care (both more frequent in bvFTD), and eating habits, specifically overeating and altered dietary preference (more frequent in SD), were the most valuable in group discrimination. CONCLUSION Our study highlights the value of a comprehensive neuropsychological and neuropsychiatric evaluation for the differential diagnosis between FTD syndromes and AD.
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Affiliation(s)
- Ana Pozueta
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Carmen Lage
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - María García-Martínez
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Martha Kazimierczak
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - María Bravo
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Sara López-García
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Javier Riancho
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Sierrallana, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Andrea González-Suarez
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - José Luis Vázquez-Higuera
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - María de Arcocha-Torres
- Department of Nuclear Medicine, University Hospital 'Marqués de Valdecilla', University of Cantabria, Molecular imaging Group - IDIVAL, Santander, Spain
| | - Ignacio Banzo
- Department of Nuclear Medicine, University Hospital 'Marqués de Valdecilla', University of Cantabria, Molecular imaging Group - IDIVAL, Santander, Spain
| | - Julio Jiménez-Bonilla
- Department of Nuclear Medicine, University Hospital 'Marqués de Valdecilla', University of Cantabria, Molecular imaging Group - IDIVAL, Santander, Spain
| | - José Berciano
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Pascual Sánchez-Juan
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
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56
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Cretin B, Fleury M, Philippi N, Blanc F. Transient epileptic amnesia can inaugurate the behavioural variant of frontotemporal dementia. Psychogeriatrics 2020; 20:910-913. [PMID: 32939905 DOI: 10.1111/psyg.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin Cretin
- Clinical Neuropsychology Unit, Neurology Department, University Hospital of Strasbourg, CM2R (Memory Resource and Research Centre), Strasbourg, France.,ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, CNRS, Strasbourg, France
| | - Marie Fleury
- ALS Center, Neurology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- Clinical Neuropsychology Unit, Neurology Department, University Hospital of Strasbourg, CM2R (Memory Resource and Research Centre), Strasbourg, France.,ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, CNRS, Strasbourg, France
| | - Frederic Blanc
- Clinical Neuropsychology Unit, Neurology Department, University Hospital of Strasbourg, CM2R (Memory Resource and Research Centre), Strasbourg, France.,CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
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58
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Pascual B, Masdeu JC, Funk Q, Zanotti-Fregonara P, Shyer M, Rockers E, Schulz PE. Posterior primary progressive prosopagnosia: Structural and molecular imaging. Neurology 2020; 94:360-361. [PMID: 31964687 DOI: 10.1212/wnl.0000000000009001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Belen Pascual
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX.
| | - Joseph C Masdeu
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
| | - Quentin Funk
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
| | - Paolo Zanotti-Fregonara
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
| | - Madison Shyer
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
| | - Elijah Rockers
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
| | - Paul E Schulz
- From the Department of Stanley H. Appel Neurology (B.P., J.C.M., Q.F., P.Z.-F., M.S., E.R.) and the Nantz National Alzheimer Center, Houston Methodist Neurological Institute, TX; Weill Cornell Medical College (B.P., J.C.M., P.Z.-F.), New York, NY; and Department of Neurology (P.E.S.), McGovern Medical School of UTHealth, Houston, TX
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Abstract
Frontotemporal dementia is a clinically and pathologically heterogeneous group of neurodegenerative disorders, with progressive impairment of behavior and language. They can be closely related to amyotrophic lateral sclerosis, clinically and through shared genetics and similar pathology. Approximately 40% of people with frontotemporal dementia report a family history of dementia, motor neuron disease or parkinsonism, and half of these familial cases are attributed to mutations in three genes (C9orf72, MAPT and PGRN). Akinetic-rigidity is a common feature in several types of frontotemporal dementia, particularly the behavioral variant and the non-fluent agrammatic variant of primary progressive aphasia, and the familial dementias. The majority of patients develop a degree of parkinsonism during the course of the illness, and signs may be present at the time of initial diagnosis. However, the parkinsonism of frontotemporal dementia is very different from that observed in idiopathic Parkinson's disease: it may be symmetric, axial, and poorly responsive to levodopa. Tremor is uncommon, and may be postural, action or occasionally rest tremor. The emergence of parkinsonism is often part of an evolving phenotype, in which frontotemporal dementia comes to resemble corticobasal syndrome or progressive supranuclear palsy. This chapter describes the prevalence and phenomenology of parkinsonism in each of the major syndromes, and according to the common genetic forms of frontotemporal dementia. We discuss the changing nosology and terminology surrounding the diagnoses, and the significance of parkinsonism as a core feature of frontotemporal dementia, relevant to clinical management and the design of future clinical trials.
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Affiliation(s)
- James B Rowe
- Cambridge University Centre for Frontotemporal Dementia and Cambridge University Centre for Parkinson-plus, Cambridge University, Cambridge, United Kingdom
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60
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Shad MU, Howard L, Thomas K, Aga VM. Right Temporal Variant Frontotemporal Dementia Misdiagnosed as Schizophrenia. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190617154129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Schizophrenia-like presentations of frontotemporal dementia (FTD) are
well documented in medical literature, especially during the initial stage of the illness. We present
an interesting case of middle-aged white male, who was initially misdiagnosed with major depression
at age 50 and then with schizophrenia due to florid psychosis typically seen in Mild Behavioral
Impairment (MBI). It was not until over 4-years that a detailed clinical history along with specific
investigations confirmed the diagnosis of right temporal variant frontotemporal dementia (rtv-FTD).
Methods:
The unusual presentation of this case warranted 2-deoxy-2-[fluorine-18]fluoro- D-glucose
integrated with computed tomography (FDG-PET) and comprehensive neuropsychological testing
to estblish a final diagnosis.
Results:
The results from neuroimaging and neuropsychological testing supported a diagnosis of
rtv-FTD without any evidence for Alzheimer’s dementia.
Conclusion:
This case illustrates that late-onset atypical psychiatric symptoms should be evaluated
for neurocognitive disorders, and the evaluation should include neuroimaging. It is preferable that
the neuroimaging findings be personally interpreted by the provider, who therefore needs to be
skilled in interpreting neuroimaging studies.
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Affiliation(s)
- Mujeeb U. Shad
- School of Medicine, Oregon Health & Science University, Portland, OR 97239, United States
| | - Lindsay Howard
- School of Medicine, Oregon Health & Science University, Portland, OR 97239, United States
| | - Kristopher Thomas
- Department of Psychology, Oregon State Hospital, Salem, OR 97301, United States
| | - Vimal M. Aga
- Department of Psychiatry, Oregon State Hospital, Salem, OR 97301, United States
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Pressman PS, Ross ED, Cohen KB, Chen K, Miller BL, Hunter LE, Gorno‐Tempini ML, Levenson RW. Interpersonal prosodic correlation in frontotemporal dementia. Ann Clin Transl Neurol 2019; 6:1352-1357. [PMID: 31353851 PMCID: PMC6649473 DOI: 10.1002/acn3.50816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/08/2019] [Accepted: 05/23/2019] [Indexed: 11/06/2022] Open
Abstract
Communication accommodation describes how individuals adjust their communicative style to that of their conversational partner. We predicted that interpersonal prosodic correlation related to pitch and timing would be decreased in behavioral variant frontotemporal dementia (bvFTD). We predicted that the interpersonal correlation in a timing measure and a pitch measure would be increased in right temporal FTD (rtFTD) due to sparing of the neural substrate for speech timing and pitch modulation but loss of social semantics. We found no significant effects in bvFTD, but conversations including rtFTD demonstrated higher interpersonal correlations in speech rate than healthy controls.
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Affiliation(s)
- Peter S. Pressman
- Department of Neurology, Section of Behavioral Neurology and NeuropsychiatryUniversity of Colorado DenverAnschutz Medical Campus, Academic Office Building 1, Mail Stop #B185, 12631 East 17th AvenueAuroraColorado80045
| | - Elliott D. Ross
- Department of Neurology, Section of Behavioral Neurology and NeuropsychiatryUniversity of Colorado DenverAnschutz Medical Campus, Academic Office Building 1, Mail Stop #B185, 12631 East 17th AvenueAuroraColorado80045
| | - Kevin B. Cohen
- Department of Neurology, Section of Behavioral Neurology and NeuropsychiatryUniversity of Colorado DenverAnschutz Medical Campus, Academic Office Building 1, Mail Stop #B185, 12631 East 17th AvenueAuroraColorado80045
| | - Kuan‐Hua Chen
- Berkeley Psychophysiology LabUniversity of California, Berkeley4143 Tolman Hall, MC 5050BerkeleyCalifornia94720‐5050
| | - Bruce L. Miller
- Memory and Aging CenterUniversity of California675 Nelson Rising LnSan FranciscoCalifornia94158
| | - Lawrence E. Hunter
- Department of Neurology, Section of Behavioral Neurology and NeuropsychiatryUniversity of Colorado DenverAnschutz Medical Campus, Academic Office Building 1, Mail Stop #B185, 12631 East 17th AvenueAuroraColorado80045
| | | | - Robert W. Levenson
- Berkeley Psychophysiology LabUniversity of California, Berkeley4143 Tolman Hall, MC 5050BerkeleyCalifornia94720‐5050
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Whitwell JL. FTD spectrum: Neuroimaging across the FTD spectrum. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:187-223. [PMID: 31481163 DOI: 10.1016/bs.pmbts.2019.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia is a complex and heterogeneous neurodegenerative disease that encompasses many clinical syndromes, pathological diseases, and genetic mutations. Neuroimaging has played a critical role in our understanding of the underlying pathophysiology of frontotemporal dementia and provided biomarkers to aid diagnosis. Early studies defined patterns of neurodegeneration and hypometabolism associated with the clinical, pathological and genetic aspects of frontotemporal dementia, with more recent studies highlighting how the breakdown of structural and functional brain networks define frontotemporal dementia. Molecular positron emission tomography ligands allowing the in vivo imaging of tau proteins have also provided important insights, although more work is needed to understand the biology of the currently available ligands.
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Abstract
Capgras syndrome (CS), also called imposter syndrome, is a rare psychiatric condition that is characterized by the delusion that a family relative or close friend has been replaced by an identical imposter. Here, we describe a 69-year-old man with CS who presented to the Kemal Arikan Psychiatry Clinic with an ongoing belief that his wife had been replaced by an identical imposter. MRI showed selective anterior left temporal lobe atrophy. Quantitative EEG showed bilateral frontal and temporal slowing. Neuropsychological profiling identified a broad range of deficits in the areas of naming, executive function, and long-term memory. On the basis of these findings, we diagnosed frontotemporal dementia. This case demonstrates that CS can clinically accompany frontotemporal dementia.
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Abstract
PURPOSE OF REVIEW This article reviews two of the primary progressive aphasias (PPAs), disorders characterized by the early and predominant impairment of language, and primary progressive apraxia of speech, a degenerative motor speech disorder that is closely related to PPA. An outline of the history and controversy surrounding how these disorders are classified is provided before the article focuses on each disorder's clinical and imaging features. RECENT FINDINGS Over the past decade, the classification of degenerative speech and language disorders has been refined. Clinical, imaging, and pathologic evidence suggests that primary progressive apraxia of speech is a distinct degenerative disorder. Furthermore, multiple lines of evidence have highlighted issues with nonfluent/agrammatic variant PPA, which complicates the diagnosis, prognosis, and study of this disorder. Semantic variant PPA, while not without controversy, remains one of the most well-defined disorders, with good clinicopathologic correlation. SUMMARY Accurate classification and diagnosis of these degenerative speech and language disorders is crucial in clinical practice and ongoing research efforts. For nonfluent/agrammatic variant PPA, the authors suggest emphasizing agrammatism as the core inclusion criterion and taking care not to include patients with isolated or predominant apraxia of speech. Isolated apraxia of speech can be the manifestation of a degenerative disease and, based on the different prognosis, should be recognized as distinct from PPA. Finally, it is important to recognize that some patients with semantic dementia, despite sharing the same pathologic associations, may not meet criteria for PPA.
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Butler PM, Chiong W. Neurodegenerative disorders of the human frontal lobes. HANDBOOK OF CLINICAL NEUROLOGY 2019; 163:391-410. [PMID: 31590743 DOI: 10.1016/b978-0-12-804281-6.00021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The frontal lobes play an integral role in human socioemotional and cognitive function. Sense of self, moral decisions, empathy, and behavioral monitoring of goal-states all depend on key nodes within frontal cortex. While several neurodegenerative diseases can affect frontal function, frontotemporal dementia (FTD) has particularly serious and specific effects, which thus provide insights into the role of frontal circuits in homeostasis and adaptive behavior. FTD represents a collection of disorders with specific clinical-pathologic correlates, imaging, and genetics. Patients with FTD and initial prefrontal degeneration often present with neuropsychiatric symptoms such as loss of social decorum, new obsessions, or lack of empathy. In those patients with early anterior temporal degeneration, language (particularly in patients with left-predominant disease) and socioemotional changes (particularly in patients with right-predominant disease) precede eventual frontal dysregulation. Herein, we review a brief history of FTD, initial clinical descriptions, and the evolution of nomenclature. Next, we consider clinical features, neuropathology, imaging, and genetics in FTD-spectrum disorders in relation to the integrity of frontal circuits. In particular, we focus our discussion on behavioral variant FTD given its profound impact on cortical and subcortical frontal structures. This review highlights the clinical heterogeneity of behavioral phenotypes as well as the clinical-anatomic convergence of varying proteinopathies at the neuronal, regional, and network level. Recent neuroimaging and modeling approaches in FTD reveal varying network dysfunction centered on frontal-insular cortices, which underscores the role of the human frontal lobes in complex behaviors. We conclude the chapter reviewing the cognitive and behavioral neuroscience findings furnished from studies in FTD related to executive and socioemotional function, reward-processing, decision-making, and sense of self.
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Affiliation(s)
- P Monroe Butler
- Department of Neurology, UCSF Memory and Aging Center, UCSF School of Medicine, San Francisco, CA, United States
| | - Winston Chiong
- Department of Neurology, UCSF Memory and Aging Center, UCSF School of Medicine, San Francisco, CA, United States.
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Castelnovo V, Caminiti SP, Riva N, Magnani G, Silani V, Perani D. Heterogeneous brain FDG-PET metabolic patterns in patients with C9orf72 mutation. Neurol Sci 2018; 40:515-521. [PMID: 30554355 DOI: 10.1007/s10072-018-3685-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The hexanucleotide repeat expansion in C9orf72 is an associated genetic cause in amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). In the "ALS/FTD" spectrum prevails clinical heterogeneity and an in vivo knowledge of the underling brain dysfunction in patients carrying C9orf72 mutation remain limited and only described at group level. The study aimed to assess the brain metabolic alterations characterizing patients with C9orf72 mutation using FDG-PET in single individuals. METHODS We applied a validated statistical parametric mapping (SPM) voxel-based procedure for FDG-PET data to obtain maps of brain relative hypometabolism and hypermetabolism at single-subject level in six FTD/ALS patients carrying the C9orf72 mutation. RESULTS Clinical diagnoses classified the patients as right semantic variant of frontotemporal dementia (one case, C9svFTD), behavioral variant of frontotemporal dementia (two cases, C9bvFTD), and bulbar amyotrophic lateral sclerosis (three cases, C9bALS). The FDG-PET SPM revealed a prevalent frontal hypometabolism in C9bvFTD cases, and right temporal polar and lateral involvement in C9svFTD, consistent with the clinical diagnosis. There was a quite comparable occipital and cerebellar hypermetabolism in these cases. The three C9bALS patients showed variable patterns of hypo- and hypermetabolism. CONCLUSIONS The present work is the first in vivo FDG-PET study showing the heterogeneous patterns of brain regional hypo- and hypermetabolism in single patients sharing C9orf72 mutation. Brain hypometabolism was consistent with the clinical phenotypes, supporting the diagnostic importance of neuroimaging functional biomarkers to capture at single-subject level specific brain dysfunction.
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Affiliation(s)
- Veronica Castelnovo
- Vita-Salute San Raffaele University, Milan, Italy.,Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo Structural and Molecular Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | | | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy. .,In vivo Structural and Molecular Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy. .,Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy.
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Facial expressiveness and physiological arousal in frontotemporal dementia: Phenotypic clinical profiles and neural correlates. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2018; 19:197-210. [DOI: 10.3758/s13415-018-00658-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The neuropsychological profiles and semantic-critical regions of right semantic dementia. NEUROIMAGE-CLINICAL 2018; 19:767-774. [PMID: 30009130 PMCID: PMC6041419 DOI: 10.1016/j.nicl.2018.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022]
Abstract
Introduction Previous literature has revealed that the anterior temporal lobe (ATL) is the semantic hub of left-sided or mixed semantic dementia (SD), whilst the semantic hub of right-sided SD has not been examined. Methods Seventeen patients with right-sided SD, 18 patients with left-sided SD and 20 normal controls (NC) underwent neuropsychological assessments and magnetic resonance imaging scans. We investigated the relationship between the degree of cerebral atrophy in the whole brain and the severity of semantic deficits in left and right-sided SD samples, respectively. Results We found the semantic deficits of right-sided SD patients were related to bilateral fusiform gyri and left temporal pole, whilst the left fusiform gyrus correlated with the semantic performance of left-sided SD patients. Moreover, all the findings couldn't be accounted for by total gray matter volume (GMV) or general cognitive degradation of patients. Discussion These results provide novel evidence for the current semantic theory, that the important regions for semantic processing include both anterior and posterior temporal lobes. Left SD presented more impairment on the naming, reading and Stroop tests. Right SD exhibited more deficits on the symbol digit modalities task. Left fusiform gyrus correlated with the semantic performance of left SD. The semantic hubs of right SD were bilateral fusiform gyri and left temporal pole.
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Caplan A, Marx G, Elofson J, Lis C, Grinberg L, Miller B, Rosen H. A case of semantic variant primary progressive aphasia with Pick's pathology. Neurocase 2018; 24:90-94. [PMID: 29508660 PMCID: PMC5990456 DOI: 10.1080/13554794.2018.1447134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurodegenerative diseases are caused by aggregation of specific proteins that catalyze a cascade of changes that ultimately lead to neurodegeneration. This concept guides current diagnostic approaches, as well as clinical trials, that focus on detecting or removing amyloid or tau from the brain. The semantic variant of primary progressive aphasia (svPPA), a clinical syndrome associated with frontotemporal lobar degeneration (FTLD) pathology, is usually associated with the molecular pathology TDP-C, but there are cases with TDP-B and Pick's disease. The existing literature on the clinical differentiation of these pathologies is limited. Here, we present a case study, in conjunction with a cross-sectional voxel-based morphometry (VBM), to elucidate the clinical and imaging features of a patient with svPPA due to Pick's disease.
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Affiliation(s)
- Alyssa Caplan
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Gabe Marx
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Jonathan Elofson
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Claire Lis
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Lea Grinberg
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Bruce Miller
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
| | - Howard Rosen
- a Memory and Aging Center , University of California San Francisco , San Francisco , CA , USA
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Ringman JM, Casado M, Van Berlo V, Pa J, Joseph-Mathurin N, Fagan AM, Benzinger T, Bateman RJ, Morris JC. A novel PSEN1 (S230N) mutation causing early-onset Alzheimer's Disease associated with prosopagnosia, hoarding, and Parkinsonism. Neurosci Lett 2017; 657:11-15. [PMID: 28764909 DOI: 10.1016/j.neulet.2017.07.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
We describe clinical and biomarker findings in an index patient with the onset of Alzheimer's disease (AD) symptoms at age 57 and a family history consistent with an autosomal dominant pattern of inheritance. She had the atypical early features of visual agnosia and prosopagnosia followed by hoarding behavior and Parkinsonism. Structural MRI revealed global atrophy that was most severe in the lateral temporal lobes and insular cortex bilaterally. CSF biomarker assessment showed Aβ42, p-tau181, and total tau levels consistent with AD. Genetic assessment revealed a novel mutation in the PSEN1 gene (S230N) in the index patient and her affected brother which was absent in her two clinically unaffected and AD-biomarker negative sisters. The serine residue at codon 230 in PSEN1 is highly conserved across species and in PSEN2, providing strong evidence for its pathogenicity in this family.
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Affiliation(s)
- John M Ringman
- Department of Neurology, Keck School of Medicine of the University of Southern California, 1540 Alcazar Street, Suite 209F, Los Angeles, CA, 90033, USA; Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room C-224, Los Angeles, CA 90095-1769, USA.
| | - Maria Casado
- Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room C-224, Los Angeles, CA 90095-1769, USA
| | - Victoria Van Berlo
- Semel Institute for Neuroscience and Human Behavior, 695 Charles Young Drive South, Los Angeles, CA 90095, USA
| | - Judy Pa
- Department of Neurology, Keck School of Medicine of the University of Southern California, 1540 Alcazar Street, Suite 209F, Los Angeles, CA, 90033, USA; Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, 2025 Zonal Ave, Los Angeles, CA 90033, USA
| | - Nelly Joseph-Mathurin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd. #1610, St. Louis, MO, 63110, USA
| | - Anne M Fagan
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Tammie Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd. #1610, St. Louis, MO, 63110, USA
| | - Randall J Bateman
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
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Abstract
Sleep disorders appear to be frequent comorbidities in patients with frontotemporal dementia (FTD). Insomnia and excessive daytime sleepiness commonly occur in patients with FTD and significantly contribute to caregiver burden and burnout. Sleep is severely fragmented in FTD patients, likely secondary to behavioral disturbances, other primary sleep disorders such as sleep disordered breathing and restless leg syndrome, and neurodegeneration of nuclei involved in sleep and wakefulness. Treatment of primary sleep disorders may improve excessive daytime sleepiness and sleep quality and may improve daytime cognitive functioning. Rapid eye movement (REM) sleep behavior disorder is rare in FTD and may be confused with excessive nocturnal activity due to disturbed circadian rhythm. The relationship between FTD, sleep quality, and sleep disorders requires further study to better understand the contribution of disturbed sleep to daytime neurocognitive functioning and quality of life in FTD. Further, future studies should focus on comparing sleep disturbances between different FTD syndromes, especially behavioral variant FTD and primary progressive aphasia. Comorbid sleep disorders should be promptly sought and treated in patients with FTD to improve patient and caregiver quality of life.
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Affiliation(s)
- Stuart J McCarter
- Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN, 55905, USA
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN, 55905, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
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Gordon E, Rohrer JD, Fox NC. Advances in neuroimaging in frontotemporal dementia. J Neurochem 2017; 138 Suppl 1:193-210. [PMID: 27502125 DOI: 10.1111/jnc.13656] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) is a clinically and neuroanatomically heterogeneous neurodegenerative disorder with multiple underlying genetic and pathological causes. Whilst initial neuroimaging studies highlighted the presence of frontal and temporal lobe atrophy or hypometabolism as the unifying feature in patients with FTD, more detailed studies have revealed diverse patterns across individuals, with variable frontal or temporal predominance, differing degrees of asymmetry, and the involvement of other cortical areas including the insula and cingulate, as well as subcortical structures such as the basal ganglia and thalamus. Recent advances in novel imaging modalities including diffusion tensor imaging, resting-state functional magnetic resonance imaging and molecular positron emission tomography imaging allow the possibility of investigating alterations in structural and functional connectivity and the visualisation of pathological protein deposition. This review will cover the major imaging modalities currently used in research and clinical practice, focusing on the key insights they have provided into FTD, including the onset and evolution of pathological changes and also importantly their utility as biomarkers for disease detection and staging, differential diagnosis and measurement of disease progression. Validating neuroimaging biomarkers that are able to accomplish these tasks will be crucial for the ultimate goal of powering upcoming clinical trials by correctly stratifying patient enrolment and providing sensitive markers for evaluating the effects and efficacy of disease-modifying therapies. This review describes the key insights provided by research into the major neuroimaging modalities currently used in research and clinical practice, including what they tell us about the onset and evolution of FTD and how they may be used as biomarkers for disease detection and staging, differential diagnosis and measurement of disease progression. This article is part of the Frontotemporal Dementia special issue.
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Affiliation(s)
- Elizabeth Gordon
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
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Ranasinghe KG, Rankin KP, Pressman PS, Perry DC, Lobach IV, Seeley WW, Coppola G, Karydas AM, Grinberg LT, Shany-Ur T, Lee SE, Rabinovici GD, Rosen HJ, Gorno-Tempini ML, Boxer AL, Miller ZA, Chiong W, DeMay M, Kramer JH, Possin KL, Sturm VE, Bettcher BM, Neylan M, Zackey DD, Nguyen LA, Ketelle R, Block N, Wu TQ, Dallich A, Russek N, Caplan A, Geschwind DH, Vossel KA, Miller BL. Distinct Subtypes of Behavioral Variant Frontotemporal Dementia Based on Patterns of Network Degeneration. JAMA Neurol 2017; 73:1078-88. [PMID: 27429218 DOI: 10.1001/jamaneurol.2016.2016] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Clearer delineation of the phenotypic heterogeneity within behavioral variant frontotemporal dementia (bvFTD) will help uncover underlying biological mechanisms and improve clinicians' ability to predict disease course and to design targeted management strategies. OBJECTIVE To identify subtypes of bvFTD syndrome based on distinctive patterns of atrophy defined by selective vulnerability of specific functional networks targeted in bvFTD using statistical classification approaches. DESIGN, SETTING AND PARTICIPANTS In this retrospective observational study, 90 patients meeting the Frontotemporal Dementia Consortium consensus criteria for bvFTD underwent evaluation at the Memory and Aging Center of the Department of Neurology at University of California, San Francisco. Patients underwent a multidisciplinary clinical evaluation, including clinical demographics, genetic testing, symptom evaluation, neurologic examination, neuropsychological bedside testing, and socioemotional assessments. All patients underwent structural magnetic resonance imaging at their earliest evaluation at the memory clinic. From each patient's structural imaging scans, the mean volumes of 18 regions of interest (ROI) constituting the functional networks specifically vulnerable in bvFTD, including the salience network (SN), with key nodes in the frontoinsula and pregenual anterior cingulate, and the semantic appraisal network (SAN), anchored in the anterior temporal lobe and subgenual cingulate, were estimated. Principal component and cluster analyses of ROI volumes were used to identify patient clusters with anatomically distinct atrophy patterns. Data were collected from from June 19, 2002, to January 13, 2015. MAIN OUTCOMES AND MEASURES Evaluation of brain morphology and other clinical features, including presenting symptoms, neurologic examination signs, neuropsychological performance, rate of dementia progression, and socioemotional function, in each patient cluster. RESULTS Ninety patients (54 men [60%]; 36 women [40%]; mean [SD] age at evaluation, 55.1 [9.7] years) were included in the analysis. Four subgroups of patients with bvFTD with distinct anatomic patterns of network degeneration were identified, including 2 salience network-predominant subgroups (frontal/temporal [SN-FT] and frontal [SN-F]), a semantic appraisal network-predominant group (SAN), and a subcortical-predominant group. Subgroups demonstrated distinct patterns of cognitive, socioemotional, and motor symptoms, as well as genetic compositions and estimated rates of disease progression. CONCLUSIONS AND RELEVANCE Divergent patterns of vulnerability in specific functional network components make an important contribution to the clinical heterogeneity of bvFTD. The data-driven anatomic classification identifies biologically meaningful anatomic phenotypes and provides a replicable approach to disambiguate the bvFTD syndrome.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Peter S Pressman
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - David C Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Iryna V Lobach
- Memory and Aging Center, Department of Neurology, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco3Department of Pathology, University of California, San Francisco
| | - Giovanni Coppola
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Anna M Karydas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco3Department of Pathology, University of California, San Francisco
| | - Tal Shany-Ur
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Suzee E Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | | | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Mary DeMay
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Virginia E Sturm
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Brianne M Bettcher
- Memory and Aging Center, Department of Neurology, University of California, San Francisco5Departments of Neurosurgery and Neurology, University of Colorado Anschutz School of Medicine, Aurora
| | - Michael Neylan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Diana D Zackey
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Lauren A Nguyen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Robin Ketelle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Nikolas Block
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Teresa Q Wu
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Alison Dallich
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Natanya Russek
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Alyssa Caplan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Daniel H Geschwind
- Center for Autism Research and Treatment, University of California, Los Angeles
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco7Gladstone Institute of Neurological Disease, San Francisco, California
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Collins JA, Montal V, Hochberg D, Quimby M, Mandelli ML, Makris N, Seeley WW, Gorno-Tempini ML, Dickerson BC. Focal temporal pole atrophy and network degeneration in semantic variant primary progressive aphasia. Brain 2017; 140:457-471. [PMID: 28040670 PMCID: PMC5278308 DOI: 10.1093/brain/aww313] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/10/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022] Open
Abstract
A wealth of neuroimaging research has associated semantic variant primary progressive aphasia with distributed cortical atrophy that is most prominent in the left anterior temporal cortex; however, there is little consensus regarding which region within the anterior temporal cortex is most prominently damaged, which may indicate the putative origin of neurodegeneration. In this study, we localized the most prominent and consistent region of atrophy in semantic variant primary progressive aphasia using cortical thickness analysis in two independent patient samples (n = 16 and 28, respectively) relative to age-matched controls (n = 30). Across both samples the point of maximal atrophy was located in the same region of the left temporal pole. This same region was the point of maximal atrophy in 100% of individual patients in both semantic variant primary progressive aphasia samples. Using resting state functional connectivity in healthy young adults (n = 89), we showed that the seed region derived from the semantic variant primary progressive aphasia analysis was strongly connected with a large-scale network that closely resembled the distributed atrophy pattern in semantic variant primary progressive aphasia. In both patient samples, the magnitude of atrophy within a brain region was predicted by that region's strength of functional connectivity to the temporopolar seed region in healthy adults. These findings suggest that cortical atrophy in semantic variant primary progressive aphasia may follow connectional pathways within a large-scale network that converges on the temporal pole.
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Affiliation(s)
- Jessica A Collins
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Victor Montal
- Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau-Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daisy Hochberg
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Megan Quimby
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Maria Luisa Mandelli
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Nikos Makris
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - William W Seeley
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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76
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A neural network underlying intentional emotional facial expression in neurodegenerative disease. NEUROIMAGE-CLINICAL 2017; 14:672-678. [PMID: 28373956 PMCID: PMC5367861 DOI: 10.1016/j.nicl.2017.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
Intentional facial expression of emotion is critical to healthy social interactions. Patients with neurodegenerative disease, particularly those with right temporal or prefrontal atrophy, show dramatic socioemotional impairment. This was an exploratory study examining the neural and behavioral correlates of intentional facial expression of emotion in neurodegenerative disease patients and healthy controls. One hundred and thirty three participants (45 Alzheimer's disease, 16 behavioral variant frontotemporal dementia, 8 non-fluent primary progressive aphasia, 10 progressive supranuclear palsy, 11 right-temporal frontotemporal dementia, 9 semantic variant primary progressive aphasia patients and 34 healthy controls) were video recorded while imitating static images of emotional faces and producing emotional expressions based on verbal command; the accuracy of their expression was rated by blinded raters. Participants also underwent face-to-face socioemotional testing and informants described participants' typical socioemotional behavior. Patients' performance on emotion expression tasks was correlated with gray matter volume using voxel-based morphometry (VBM) across the entire sample. We found that intentional emotional imitation scores were related to fundamental socioemotional deficits; patients with known socioemotional deficits performed worse than controls on intentional emotion imitation; and intentional emotional expression predicted caregiver ratings of empathy and interpersonal warmth. Whole brain VBMs revealed a rightward cortical atrophy pattern homologous to the left lateralized speech production network was associated with intentional emotional imitation deficits. Results point to a possible neural mechanisms underlying complex socioemotional communication deficits in neurodegenerative disease patients. A rightward atrophy pattern homologous to the leftward "speech production network" predicted patients' ability to intentionally imitate emotional facial expressions. Neurodegenerative disease patients with core deficits in social functioning show deficits in the ability to intentionally imitate facial expressions of emotion. Intentional emotion imitation deficits were related to more fundamental deficits in emotion reading and general emotional expressiveness. Emotion imitation deficits predicted caregivers’ ratings of interpersonal warmth and empathy.
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77
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Lee JS, Jung NY, Jang YK, Kim HJ, Seo SW, Lee J, Kim YJ, Lee JH, Kim BC, Park KW, Yoon SJ, Jeong JH, Kim SY, Kim SH, Kim EJ, Park KC, Knopman DS, Na DL. Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy. J Clin Neurol 2017; 13:234-242. [PMID: 28748674 PMCID: PMC5532319 DOI: 10.3988/jcn.2017.13.3.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Only a few studies have investigated the relationship between different subtypes and disease progression or prognosis in patients with behavioral variant frontotemporal dementia (bvFTD). Since a localized injury often produces more focal signs than a diffuse injury, we hypothesized that the clinical characteristics differ between patients with bvFTD who show diffuse frontal lobe atrophy (D-type) on axial magnetic resonance imaging (MRI) scans versus those with focal or circumscribed frontal lobe atrophy (F-type). Methods In total, 94 MRI scans (74 scans from bvFTD and 20 scans from age-matched normal controls) were classified into 35 D- and 39 F-type bvFTD cases based on an axial MRI visual rating scale. We compared baseline clinical characteristics, progression in motor and cognitive symptoms, and survival times between D- and F-types. Survival analyses were performed for 62 of the 74 patients. Results While D-type performed better on neuropsychological tests than F-type at baseline, D-type had higher baseline scores on the Unified Parkinson's Disease Rating Scale (UPDRS) Part III. Evaluations of motor progression showed that the disease duration with motor symptoms was shorter in D-type than F-type. Moreover, the survival time was shorter in D-type (6.9 years) than F-type (9.4 years). Cox regression analyses revealed that a high UPDRS Part III score at baseline contributed to an increased risk of mortality, regardless of the pattern of atrophy. Conclusions The prognosis is worse for D-type than for those with F-type. Shorter survival in D-type may be associated with the earlier appearance of motor symptoms.
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Affiliation(s)
- Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Na Yeon Jung
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Young Kyoung Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Juyoun Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jee H Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Key Chung Park
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea.
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78
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Koriath CA, Bocchetta M, Brotherhood E, Woollacott IO, Norsworthy P, Simón-Sánchez J, Blauwendraat C, Dick KM, Gordon E, Harding SR, Fox NC, Crutch S, Warren JD, Revesz T, Lashley T, Mead S, Rohrer JD. The clinical, neuroanatomical, and neuropathologic phenotype of TBK1-associated frontotemporal dementia: A longitudinal case report. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 6:75-81. [PMID: 28229125 PMCID: PMC5312484 DOI: 10.1016/j.dadm.2016.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Mutations in the TANK-binding kinase 1 (TBK1) gene have recently been shown to cause frontotemporal dementia (FTD). However, the phenotype of TBK1-associated FTD is currently unclear. METHODS We performed a single case longitudinal study of a patient who was subsequently found to have a novel A705fs mutation in the TBK1 gene. He was assessed annually over a 7-year period with a series of clinical, cognitive, and magnetic resonance imaging assessments. His brain underwent pathological examination at postmortem. RESULTS The patient presented at the age of 64 years with an 18-month history of personality change including increased rigidity and obsessiveness, apathy, loss of empathy, and development of a sweet tooth. His mother had developed progressive behavioral and cognitive impairment from the age of 57 years. Neuropsychometry revealed intact cognition at first assessment. Magnetic resonance imaging showed focal right temporal lobe atrophy. Over the next few years his behavioral problems progressed and he developed cognitive impairment, initially with anomia and prosopagnosia. Neurological examination remained normal throughout without any features of motor neurone disease. He died at the age of 72 years and postmortem showed TDP-43 type A pathology but with an unusual novel feature of numerous TAR DNA-binding protein 43 (TDP-43)-positive neuritic structures at the cerebral cortex/subcortical white matter junction. There was also associated argyrophilic grain disease not previously reported in other TBK1 mutation cases. DISCUSSION TBK1-associated FTD can be associated with right temporal variant FTD with progressive behavioral change and relatively intact cognition initially. The case further highlights the benefits of next-generation sequencing technologies in the diagnosis of neurodegenerative disorders and the importance of detailed neuropathologic analysis.
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Affiliation(s)
- Carolin A.M. Koriath
- Department of Neurodegenerative Disease, MRC Prion Unit, UCL Institute of Neurology, London, UK
| | - Martina Bocchetta
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Emilie Brotherhood
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Ione O.C. Woollacott
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Penny Norsworthy
- Department of Neurodegenerative Disease, MRC Prion Unit, UCL Institute of Neurology, London, UK
| | - Javier Simón-Sánchez
- Genetics and Epigenetics of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), Tübingen, Germany
| | - Cornelis Blauwendraat
- Applied Genomics for Neurodegenerative Diseases, German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Katrina M. Dick
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Elizabeth Gordon
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Sophie R. Harding
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Nick C. Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Sebastian Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Jason D. Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Simon Mead
- Department of Neurodegenerative Disease, MRC Prion Unit, UCL Institute of Neurology, London, UK
| | - Jonathan D. Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
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79
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Cerami C, Dodich A, Lettieri G, Iannaccone S, Magnani G, Marcone A, Gianolli L, Cappa SF, Perani D. Different FDG-PET metabolic patterns at single-subject level in the behavioral variant of fronto-temporal dementia. Cortex 2016; 83:101-12. [DOI: 10.1016/j.cortex.2016.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 05/23/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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80
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Jastorff J, De Winter FL, Van den Stock J, Vandenberghe R, Giese MA, Vandenbulcke M. Functional dissociation between anterior temporal lobe and inferior frontal gyrus in the processing of dynamic body expressions: Insights from behavioral variant frontotemporal dementia. Hum Brain Mapp 2016; 37:4472-4486. [PMID: 27510944 DOI: 10.1002/hbm.23322] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/29/2016] [Accepted: 07/15/2016] [Indexed: 11/11/2022] Open
Abstract
Several brain regions are involved in the processing of emotional stimuli, however, the contribution of specific regions to emotion perception is still under debate. To investigate this issue, we combined behavioral testing, structural and resting state imaging in patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and age matched controls, with task-based functional imaging in young, healthy volunteers. As expected, bvFTD patients were impaired in emotion detection as well as emotion categorization tasks, testing dynamic emotional body expressions as stimuli. Interestingly, their performance in the two tasks correlated with gray matter volume in two distinct brain regions, the left anterior temporal lobe for emotion detection and the left inferior frontal gyrus (IFG) for emotion categorization. Confirming this observation, multivoxel pattern analysis in healthy volunteers demonstrated that both ROIs contained information for emotion detection, but that emotion categorization was only possible from the pattern in the IFG. Furthermore, functional connectivity analysis showed reduced connectivity between the two regions in bvFTD patients. Our results illustrate that the mentalizing network and the action observation network perform distinct tasks during emotion processing. In bvFTD, communication between the networks is reduced, indicating one possible cause underlying the behavioral symptoms. Hum Brain Mapp 37:4472-4486, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jan Jastorff
- Laboratory for Translational Neuropsychiatry, Division of Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | - Francois-Laurent De Winter
- Laboratory for Translational Neuropsychiatry, Division of Psychiatry, Department of Neurosciences, KU Leuven, Belgium.,Department of Old Age Psychiatry, University Hospitals Leuven, Belgium
| | - Jan Van den Stock
- Laboratory for Translational Neuropsychiatry, Division of Psychiatry, Department of Neurosciences, KU Leuven, Belgium.,Department of Old Age Psychiatry, University Hospitals Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Martin A Giese
- Section for Computational Sensomotorics, Department of Cognitive Neurology, University Clinic Tübingen, Tübingen, 72076, Germany
| | - Mathieu Vandenbulcke
- Laboratory for Translational Neuropsychiatry, Division of Psychiatry, Department of Neurosciences, KU Leuven, Belgium.,Department of Old Age Psychiatry, University Hospitals Leuven, Belgium
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81
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Reading words and other people: A comparison of exception word, familiar face and affect processing in the left and right temporal variants of primary progressive aphasia. Cortex 2016; 82:147-163. [PMID: 27389800 DOI: 10.1016/j.cortex.2016.05.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 12/12/2022]
Abstract
Semantic variant primary progressive aphasia (svPPA) typically presents with left-hemisphere predominant rostral temporal lobe (rTL) atrophy and the most significant complaints within the language domain. Less frequently, patients present with right-hemisphere predominant temporal atrophy coupled with marked impairments in processing of famous faces and emotions. Few studies have objectively compared these patient groups in both domains and therefore it is unclear to what extent the syndromes overlap. Clinically diagnosed svPPA patients were characterized as left- (n = 21) or right-predominant (n = 12) using imaging and compared along with 14 healthy controls. Regarding language, our primary focus was upon two hallmark features of svPPA; confrontation naming and surface dyslexia. Both groups exhibited naming deficits and surface dyslexia although the impairments were more severe in the left-predominant group. Familiarity judgments on famous faces and affect processing were more profoundly impaired in the right-predominant group. Our findings suggest that the two syndromes overlap significantly but that early cases at the tail ends of the continuum constitute a challenge for current clinical criteria. Correlational neuroimaging analyses implicated a mid portion of the left lateral temporal lobe in exception word reading impairments in line with proposals that this region is an interface between phonology and semantic knowledge.
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82
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Kumfor F, Landin-Romero R, Devenney E, Hutchings R, Grasso R, Hodges JR, Piguet O. On the right side? A longitudinal study of left- versus right-lateralized semantic dementia. Brain 2016; 139:986-98. [DOI: 10.1093/brain/awv387] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/06/2015] [Indexed: 01/29/2023] Open
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83
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Masdeu JC, Pascual B. Genetic and degenerative disorders primarily causing dementia. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:525-564. [PMID: 27432682 DOI: 10.1016/b978-0-444-53485-9.00026-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuroimaging comprises a powerful set of instruments to diagnose the different causes of dementia, clarify their neurobiology, and monitor their treatment. Magnetic resonance imaging (MRI) depicts volume changes with neurodegeneration and inflammation, as well as abnormalities in functional and structural connectivity. MRI arterial spin labeling allows for the quantification of regional cerebral blood flow, characteristically altered in Alzheimer's disease, diffuse Lewy-body disease, and the frontotemporal dementias. Positron emission tomography allows for the determination of regional metabolism, with similar abnormalities as flow, and for the measurement of β-amyloid and abnormal tau deposition in the brain, as well as regional inflammation. These instruments allow for the quantification in vivo of most of the pathologic features observed in disorders causing dementia. Importantly, they allow for the longitudinal study of these abnormalities, having revealed, for instance, that the deposition of β-amyloid in the brain can antecede by decades the onset of dementia. Thus, a therapeutic window has been opened and the efficacy of immunotherapies directed at removing β-amyloid from the brain of asymptomatic individuals is currently being tested. Tau and inflammation imaging, still in their infancy, combined with genomics, should provide powerful insights into these disorders and facilitate their treatment.
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Affiliation(s)
- Joseph C Masdeu
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA.
| | - Belen Pascual
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA
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84
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Kamminga J, Kumfor F, Burrell JR, Piguet O, Hodges JR, Irish M. Differentiating between right-lateralised semantic dementia and behavioural-variant frontotemporal dementia: an examination of clinical characteristics and emotion processing. J Neurol Neurosurg Psychiatry 2015; 86:1082-8. [PMID: 25511791 DOI: 10.1136/jnnp-2014-309120] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Right-lateralised semantic dementia (right SD) and behavioural-variant frontotemporal dementia (bvFTD) appear clinically similar, despite different patterns of underlying brain changes. This study aimed to elucidate distinguishing clinical and cognitive features in right SD versus bvFTD, emphasising emotion processing and its associated neural correlates. METHODS 12 patients with right SD and 19 patients with bvFTD were recruited. Clinical features were documented. All patients were assessed on standardised neuropsychological tests and a facial emotion processing battery. Performance was compared to 20 age-matched and education-matched controls. Grey matter intensity was related to emotion processing performance using whole-brain voxel-based morphometry analysis. RESULTS Patients with right SD exhibited disproportionate language dysfunction, prosopagnosia and a suggestion of increased obsessive personality/behavioural changes versus patients with bvFTD. In contrast, patients with bvFTD demonstrated pronounced deficits in attention/working memory, increased apathy and greater executive dysfunction, compared to patients with right SD. Decreased empathy, disinhibition and diet changes were common to both dementia subtypes. Emotion processing deficits were present in both FTD syndromes but were associated with divergent patterns of brain atrophy. In right SD, emotion processing dysfunction was associated with predominantly right medial and lateral temporal integrity, compared to mainly left temporal, inferior frontal and orbitofrontal and right frontal gyrus integrity in bvFTD. CONCLUSIONS This study demonstrates comparable deficits in facial emotion processing in right SD and bvFTD, in keeping with their similar clinical profiles. These deficits are attributable to divergent neural substrates in each patient group, namely, right lateralised regions in right SD, versus predominantly left lateralised regions in bvFTD.
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Affiliation(s)
- Jody Kamminga
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Kumfor
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Muireann Irish
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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85
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Hopkins SAA, Chan D. Key emerging issues in frontotemporal dementia. J Neurol 2015; 263:407-413. [PMID: 26338811 DOI: 10.1007/s00415-015-7880-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) encompasses the syndromes of behavioural variant FTD (bvFTD) and primary progressive aphasia (PPA) and refers to those neurodegenerative diseases characterised by predominant pathological involvement of the frontal and temporal lobes. Recent years have witnessed major advances in the clinical characterisation of FTD, reflected in the publication of updated diagnostic criteria for bvFTD and PPA, and the discovery of new pathogenic mutations has added to the understanding of genotype-phenotype interactions and of disease mechanisms. Emerging results from longitudinal studies of familial FTD show that imaging and cognitive changes occur years before symptom onset and such studies may yield biomarkers of early disease that in turn will facilitate earlier diagnosis. The hope and (guarded) expectation is that these advances may together herald the beginning of the end of the chapter in which FTD is considered an inexorably progressive and untreatable condition.
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Affiliation(s)
- Sarah A A Hopkins
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Dennis Chan
- Department of Clinical Neurosciences, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK.
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86
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Shinagawa S, Babu A, Sturm V, Shany-Ur T, Toofanian Ross P, Zackey D, Poorzand P, Grossman S, Miller BL, Rankin KP. Neural basis of motivational approach and withdrawal behaviors in neurodegenerative disease. Brain Behav 2015; 5:e00350. [PMID: 26442751 PMCID: PMC4589805 DOI: 10.1002/brb3.350] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/22/2015] [Accepted: 04/05/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS) have been theorized as neural systems that regulate approach/withdrawal behaviors. Behavioral activation/inhibition balance may change in neurodegenerative disease based on underlying alterations in systems supporting motivation and approach/withdrawal behaviors, which may in turn be reflected in neuropsychiatric symptoms. METHOD A total of 187 participants (31 patients diagnosed with behavioral variant of FTD [bvFTD], 13 semantic variant of primary progressive aphasia [svPPA], 14 right temporal variant FTD [rtFTD], 54 Alzheimer's disease [AD], and 75 older healthy controls [NCs]) were included in this study. Changes in behavioral inhibition/activation were measured using the BIS/BAS scale. We analyzed the correlation between regional atrophy pattern and BIS/BAS score, using voxel-based morphometry (VBM). RESULTS ADs had significantly higher BIS scores than bvFTDs and NCs. bvFTDs activation-reward response (BAS-RR) was significantly lower than ADs and NCs, though their activation-drive (BAS-D) was significantly higher than in ADs. Both AD and rtFTD patients had abnormally low activation fun-seeking (BAS-FS) scores. BIS score correlated positively with right anterior cingulate and middle frontal gyrus volume, as well as volume in the right precentral gyrus and left insula/operculum. CONCLUSIONS AD, bvFTD, and rtFTD patients show divergent patterns of change in approach/withdrawal reactivity. High BIS scores correlated with preservation of right-predominant structures involved in task control and self-protective avoidance of potentially negative reinforcers. Damage to these regions in bvFTD may create a punishment insensitivity that underlies patients' lack of self-consciousness in social contexts.
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Affiliation(s)
- Shunichiro Shinagawa
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Adhimoolam Babu
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Virginia Sturm
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Tal Shany-Ur
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Parnian Toofanian Ross
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Diana Zackey
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Pardis Poorzand
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Scott Grossman
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of CaliforniaSan Francisco, California
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87
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Botha H, Duffy JR, Whitwell JL, Strand EA, Machulda MM, Schwarz CG, Reid RI, Spychalla AJ, Senjem ML, Jones DT, Lowe V, Jack CR, Josephs KA. Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech. Cortex 2015; 69:220-36. [PMID: 26103600 PMCID: PMC4522343 DOI: 10.1016/j.cortex.2015.05.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
The consensus criteria for the diagnosis and classification of primary progressive aphasia (PPA) have served as an important tool in studying this group of disorders. However, a large proportion of patients remain unclassifiable whilst others simultaneously meet criteria for multiple subtypes. We prospectively evaluated a large cohort of patients with degenerative aphasia and/or apraxia of speech using multidisciplinary clinical assessments and multimodal imaging. Blinded diagnoses were made using operational definitions with important differences compared to the consensus criteria. Of the 130 included patients, 40 were diagnosed with progressive apraxia of speech (PAOS), 12 with progressive agrammatic aphasia, 9 with semantic dementia, 52 with logopenic progressive aphasia, and 4 with progressive fluent aphasia, while 13 were unclassified. The PAOS and progressive fluent aphasia groups were least impaired. Performance on repetition and sentence comprehension was especially poor in the logopenic group. The semantic and progressive fluent aphasia groups had prominent anomia, but only semantic subjects had loss of word meaning and object knowledge. Distinct patterns of grey matter loss and white matter changes were found in all groups compared to controls. PAOS subjects had bilateral frontal grey matter loss, including the premotor and supplementary motor areas, and bilateral frontal white matter involvement. The agrammatic group had more widespread, predominantly left sided grey matter loss and white matter abnormalities. Semantic subjects had bitemporal grey matter loss and white matter changes, including the uncinate and inferior occipitofrontal fasciculi, whereas progressive fluent subjects only had left sided temporal involvement. Logopenic subjects had diffuse and bilateral grey matter loss and diffusion tensor abnormalities, maximal in the posterior temporal region. A diagnosis of logopenic aphasia was strongly associated with being amyloid positive (46/52 positive). Our findings support consideration of an alternative way of identifying and categorizing subtypes of degenerative speech and language disorders.
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Affiliation(s)
- Hugo Botha
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | | | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | | | - Robert I Reid
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Val Lowe
- Department of Radiology (Nuclear Medicine), Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA; Department of Neurology (Movement Disorders), Mayo Clinic, Rochester, MN, USA.
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88
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Moodley KK, Perani D, Minati L, Anthony Della Rosa P, Pennycook F, Dickson JC, Barnes A, Elisa Contarino V, Michopoulou S, D’Incerti L, Good C, Fallanca F, Giovanna Vanoli E, Ell PJ, Chan D. Simultaneous PET-MRI Studies of the Concordance of Atrophy and Hypometabolism in Syndromic Variants of Alzheimer’s Disease and Frontotemporal Dementia: An Extended Case Series. J Alzheimers Dis 2015; 46:639-53. [DOI: 10.3233/jad-150151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit San Raffaele Hospital, Division of Neuroscience IRCCS San Raffaele, Milano, Italy
| | - Ludovico Minati
- Brighton and Sussex Medical School, Falmer, UK
- Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | - John C. Dickson
- Institute of Nuclear Medicine, University College London, London, UK
| | - Anna Barnes
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Sofia Michopoulou
- Institute of Nuclear Medicine, University College London, London, UK
| | - Ludovico D’Incerti
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Catriona Good
- Hurstwood Park Neurosciences Centre, West Sussex, UK
| | - Federico Fallanca
- Vita-Salute San Raffaele University, Nuclear Medicine Unit San Raffaele Hospital, Division of Neuroscience IRCCS San Raffaele, Milano, Italy
| | - Emilia Giovanna Vanoli
- Vita-Salute San Raffaele University, Nuclear Medicine Unit San Raffaele Hospital, Division of Neuroscience IRCCS San Raffaele, Milano, Italy
| | - Peter J. Ell
- Institute of Nuclear Medicine, University College London, London, UK
| | - Dennis Chan
- Brighton and Sussex Medical School, Falmer, UK
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89
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Abstract
Although Alzheimer's disease is the most common cause of dementia in the elderly, there are several conditions (ie, frontotemporal dementia or Huntington's disease) associated with a relatively earlier onset. This article provides arguments in favor of a comprehensive neuropsychological assessment in the differential diagnosis of young-onset dementia, as episodic memory impairment is not observed early in the course of most types of young-onset dementia that predominantly affect the domains of behavior, executive, language, and/or motor function.
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90
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Clark CN, Lashley T, Mahoney CJ, Warren JD, Revesz T, Rohrer JD. Temporal Variant Frontotemporal Dementia is Associated with Globular Glial Tauopathy. Cogn Behav Neurol 2015; 28:92-7. [PMID: 26102999 PMCID: PMC4478068 DOI: 10.1097/wnn.0000000000000060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous neurodegenerative disorder associated with atrophy of the frontal and temporal lobes. Most patients with focal temporal lobe atrophy present with either the semantic dementia subtype of FTD or the behavioral variant subtype. For patients with temporal variant FTD, the most common cause found on post-mortem examination has been a TDP-43 (transactive response DNA-binding protein 43 kDa) proteinopathy, but tauopathies have also been described, including Pick's disease and mutations in the microtubule-associated protein tau (MAPT) gene. We report the clinical and imaging features of 2 patients with temporal variant FTD associated with a rare frontotemporal lobar degeneration pathology known as globular glial tauopathy. The pathologic diagnosis of globular glial tauopathy should be considered in patients with temporal variant FTD, particularly those who have atypical semantic dementia or an atypical parkinsonian syndrome in association with the right temporal variant.
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Affiliation(s)
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, University College London, Institute of Neurology, London, United Kingdom
| | | | | | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Institute of Neurology, London, United Kingdom
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91
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Right temporal lobe variant of frontotemporal dementia. J Clin Neurosci 2015; 22:1139-43. [PMID: 25981552 DOI: 10.1016/j.jocn.2014.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/03/2014] [Accepted: 12/07/2014] [Indexed: 11/22/2022]
Abstract
We present two women with the right temporal lobe variant (RTLV) of frontotemporal dementia (FTD) and analyse the clinical features that are determined by the anatomical distribution of atrophy. Each of our patients displayed different clinical and radiological profiles which were in line with findings reported by other authors. One of two patients carries a novel mutation in the granulin gene. FTD is heterogeneous with regard to clinical manifestation, genetics, distribution of cortical atrophy and underlying disease. Its clinical manifestations are related to the distribution of the cortical atrophy. The RTLV of FTD is an uncommon entity. There is no consensus about its name despite the fact that its clinical and radiological features are well-defined and distinguish it from other types of FTD including semantic dementia.
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92
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Kumfor F, Hutchings R, Irish M, Hodges JR, Rhodes G, Palermo R, Piguet O. Do I know you? Examining face and object memory in frontotemporal dementia. Neuropsychologia 2015; 71:101-11. [PMID: 25797589 DOI: 10.1016/j.neuropsychologia.2015.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
The ability to perceive, learn and recognise faces is a complex ability, which is key to successful social interactions. This ability is proposed to be coordinated by neural regions in the occipital and temporal lobes, specialised for face perception and memory. While previous studies have suggested that memory for faces is compromised in some dementia syndromes, it remains unclear whether this simply reflects more generalised memory deficits. Here, we examined basic face perception (Identity-Matching), face recognition (Cambridge Face Memory Task) and object recognition (Cambridge Car Memory Task) in 11 semantic dementia (SD) patients (8 left-lateralised, 3 right-lateralised) and 13 behavioural-variant frontotemporal dementia (bvFTD) patients, compared with 11 controls. On the Identity-Matching task, bvFTD were impaired compared to controls, with a similar trend observed in the SD group. Importantly, both bvFTD and SD also demonstrated impaired face recognition. In contrast, only bvFTD showed impaired object recognition, with SD performing within normal limits on this task. Voxel-based morphometry analyses revealed that Identity-Matching and face recognition were associated with partly dissociable regions including the fusiform cortex and anterior temporal lobe. Object-memory was associated with thalamic integrity in the bvFTD group only. These results reveal that face perception and face memory deficits are common in bvFTD and SD, and have been previously underestimated. These deficits are due to neurodegeneration of key regions within the 'core' and 'extended' face processing system, providing convergent evidence of the neural regions supporting face perception. From a clinical perspective, impaired ability to recognise faces is common in bvFTD and SD and therefore strategies to improve face perception and memory may be beneficial for these patients.
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Affiliation(s)
- Fiona Kumfor
- Neuroscience Research Australia, Sydney, Australia; The School of Medical Sciences, The University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | | | - Muireann Irish
- Neuroscience Research Australia, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia; School of Psychology, The University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia; The School of Medical Sciences, The University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Gillian Rhodes
- ARC Centre of Excellence in Cognition and its Disorders, Australia; School of Psychology, University of Western Australia, Perth, Australia
| | - Romina Palermo
- ARC Centre of Excellence in Cognition and its Disorders, Australia; School of Psychology, University of Western Australia, Perth, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia; The School of Medical Sciences, The University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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93
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Identification of environmental sounds and melodies in syndromes of anterior temporal lobe degeneration. J Neurol Sci 2015; 352:94-8. [PMID: 25843288 PMCID: PMC4425361 DOI: 10.1016/j.jns.2015.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/31/2015] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
Recognition of nonverbal sounds in semantic dementia and other syndromes of anterior temporal lobe degeneration may determine clinical symptoms and help to define phenotypic profiles. However, nonverbal auditory semantic function has not been widely studied in these syndromes. Here we investigated semantic processing in two key nonverbal auditory domains – environmental sounds and melodies – in patients with semantic dementia (SD group; n = 9) and in patients with anterior temporal lobe atrophy presenting with behavioural decline (TL group; n = 7, including four cases with MAPT mutations) in relation to healthy older controls (n = 20). We assessed auditory semantic performance in each domain using novel, uniform within-modality neuropsychological procedures that determined sound identification based on semantic classification of sound pairs. Both the SD and TL groups showed comparable overall impairments of environmental sound and melody identification; individual patients generally showed superior identification of environmental sounds than melodies, however relative sparing of melody over environmental sound identification also occurred in both groups. Our findings suggest that nonverbal auditory semantic impairment is a common feature of neurodegenerative syndromes with anterior temporal lobe atrophy. However, the profile of auditory domain involvement varies substantially between individuals. Nonverbal auditory processing is an understudied area of semantic memory. We assessed novel auditory semantic tasks in patients with temporal lobe atrophy. Environmental sound and music processing were comparably impaired across the cohort. Individual patients may show relative sparing of melody processing. Nonverbal auditory deficits integrally accompany temporal lobe degeneration.
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94
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Demencia frontotemporal variante conductual: biomarcadores, una aproximación a la enfermedad. Neurologia 2015; 30:50-61. [DOI: 10.1016/j.nrl.2013.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/16/2013] [Indexed: 11/22/2022] Open
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95
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Biomarkers: a new approach to behavioural variant frontotemporal dementia. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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96
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Narayanan L, Murray AD. What is the role of neuroimaging in dementia? A review. IMAGING 2014. [DOI: 10.1259/img.20120015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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97
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Clinical phenotypes and radiological findings in frontotemporal dementia related to TARDBP mutations. J Neurol 2014; 262:375-84. [DOI: 10.1007/s00415-014-7575-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/02/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022]
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98
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Mahoney CJ, Ridgway GR, Malone IB, Downey LE, Beck J, Kinnunen KM, Schmitz N, Golden HL, Rohrer JD, Schott JM, Rossor MN, Ourselin S, Mead S, Fox NC, Warren JD. Profiles of white matter tract pathology in frontotemporal dementia. Hum Brain Mapp 2014; 35:4163-79. [PMID: 24510641 PMCID: PMC4312919 DOI: 10.1002/hbm.22468] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/13/2013] [Accepted: 01/07/2014] [Indexed: 12/11/2022] Open
Abstract
Despite considerable interest in improving clinical and neurobiological characterisation of frontotemporal dementia and in defining the role of brain network disintegration in its pathogenesis, information about white matter pathway alterations in frontotemporal dementia remains limited. Here we investigated white matter tract damage using an unbiased, template-based diffusion tensor imaging (DTI) protocol in a cohort of 27 patients with the behavioral variant of frontotemporal dementia (bvFTD) representing both major genetic and sporadic forms, in relation both to healthy individuals and to patients with Alzheimer's disease. Widespread white matter tract pathology was identified in the bvFTD group compared with both healthy controls and Alzheimer's disease group, with prominent involvement of uncinate fasciculus, cingulum bundle and corpus callosum. Relatively discrete and distinctive white matter profiles were associated with genetic subgroups of bvFTD associated with MAPT and C9ORF72 mutations. Comparing diffusivity metrics, optimal overall separation of the bvFTD group from the healthy control group was signalled using radial diffusivity, whereas optimal overall separation of the bvFTD group from the Alzheimer's disease group was signalled using fractional anisotropy. Comparing white matter changes with regional grey matter atrophy (delineated using voxel based morphometry) in the bvFTD cohort revealed co-localisation between modalities particularly in the anterior temporal lobe, however white matter changes extended widely beyond the zones of grey matter atrophy. Our findings demonstrate a distributed signature of white matter alterations that is likely to be core to the pathophysiology of bvFTD and further suggest that this signature is modulated by underlying molecular pathologies.
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Affiliation(s)
- Colin J Mahoney
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
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99
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Shany-Ur T, Lin N, Rosen HJ, Sollberger M, Miller BL, Rankin KP. Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention. ACTA ACUST UNITED AC 2014; 137:2368-81. [PMID: 24951639 DOI: 10.1093/brain/awu161] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accurate self-awareness is essential for adapting one's tasks and goals to one's actual abilities. Patients with neurodegenerative diseases, particularly those with right frontal involvement, often present with poor self-awareness of their functional limitations that may exacerbate their already jeopardized decision-making and behaviour. We studied the structural neuroanatomical basis for impaired self-awareness among patients with neurodegenerative disease and healthy older adults. One hundred and twenty-four participants (78 patients with neurodegenerative diseases including Alzheimer's disease, behavioural variant frontotemporal dementia, right-temporal frontotemporal dementia, semantic variant and non-fluent variant primary progressive aphasia, and 46 healthy controls) described themselves on the Patient Competency Rating Scale, rating observable functioning across four domains (daily living activities, cognitive, emotional control, interpersonal). All participants underwent structural magnetic resonance imaging. Informants also described subjects' functioning on the same scale. Self-awareness was measured by comparing self and informant ratings. Group differences in discrepancy scores were analysed using general linear models, controlling for age, sex and disease severity. Compared with controls, patients with behavioural variant frontotemporal dementia overestimated their functioning in all domains, patients with Alzheimer's disease overestimated cognitive and emotional functioning, patients with right-temporal frontotemporal dementia overestimated interpersonal functioning, and patients with non-fluent aphasia overestimated emotional and interpersonal functioning. Patients with semantic variant aphasia did not overestimate functioning on any domain. To examine the neuroanatomic correlates of impaired self-awareness, discrepancy scores were correlated with brain volume using voxel-based morphometry. To identify the unique neural correlates of overlooking versus exaggerating deficits, overestimation and underestimation scores were analysed separately, controlling for age, sex, total intracranial volume and extent of actual functional decline. Atrophy related to overestimating one's functioning included bilateral, right greater than left frontal and subcortical regions, including dorsal superior and middle frontal gyri, lateral and medial orbitofrontal gyri, right anterior insula, putamen, thalamus, and caudate, and midbrain and pons. Thus, our patients' tendency to under-represent their functional decline was related to degeneration of domain-general dorsal frontal regions involved in attention, as well as orbitofrontal and subcortical regions likely involved in assigning a reward value to self-related processing and maintaining accurate self-knowledge. The anatomic correlates of underestimation (right rostral anterior cingulate cortex, uncorrected significance level) were distinct from overestimation and had a substantially smaller effect size. This suggests that underestimation or 'tarnishing' may be influenced by non-structural neurobiological and sociocultural factors, and should not be considered to be on a continuum with overestimation or 'polishing' of functional capacity, which appears to be more directly mediated by neural circuit dysfunction.
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Affiliation(s)
- Tal Shany-Ur
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA2 The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
| | - Nancy Lin
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Howard J Rosen
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Marc Sollberger
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA3 Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Bruce L Miller
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Katherine P Rankin
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
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100
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Riedl L, Mackenzie IR, Förstl H, Kurz A, Diehl-Schmid J. Frontotemporal lobar degeneration: current perspectives. Neuropsychiatr Dis Treat 2014; 10:297-310. [PMID: 24600223 PMCID: PMC3928059 DOI: 10.2147/ndt.s38706] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The term frontotemporal lobar degeneration (FTLD) refers to a group of progressive brain diseases, which preferentially involve the frontal and temporal lobes. Depending on the primary site of atrophy, the clinical manifestation is dominated by behavior alterations or impairment of language. The onset of symptoms usually occurs before the age of 60 years, and the mean survival from diagnosis varies between 3 and 10 years. The prevalence is estimated at 15 per 100,000 in the population aged between 45 and 65 years, which is similar to the prevalence of Alzheimer's disease in this age group. There are two major clinical subtypes, behavioral-variant frontotemporal dementia and primary progressive aphasia. The neuropathology underlying the clinical syndromes is also heterogeneous. A common feature is the accumulation of certain neuronal proteins. Of these, the microtubule-associated protein tau (MAPT), the transactive response DNA-binding protein, and the fused in sarcoma protein are most important. Approximately 10% to 30% of FTLD shows an autosomal dominant pattern of inheritance, with mutations in the genes for MAPT, progranulin (GRN), and in the chromosome 9 open reading frame 72 (C9orf72) accounting for more than 80% of familial cases. Although significant advances have been made in recent years regarding diagnostic criteria, clinical assessment instruments, neuropsychological tests, cerebrospinal fluid biomarkers, and brain imaging techniques, the clinical diagnosis remains a challenge. To date, there is no specific pharmacological treatment for FTLD. Some evidence has been provided for serotonin reuptake inhibitors to reduce behavioral disturbances. No large-scale or high-quality studies have been conducted to determine the efficacy of non-pharmacological treatment approaches in FTLD. In view of the limited treatment options, caregiver education and support is currently the most important component of the clinical management.
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Affiliation(s)
- Lina Riedl
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ian R Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Hans Förstl
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Kurz
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Janine Diehl-Schmid
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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