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Liew TM. Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment. J Am Med Dir Assoc 2019; 20:1054.e11-1054.e20. [PMID: 30992186 PMCID: PMC6663638 DOI: 10.1016/j.jamda.2019.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Early diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition. DESIGN Cross-sectional diagnostic study. SETTING Alzheimer's Disease Centers across the United States. PARTICIPANTS Older participants (≥50 years) who completed MoCA and the FNB (N = 9187). MEASURES The study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia. RESULTS A 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB. CONCLUSIONS/IMPLICATIONS Using rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients' access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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The Comprehensive Assessment of Neurodegeneration and Dementia: Canadian Cohort Study. Can J Neurol Sci 2019; 46:499-511. [PMID: 31309917 DOI: 10.1017/cjn.2019.27] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams. METHODS The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here. RESULTS The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020. CONCLUSION Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
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Chavda R, Cao JS, Benge JF. Neuropsychological impact of white matter hyperintensities in older adults without dementia. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:354-362. [PMID: 31287337 DOI: 10.1080/23279095.2019.1633536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to determine (a) if simple clinical judgements of white matter hyperintensities (WMH) on imaging are associated with measurable cognitive impacts in otherwise cognitively normal older adults, (b) if neuropsychological measures can predict those with WMH, and (c) the frequency of low cognitive scores in those with WMH on a battery of measures. Forty-four individuals judged free of other cognitive disorders despite moderate to extensive WMH were compared with 50 individuals matched on age (mean of 83), education (college educated), and gender (predominantly female). Data was obtained from the National Alzheimer's Coordinating Center database. The group with at least moderate WMH had lower scores on the Trail Making Test A, verbal fluency, and digit span. A component score derived from these measures was a significant predictor of the presence of WMH, though only correctly classified 68% of participants. Even in individuals free from other suspected conditions, clinically judged moderate to extensive WMH was associated with cognitive weaknesses for processing speed, working memory, and executive functioning. This shows that a relatively simple judgment of WMH burden is meaningfully associated with worse cognition. Implications and future directions for are discussed.
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Affiliation(s)
- Rihin Chavda
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Jeffrey S Cao
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Jared F Benge
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA.,Department of Neurology and Plummer Movement Disorders Center, Baylor Scott and White Health, Temple, Texas, USA
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Salimi S, Irish M, Foxe D, Hodges JR, Piguet O, Burrell JR. Visuospatial dysfunction in Alzheimer's disease and behavioural variant frontotemporal dementia. J Neurol Sci 2019; 402:74-80. [DOI: 10.1016/j.jns.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/30/2019] [Accepted: 04/14/2019] [Indexed: 01/01/2023]
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105
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Delhaye E, Mechanic-Hamilton D, Saad L, Das SR, Wisse LEM, Yushkevich PA, Wolk DA, Bastin C. Associative memory for conceptually unitized word pairs in mild cognitive impairment is related to the volume of the perirhinal cortex. Hippocampus 2019; 29:630-638. [PMID: 30588714 PMCID: PMC6565465 DOI: 10.1002/hipo.23063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 11/06/2022]
Abstract
Unitization, that is, the encoding of an association as one integrated entity, has been shown to improve associative memory in populations presenting with associative memory deficit due to hippocampal dysfunction, such as amnesic patients with focal hippocampal lesions and healthy older adults. One reason for this benefit is that encoding of unitized associations would rely on the perirhinal cortex (PrC) and thus minimize the need for hippocampal recruitment. Mild cognitive impairment (MCI) is accompanied by a deficit in associative memory. However, unitization has never been studied to explore the potential benefit in associative memory in MCI, maybe because MCI is characterized by PrC pathology. However, the PrC may potentially still function sufficiently to allow for the successful adoption of unitization. In this study, we aimed at assessing whether unitization could attenuate MCI patients' associative memory deficit, and whether the ability to remember unitized associations would be modulated by the integrity of the PrC in MCI patients. Unitization was manipulated at a conceptual level, by encouraging participants to encode unrelated word pairs as new compound words. Participants also underwent a structural MRI exam, and measures of PrC were extracted (Brodmann Areas [BA] 35 and 36). Results showed that, contrary to healthy controls, MCI patients did not benefit from unitization. Moreover, their memory performance for unitized associations was related to the measure of PrC integrity (BA35), while it was not the case in controls. This finding thus suggests that unitization does not help to attenuate the associative deficit in MCI patients, and brings support to the literature linking unitization to the PrC function.
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Affiliation(s)
- Emma Delhaye
- GIGA-CRC In-Vivo Imaging, Liege University, Liège, Belgium
- PsyNCog, Faculty of Psychology, Liege, Belgium
| | - Dawn Mechanic-Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Saad
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandhitsu R. Das
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura E. M. Wisse
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A. Yushkevich
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A. Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine Bastin
- GIGA-CRC In-Vivo Imaging, Liege University, Liège, Belgium
- PsyNCog, Faculty of Psychology, Liege, Belgium
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Johnen A, Bertoux M. Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond. Front Neurol 2019; 10:594. [PMID: 31231305 PMCID: PMC6568027 DOI: 10.3389/fneur.2019.00594] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.
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Affiliation(s)
- Andreas Johnen
- Section for Neuropsychology, Department of Neurology, University Hospital Münster, Münster, Germany
| | - Maxime Bertoux
- Univ Lille, Inserm UMR 1171 Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
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107
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Alzheimer Disease-associated Cortical Atrophy Does not Differ Between Chinese and Whites. Alzheimer Dis Assoc Disord 2019; 33:186-193. [PMID: 31094707 DOI: 10.1097/wad.0000000000000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess whether there are differences in Alzheimer disease (AD)-associated atrophy regions in Chinese and white patients with AD versus cognitively normal older adults, and to test whether associations between clinical severity and gray matter volume are similar or different across these ethnic groups in a cross-sectional analysis. MATERIALS AND METHODS Chinese and white patients with AD, individuals with mild cognitive impairment, and cognitively normal controls (46 white and 48 Chinese) were clinically evaluated at an academic center within 1 year of magnetic resonance imaging acquisition. Clinical severity was assessed using the Clinical Dementia Rating Sum of Boxes and cortical atrophy was measured using voxel-based morphometry as well as Freesurfer. Chinese and white cohorts were demographically matched for age, sex, and education. RESULTS Clinical severity by diagnosis was similar across ethnicities. Chinese and white patient groups showed similar amounts of atrophy in the regions most affected in AD after accounting for demographic variables and head size. There was no significant difference between ethnic groups when compared by atrophy and clinical severity. CONCLUSIONS Our study suggests that Chinese and white patients with AD, when matched demographically, are clinically and neuroanatomically similar on normalized measures of cortical atrophy and clinical severity.
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108
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Torres VL, Rosselli M, Loewenstein DA, Curiel RE, Vélez Uribe I, Lang M, Arruda F, Penate A, Vaillancourt DE, Greig MT, Barker WW, Bauer RM, Duara R. Types of errors on a semantic interference task in mild cognitive impairment and dementia. Neuropsychology 2019; 33:670-684. [PMID: 31070384 DOI: 10.1037/neu0000542] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This research aimed to determine whether qualitative analysis of different types of intrusion errors on a verbal cognitive task was useful in detecting subtle cognitive impairment in preclinical stages prior to the progression to dementia. METHOD Different types of semantic intrusions on the Loewenstein-Acevedo Scales of Semantic Interference and Learning (LASSI-L) were compared across 160 individuals diagnosed as cognitively normal (CN), amnestic Mild Cognitive Impairment (aMCI), and dementia. The sample included Hispanics and non-Hispanic European Americans. RESULTS Across diagnostic groups, the most common type of intrusion error was actual targets presented from a competing word list under conditions eliciting proactive semantic interference (PSI), and retroactive semantic interference (RSI), followed by intrusions that represented one of three overlapping semantic categories but none of the targets from List A or B. Nonsemantic intrusions rarely occurred. These competing list intrusions (CLI) and semantically related intrusions (SRI) differentiated between aMCI and CN participants. Further, these intrusion error were related to brain amyloid load, indicating their importance as potential primary markers of AD-related neurodegeneration. Ethnicity effects were not seen across the types of intrusion errors. CONCLUSIONS Two types of intrusion errors (CLI and SRI) showed differences between the CN and aMCI group, with the aMCI group evidencing a higher rate of these intrusion errors compared with the CN group. These results support previous literature about the LASSI-L's sensitivity at the earliest stages of abnormal aging. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Merike Lang
- 1Florida Alzheimer's Disease Research Center
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109
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Delvecchio G, Rossetti MG, Caletti E, Arighi A, Galimberti D, Basilico P, Mercurio M, Paoli R, Cinnante C, Triulzi F, Altamura AC, Scarpini E, Brambilla P. The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study. PSYCHOSOMATICS 2019; 60:278-288. [DOI: 10.1016/j.psym.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022]
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Wharton W, Goldstein FC, Tansey MG, Brown AL, Tharwani SD, Verble DD, Cintron A, Kehoe PG. Rationale and Design of the Mechanistic Potential of Antihypertensives in Preclinical Alzheimer's (HEART) Trial. J Alzheimers Dis 2019; 61:815-824. [PMID: 29254080 DOI: 10.3233/jad-161198] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Research indicates that certain antihypertensive medications alter Alzheimer's disease (AD) biomarkers in Caucasians. The renin angiotensin system (RAS) regulates blood pressure (BP) in the body and the brain and may directly influence AD biomarkers, including amyloid-β (Aβ) neuropathology, cerebral blood flow (CBF), and inflammatory markers. This hypothesis is supported by studies, including ours, showing that antihypertensives targeting the RAS reduce the risk and slow the progression of AD in Caucasians. While mounting evidence supports a protective role of RAS medications in Caucasians, this mechanism has not been explored in African Americans. To assess the mechanism by which RAS medications modify the brain RAS, cerebrospinal fluid (CSF) Aβ, CBF, and inflammatory markers in African Americans, we are conducting an eight month, Phase Ib randomized, placebo controlled trial, enrolling 60 middle-aged (45-70 years), non-demented individuals, at risk for AD by virtue of a parental history. Participants include normotensive and treated hypertensives that have never been exposed to a RAS medication. Participants are randomized (1 : 1:1) by gender and BP medication use (yes/no) to one of three groups: placebo, or 20 mg, or 40 mg telmisartan (Micardis), to determine the dose required to penetrate the CNS. Our overarching hypothesis is that, compared to placebo, both doses of telmisartan will penetrate the CNS and produce salutary, dose dependent effects on the brain RAS as well as CSF Aβ, CBF, and CSF inflammatory markers in African Americans, over eight months. This manuscript describes the trial rationale and design.
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Affiliation(s)
- Whitney Wharton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Malú G Tansey
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexandra L Brown
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sonum D Tharwani
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle D Verble
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amarallys Cintron
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick G Kehoe
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Learning and Research, Southmead Hospital, Bristol, UK
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Abstract
OBJECTIVES Maintaining two active languages may increase cognitive and brain reserve among bilingual individuals. We explored whether such a neuroprotective effect was manifested in the performance of memory tests for participants with amnestic mild cognitive impairment (aMCI). METHODS We compared 42 bilinguals to 25 monolinguals on verbal and nonverbal memory tests. We used: (a) the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), a sensitive test that taps into proactive, retroactive, and recovery from proactive semantic interference (verbal memory), and (b) the Benson Figure delayed recall (nonverbal memory). A subsample had volumetric MRI scans. RESULTS The bilingual group significantly outperformed the monolingual group on two LASSI-L cued recall measures (Cued A2 and Cued B2). A measure of maximum learning (Cued A2) showed a correlation with the volume of the left hippocampus in the bilingual group only. Cued B2 recall (sensitive to recovery from proactive semantic interference) was correlated with the volume of the hippocampus and the entorhinal cortex of both cerebral hemispheres in the bilingual group, as well as with the left and right hippocampus in the monolingual group. The memory advantage in bilinguals on these measures was associated with higher inhibitory control as measured by the Stroop Color-Word test. CONCLUSIONS Our results demonstrated a superior performance of aMCI bilinguals over aMCI monolinguals on selected verbal memory tasks. This advantage was not observed in nonverbal memory. Superior memory performance of bilinguals over monolinguals suggests that bilinguals develop a different and perhaps more efficient semantic association system that influences verbal recall. (JINS, 2019, 25, 15-28).
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Fredericks CA, Brown JA, Deng J, Kramer A, Ossenkoppele R, Rankin K, Kramer JH, Miller BL, Rabinovici GD, Seeley WW. Intrinsic connectivity networks in posterior cortical atrophy: A role for the pulvinar? Neuroimage Clin 2018; 21:101628. [PMID: 30528957 PMCID: PMC6411779 DOI: 10.1016/j.nicl.2018.101628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/26/2018] [Accepted: 12/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) is a clinical variant of Alzheimer's disease (AD) that presents with progressive visuospatial symptoms. While amnestic AD is characterized by disrupted default mode network (DMN) connectivity with corresponding increases in salience network (SN) connectivity, a visuospatial network appears to be disrupted early in PCA. Based on PCA patients' clinical features, we hypothesized that, in addition to early decreased integrity within the visuospatial network, patients with PCA would show increases in SN connectivity despite relative preservation of DMN. As the lateral pulvinar nucleus of the thalamus has direct anatomical connections with striate and extrastriate cortex and DMN, and the medial pulvinar is anatomically interconnected with SN, we further hypothesized that lateral and medial pulvinar nuclei might be implicated in intrinsic connectivity changes in PCA. METHODS 26 patients with PCA and 64 matched controls were recruited through UCSF Memory and Aging Center research programs. Each completed a standardized neuropsychological battery, structural MRI, and task-free fMRI. Seed-based functional correlations were used to probe networks of interest, including those seeded by the medial and lateral pulvinar thalamic nuclei, across the whole brain, and functional data analyses were adjusted for brain atrophy. RESULTS Patients with PCA showed disproportionate deficits in the visuospatial domain; they also showed preserved social sensitivity and endorsed more depressive symptoms than HCs. PCA patients had significant parietooccipital atrophy accompanied by widespread connectivity decreases within the visuospatial network, enhanced connectivity between some structures in SN, and enhanced connectivity between key nodes of the DMN compared to controls. Increased SN connectivity correlated with a measure of social sensitivity, and increased DMN connectivity correlated with short-term memory performance. Medial pulvinar connectivity increases in PCA were topographically similar to SN (anterior insula) connectivity increases, while lateral pulvinar connectivity increases were similar to DMN (posterior cingulate) connectivity increases. CONCLUSIONS PCA is characterized by preserved to heightened connectivity in the SN and DMN despite decreased visuospatial network connectivity. The spatial similarity of medial and lateral pulvinar connectivity changes to those seen in the SN and DMN suggests a role for the pulvinar in intrinsic connectivity network changes in PCA.
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Affiliation(s)
- Carolyn A Fredericks
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Jesse A Brown
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Jersey Deng
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
| | - Abigail Kramer
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Rik Ossenkoppele
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Katherine Rankin
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Joel H Kramer
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Bruce L Miller
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - Gil D Rabinovici
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
| | - William W Seeley
- Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA 94143, USA.
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Gurvich C, Gavrilidis E, Worsley R, Hudaib A, Thomas N, Kulkarni J. Menstrual cycle irregularity and menopause status influence cognition in women with schizophrenia. Psychoneuroendocrinology 2018; 96:173-178. [PMID: 29980009 DOI: 10.1016/j.psyneuen.2018.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
Cognitive impairments are a core feature of schizophrenia and contribute significantly to functional complications. Current pharmacological treatments do not ameliorate cognitive dysfunction and the aetiology of cognitive impairments are poorly understood. Hormones of the hypothalamic-pituitary-gonadal (HPG) axis that regulate reproductive function have multiple effects on the development, maintenance and function of the brain and have been suggested to also influence cognition. The aim of the current study was to investigate how HPG axis hormones effect cognition, specifically exploring the influence of menopause status and menstrual cycle irregularity on cognitive performance in women with schizophrenia. The data for the present study represents pooled baseline data from three clinical trials. Two hundred and forty female participants with a diagnosis of schizophrenia or schizoaffective disorder were included in the analysis. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. Hormone assays for serum sex steroids and pituitary hormones (including estradiol, progesterone, luteinising hormone and follicle-stimulating hormone) were conducted and women were classified as postmenopausal; perimenopausal; premenopausal/reproductive, further classified into regular and irregular menstrual cycles. To model a comparison of cognitive performance for i) perimenopausal; ii) post-menopausal women and iii) reproductive aged women with irregular cycles to reproductive aged women with regular cycles a semiparametric regression model (generalised additive mode) was fitted. The results revealed that in females with schizophrenia, menstrual cycle irregularity predicted significantly poorer cognitive performance in the areas of psychomotor speed, verbal fluency and verbal memory. Perimenopause was not associated with cognitive changes and the post-menopausal period was associated with poorer visuospatial performance. This study provides evidence to associate reproductive hormones with cognitive dysfunction in schizophrenia.
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Affiliation(s)
- C Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia.
| | - E Gavrilidis
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - R Worsley
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - A Hudaib
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - N Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - J Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
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Freedman M, Leach L, Carmela Tartaglia M, Stokes KA, Goldberg Y, Spring R, Nourhaghighi N, Gee T, Strother SC, Alhaj MO, Borrie M, Darvesh S, Fernandez A, Fischer CE, Fogarty J, Greenberg BD, Gyenes M, Herrmann N, Keren R, Kirstein J, Kumar S, Lam B, Lena S, McAndrews MP, Naglie G, Partridge R, Rajji TK, Reichmann W, Uri Wolf M, Verhoeff NPLG, Waserman JL, Black SE, Tang-Wai DF. The Toronto Cognitive Assessment (TorCA): normative data and validation to detect amnestic mild cognitive impairment. ALZHEIMERS RESEARCH & THERAPY 2018; 10:65. [PMID: 30021658 PMCID: PMC6052695 DOI: 10.1186/s13195-018-0382-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022]
Abstract
Background A need exists for easily administered assessment tools to detect mild cognitive changes that are more comprehensive than screening tests but shorter than a neuropsychological battery and that can be administered by physicians, as well as any health care professional or trained assistant in any medical setting. The Toronto Cognitive Assessment (TorCA) was developed to achieve these goals. Methods We obtained normative data on the TorCA (n = 303), determined test reliability, developed an iPad version, and validated the TorCA against neuropsychological assessment for detecting amnestic mild cognitive impairment (aMCI) (n = 50/57, aMCI/normal cognition). For the normative study, healthy volunteers were recruited from the Rotman Research Institute registry. For the validation study, the sample was comprised of participants with aMCI or normal cognition based on neuropsychological assessment. Cognitively normal participants were recruited from both healthy volunteers in the normative study sample and the community. Results The TorCA provides a stable assessment of multiple cognitive domains. The total score correctly classified 79% of participants (sensitivity 80%; specificity 79%). In an exploratory logistic regression analysis, indices of Immediate Verbal Recall, Delayed Verbal and Visual Recall, Visuospatial Function, and Working Memory/Attention/Executive Control, a subset of the domains assessed by the TorCA, correctly classified 92% of participants (sensitivity 92%; specificity 91%). Paper and iPad version scores were equivalent. Conclusions The TorCA can improve resource utilization by identifying patients with aMCI who may not require more resource-intensive neuropsychological assessment. Future studies will focus on cross-validating the TorCA for aMCI, and validation for disorders other than aMCI.
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Affiliation(s)
- Morris Freedman
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada. .,Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada. .,Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada. .,Toronto Dementia Research Alliance, Toronto, ON, Canada. .,Mt. Sinai Hospital, Toronto, ON, Canada.
| | - Larry Leach
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychology, Glendon College, Toronto, ON, Canada
| | - M Carmela Tartaglia
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, Toronto, ON, Canada
| | - Kathryn A Stokes
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Yael Goldberg
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Robyn Spring
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Nima Nourhaghighi
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom Gee
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Stephen C Strother
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Mohammad O Alhaj
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.,Canada International Scientific Exchange Program, Toronto, ON, Canada
| | - Michael Borrie
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Institute, London, ON, Canada
| | - Sultan Darvesh
- Department of Medicine (Neurology and Geriatric Medicine) and Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Alita Fernandez
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Corinne E Fischer
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jennifer Fogarty
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Institute, London, ON, Canada
| | - Barry D Greenberg
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Michelle Gyenes
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Nathan Herrmann
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ron Keren
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Josh Kirstein
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Sanjeev Kumar
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benjamin Lam
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Suvendrini Lena
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mary Pat McAndrews
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gary Naglie
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.,Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Medicine (Geriatric Medicine) and Institute of Health Policy, University of Toronto, Toronto, ON, Canada
| | - Robert Partridge
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Tarek K Rajji
- Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - William Reichmann
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M Uri Wolf
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicolaas P L G Verhoeff
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jordana L Waserman
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,LC Campbell Cognitive Neurology Research Unit, Toronto, ON, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.,Toronto Dementia Research Alliance, Toronto, ON, Canada.,Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
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Hua AY, Sible IJ, Perry DC, Rankin KP, Kramer JH, Miller BL, Rosen HJ, Sturm VE. Enhanced Positive Emotional Reactivity Undermines Empathy in Behavioral Variant Frontotemporal Dementia. Front Neurol 2018; 9:402. [PMID: 29915557 PMCID: PMC5994409 DOI: 10.3389/fneur.2018.00402] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disease characterized by profound changes in emotions and empathy. Although most patients with bvFTD become less sensitive to negative emotional cues, some patients become more sensitive to positive emotional stimuli. We investigated whether dysregulated positive emotions in bvFTD undermine empathy by making it difficult for patients to share (emotional empathy), recognize (cognitive empathy), and respond (real-world empathy) to emotions in others. Fifty-one participants (26 patients with bvFTD and 25 healthy controls) viewed photographs of neutral, positive, negative, and self-conscious emotional faces and then identified the emotions displayed in the photographs. We used facial electromyography to measure automatic, sub-visible activity in two facial muscles during the task: Zygomaticus major (ZM), which is active during positive emotional reactions (i.e., smiling), and Corrugator supercilii (CS), which is active during negative emotional reactions (i.e., frowning). Participants rated their baseline positive and negative emotional experience before the task, and informants rated participants' real-world empathic behavior on the Interpersonal Reactivity Index. The majority of participants also underwent structural magnetic resonance imaging. A mixed effects model found a significant diagnosis X trial interaction: patients with bvFTD showed greater ZM reactivity to neutral, negative (disgust and surprise), self-conscious (proud), and positive (happy) faces than healthy controls. There was no main effect of diagnosis or diagnosis X trial interaction on CS reactivity. Compared to healthy controls, patients with bvFTD had impaired emotion recognition. Multiple regression analyses revealed that greater ZM reactivity predicted worse negative emotion recognition and worse real-world empathy. At baseline, positive emotional experience was higher in bvFTD than healthy controls and also predicted worse negative emotion recognition. Voxel-based morphometry analyses found that smaller volume in the thalamus, midcingulate cortex, posterior insula, anterior temporal pole, amygdala, precentral gyrus, and inferior frontal gyrus—structures that support emotion generation, interoception, and emotion regulation—was associated with greater ZM reactivity in bvFTD. These findings suggest that dysregulated positive emotional reactivity may relate to reduced empathy in bvFTD by making patients less likely to tune their reactions to the social context and to share, recognize, and respond to others' feelings and needs.
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Affiliation(s)
- Alice Y Hua
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Isabel J Sible
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - David C Perry
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Virginia E Sturm
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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Abstract
PURPOSE OF REVIEW This article presents a clinically useful approach to obtaining the history and performing the mental status examination of patients with cognitive, language, or behavioral problems. RECENT FINDINGS Laboratory and imaging biomarkers are being developed for accurate diagnosis of neurobehavioral disorders, yet few are currently available for clinical use. Moreover, not all centers have access to these potential tools. Practicing clinicians are therefore left primarily with their skills of history taking and examination. Although geared for research, diagnostic criteria have been refined over the past several years and can nevertheless aid the clinician with the diagnosis of disorders such as mild cognitive impairment, Alzheimer disease, frontotemporal dementia, dementia with Lewy bodies, the primary progressive aphasias, corticobasal syndrome, vascular cognitive impairment, and posterior cortical atrophy. Regularly revised criteria reflect ongoing knowledge gained from in-depth studies of these disorders. SUMMARY The focused history and mental status examination remain essential tools for the evaluation and diagnosis of neurologic disorders affecting cognition, language, and behavior.
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117
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Toller G, Brown J, Sollberger M, Shdo SM, Bouvet L, Sukhanov P, Seeley WW, Miller BL, Rankin KP. Individual differences in socioemotional sensitivity are an index of salience network function. Cortex 2018; 103:211-223. [PMID: 29656245 PMCID: PMC6143366 DOI: 10.1016/j.cortex.2018.02.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/09/2018] [Accepted: 02/18/2018] [Indexed: 12/12/2022]
Abstract
Connectivity in intrinsically connected networks (ICNs) may predict individual differences in cognition and behavior. The drastic alterations in socioemotional awareness of patients with behavioral variant frontotemporal dementia (bvFTD) are presumed to arise from changes in one such ICN, the salience network (SN). We examined how individual differences in SN connectivity are reflected in overt social behavior in healthy individuals and patients, both to provide neuroscientific insight into this key brain-behavior relationship, and to provide a practical tool to diagnose patients with early bvFTD. We measured SN functional connectivity and socioemotional sensitivity in 65 healthy older adults and 103 patients in the earliest stage [Clinical Dementia Rating (CDR) Scale score ≤1] of five neurodegenerative diseases [14 bvFTD, 29 Alzheimer's disease (AD), 20 progressive supranuclear palsy (PSP), 21 semantic variant primary progressive aphasia (svPPA), and 19 non-fluent variant primary progressive aphasia (nfvPPA)]. All participants underwent resting-state functional imaging and an informant described their responsiveness to subtle emotional expressions using the Revised Self-Monitoring Scale (RSMS). Higher functional connectivity in the SN, predominantly between the right anterior insula (AI) and both "hub" cortical and "interoceptive" subcortical nodes, predicted socioemotional sensitivity among healthy individuals, showing that socioemotional sensitivity is a behavioral marker of SN function, and particularly of right AI functional connectivity. The continuity of this relationship in both healthy and neurologically affected individuals highlights the role of socioemotional sensitivity as an early diagnostic marker of SN connectivity. Clinically, this is particularly important for identification of patients in the earliest stage of bvFTD, where the SN is selectively vulnerable.
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Affiliation(s)
- Gianina Toller
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Jesse Brown
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Marc Sollberger
- Memory Clinic, University Center for Medicine of Aging, Felix Platter-Hospital, Basel, Switzerland; Department of Neurology, University Hospital Basel, Basel, Switzerland.
| | - Suzanne M Shdo
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Laura Bouvet
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Paul Sukhanov
- Memory and Aging Center, University of California, San Francisco, United States.
| | - William W Seeley
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Katherine P Rankin
- Memory and Aging Center, University of California, San Francisco, United States.
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118
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Gossink F, Schouws S, Krudop W, Scheltens P, Stek M, Pijnenburg Y, Dols A. Social Cognition Differentiates Behavioral Variant Frontotemporal Dementia From Other Neurodegenerative Diseases and Psychiatric Disorders. Am J Geriatr Psychiatry 2018; 26:569-579. [PMID: 29501411 DOI: 10.1016/j.jagp.2017.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Although deficits in social cognition are established as core features in behavioral variant frontotemporal dementia (bvFTD), it remains unresolved if impaired social cognition distinguishes bvFTD from the broad differential diagnoses in clinical practice. Our aim was to study whether social cognition discriminates bvFTD from other neurodegenerative diseases and psychiatric disorders in patients presenting with late-onset frontal symptoms. Next, we studied the association of social cognition with frontal symptoms and cognitive functioning. METHODS In this longitudinal multicenter study, besides clinical rating scales for frontal symptoms, social cognition was determined by Ekman 60 Faces test and Faux Pas in addition to neuropsychological tests for other cognitive domains in patients with probable and definite bvFTD (N = 22), other neurodegenerative diseases (N = 24), and psychiatric disorders (N = 33). Median symptom duration was 2.8 years, and patients were prospectively followed over 2 years. RESULTS Total scores from Ekman 60 Faces test were significantly lower in bvFTD than in other neurodegenerative diseases and psychiatric disorders. Ekman 60 Faces test explained 91.2% of the variance of psychiatric disorders and other neurodegenerative diseases versus bvFTD (χ2 = 11.02, df = 1, p = 0.001) and was associated with all other cognitive domains. Faux Pas and the other cognitive domains did not differ between these diagnostic groups. CONCLUSION In this clinical sample Ekman 60 Faces test distinguished bvFTD successfully from other neurodegenerative diseases and psychiatric disorders. Although associated with social cognition, other cognitive domains were not discriminative. This study provides arguments to add the Ekman 60 Faces test to the neuropsychological examination in the diagnostic procedure of bvFTD.
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Affiliation(s)
- Flora Gossink
- Department of Old Age Psychiatry, GGZinGeest, VU University Medical Center, Amsterdam, The Netherlands; Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZinGeest, VU University Medical Center, Amsterdam, The Netherlands
| | - Welmoed Krudop
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, GGZinGeest, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest, VU University Medical Center, Amsterdam, The Netherlands; Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest, VU University Medical Center, Amsterdam, The Netherlands; Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
OBJECTIVES The aim of this study was to identify whether the three main primary progressive aphasia (PPA) variants would show differential profiles on measures of visuospatial cognition. We hypothesized that the logopenic variant would have the most difficulty across tasks requiring visuospatial and visual memory abilities. METHODS PPA patients (n=156), diagnosed using current criteria, and controls were tested on a battery of tests tapping different aspects of visuospatial cognition. We compared the groups on an overall visuospatial factor; construction, immediate recall, delayed recall, and executive functioning composites; and on individual tests. Cross-sectional and longitudinal comparisons were made, adjusted for disease severity, age, and education. RESULTS The logopenic variant had significantly lower scores on the visuospatial factor and the most impaired scores on all composites. The nonfluent variant had significant difficulty on all visuospatial composites except the delayed recall, which differentiated them from the logopenic variant. In contrast, the semantic variants performed poorly only on delayed recall of visual information. The logopenic and nonfluent variants showed decline in figure copying performance over time, whereas in the semantic variant, this skill was remarkably preserved. CONCLUSIONS This extensive examination of performance on visuospatial tasks in the PPA variants solidifies some previous findings, for example, delayed recall of visual stimuli adds value in differential diagnosis between logopenic variant PPA and nonfluent variant PPA variants, and illuminates the possibility of common mechanisms that underlie both linguistic and non-linguistic deficits in the variants. Furthermore, this is the first study that has investigated visuospatial functioning over time in the PPA variants. (JINS, 2018, 24, 259-268).
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Abstract
Since the classic papers of Kleist, Mayer Gross, and Critchley, constructional apraxia (CA) has been considered to be a typical sign of a parietal lobe lesion, and as a precious tool to appreciate the spatial abilities subserved by this lobe. However, the development of more sophisticated neuropsychologic models and methods of investigation has revealed several problematic aspects. It has become increasingly clear that CA is a heterogeneous construct that can be examined with very different tasks, that are only mildly interconnected, and tap various kinds of visuospatial, perceptual, attentional, planning, and motor mechanisms. On the basis of these considerations, the relationships between parietal lobe functions and constructional activities must be considered, taking into account on the one hand the heterogeneity of the tasks and of the cognitive functions requested by different kinds of constructional activities and, on the other hand, the plurality of functions and of processing streams linking different parts of the parietal lobes to the occipital and frontal lobes.
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121
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Weintraub S, Besser L, Dodge HH, Teylan M, Ferris S, Goldstein FC, Giordani B, Kramer J, Loewenstein D, Marson D, Mungas D, Salmon D, Welsh-Bohmer K, Zhou XH, Shirk SD, Atri A, Kukull WA, Phelps C, Morris JC. Version 3 of the Alzheimer Disease Centers' Neuropsychological Test Battery in the Uniform Data Set (UDS). Alzheimer Dis Assoc Disord 2018; 32:10-17. [PMID: 29240561 PMCID: PMC5821520 DOI: 10.1097/wad.0000000000000223] [Citation(s) in RCA: 336] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/29/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The neuropsychological battery of the Uniform Data Set (UDSNB) was implemented in 2005 by the National Institute on Aging (NIA) Alzheimer Disease Centers program to measure cognitive performance in dementia and mild cognitive impairment due to Alzheimer Disease. This paper describes a revision, the UDSNB 3.0. METHODS The Neuropsychology Work Group of the NIA Clinical Task Force recommended revisions through a process of due diligence to address shortcomings of the original battery. The UDSNB 3.0 covers episodic memory, processing speed, executive function, language, and constructional ability. Data from 3602 cognitively normal participants in the National Alzheimer Coordinating Center database were analyzed. RESULTS Descriptive statistics are presented. Multivariable linear regression analyses demonstrated score differences by age, sex, and education and were also used to create a normative calculator available online. DISCUSSION The UDSNB 3.0 neuropsychological battery provides a valuable non proprietary resource for conducting research on cognitive aging and dementia.
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Affiliation(s)
- Sandra Weintraub
- Departments of Psychiatry
- Neurology Northwestern University Feinberg School of Medicine, Cognitive Neurology and Alzheimer’s Disease Center, Chicago, IL
| | - Lilah Besser
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA
| | - Hiroko H. Dodge
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI
| | - Merilee Teylan
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA
| | - Steven Ferris
- Alzheimer’s Disease Center, New York University, New York, NY
| | - Felicia C. Goldstein
- Department of Neurology, Alzheimer’s Disease Center, Emory University, Atlanta, GA
| | - Bruno Giordani
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI
| | - Joel Kramer
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA
| | - David Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miller Medical School, Miami, FL
| | - Dan Marson
- Department of Psychiatry, Alzheimer’s Disease Center, University of Alabama-Birmingham, Birmingham, AL
| | - Dan Mungas
- Department of Neurology, University of California-Davis, Sacramento, CA
| | - David Salmon
- Department of Neurosciences, University of California- San Diego Medical School, San Diego, CA
| | | | - Xiao-Hua Zhou
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA
| | - Steven D. Shirk
- Mental Illness Research Education Clinical Center, ENRM Veterans Affairs Hospital, Bedford, MA
| | - Alireza Atri
- Ray Dolby Brain Health Center
- California Pacific Medical Center, San Francisco, CA
- Department of Neurology, Harvard Medical School, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Walter A. Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA
| | | | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Possin KL, Moskowitz T, Erlhoff SJ, Rogers K, Johnson ET, Steele NZ, Higgins JJ, Stiver J, Alioto AG, Farias ST, Miller BL, Rankin KP. The Brain Health Assessment for Detecting and Diagnosing Neurocognitive Disorders. J Am Geriatr Soc 2018; 66:150-156. [PMID: 29355911 PMCID: PMC5889617 DOI: 10.1111/jgs.15208] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/OBJECTIVES Brief cognitive screens lack the sensitivity to detect mild cognitive impairment (MCI) or support differential diagnoses. The objective of this study was to validate the 10-minute, tablet-based University of California, San Francisco (UCSF) Brain Health Assessment (BHA) to overcome these limitations. DESIGN Cross-sectional. SETTING UCSF Memory and Aging Center. PARTICIPANTS Older adults (N = 347) (neurologically healthy controls (n = 185), and individuals diagnosed with MCI (n = 99), dementia (n = 42), and as normal with concerns (n = 21)). MEASUREMENTS The BHA includes subtests of memory, executive function and speed, visuospatial skills, and language and an optional informant survey. Participants completed the Montreal Cognitive Assessment (MoCA) and criterion-standard neuropsychological tests. Standardized structural 3T brain magnetic resonance imaging was performed in 145 participants. RESULTS At a fixed 85% specificity rate, the BHA had 100% sensitivity to dementia and 84% to MCI; the MoCA had 75% sensitivity to dementia and 25% to MCI. The BHA had 83% sensitivity to MCI likely due to AD and 88% to MCI unlikely due to AD, and the MoCA had 58% sensitivity to MCI likely AD and 24% to MCI unlikely AD. The BHA subtests demonstrated moderate to high correlations with the criterion-standard tests from their respective cognitive domains. Memory test performance correlated with medial temporal lobe volumes; executive and speed with frontal, parietal, and basal ganglia volumes; and visuospatial with right parietal volumes. CONCLUSION The BHA had excellent combined sensitivity and specificity to detect dementia and MCI, including MCI due to diverse etiologies. The subtests provide efficient, valid measures of neurocognition that are critical in making a differential diagnosis.
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Affiliation(s)
| | - Tacie Moskowitz
- University of California San Francisco, San Francisco, CA USA
| | | | - Kirsten Rogers
- University of California San Francisco, San Francisco, CA USA
| | | | | | | | - Jordan Stiver
- University of California San Francisco, San Francisco, CA USA
| | | | | | - Bruce L. Miller
- University of California San Francisco, San Francisco, CA USA
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Gazzina S, Benussi A, Premi E, Paternicò D, Cristillo V, Dell’Era V, Cosseddu M, Archetti S, Alberici A, Gasparotti R, Padovani A, Borroni B. Neuroanatomical Correlates of Transcranial Magnetic Stimulation in Presymptomatic Granulin Mutation Carriers. Brain Topogr 2017; 31:488-497. [DOI: 10.1007/s10548-017-0612-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/09/2017] [Indexed: 12/13/2022]
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Salimi S, Irish M, Foxe D, Hodges JR, Piguet O, Burrell JR. Can visuospatial measures improve the diagnosis of Alzheimer's disease? ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 10:66-74. [PMID: 29780858 PMCID: PMC5956809 DOI: 10.1016/j.dadm.2017.10.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction Overlapping and evolving symptoms lead to ambiguity in the diagnosis of dementia. Visuospatial function relies on parietal lobe function, which may be affected in the early stages of Alzheimer's disease (AD). This review evaluates visuospatial dysfunction in patients with AD, frontotemporal dementia, dementia with Lewy bodies, and vascular dementia to determine the diagnostic and prognostic potential of visuospatial tasks in AD. Methods A systematic search of studies (1960–2016) investigating visuospatial dysfunction in dementia was conducted. Results Tests measuring construction, specifically Block Design and Clock Drawing Test, and visual memory, specifically Rey-Osterrieth Complex Figure recall and topographical tasks, show the greatest diagnostic potential in dementia. The Benton visual retention, Doors and People, and topographical memory tests show potential as prognostic markers. Discussion Tests of visuospatial function demonstrate significant diagnostic and prognostic potential in dementia. Further studies with larger samples of pathologically confirmed cases are required to verify clinical utility. Memory deficits have been demonstrated in Alzheimer's and non-Alzheimer's dementias. Parietal lobes are uniquely affected in the early stages of Alzheimer's disease. Visuospatial tasks demonstrate significant diagnostic and prognostic potential. Computerized test protocols have been developed to test aspects of visuospatial function and memory. Novel topographical memory tasks demonstrated the greatest prognostic potential.
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Affiliation(s)
- Shirin Salimi
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - David Foxe
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - John R Hodges
- Central Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - James R Burrell
- Central Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.,Neurosciences, Concord Hospital, Sydney, New South Wales, Australia
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125
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Benge JF, Balsis S, Madeka T, Uhlman C, Lantrip C, Soileau MJ. Factor structure of the Montreal Cognitive Assessment items in a sample with early Parkinson's disease. Parkinsonism Relat Disord 2017; 41:104-108. [DOI: 10.1016/j.parkreldis.2017.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
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126
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Casaletto KB, Marx G, Dutt S, Neuhaus J, Saloner R, Kritikos L, Miller B, Kramer JH. Is "Learning" episodic memory? Distinct cognitive and neuroanatomic correlates of immediate recall during learning trials in neurologically normal aging and neurodegenerative cohorts. Neuropsychologia 2017; 102:19-28. [PMID: 28549937 DOI: 10.1016/j.neuropsychologia.2017.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 11/19/2022]
Abstract
Although commonly interpreted as a marker of episodic memory during neuropsychological exams, relatively little is known regarding the neurobehavior of "total learning" immediate recall scores. Medial temporal lobes are clearly associated with delayed recall performances, yet immediate recall may necessitate networks beyond traditional episodic memory. We aimed to operationalize cognitive and neuroanatomic correlates of total immediate recall in several aging syndromes. Demographically-matched neurologically normal adults (n=91), individuals with Alzheimer's disease (n=566), logopenic variant primary progressive aphasia (PPA) (n=34), behavioral variant frontotemporal dementia (n=97), semantic variant PPA (n=71), or nonfluent/agrammatic variant PPA (n=39) completed a neurocognitive battery, including the CVLT-Short Form trials 1-4 Total Immediate Recall; a majority subset also completed a brain MRI. Regressions covaried for age and sex, and MMSE in cognitive and total intracranial volume in neuroanatomic models. Neurologically normal adults demonstrated a heterogeneous pattern of cognitive associations with total immediate recall (executive, speed, delayed recall), such that no singular cognitive or neuroanatomic correlate uniquely predicted performance. Within the clinical cohorts, there were syndrome-specific cognitive and neural associations with total immediate recall; e.g., semantic processing was the strongest cognitive correlate in svPPA (partial r=0.41), while frontal volumes was the only meaningful neural correlate in bvFTD (partial r=0.20). Medial temporal lobes were not independently associated with total immediate recall in any group (ps>0.05). Multiple neurobehavioral systems are associated with "total learning" immediate recall scores that importantly differ across distinct clinical syndromes. Conventional memory networks may not be sufficient or even importantly contribute to total immediate recall in many syndromes. Interpreting learning scores as equivalent to episodic memory may be erroneous.
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Affiliation(s)
- K B Casaletto
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - G Marx
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - S Dutt
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - J Neuhaus
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - R Saloner
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - L Kritikos
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
| | - B Miller
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA
| | - J H Kramer
- University of California, San Francisco, Department of Neurology, 675 Rising Nelson Lane, San Francisco, CA 94158 USA.
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127
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Costa A, Bak T, Caffarra P, Caltagirone C, Ceccaldi M, Collette F, Crutch S, Della Sala S, Démonet JF, Dubois B, Duzel E, Nestor P, Papageorgiou SG, Salmon E, Sikkes S, Tiraboschi P, van der Flier WM, Visser PJ, Cappa SF. The need for harmonisation and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group. ALZHEIMERS RESEARCH & THERAPY 2017; 9:27. [PMID: 28412978 PMCID: PMC5392959 DOI: 10.1186/s13195-017-0254-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status. Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a “big data” common data set. We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe. A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries.
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Affiliation(s)
- Alberto Costa
- Niccolò Cusano University, via Don Carlo Gnocchi, 3, Rome, Italy. .,IRCCS Fondazione Santa Lucia, via Ardeatina 354, Rome, Italy.
| | - Thomas Bak
- University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, Scotland, UK
| | | | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, via Ardeatina 354, Rome, Italy.,Medicina dei sistemi, Tor Vergata University, Via Montpellier, 1, Rome, Italy
| | - Mathieu Ceccaldi
- University Hospital La Timone, 264 Rue Saint-Pierre, Marseille, France.,Aix Marseille University, Jardin du Pharo, 58 Boulevard Charles Livon, Marseille, France
| | - Fabienne Collette
- National Fund for Scientific Research (F.R.S-FNRS), Quartier Agora place des Orateurs 1, Liège, Belgium.,Cyclotron Research Centre, University of Liege, Allée du VI août, 8, Liège, Belgium
| | - Sebastian Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College of London, Queen Square, WC1N 3BG, London, UK
| | | | - Jean François Démonet
- Leenaards Memory Centre CHUV, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IMMA), Hôpital de la Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, Paris, France
| | - Emrah Duzel
- Dementia Research Centre, UCL Institute of Neurology, University College of London, Queen Square, WC1N 3BG, London, UK.,German Center for Neurodegenerative Diseases (DZNE), Holbeinstraße 13-15, Bonn, Germany
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Holbeinstraße 13-15, Bonn, Germany
| | - Sokratis G Papageorgiou
- Medical School, National and Kapodistrian University of Athens, Rimini street, 124 62, Haidari, Athens, Greece
| | - Eric Salmon
- Cyclotron Research Centre, University of Liege, Allée du VI août, 8, Liège, Belgium.,University Hospital of Liege, Liege, Belgium
| | - Sietske Sikkes
- Alzheimer Center/dpt Neurology, VU University Medical Center of Amsterdam, Amsterdam Neuroscience, De Boelelaan 1118, Amsterdam, The Netherlands
| | - Pietro Tiraboschi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria, 11, Milan, Italy
| | - Wiesje M van der Flier
- Alzheimer Center/dpt Neurology, VU University Medical Center of Amsterdam, Amsterdam Neuroscience, De Boelelaan 1118, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Maastricht University Medical Centre, Dr. Tanslaan 12, Maastricht, The Netherlands
| | - Stefano F Cappa
- IUSS Pavia, Piazza della Vittoria 15, 27100, Pavia, Italy.,IRCCS Centro San Giovanni di Dio, via Pilastroni 4, Brescia, Italy
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128
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Trojano L, Gainotti G. Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia. J Alzheimers Dis 2017; 53:31-52. [PMID: 27104898 DOI: 10.3233/jad-160009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
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Affiliation(s)
- Luigi Trojano
- Department of Psychology, Second University of Naples, Italy.,S. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy
| | - Guido Gainotti
- Center for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
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129
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Bonham LW, Sirkis DW, Fan J, Aparicio RE, Tse M, Ramos EM, Wang Q, Coppola G, Rosen HJ, Miller BL, Yokoyama JS. Identification of a rare coding variant in TREM2 in a Chinese individual with Alzheimer's disease. Neurocase 2017; 23:65-69. [PMID: 28376694 PMCID: PMC5639900 DOI: 10.1080/13554794.2017.1294182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rare variation in the TREM2 gene is associated with a broad spectrum of neurodegenerative disorders including Alzheimer's disease (AD). TREM2 encodes a receptor expressed in microglia which is thought to influence neurodegeneration by sensing damage signals and regulating neuroinflammation. Many of the variants reported to be associated with AD, including the rare R47H variant, were discovered in populations of European ancestry and have not replicated in diverse populations from other genetic backgrounds. We utilized a cohort of elderly Chinese individuals diagnosed as cognitively normal, or with mild cognitive impairment or AD to identify a rare variant, A192T, present in a single patient diagnosed with AD. We characterized this variant using biochemical cell surface expression assays and found that it significantly altered cell surface expression of the TREM2 protein. Together these data provide evidence that the A192T variant in TREM2 could contribute risk for AD. This study underscores the increasingly recognized role of immune-related processes in AD and highlights the importance of including diverse populations in research to identify genetic variation that contributes risk for AD and other neurodegenerative disorders.
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Affiliation(s)
- Luke W Bonham
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA
| | - Daniel W Sirkis
- b Department of Molecular and Cell Biology, Howard Hughes Medical Institute , University of California, Berkeley , Berkeley , CA , USA
| | - Jia Fan
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA.,c Department of Neurology , Second Hospital of Jilin University , Changchun , China
| | - Renan E Aparicio
- b Department of Molecular and Cell Biology, Howard Hughes Medical Institute , University of California, Berkeley , Berkeley , CA , USA
| | - Marian Tse
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA
| | - Eliana Marisa Ramos
- d Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior , The David Geffen School of Medicine at University of California Los Angeles , Los Angeles , CA , USA
| | - Qing Wang
- d Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior , The David Geffen School of Medicine at University of California Los Angeles , Los Angeles , CA , USA
| | - Giovanni Coppola
- d Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior , The David Geffen School of Medicine at University of California Los Angeles , Los Angeles , CA , USA
| | - Howard J Rosen
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA
| | - Bruce L Miller
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA
| | - Jennifer S Yokoyama
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , San Francisco , CA , USA
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130
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Migliaccio R, Agosta F, Possin KL, Canu E, Filippi M, Rabinovici GD, Rosen HJ, Miller BL, Gorno-Tempini ML. Mapping the Progression of Atrophy in Early- and Late-Onset Alzheimer's Disease. J Alzheimers Dis 2016; 46:351-64. [PMID: 25737041 DOI: 10.3233/jad-142292] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The term early-onset Alzheimer's disease (EOAD) identifies patients who meet criteria for AD, but show onset of symptoms before the age of 65. We map progression of gray matter atrophy in EOAD patients compared to late-onset AD (LOAD). T1-weighted MRI scans were obtained at diagnosis and one-year follow-up from 15 EOAD, 10 LOAD, and 38 age-matched controls. Voxel-based and tensor-based morphometry were used, respectively, to assess the baseline and progression of atrophy. At baseline, EOAD patients already showed a widespread atrophy in temporal, parietal, occipital, and frontal cortices. After one year, EOAD had atrophy progression in medial temporal and medial parietal cortices. At baseline, LOAD patients showed atrophy in the medial temporal regions only, and, after one year, an extensive pattern of atrophy progression in the same neocortical cortices of EOAD. Although atrophy mainly involved different lateral neocortical or medial temporal hubs at baseline, it eventually progressed along the same brain default-network regions in both groups. The cortical region showing a significant progression in both groups was the medial precuneus/posterior cingulate.
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131
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Bettcher BM, Fitch R, Wynn MJ, Lalli MA, Elofson J, Jastrzab L, Mitic L, Miller ZA, Rabinovici GD, Miller BL, Kao AW, Kosik KS, Kramer JH. MCP-1 and eotaxin-1 selectively and negatively associate with memory in MCI and Alzheimer's disease dementia phenotypes. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 3:91-7. [PMID: 27453930 PMCID: PMC4941041 DOI: 10.1016/j.dadm.2016.05.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction MCP-1 and eotaxin-1 are encoded on chromosome 17 and have been shown to reduce hippocampal neurogenesis in mice. We investigated whether these chemokines selectively associate with memory in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. Methods MCP-1 and eotaxin-1 were assayed in controls, MCI, and AD dementia patients with varying phenotypes (n = 171). A subset of 55 individuals had magnetic resonance imaging (MRI) scans available. Composite scores for cognitive variables were created, and medial temporal lobe volumes were obtained. Results An interaction was noted between MCP-1 and eotaxin-1, such that deleterious associations with memory were seen when both chemokines were elevated. These associations remained significant after adding APOE genotype and comparison (non-chromosome 17) chemokines into the model. These chemokines predicted left medial temporal lobe volume and were not related to other cognitive domains. Discussion These results suggest a potentially selective role for MCP-1 and eotaxin-1 in memory dysfunction in the context of varied MCI and AD dementia phenotypes.
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Affiliation(s)
- Brianne M Bettcher
- Rocky Mountain Alzheimer's Disease Center, Departments of Neurosurgery and Neurology, University of Colorado Anschutz School of Medicine, Aurora, CA, USA; Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan Fitch
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew J Wynn
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew A Lalli
- Neuroscience Research Institute, Department of Molecular, Cellular, and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Jonathan Elofson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Jastrzab
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Mitic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Aimee W Kao
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kenneth S Kosik
- Neuroscience Research Institute, Department of Molecular, Cellular, and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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132
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Chen H, Pan X, Lau JKL, Bickerton WL, Pradeep B, Taheri M, Humphreys G, Rotshtein P. Lesion-symptom mapping of a complex figure copy task: A large-scale PCA study of the BCoS trial. NEUROIMAGE-CLINICAL 2016; 11:622-634. [PMID: 27182489 PMCID: PMC4857225 DOI: 10.1016/j.nicl.2016.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/02/2016] [Accepted: 04/12/2016] [Indexed: 11/18/2022]
Abstract
Complex figure copying is a commonly used neuropsychological test. Here we explored the neural basis of the factors underlying complex figure copying (CFC), using data from the Birmingham Cognitive Screen (BCoS) in a large group of sub-acute, ischemic stroke patients (239). We computed two analyses: in the first we assessed the contribution of co-morbid deficits (i.e. in gesture processing, object use, visual neglect, pictures naming and sustained attention) to the lesions associated with CFC. In a second analysis a Principle Component Analysis (PCA) was used to isolate different underlying task components and to link to clinical neuroimaging scans. A voxel-based morphometry (VBM) analysis showed that poor CFC performance was associated with lesions to bi-lateral thalamus, lingual, right fusiform and right inferior parietal cortices (rIPC). The latter association with the posterior parietal cortex was diminished after controlling for neglect. Follow up analysis showed the neglect partially mediated the correlation of CFC and rIPC. The PCA revealed three main underlying components: (1) a component associated with high-level motor control common to different measures of apraxia and linked to the left postcentral gyrus, the right thalamus and middle frontal gyrus; (2) a visuo-motor transformation component unique to the CFC and associated with lesions to the posterior occipital and sensory cortices; (3) a component associated with multistep object use tasks which was correlated with lesions to the left inferior frontal orbital gyrus, the right fusiform and cerebellum. Using clinical symptoms, cognitive profiles and lesion mapping we showed that beyond visual perception, CFC performance is supported by three functional networks: one for high-level motor control, a visuo-motor transformation component, and multistep object use network.
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Affiliation(s)
- Haobo Chen
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510000, PR China; School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Xiaoping Pan
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510000, PR China
| | | | | | - Boddana Pradeep
- Consultant in Old Age Psychiatry, Avon & Wiltshire NHS Trust, Green Lane Hospital, Devizes, Wiltshire SN105 DS, UK
| | - Maliheh Taheri
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Glyn Humphreys
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - Pia Rotshtein
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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133
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Iverson GL, Gardner AJ, McCrory P, Zafonte R, Castellani RJ. A critical review of chronic traumatic encephalopathy. Neurosci Biobehav Rev 2015; 56:276-93. [PMID: 26183075 DOI: 10.1016/j.neubiorev.2015.05.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/14/2015] [Accepted: 05/08/2015] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulations of phosphorylated tau (p-tau) involving perivascular areas of the cerebral cortex, sulcal depths, and with a preference for neurons within superficial cortical laminae; (ii) multifocal axonal varicosities and axonal loss involving deep cortex and subcortical white matter; (iii) relative absence of beta-amyloid deposits; (iv) TDP-43 immunoreactive inclusions and neurites; and (v) broad and diverse clinical features. Some of the pathological findings reported in the literature may be encountered with age and other neurodegenerative diseases. However, the focality of the p-tau cortical findings in particular, and the regional distribution, are believed to be unique to CTE. The described clinical features in recent cases are very similar to how depression manifests in middle-aged men and with frontotemporal dementia as the disease progresses. It has not been established that the described tau pathology, especially in small amounts, can cause complex changes in behavior such as depression, substance abuse, suicidality, personality changes, or cognitive impairment. Future studies will help determine the extent to which the neuropathology is causally related to the diverse clinical features.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, MassGeneral Hospital for Children Sports Concussion Program, & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA.
| | - Andrew J Gardner
- Hunter New England Local Health District Sports Concussion Program; & Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Victoria, Australia
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Brigham and Women's Hospital; & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA
| | - Rudy J Castellani
- Division of Neuropathology, University of Maryland School of Medicine, USA
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Practice effects and amyloid deposition: preliminary data on a method for enriching samples in clinical trials. Alzheimer Dis Assoc Disord 2015; 28:247-52. [PMID: 24614265 DOI: 10.1097/wad.0000000000000021] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical trials in Alzheimer disease are moving toward prevention studies in prodromal individuals with amyloid burden. However, methods are needed to identify individuals expected to be amyloid positive for these studies to be feasible and cost-effective. The current study sought to determine whether short-term practice effects on cognitive tests can identify those with notable uptake on amyloid imaging. Twenty-five, nondemented older adults (15 cognitively intact, 10 with mild cognitive impairment) underwent amyloid imaging through F-flutemetamol and 2 cognitive testing sessions across 1 week to determine practice effects on a visual memory test. Results indicated that, whereas F-flutemetamol uptake showed little association with baseline performance on a visual memory test (r=-0.04, P=0.85), it was significantly correlated with practice effects across 1 week on that same memory measure (r=-0.45, P=0.02), with greater uptake being associated with lower practice effects. The odds ratio of notable F-flutemetamol uptake was 5 times higher in individuals with low practice effects compared with high practice effects. Although these preliminary results need to be replicated in larger samples, short-term practice effects on cognitive tests may provide an affordable screening method to identify individuals who are amyloid positive, which could enrich samples for preventative clinical trials in Alzheimer disease.
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Wagshal D, Sankaranarayanan S, Guss V, Hall T, Berisha F, Lobach I, Karydas A, Voltarelli L, Scherling C, Heuer H, Tartaglia MC, Miller Z, Coppola G, Ahlijanian M, Soares H, Kramer JH, Rabinovici GD, Rosen HJ, Miller BL, Meredith J, Boxer AL. Divergent CSF τ alterations in two common tauopathies: Alzheimer's disease and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 2015; 86:244-50. [PMID: 24899730 PMCID: PMC4256124 DOI: 10.1136/jnnp-2014-308004] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Elevated CSF τ is considered a biomarker of neuronal injury in newly developed Alzheimer's disease (AD) and mild cognitive impairment (MCI) criteria. However, previous studies have failed to detect alterations of τ species in other primary tauopathies. We assessed CSF τ protein abnormalities in AD, a tauopathy with prominent Aβ pathology, and progressive supranuclear palsy (PSP), a primary tauopathy characterised by deposition of four microtubule-binding repeat (4R) τ with minimal Aβ pathology. METHODS 26 normal control (NC), 37 AD, and 24 patients with PSP participated in the study. AD and PSP were matched for severity using the clinical dementia rating sum of boxes (CDR-sb) scores. The INNO BIA AlzBio3 multiplex immunoassay was used to measure CSF Aβ, total τ, and ptau181. Additional, novel ELISAs targeting different N-terminal and central τ epitopes were developed to examine CSF τ components and to investigate interactions between diagnostic group, demographics and genetic variables. RESULTS PSP had lower CSF N-terminal and C-terminal τ concentrations than NC and AD measured with the novel τ ELISAs and the standard AlzBio3 τ and ptau assays. AD had higher total τ and ptau levels than NC and PSP. There was a gender by diagnosis interaction in AD and PSP for most τ species, with lower concentrations for male compared to female patients. CONCLUSIONS CSF τ fragment concentrations are different in PSP compared with AD despite the presence of severe τ pathology and neuronal injury in both disorders. CSF τ concentration likely reflects multiple factors in addition to the degree of neuronal injury.
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Affiliation(s)
- Dana Wagshal
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | | | - Valerie Guss
- Bristol-Myers Squibb, Wallingford, Connecticut, USA
| | - Tracey Hall
- Bristol-Myers Squibb, Wallingford, Connecticut, USA
| | - Flora Berisha
- Kyowa Hakko Kirin Pharma, Inc., Princeton, New Jersey, USA
| | - Iryna Lobach
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Anna Karydas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Lisa Voltarelli
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Carole Scherling
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Hilary Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Maria Carmela Tartaglia
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA Tanz Center for Research in Neurodegenerative disease, University of Toronto, Toronto, Canada
| | - Zachary Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Giovanni Coppola
- Department of Psychiatry, Semel Institute, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Holly Soares
- Bristol-Myers Squibb, Wallingford, Connecticut, USA
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | | | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
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Sturm VE, Yokoyama JS, Eckart JA, Zakrzewski J, Rosen HJ, Miller BL, Seeley WW, Levenson RW. Damage to left frontal regulatory circuits produces greater positive emotional reactivity in frontotemporal dementia. Cortex 2014; 64:55-67. [PMID: 25461707 DOI: 10.1016/j.cortex.2014.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 09/08/2014] [Accepted: 10/04/2014] [Indexed: 12/18/2022]
Abstract
Positive emotions foster social relationships and motivate thought and action. Dysregulation of positive emotion may give rise to debilitating clinical symptomatology such as mania, risk-taking, and disinhibition. Neuroanatomically, there is extensive evidence that the left hemisphere of the brain, and the left frontal lobe in particular, plays an important role in positive emotion generation. Although prior studies have found that left frontal injury decreases positive emotion, it is not clear whether selective damage to left frontal emotion regulatory systems can actually increase positive emotion. We measured happiness reactivity in 96 patients with frontotemporal dementia (FTD), a neurodegenerative disease that targets emotion-relevant neural systems and causes alterations in positive emotion (i.e., euphoria and jocularity), and in 34 healthy controls. Participants watched a film clip designed to elicit happiness and a comparison film clip designed to elicit sadness while their facial behavior, physiological reactivity, and self-reported emotional experience were monitored. Whole-brain voxel-based morphometry (VBM) analyses revealed that atrophy in predominantly left hemisphere fronto-striatal emotion regulation systems including left ventrolateral prefrontal cortex, orbitofrontal cortex, anterior insula, and striatum was associated with greater happiness facial behavior during the film (pFWE < .05). Atrophy in left anterior insula and bilateral frontopolar cortex was also associated with higher cardiovascular reactivity (i.e., heart rate and blood pressure) but not self-reported positive emotional experience during the happy film (p < .005, uncorrected). No regions emerged as being associated with greater sadness reactivity, which suggests that left-lateralized fronto-striatal atrophy is selectively associated with happiness dysregulation. Whereas previous models have proposed that left frontal injury decreases positive emotional responding, we argue that selective disruption of left hemisphere emotion regulating systems can impair the ability to suppress positive emotions such as happiness.
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Affiliation(s)
- Virginia E Sturm
- Department of Neurology, University of California, San Francisco, CA, USA.
| | | | - Janet A Eckart
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Jessica Zakrzewski
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, CA, USA
| | - William W Seeley
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, CA, USA
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137
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Dalagdi A, Arvaniti A, Papatriantafyllou J, Xenitidis K, Samakouri M, Livaditis M. Psychosocial support and cognitive deficits in adults with schizophrenia. Int J Soc Psychiatry 2014; 60:417-25. [PMID: 23828764 DOI: 10.1177/0020764013491899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent decades there has been an increasing interest in cognitive deficits in schizophrenia. However, only a few studies have examined the impact of psychosocial support on the prevention of cognitive deterioration in patients who suffer from schizophrenia. AIM The aims of the present study are: (1) to confirm the presence of cognitive deficits among patients with schizophrenia; (2) to explore any correlations between such deficits and a range of clinical and/or demographic characteristics of the patients; and (3) to investigate any association between cognitive deficits and psychosocial support. METHOD A total of 118 patients with schizophrenia (the patient group) and 102 healthy volunteers (the control group) had a cognitive assessment using a battery of neuropsychological tests. The patients were allocated to one of the following groups: (1) patients under routine outpatient follow-up; or (2) patients receiving or having recently received intensive psychosocial support, in addition to follow-up. This included daily participation in vocational and recreational activities provided by dedicated mental health day centers. The findings of the neuropsychological testing of individuals in all groups were compared, after controlling for clinical or demographic factors. RESULTS The scores in the neuropsychological tests were lower overall in the patients group compared to healthy volunteers. Within the patients group, those receiving/having received psychosocial support had higher scores compared to those on routine follow-up alone. There were no significant differences between patients currently receiving psychosocial support and those having received it in the past. Lower education, age and illness duration (but not severity of positive or negative symptoms) were factors associated with lower test scores. CONCLUSIONS The study provides some evidence that psychosocial support may be beneficial for the cognitive functioning of patients with schizophrenia and this benefit may be a lasting one.
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Affiliation(s)
- Aikaterini Dalagdi
- Department of Psychiatry, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, Greece
| | - Aikaterini Arvaniti
- Department of Psychiatry, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, Greece
| | | | - Kiriakos Xenitidis
- South London and Maudsley NHS Foundation Trust, The Maudsley Hospital, London, UK
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, Greece
| | - Miltos Livaditis
- Department of Psychiatry, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, Greece
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Bettcher BM, Gelfand JM, Irani SR, Neuhaus J, Forner S, Hess CP, Geschwind MD. More than memory impairment in voltage-gated potassium channel complex encephalopathy. Eur J Neurol 2014; 21:1301-10. [PMID: 24981998 DOI: 10.1111/ene.12482] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalopathies (AEs) are a heterogeneous group of neurological disorders that affect cognition. Although memory difficulties are commonly endorsed, few reports of AEs inclusively assess all cognitive domains in detail. Our aim was to perform an unbiased cognitive evaluation of AE patients with voltage-gated potassium channel complex antibodies (VGKCC -Abs) in order to delineate cognitive strengths and weaknesses. METHODS Serial VGKCC -Ab AE subjects (n = 12) were assessed with a comprehensive evaluation of memory, executive functions, visuospatial skills and language. Clinical magnetic resonance imaging (MRI) (n = 10/12) was evaluated. Five subjects had serial cognitive testing available, permitting descriptive analysis of change. RESULTS Subjects demonstrated mild to moderate impairment in memory (mean Z = -1.9) and executive functions (mean Z = -1.5), with variable impairments in language and sparing of visuospatial skills. MRI findings showed T2 hyperintensities in medial temporal lobe (10/10) and basal ganglia (2/10). Serial cognitive examination revealed heterogeneity in cognitive function; whereas most patients improved in one or more domains, residual impairments were observed in some patients. CONCLUSIONS This study augments previous neuropsychological analyses in VGKCC -Ab AE by identifying not only memory and executive function deficits but also language impairments, with preservation of visuospatial functioning. The study further highlights the importance of domain-specific testing to parse out the complex cognitive phenotypes of VGKCC -Ab AE.
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Affiliation(s)
- B M Bettcher
- Department of Neurology, Memory and Aging Center, UCSF, San Francisco, CA, USA
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139
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Pa J, Dutt S, Mirsky JB, Heuer HW, Keselman P, Kong E, Trujillo A, Gazzaley A, Kramer JH, Seeley WW, Miller BL, Boxer AL. The functional oculomotor network and saccadic cognitive control in healthy elders. Neuroimage 2014; 95:61-8. [PMID: 24675647 DOI: 10.1016/j.neuroimage.2014.03.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/21/2014] [Accepted: 03/17/2014] [Indexed: 12/17/2022] Open
Abstract
Decline in executive function is the most common age-associated cognitive deficit and may be a risk factor for neurodegenerative disease. The antisaccade (AS) task involves inhibition of a prepotent visuomotor response and is a well-validated executive function test in aging and neurodegeneration. We investigated the functional connectivity of the cortical oculomotor network during successful AS performance in healthy elders. Elevated BOLD activity in the right lateral frontal eye field (rlatFEF), a region linked to volume loss in individuals with impaired AS performance, was associated with worse AS performance and weaker network efficiency. In contrast, hub integrity of the right dorsolateral prefrontal cortex (rDLPFC) and anterior cingulate cortex (rACC) was associated with better AS performance. These data suggest that while several right lateral frontal regions are central nodes in the oculomotor network, the rlatFEF demonstrates early neural aberrations and the rDLPFC and rACC continue to support inhibitory cognitive control in healthy elders. We conclude that alterations in AS task functional connectivity, quantified as hub and network efficiency, may be clinically-relevant biomarkers of cognitive decline in executive functioning.
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Affiliation(s)
- Judy Pa
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA.
| | - Shubir Dutt
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Jacob B Mirsky
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Hilary W Heuer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Paul Keselman
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Erwin Kong
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Andrew Trujillo
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Adam Gazzaley
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA.
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140
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Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM, Valcour VG. Mapping white matter integrity in elderly people with HIV. Hum Brain Mapp 2014; 35:975-92. [PMID: 23362139 PMCID: PMC3775847 DOI: 10.1002/hbm.22228] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 11/02/2012] [Accepted: 11/05/2012] [Indexed: 01/23/2023] Open
Abstract
People with HIV are living longer as combination antiretroviral therapy (cART) becomes more widely available. However, even when plasma viral load is reduced to untraceable levels, chronic HIV infection is associated with neurological deficits and brain atrophy beyond that of normal aging. HIV is often marked by cortical and subcortical atrophy, but the integrity of the brain's white matter (WM) pathways also progressively declines. Few studies focus on older cohorts where normal aging may be compounded with HIV infection to influence deficit patterns. In this relatively large diffusion tensor imaging (DTI) study, we investigated abnormalities in WM fiber integrity in 56 HIV+ adults with access to cART (mean age: 63.9 ± 3.7 years), compared to 31 matched healthy controls (65.4 ± 2.2 years). Statistical 3D maps revealed the independent effects of HIV diagnosis and age on fractional anisotropy (FA) and diffusivity, but we did not find any evidence for an age by diagnosis interaction in our current sample. Compared to healthy controls, HIV patients showed pervasive FA decreases and diffusivity increases throughout WM. We also assessed neuropsychological (NP) summary z-score associations. In both patients and controls, fiber integrity measures were associated with NP summary scores. The greatest differences were detected in the corpus callosum and in the projection fibers of the corona radiata. These deficits are consistent with published NP deficits and cortical atrophy patterns in elderly people with HIV.
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Affiliation(s)
- Talia M Nir
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, California
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141
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Zanto TP, Pa J, Gazzaley A. Reliability measures of functional magnetic resonance imaging in a longitudinal evaluation of mild cognitive impairment. Neuroimage 2014; 84:443-52. [PMID: 24018304 PMCID: PMC3855402 DOI: 10.1016/j.neuroimage.2013.08.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/24/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022] Open
Abstract
As the aging population grows, it has become increasingly important to carefully characterize amnestic mild cognitive impairment (aMCI), a preclinical stage of Alzheimer's disease (AD). Functional magnetic resonance imaging (fMRI) is a valuable tool for monitoring disease progression in selectively vulnerable brain regions associated with AD neuropathology. However, the reliability of fMRI data in longitudinal studies of older adults with aMCI is largely unexplored. To address this, aMCI participants completed two visual working tasks, a Delayed-Recognition task and a One-Back task, on three separate scanning sessions over a three-month period. Test-retest reliability of the fMRI blood oxygen level dependent (BOLD) activity was assessed using an intraclass correlation (ICC) analysis approach. Results indicated that brain regions engaged during the task displayed greater reliability across sessions compared to regions that were not utilized by the task. During task-engagement, differential reliability scores were observed across the brain such that the frontal lobe, medial temporal lobe, and subcortical structures exhibited fair to moderate reliability (ICC=0.3-0.6), while temporal, parietal, and occipital regions exhibited moderate to good reliability (ICC=0.4-0.7). Additionally, reliability across brain regions was more stable when three fMRI sessions were used in the ICC calculation relative to two fMRI sessions. In conclusion, the fMRI BOLD signal is reliable across scanning sessions in this population and thus a useful tool for tracking longitudinal change in observational and interventional studies in aMCI.
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Affiliation(s)
- Theodore P Zanto
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA.
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142
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Henry ML, Rising K, DeMarco AT, Miller BL, Gorno-Tempini ML, Beeson PM. Examining the value of lexical retrieval treatment in primary progressive aphasia: two positive cases. BRAIN AND LANGUAGE 2013; 127:145-56. [PMID: 23871425 PMCID: PMC4026252 DOI: 10.1016/j.bandl.2013.05.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 05/16/2013] [Accepted: 05/26/2013] [Indexed: 05/13/2023]
Abstract
Individuals with primary progressive aphasia (PPA) suffer a gradual decline in communication ability as a result of neurodegenerative disease. Language treatment shows promise as a means of addressing these difficulties but much remains to be learned with regard to the potential value of treatment across variants and stages of the disorder. We present two cases, one with semantic variant of PPA and the other with logopenic PPA, each of whom underwent treatment that was unique in its focus on training self-cueing strategies to engage residual language skills. Despite differing language profiles and levels of aphasia severity, each individual benefited from treatment and showed maintenance of gains as well as generalization to untrained lexical items. These cases highlight the potential for treatment to capitalize on spared cognitive and neural systems in individuals with PPA, improving current language function as well as potentially preserving targeted skills in the face of disease progression.
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Affiliation(s)
- M L Henry
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158, United States; Communicative Disorders Program, Department of Special Education, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, United States.
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143
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Pa J, Berry AS, Compagnone M, Boccanfuso J, Greenhouse I, Rubens MT, Johnson JK, Gazzaley A. Cholinergic enhancement of functional networks in older adults with mild cognitive impairment. Ann Neurol 2013; 73:762-73. [PMID: 23447373 DOI: 10.1002/ana.23874] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/15/2013] [Accepted: 02/15/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The importance of the cholinergic system for cognitive function has been well documented in animal and human studies. The objective of this study was to elucidate the cognitive and functional connectivity changes associated with enhanced acetylcholine levels. We hypothesized that older adults with mild memory deficits would show behavioral and functional network enhancements with an acetylcholinesterase inhibitor treatment (donepezil) when compared to a placebo control group. METHODS We conducted a 3-month, double-blind, placebo-controlled study on the effects of donepezil in 27 older adults with mild memory deficits. Participants completed a delayed recognition memory task. Functional magnetic resonance imaging (fMRI) scans were collected at baseline prior to treatment and at 3-month follow-up while subjects were on a 10mg daily dose of donepezil or placebo. RESULTS Donepezil treatment significantly enhanced the response time for face and scene memory probes when compared to the placebo group. A group-by-visit interaction was identified for the functional network connectivity of the left fusiform face area (FFA) with the hippocampus and inferior frontal junction, such that the treatment group showed increased connectivity over time when compared to the placebo group. Additionally, the enhanced functional network connectivity of the FFA and hippocampus significantly predicted memory response time at 3-month follow-up in the treatment group. INTERPRETATION These findings suggest that increased cholinergic transmission improves goal-directed neural processing and cognitive ability and may serve to facilitate communication across functionally-connected attention and memory networks. Longitudinal fMRI is a useful method for elucidating the neural changes associated with pharmacological modulation and is a potential tool for monitoring intervention efficacy in clinical trials.
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Affiliation(s)
- Judy Pa
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Wood JS, Firbank MJ, Mosimann UP, Watson R, Barber R, Blamire AM, O'Brien JT. Testing visual perception in dementia with Lewy bodies and Alzheimer disease. Am J Geriatr Psychiatry 2013; 21:501-8. [PMID: 23567415 DOI: 10.1016/j.jagp.2012.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/29/2011] [Accepted: 10/12/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Visuoperceptual deficits are common in dementia with Lewy bodies (DLB) and Alzheimer disease (AD). Testing visuoperception in dementia is complicated by decline in other cognitive domains and extrapyramidal features. To overcome these issues, we developed a computerized test, the Newcastle visuoperception battery (NEVIP), which is independent of motor function and has minimal cognitive load.We aimed to test its utility to identify visuoperceptual deficits in people with dementia. PARTICIPANTS AND MEASUREMENTS We recruited 28 AD and 26 DLB participants with 35 comparison participants of similar age and education. The NEVIP was used to test angle, color, and form discrimination along with motion perception to obtain a composite visuoperception score. RESULTS Those with DLB performed significantly worse than AD participants on the composite visuoperception score (Mann-Whitney U = 142, p = 0.01). Visuoperceptual deficits (defined as 2 SD below the performance of comparisons) were present in 71% of the DLB group and 40% of the AD group. Performance was not significantly correlated with motor impairment, but was significantly related to global cognitive impairment in DLB (rs = -0.689, p <0.001), but not in AD. CONCLUSION Visuoperceptual deficits can be detected in both DLB and AD participants using the NEVIP, with the DLB group performing significantly worse than AD. Visuoperception scores obtained by the NEVIP are independent of participant motor deficits and participants are able to comprehend and perform the tasks.
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Affiliation(s)
- Joshua S Wood
- Institute for Cellular Medicine, Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle, United Kingdom.
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145
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Lamarre AK, Rascovsky K, Bostrom A, Toofanian P, Wilkins S, Sha SJ, Perry DC, Miller ZA, Naasan G, Laforce R, Hagen J, Takada LT, Tartaglia MC, Kang G, Galasko D, Salmon DP, Farias ST, Kaur B, Olichney JM, Quitania Park L, Mendez MF, Tsai PH, Teng E, Dickerson BC, Domoto-Reilly K, McGinnis S, Miller BL, Kramer JH. Interrater reliability of the new criteria for behavioral variant frontotemporal dementia. Neurology 2013; 80:1973-7. [PMID: 23635967 DOI: 10.1212/wnl.0b013e318293e368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the interrater reliability of the new International Behavioural Variant FTD Criteria Consortium (FTDC) criteria for behavioral variant frontotemporal dementia (bvFTD). METHODS Twenty standardized clinical case modules were developed for patients with a range of neurodegenerative diagnoses, including bvFTD, primary progressive aphasia (nonfluent, semantic, and logopenic variant), Alzheimer disease, and Lewy body dementia. Eighteen blinded raters reviewed the modules and 1) rated the presence or absence of core diagnostic features for the FTDC criteria, and 2) provided an overall diagnostic rating. Interrater reliability was determined by κ statistics for multiple raters with categorical ratings. RESULTS The mean κ value for diagnostic agreement was 0.81 for possible bvFTD and 0.82 for probable bvFTD ("almost perfect agreement"). Interrater reliability for 4 of the 6 core features had "substantial" agreement (behavioral disinhibition, perseverative/compulsive, sympathy/empathy, hyperorality; κ = 0.61-0.80), whereas 2 had "moderate" agreement (apathy/inertia, neuropsychological; κ = 0.41-0.6). Clinician years of experience did not significantly influence rater accuracy. CONCLUSIONS The FTDC criteria show promise for improving the diagnostic accuracy and reliability of clinicians and researchers. As disease-altering therapies are developed, accurate differential diagnosis between bvFTD and other neurodegenerative diseases will become increasingly important.
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Affiliation(s)
- Amanda K Lamarre
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA.
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Migliaccio R, Agosta F, Possin KL, Rabinovici GD, Miller BL, Gorno-Tempini ML. White matter atrophy in Alzheimer's disease variants. Alzheimers Dement 2013; 8:S78-87.e1-2. [PMID: 23021625 DOI: 10.1016/j.jalz.2012.04.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 04/12/2012] [Accepted: 04/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In comparison with late-onset Alzheimer's disease (LOAD, onset, >65 years), early-age-of-onset Alzheimer's disease (EOAD, onset, <65 years) more often presents with language, visuospatial, and/or executive impairment, often occurring earlier than a progressive memory deficit. The logopenic variant of primary progressive aphasia (lv-PPA) and posterior cortical atrophy (PCA) have recently been described as possible atypical variants of EOAD. Lv-PPA is characterized by isolated language deficit, whereas PCA is characterized by predominant visuospatial deficits. Severe hemispheric gray matter (GM) atrophy associated with EOAD, lv-PPA, and PCA has been described, but regional patterns of white matter (WM) damage are still poorly understood. METHODS Using structural magnetic resonance imaging and voxel-based morphometry, we investigated WM damage in patients with EOAD (n = 16), PCA (n = 13), lv-PPA (n = 10), and LOAD (n = 14) at presentation and 72 age-matched control subjects. RESULTS In patients with EOAD, PCA, and lv-PPA, WM atrophy was centered on the lateral temporal and parietal regions, including the cingulum and posterior corpus callosum. Compared with control subjects, patients with lv-PPA showed more severe left parietal damage, and patients with PCA showed more severe occipital atrophy. Moreover, patients with EOAD had greater cingulum atrophy compared with those with LOAD. LOAD showed WM damage in the medial temporal regions and less extensive hemispheric involvement. CONCLUSION Patterns of WM damage in EOAD, lv-PPA, and PCA are consistent with the clinical syndromes and GM atrophy patterns. WM injury in AD atypical variants may contribute to symptoms and disease pathogenesis.
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Affiliation(s)
- Raffaella Migliaccio
- Memory and Aging Center, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
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147
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Wilson SM, Rising K, Stib MT, Rapcsak SZ, Beeson PM. Dysfunctional visual word form processing in progressive alexia. ACTA ACUST UNITED AC 2013; 136:1260-73. [PMID: 23471694 DOI: 10.1093/brain/awt034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Progressive alexia is an acquired reading deficit caused by degeneration of brain regions that are essential for written word processing. Functional imaging studies have shown that early processing of the visual word form depends on a hierarchical posterior-to-anterior processing stream in occipito-temporal cortex, whereby successive areas code increasingly larger and more complex perceptual attributes of the letter string. A region located in the left lateral occipito-temporal sulcus and adjacent fusiform gyrus shows maximal selectivity for words and has been dubbed the 'visual word form area'. We studied two patients with progressive alexia in order to determine whether their reading deficits were associated with structural and/or functional abnormalities in this visual word form system. Voxel-based morphometry showed left-lateralized occipito-temporal atrophy in both patients, very mild in one, but moderate to severe in the other. The two patients, along with 10 control subjects, were scanned with functional magnetic resonance imaging as they viewed rapidly presented words, false font strings, or a fixation crosshair. This paradigm was optimized to reliably map brain regions involved in orthographic processing in individual subjects. All 10 control subjects showed a posterior-to-anterior gradient of selectivity for words, and all 10 showed a functionally defined visual word form area in the left hemisphere that was activated for words relative to false font strings. In contrast, neither of the two patients with progressive alexia showed any evidence for a selectivity gradient or for word-specific activation of the visual word form area. The patient with mild atrophy showed normal responses to both words and false font strings in the posterior part of the visual word form system, but a failure to develop selectivity for words in the more anterior part of the system. In contrast, the patient with moderate to severe atrophy showed minimal activation of any part of the visual word form system for either words or false font strings. Our results suggest that progressive alexia is associated with a dysfunctional visual word form system, with or without substantial cortical atrophy. Furthermore, these findings demonstrate that functional MRI has the potential to reveal the neural bases of cognitive deficits in neurodegenerative patients at very early stages, in some cases before the development of extensive atrophy.
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Affiliation(s)
- Stephen M Wilson
- Department of Speech, Language and Hearing Sciences, P.O. Box 210071, Tucson, AZ 85721, USA.
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148
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Henry ML, Wilson SM, Ogar JM, Sidhu MS, Rankin KP, Cattaruzza T, Miller BL, Gorno-Tempini ML, Seeley WW. Neuropsychological, behavioral, and anatomical evolution in right temporal variant frontotemporal dementia: a longitudinal and post-mortem single case analysis. Neurocase 2012; 20:100-9. [PMID: 23171151 PMCID: PMC3775867 DOI: 10.1080/13554794.2012.732089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a patient with semantic variant of frontotemporal dementia who received longitudinal clinical evaluations and structural MRI scans and subsequently came to autopsy. She presented with early behavior changes and semantic loss for foods and people and ultimately developed a pervasive semantic impairment affecting social-emotional as well as linguistic domains. Imaging revealed predominant atrophy of the right temporal lobe, with later involvement of the left, and pathology confirmed bilateral temporal involvement. Findings support the view that left and right anterior temporal lobes serve as semantic hubs that may be affected differentially in semantic variant by early, relatively unilateral damage.
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Affiliation(s)
- Maya L. Henry
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Stephen M. Wilson
- Speech, Language and Hearing Sciences, University of Arizona. Tucson, AZ, USA
| | - Jennifer M. Ogar
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Manu S. Sidhu
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Tatiana Cattaruzza
- Department of Clinical Neurology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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149
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Pan PL, Song W, Yang J, Huang R, Chen K, Gong QY, Zhong JG, Shi HC, Shang HF. Gray matter atrophy in behavioral variant frontotemporal dementia: a meta-analysis of voxel-based morphometry studies. Dement Geriatr Cogn Disord 2012; 33:141-8. [PMID: 22722668 DOI: 10.1159/000338176] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Structural neuroimaging studies on behavioral variant frontotemporal dementia (bvFTD) using the voxel-based morphometry (VBM) method reported not entirely consistent findings. METHODS A systematic review of VBM studies of bvFTD patients and healthy controls (HC) published in PubMed and Embase databases from 2000 to June 2011 was conducted. Meta-analysis was performed using a newly improved voxel-based meta-analytic tool, namely, effect size signed differential mapping, to quantitatively explore the gray matter (GM) changes between bvFTD patients and HC subjects. RESULTS 11 VBM studies involving 237 bvFTD patients and 297 HC subjects met the inclusion criteria. Considerable regional GM volume decrease was detected in the anterior medial frontal cortex (BA 9), extending to other frontal areas (BA 8, 10, 46, 24, 32), and other brain areas, such as the insula cortex, as well as the subcortical striatal regions in patients with bvFTD compared with HC subjects. The findings of the present study remain largely unchanged in the entire brain jackknife sensitivity analyses. CONCLUSIONS The present meta-analysis provides evidence of GM changes in the frontal-striatal-limbic brain areas in patients with bvFTD. Furthermore, GM atrophy in the fron-toinsular cortex and anterior cingulate cortex may be important anatomical changes for the diagnosis of patients with bvFTD.
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Affiliation(s)
- Ping Lei Pan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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150
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Silverberg NB, Ryan LM, Carrillo MC, Sperling R, Petersen RC, Posner HB, Snyder PJ, Hilsabeck R, Gallagher M, Raber J, Rizzo A, Possin K, King J, Kaye J, Ott BR, Albert MS, Wagster MV, Schinka JA, Cullum CM, Farias ST, Balota D, Rao S, Loewenstein D, Budson AE, Brandt J, Manly JJ, Barnes L, Strutt A, Gollan TH, Ganguli M, Babcock D, Litvan I, Kramer JH, Ferman TJ. Assessment of cognition in early dementia. Alzheimers Dement 2011; 7:e60-e76. [PMID: 23559893 PMCID: PMC3613863 DOI: 10.1016/j.jalz.2011.05.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Better tools for assessing cognitive impairment in the early stages of Alzheimer's disease (AD) are required to enable diagnosis of the disease before substantial neurodegeneration has taken place and to allow detection of subtle changes in the early stages of progression of the disease. The National Institute on Aging and the Alzheimer's Association convened a meeting to discuss state of the art methods for cognitive assessment, including computerized batteries, as well as new approaches in the pipeline. Speakers described research using novel tests of object recognition, spatial navigation, attentional control, semantic memory, semantic interference, prospective memory, false memory and executive function as among the tools that could provide earlier identification of individuals with AD. In addition to early detection, there is a need for assessments that reflect real-world situations in order to better assess functional disability. It is especially important to develop assessment tools that are useful in ethnically, culturally and linguistically diverse populations as well as in individuals with neurodegenerative disease other than AD.
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Affiliation(s)
- Nina B Silverberg
- Division of Neuroscience, National Institute on Aging, National Institutes of Health, Bethesda MD
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