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Amyloid pet in primary progressive aphasia: case series and systematic review of the literature. J Neurol 2016; 264:121-130. [PMID: 27815682 DOI: 10.1007/s00415-016-8324-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Primary progressive aphasia (PPA) is considered a heterogeneous syndrome, with different clinical subtypes and neuropathological causes. Novel PET biomarkers may help to predict the underlying neuropathology, but many aspects remain unclear. We studied the relationship between amyloid PET and PPA variant in a clinical series of PPA patients. A systematic review of the literature was performed. Patients with PPA were assessed over a 2-year period and classified based on language testing and the International Consensus Criteria as non-fluent/agrammatic (nfvPPA), semantic (svPPA), logopenic variant (lvPPA) or as unclassifiable (ucPPA). All patients underwent a Florbetapir (18-F) PET scan and images were analysed by two nuclear medicine physicians, using a previously validated reading method. Relevant studies published between January 2004 and January 2016 were identified by searching Medline and Web of Science databases. Twenty-four PPA patients were included (13 women, mean age 68.8, SD 8.3 years; range 54-83). Overall, 13/24 were amyloid positive: 0/2 (0%) nfvPPA, 0/4 (0%) svPPA, 10/14 (71.4%) lvPPA and 3/4 (75%) ucPPA (p = 0.028). The systematic review identified seven relevant studies, six including all PPA variants and one only lvPPA. Pooling all studies together, amyloid PET positivity was 122/224 (54.5%) for PPA, 14/52 (26.9%) for nfvPPA, 6/47 (12.8%) for svPPA, 101/119 for lvPPA (84.9%) and 12/22 (54.5%) for ucPPA. Amyloid PET may help to identify the underlying neuropathology in PPA. It could be especially useful in ucPPA, because in these cases it is more difficult to predict pathology. ucPPA is frequently associated with amyloid pathology.
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102
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Gan JJ, Lin A, Samimi MS, Mendez MF. Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia. PSYCHOSOMATICS 2016; 57:598-604. [DOI: 10.1016/j.psym.2016.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
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Ljubenkov PA, Miller BL. A Clinical Guide to Frontotemporal Dementias. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:448-464. [PMID: 31975825 DOI: 10.1176/appi.focus.20160018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The term frontotemporal dementia (FTD) describes a diverse group of clinical syndromes, including behavioral-variant FTD (bvFTD), nonfluent/agrammatic-variant primary progressive aphasia (nfvPPA), semantic-variant primary progressive aphasia (svPPA), FTD motor neuron disease (FTD-MND), progressive supranuclear palsy syndrome (PSP-S), and corticobasal syndrome (CBS). Although each of these syndromes may be distinguished by their respective disturbances in behavior, language, or motor function and characteristic imaging findings, they may present a diagnostic dilemma when encountered clinically. In this article, we review the clinical features, diagnostic criteria, pathology, genetics, and therapeutic interventions for FTD spectrum disorders.
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Affiliation(s)
- Peter A Ljubenkov
- Dr. Ljubenkov is a clinical fellow and Dr. Miller is professor of neurology in the Department of Neurology, University of California, San Francisco, School of Medicine (e-mail: )
| | - Bruce L Miller
- Dr. Ljubenkov is a clinical fellow and Dr. Miller is professor of neurology in the Department of Neurology, University of California, San Francisco, School of Medicine (e-mail: )
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McCarthy RA, Warrington EK. Past, present, and prospects: Reflections 40 years on from the selective impairment of semantic memory (Warrington, 1975). Q J Exp Psychol (Hove) 2016; 69:1941-68. [DOI: 10.1080/17470218.2014.980280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We summarize the main findings and conclusions of Warrington's (1975) paper, The Selective Impairment of Semantic memory, a neuropsychological paper that described three cases with degenerative neurological conditions [Warrington, E. K. (1975). The selective impairment of semantic memory. The Quarterly Journal of Experimental Psychology, 27, 635–657]. We consider the developments that have followed from its publication and give a selective overview of the field in 2014. The initial impact of the paper was on neuropsychological investigations of semantic loss followed some 14 years later by the identification of Semantic Dementia (the condition shown by the original cases) as a distinctive form of degenerative disease with unique clinical and pathological characteristics. We discuss the distinction between disorders of semantic storage and refractory semantic access, the evidence for category- and modality-specific impairments of semantics, and the light that has been shed on the structure and organization of semantic memory. Finally we consider the relationship between semantic memory and the skills of reading and writing, phonological processing, and autobiographical memory.
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Affiliation(s)
- Rosaleen A. McCarthy
- Department of Neuropsychology, Wessex Neurosciences Centre, Southampton University Hospital NHS Trust, Southampton, UK
- Department of Psychology, University of Southampton, Southampton, UK
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Gómez-Tortosa E, Rigual R, Prieto-Jurczynska C, Mahillo-Fernández I, Guerrero-López R, Pérez-Pérez J, Sainz MJ. Behavioral Evolution of Progressive Semantic Aphasia in Comparison with Nonfluent Aphasia. Dement Geriatr Cogn Disord 2016; 41:1-8. [PMID: 26426392 DOI: 10.1159/000439521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with primary progressive aphasia (PPA) usually develop significant behavioral disturbances with progression of the disease. We tested our clinical observation that development of disruptive agitation is more likely in semantic than in nonfluent PPA and examined which clinical variables could be associated with this behavior. METHODS We retrospectively analyzed neuropsychiatric scores and the need for behavioral treatments in semantic PPA (n = 41) and nonfluent PPA (n = 39) cases and compared first (1-3 years since the onset of symptoms) and last (5-13 years since the onset) evaluations. Clinical variables and laterality of temporal atrophy were associated with symptoms in semantic PPA cases. RESULTS The semantic PPA group developed more frequent (p = 0.03) and intense agitation (p = 0.0008) and had a greater need for antipsychotic drugs (p = 0.001) than the nonfluent PPA group. Presence of agitation was clearly associated with psychotic symptoms (delusions/hallucinations) but was not associated with gender, age at onset, duration of the disease, or laterality of temporal atrophy. In contrast, nonfluent PPA cases were more frequently depressed and treated with antidepressants (p = 0.0007). There were no differences in anxiety, irritability, apathy, perseverations, hyperorality, or abnormal motor behavior. CONCLUSIONS Semantic PPA in advanced disease is frequently associated with agitation and psychotic symptoms with fewer mood symptoms, while nonfluent PPA maintains a high prevalence of depression. This implies different treatment and care and support needs for each group.
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106
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Kansal K, Mareddy M, Sloane KL, Minc AA, Rabins PV, McGready JB, Onyike CU. Survival in Frontotemporal Dementia Phenotypes: A Meta-Analysis. Dement Geriatr Cogn Disord 2016; 41:109-22. [PMID: 26854827 DOI: 10.1159/000443205] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Survival in frontotemporal dementia (FTD) is not well understood. We conducted a mixed effects meta-analysis of survival in FTD to examine phenotype differences and contributory factors. METHODS The PubMed, Medline, EMBASE, CINAHL, PsycINFO and Cochrane databases were searched for studies describing survival or natural history of behavioral variant FTD (bvFTD), progressive non-fluent aphasia (PNFA), semantic dementia (SD), FTD with amyotrophic lateral sclerosis (FTD-ALS), progressive supranuclear palsy and corticobasal degeneration. There were no language restrictions. RESULTS We included 27 studies (2,462 subjects). Aggregate mean and median survival were derived for each phenotype and, for comparison, Alzheimer's disease (AD) (using data from the selected studies). Survival was shortest in FTD-ALS (2.5 years). Mean survival was longest in bvFTD and PNFA (8 years) and median survival in SD (12 years). AD was comparable in survival to all except FTD-ALS. Age and sex did not affect survival; the education effect was equivocal. Heterogeneity in FTD survival was largely, but not wholly, explained by phenotypes. CONCLUSIONS Survival differs for FTD phenotypes but, except for FTD-ALS, compares well to AD survival. Elucidating the potential causes of within-phenotype heterogeneity in survival (such as complicating features and comorbidities) may open up opportunities for tailored interventions.
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Affiliation(s)
- Kalyani Kansal
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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107
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Progressive supranuclear palsy and corticobasal degeneration: Diagnostic challenges and clinicopathological considerations. Rev Neurol (Paris) 2016; 172:488-502. [DOI: 10.1016/j.neurol.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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108
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O'Connor CM, Clemson L, Hornberger M, Leyton CE, Hodges JR, Piguet O, Mioshi E. Longitudinal change in everyday function and behavioral symptoms in frontotemporal dementia. Neurol Clin Pract 2016; 6:419-428. [PMID: 27847684 PMCID: PMC5100706 DOI: 10.1212/cpj.0000000000000264] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The relationship between behavioral changes and functional decline in frontotemporal dementia (FTD) is not well understood. Methods: Thirty-nine patients (21 behavioral variant FTD [bvFTD], 18 semantic variant primary progressive aphasia [svPPA]) were followed up longitudinally (2–4 years follow-up). Functional (Disability Assessment for Dementia) and behavioral (Cambridge Behavioural Inventory Revised) assessments were included for between-group (pairwise comparisons, mixed model analysis) and within-group analyses (bivariate correlations). Results: Functionally, patients with bvFTD were more impaired than patients with svPPA at baseline and continued to be at follow-up, despite similar disease duration. By contrast, behavioral impairments differed between patient groups at baseline and at follow-up. At baseline, patients with bvFTD exhibited higher levels of apathy and changes in eating than patients with svPPA; disinhibited and stereotypical behaviors were similar. Over the years, patients with bvFTD showed reduction in disinhibition and stereotypical behavior while apathy and eating changes increased. By contrast, all measured behaviors increased in patients with svPPA over time. Finally, only apathy made longitudinal contributions to functional disability in patients with svPPA, whereas apathy and stereotypical behavior were associated with increased disability in patients with bvFTD. Conclusions: Despite shared overlapping baseline behavioral symptoms, patients with bvFTD are more functionally impaired than patients with svPPA. Apathy has a strong role in disability for both bvFTD and svPPA, but stereotypical behaviors only contributed to functional deficits in patients with bvFTD. Our findings suggest that rigid/compulsive behaviors may in fact support activity engagement in patients with svPPA. Taken together, our results indicate that interventions to reduce disability in the FTD spectrum require an alternative rationale in comparison to Alzheimer disease dementia, and should carefully weigh the interaction of behavioral symptoms and functional status.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Michael Hornberger
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Cristian E Leyton
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - John R Hodges
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Olivier Piguet
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Eneida Mioshi
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
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109
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Woollacott IOC, Rohrer JD. The clinical spectrum of sporadic and familial forms of frontotemporal dementia. J Neurochem 2016; 138 Suppl 1:6-31. [PMID: 27144467 DOI: 10.1111/jnc.13654] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/10/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Abstract
The term frontotemporal dementia (FTD) describes a clinically, genetically and pathologically diverse group of neurodegenerative disorders. Symptoms of FTD can present in individuals in their 20s through to their 90s, but the mean age at onset is in the sixth decade. The most common presentation is with a change in personality and impaired social conduct (behavioural variant FTD). Less frequently patients present with language problems (primary progressive aphasia). Both of these groups of patients can develop motor features consistent with either motor neuron disease (usually the amyotrophic lateral sclerosis variant) or parkinsonism (most commonly a progressive supranuclear palsy or corticobasal syndrome). In about a third of cases FTD is familial, with mutations in the progranulin, microtubule-associated protein tau and chromosome 9 open reading frame 72 genes being the major causes. Mutations in a number of other genes including TANK-binding kinase 1 are rare causes of familial FTD. This review aims to clarify the often confusing terminology of FTD, and outline the various clinical features and diagnostic criteria of sporadic and familial FTD syndromes. It will also discuss the current major challenges in FTD research and clinical practice, and potential areas for future research. This review clarifies the terminology of frontotemporal dementia (FTD) and summarizes the various clinical features and most recent diagnostic criteria of sporadic and familial FTD syndromes. It also discusses the current major challenges in FTD research and clinical practice, and highlights potential areas for future research.
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Affiliation(s)
- Ione O C Woollacott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
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110
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Lowe VJ, Curran G, Fang P, Liesinger AM, Josephs KA, Parisi JE, Kantarci K, Boeve BF, Pandey MK, Bruinsma T, Knopman DS, Jones DT, Petrucelli L, Cook CN, Graff-Radford NR, Dickson DW, Petersen RC, Jack CR, Murray ME. An autoradiographic evaluation of AV-1451 Tau PET in dementia. Acta Neuropathol Commun 2016; 4:58. [PMID: 27296779 PMCID: PMC4906968 DOI: 10.1186/s40478-016-0315-6] [Citation(s) in RCA: 348] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 12/19/2022] Open
Abstract
Background It is essential to determine the specificity of AV-1451 PET for tau in brain imaging by using pathological comparisons. We performed autoradiography in autopsy-confirmed Alzheimer disease and other neurodegenerative disorders to evaluate the specificity of AV-1451 binding for tau aggregates. Methods Tissue samples were selected that had a variety of dementia-related neuropathologies including Alzheimer disease, primary age-related tauopathy, tangle predominant dementia, non-Alzheimer disease tauopathies, frontotemporal dementia, parkinsonism, Lewy body disease and multiple system atrophy (n = 38). Brain tissue sections were stained for tau, TAR DNA-binding protein-43, and α-synuclein and compared to AV-1451 autoradiography on adjacent sections. Results AV-1451 preferentially localized to neurofibrillary tangles, with less binding to areas enriched in neuritic pathology and less mature tau. The strength of AV-1451 binding with respect to tau isoforms in various neurodegenerative disorders was: 3R + 4R tau (e.g., AD) > 3R tau (e.g., Pick disease) or 4R tau. Only minimal binding of AV-1451 to TAR DNA-binding protein-43 positive regions was detected. No binding of AV-1451 to α-synuclein was detected. “Off-target” binding was seen in vessels, iron-associated regions, substantia nigra, calcifications in the choroid plexus, and leptomeningeal melanin. Conclusions Reduced AV-1451 binding in neuritic pathology compared to neurofibrillary tangles suggests that the maturity of tau pathology may affect AV-1451 binding and suggests complexity in AV-1451 binding. Poor association of AV-1451 with tauopathies that have preferential accumulation of either 4R tau or 3R tau suggests limited clinical utility in detecting these pathologies. In contrast, for disorders associated with 3R + 4R tau, such as Alzheimer disease, AV-1451 binds tau avidly but does not completely reflect the early stage tau progression suggested by Braak neurofibrillary tangle staging. AV-1451 binding to TAR DNA-binding protein-43 or TAR DNA-binding protein-43 positive regions can be weakly positive. Clinical use of AV-1451 will require a familiarity with distinct types of “off-target” binding. Electronic supplementary material The online version of this article (doi:10.1186/s40478-016-0315-6) contains supplementary material, which is available to authorized users.
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111
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Jaeger PA, Lucin KM, Britschgi M, Vardarajan B, Huang RP, Kirby ED, Abbey R, Boeve BF, Boxer AL, Farrer LA, Finch N, Graff-Radford NR, Head E, Hofree M, Huang R, Johns H, Karydas A, Knopman DS, Loboda A, Masliah E, Narasimhan R, Petersen RC, Podtelezhnikov A, Pradhan S, Rademakers R, Sun CH, Younkin SG, Miller BL, Ideker T, Wyss-Coray T. Network-driven plasma proteomics expose molecular changes in the Alzheimer's brain. Mol Neurodegener 2016; 11:31. [PMID: 27112350 PMCID: PMC4845325 DOI: 10.1186/s13024-016-0095-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
Background Biological pathways that significantly contribute to sporadic Alzheimer’s disease are largely unknown and cannot be observed directly. Cognitive symptoms appear only decades after the molecular disease onset, further complicating analyses. As a consequence, molecular research is often restricted to late-stage post-mortem studies of brain tissue. However, the disease process is expected to trigger numerous cellular signaling pathways and modulate the local and systemic environment, and resulting changes in secreted signaling molecules carry information about otherwise inaccessible pathological processes. Results To access this information we probed relative levels of close to 600 secreted signaling proteins from patients’ blood samples using antibody microarrays and mapped disease-specific molecular networks. Using these networks as seeds we then employed independent genome and transcriptome data sets to corroborate potential pathogenic pathways. Conclusions We identified Growth-Differentiation Factor (GDF) signaling as a novel Alzheimer’s disease-relevant pathway supported by in vivo and in vitro follow-up experiments, demonstrating the existence of a highly informative link between cellular pathology and changes in circulatory signaling proteins. Electronic supplementary material The online version of this article (doi:10.1186/s13024-016-0095-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philipp A Jaeger
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. .,Institute of Chemistry and Biochemistry, Free University Berlin, Berlin, Germany. .,Departments of Bioengineering and Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Kurt M Lucin
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Present address: Biology Department, Eastern Connecticut State University, Willimantic, CT, USA
| | - Markus Britschgi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Present address: Roche Pharma Research and Early Development, NORD DTA, Roche Innovation, Center Basel, Basel, Switzerland
| | - Badri Vardarajan
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine, Boston, MA, USA
| | - Ruo-Pan Huang
- RayBiotech, Guangzhou, China.,RayBiotech, Norcrosse, GA, USA
| | - Elizabeth D Kirby
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachelle Abbey
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Adam L Boxer
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Lindsay A Farrer
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine, Boston, MA, USA.,Departments of Neurology, Ophthalmology, Genetics and Genomics, Epidemiology, and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - NiCole Finch
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Elizabeth Head
- Departments of Pharmacology and Nutritional Sciences and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Matan Hofree
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ruochun Huang
- RayBiotech, Guangzhou, China.,RayBiotech, Norcrosse, GA, USA
| | - Hudson Johns
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna Karydas
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Andrey Loboda
- Genetics and Pharmacogenomics, Merck Research Laboratories, West Point, PA, USA
| | - Eliezer Masliah
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Ramya Narasimhan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Suraj Pradhan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Chung-Huan Sun
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Bruce L Miller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Trey Ideker
- Departments of Bioengineering and Medicine, University of California San Diego, La Jolla, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. .,Center for Tissue Regeneration, Repair and Restoration, VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Leyton CE, Britton AK, Hodges JR, Halliday GM, Kril JJ. Distinctive pathological mechanisms involved in primary progressive aphasias. Neurobiol Aging 2016; 38:82-92. [DOI: 10.1016/j.neurobiolaging.2015.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 12/12/2022]
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113
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Abstract
Frontotemporal dementia (FTD) was one of the lesser known dementias until the recent advancements revealing its genetic and pathological foundation. This common neurodegenerative disorder has three clinical subtypes- behavioral, semantic and progressive non fluent aphasia. The behavioral variant mostly exhibits personality changes, while the other two encompass various language deficits. This review discusses the basic pathology, genetics, clinical and histological presentation and the diagnosis of the 3 subtypes. It also deliberates the different therapeutic modalities currently available for frontotemporal dementia and the challenges faced by the caregivers. Lastly it explores the scope of further research into the diagnosis and management of FTD.
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Affiliation(s)
- Sayantani Ghosh
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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114
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Bier N, Paquette G, Macoir J. Smartphone for smart living: Using new technologies to cope with everyday limitations in semantic dementia. Neuropsychol Rehabil 2015; 28:734-754. [DOI: 10.1080/09602011.2015.1094395] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- N. Bier
- École de réadaptation, Université de Montréal, Montréal, QC, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - G. Paquette
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - J. Macoir
- Département de réadaptation, Université Laval, Québec, QC, Canada
- Centre de recherche, Institut universitaire en santé mentale de Québec, Québec, QC, Canada
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115
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Snowden JS, Adams J, Harris J, Thompson JC, Rollinson S, Richardson A, Jones M, Neary D, Mann DM, Pickering-Brown S. Distinct clinical and pathological phenotypes in frontotemporal dementia associated with MAPT, PGRN and C9orf72 mutations. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:497-505. [PMID: 26473392 DOI: 10.3109/21678421.2015.1074700] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to compare the clinical and pathological characteristics of frontotemporal dementia patients with MAPT, GRN and C9orf72 gene mutations. We carried out a cross-sectional comparative study of 74 gene-positive patients (15 MAPT, 17 GRN and 42 C9orf72). Thirty had post mortem pathological data permitting clinico-pathological correlation. MAPT patients were younger than other groups, and showed more frequent behavioural disinhibition, repetitive and stereotyped behaviours, semantic impairment and temporal predominance of atrophy. GRN patients were older at death and more likely to present with non-fluent aphasia. C9orf72 patients alone showed a co-occurrence of ALS. They showed more psychotic symptoms and irrational behaviour, yet were more often reported clinically as socially appropriate and warm. They showed less dietary change than other groups. C9orf72 patients with and without ALS differed only in frequency of psychosis. Greater clinical overlap was observed between GRN and C9orf72 compared to MAPT cases. MAPT cases had tau and GRN and C9orf72, with one exception, TDP-43 pathology. Non-fluent aphasia was linked to TDP subtype A in both GRN and C9orf72 cases and ALS with subtype B. In conclusion, the findings reinforce clinical heterogeneity in FTD and strengthen evidence that genotype influences clinical presentation. Clinical features may inform targeted genetic testing.
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Affiliation(s)
- Julie S Snowden
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Jennifer Adams
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Jennifer Harris
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Jennifer C Thompson
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Sara Rollinson
- b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Anna Richardson
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Matthew Jones
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford.,b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - David Neary
- a Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust , Salford
| | - David M Mann
- b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
| | - Stuart Pickering-Brown
- b Institute of Brain, Behaviour and Mental Health, Faculty of Human and Medical Sciences, University of Manchester , Manchester , UK
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Kamminga J, Kumfor F, Burrell JR, Piguet O, Hodges JR, Irish M. Differentiating between right-lateralised semantic dementia and behavioural-variant frontotemporal dementia: an examination of clinical characteristics and emotion processing. J Neurol Neurosurg Psychiatry 2015; 86:1082-8. [PMID: 25511791 DOI: 10.1136/jnnp-2014-309120] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Right-lateralised semantic dementia (right SD) and behavioural-variant frontotemporal dementia (bvFTD) appear clinically similar, despite different patterns of underlying brain changes. This study aimed to elucidate distinguishing clinical and cognitive features in right SD versus bvFTD, emphasising emotion processing and its associated neural correlates. METHODS 12 patients with right SD and 19 patients with bvFTD were recruited. Clinical features were documented. All patients were assessed on standardised neuropsychological tests and a facial emotion processing battery. Performance was compared to 20 age-matched and education-matched controls. Grey matter intensity was related to emotion processing performance using whole-brain voxel-based morphometry analysis. RESULTS Patients with right SD exhibited disproportionate language dysfunction, prosopagnosia and a suggestion of increased obsessive personality/behavioural changes versus patients with bvFTD. In contrast, patients with bvFTD demonstrated pronounced deficits in attention/working memory, increased apathy and greater executive dysfunction, compared to patients with right SD. Decreased empathy, disinhibition and diet changes were common to both dementia subtypes. Emotion processing deficits were present in both FTD syndromes but were associated with divergent patterns of brain atrophy. In right SD, emotion processing dysfunction was associated with predominantly right medial and lateral temporal integrity, compared to mainly left temporal, inferior frontal and orbitofrontal and right frontal gyrus integrity in bvFTD. CONCLUSIONS This study demonstrates comparable deficits in facial emotion processing in right SD and bvFTD, in keeping with their similar clinical profiles. These deficits are attributable to divergent neural substrates in each patient group, namely, right lateralised regions in right SD, versus predominantly left lateralised regions in bvFTD.
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Affiliation(s)
- Jody Kamminga
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Kumfor
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Muireann Irish
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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Bott NT, Radke A, Stephens ML, Kramer JH. Frontotemporal dementia: diagnosis, deficits and management. Neurodegener Dis Manag 2015; 4:439-54. [PMID: 25531687 DOI: 10.2217/nmt.14.34] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Frontotemporal dementia (FTD) is a progressive neurologic syndrome with diverse clinical presentations and attendant underlying pathologies. Psychiatric prodrome, neuropsychiatric symptoms and language difficulties are common in FTD, but the diversity of presentation raises unique diagnostic challenges that can significantly impact patient care and counsel for caregivers regarding clinical status and prognosis. While neuropsychiatric symptom measures are helpful, more sensitive assessments delineating the specific behavioral and linguistic deficits accompanying FTD are needed. Comprehensive clinical assessment in combination with evaluation of language, socio-emotional functioning, cognition and neuroimaging aid in accurate and early diagnosis and treatment planning. In what follows, we review each of the FTD syndromes, highlight current research investigating the cognitive, behavioral and socio-emotional deficits observed with this disease, address common diagnostic challenges and summarize best practices associated with management of FTD.
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Affiliation(s)
- Nicholas T Bott
- Department of Neurology, Memory & Aging Center, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158, USA
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118
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Botha H, Duffy JR, Whitwell JL, Strand EA, Machulda MM, Schwarz CG, Reid RI, Spychalla AJ, Senjem ML, Jones DT, Lowe V, Jack CR, Josephs KA. Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech. Cortex 2015; 69:220-36. [PMID: 26103600 PMCID: PMC4522343 DOI: 10.1016/j.cortex.2015.05.013] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
The consensus criteria for the diagnosis and classification of primary progressive aphasia (PPA) have served as an important tool in studying this group of disorders. However, a large proportion of patients remain unclassifiable whilst others simultaneously meet criteria for multiple subtypes. We prospectively evaluated a large cohort of patients with degenerative aphasia and/or apraxia of speech using multidisciplinary clinical assessments and multimodal imaging. Blinded diagnoses were made using operational definitions with important differences compared to the consensus criteria. Of the 130 included patients, 40 were diagnosed with progressive apraxia of speech (PAOS), 12 with progressive agrammatic aphasia, 9 with semantic dementia, 52 with logopenic progressive aphasia, and 4 with progressive fluent aphasia, while 13 were unclassified. The PAOS and progressive fluent aphasia groups were least impaired. Performance on repetition and sentence comprehension was especially poor in the logopenic group. The semantic and progressive fluent aphasia groups had prominent anomia, but only semantic subjects had loss of word meaning and object knowledge. Distinct patterns of grey matter loss and white matter changes were found in all groups compared to controls. PAOS subjects had bilateral frontal grey matter loss, including the premotor and supplementary motor areas, and bilateral frontal white matter involvement. The agrammatic group had more widespread, predominantly left sided grey matter loss and white matter abnormalities. Semantic subjects had bitemporal grey matter loss and white matter changes, including the uncinate and inferior occipitofrontal fasciculi, whereas progressive fluent subjects only had left sided temporal involvement. Logopenic subjects had diffuse and bilateral grey matter loss and diffusion tensor abnormalities, maximal in the posterior temporal region. A diagnosis of logopenic aphasia was strongly associated with being amyloid positive (46/52 positive). Our findings support consideration of an alternative way of identifying and categorizing subtypes of degenerative speech and language disorders.
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Affiliation(s)
- Hugo Botha
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | | | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | | | - Robert I Reid
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Val Lowe
- Department of Radiology (Nuclear Medicine), Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA; Department of Neurology (Movement Disorders), Mayo Clinic, Rochester, MN, USA.
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119
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Diehl-Schmid J, Oexle K. [Genetics of dementia]. DER NERVENARZT 2015; 86:891-902. [PMID: 26108876 DOI: 10.1007/s00115-015-4276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most psychiatric diseases in adulthood have a multifactorial origin. This also applies for most cases of dementia; however, rare familial forms of Alzheimer's disease and frontotemporal lobar degeneration follow an autosomal dominant (Mendelian) inheritance pattern. Alzheimer's disease that is caused by mutations in the genes for presenilin 1, presenilin 2 and amyloid precursor protein has an onset under the age of 65 years in most cases. Approximately 10 % of frontotemporal lobar degeneration cases display an autosomal dominant inheritance pattern. According to the current S3 guidelines on dementia of the German Association for Psychiatry, Psychotherapy and Psychosomatics and the German Society of Neurology, genetic counseling should be offered if an autosomal dominant disease pattern is suspected. Genetic counseling must conform to the German Genetic Diagnostics Act (Gendiagnostikgesetz).
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Affiliation(s)
- J Diehl-Schmid
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Ismaninger Str. 22, 81675, München, Deutschland,
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120
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Abstract
'Primary progressive aphasia' (PPA) refers to core linguistic disorders caused by neurodegenerative disease. Three main PPA variants are recognized: nonfluent/agrammatic, semantic and logopenic. Correctly classifying patients during life according to the underlying histopathology will become increasingly important as cause-specific treatments become available. This article reviews clinical and histopathological studies of PPA, with particular reference to updated PPA classifications. Currently, one-to-one relationships do not exist within PPA subtypes. The semantic variant has the best correspondence between the clinical syndrome and the underlying pathological cause and the logopenic variant the worst correspondence. The use of future biomarkers should facilitate accurate clinicopathological correlation of patients during life.
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Affiliation(s)
- Jennifer M Harris
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK
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121
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Suhonen NM, Kaivorinne AL, Moilanen V, Bode M, Takalo R, Hänninen T, Remes AM. Slowly progressive frontotemporal lobar degeneration caused by the C9ORF72 repeat expansion: a 20-year follow-up study. Neurocase 2015; 21:85-9. [PMID: 24417314 DOI: 10.1080/13554794.2013.873057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A hexanucleotide expansion in chromosome 9 open-reading frame 72 (C9ORF72) has been found to be a major cause of frontotemporal lobar degeneration (FTLD). We describe a 20-year follow-up of a unique case with very slowly progressive FTLD caused by the C9ORF72 repeat expansion. In serial neuropsychological examinations, the patient's cognitive decline was exceptionally slow and after 20 years the patient still was mainly independent in activities of daily living. Our case indicates that there is great individual variation in the progression and duration of C9ORF72-associated FTLD, and also language variants or mixed phenotypes may be present.
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Affiliation(s)
- N-M Suhonen
- a Institute of Clinical Medicine, Neurology , University of Oulu , Oulu , Finland
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122
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Clerc MT, Deprez M, Leuba G, Lhermitte B, Lopez U, von Gunten A. Atypical association of semantic dementia, corticobasal syndrome, and 4R tauopathy. Neurocase 2015; 21:1-15. [PMID: 24156410 DOI: 10.1080/13554794.2013.841953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 57-year-old male with no family history was diagnosed with semantic dementia. He also showed some unusual cognitive features such as episodic memory and executive dysfunctions, spatial disorientation, and dyscalculia. Rapidly progressive cognitive and physical decline occurred. About 1.5 years later, he developed clinical features of a corticobasal syndrome. He died at the age of 60. Brain autopsy revealed numerous 4R-tau-positive lesions in the frontal, parietal and temporal lobes, basal ganglia, and brainstem. Neuronal loss was severe in the temporal cortex. Such association of semantic dementia with tauopathy and corticobasal syndrome is highly unusual. These findings are discussed in the light of current knowledge about frontotemporal lobar degeneration.
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Affiliation(s)
- Marie-Therese Clerc
- a Service Universitaire de Psychiatrie de l'âge avancé, Département de Psychiatrie , Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
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123
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Brambati SM, Amici S, Racine CA, Neuhaus J, Miller Z, Ogar J, Dronkers N, Miller BL, Rosen H, Gorno-Tempini ML. Longitudinal gray matter contraction in three variants of primary progressive aphasia: A tenser-based morphometry study. NEUROIMAGE-CLINICAL 2015; 8:345-55. [PMID: 26106560 PMCID: PMC4473099 DOI: 10.1016/j.nicl.2015.01.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/14/2015] [Accepted: 01/17/2015] [Indexed: 12/13/2022]
Abstract
The present study investigated the pattern of longitudinal changes in cognition and anatomy in three variants of primary progressive aphasia (PPA). Eight patients with the non-fluent variant of PPA (nfvPPA), 13 patients with the semantic variant (svPPA), seven patients with the logopenic variant (lvPPA), and 29 age-matched, neurologically healthy controls were included in the study. All participants underwent longitudinal MRI, neuropsychological and language testing at baseline and at a 1-year follow-up. Tenser-based morphometry (TBM) was applied to T1-weighted MRI images in order to map the progression of gray and white matter atrophy over a 1-year period. Results showed that each patient group was characterized by a specific pattern of cognitive and anatomical changes. Specifically, nfvPPA patients showed gray matter atrophy progression in the left frontal and subcortical areas as well as a decline in motor speech and executive functions; svPPA patients presented atrophy progression in the medial and lateral temporal lobe and decline in semantic memory abilities; and lvPPA patients showed atrophy progression in lateral/posterior temporal and medial parietal regions with a decline in memory, sentence repetition and calculations. In addition, in all three variants, the white matter fibers underlying the abovementioned cortical areas underwent significant volume contraction over a 1-year period. Overall, these results indicate that the three PPA variants present distinct patterns of neuroanatomical contraction, which reflect their clinical and cognitive progression.
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Affiliation(s)
- Simona Maria Brambati
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Serena Amici
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline A Racine
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - John Neuhaus
- Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jenny Ogar
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA ; Department of Veteran's Affairs, Martinez, CA, USA ; University of California, Davis, CA, USA
| | - Nina Dronkers
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA ; Department of Veteran's Affairs, Martinez, CA, USA ; University of California, Davis, CA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Howard Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
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124
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Matias-Guiu JA, Cabrera-Martín MN, Moreno-Ramos T, García-Ramos R, Porta-Etessam J, Carreras JL, Matías-Guiu J. Clinical course of primary progressive aphasia: clinical and FDG-PET patterns. J Neurol 2014; 262:570-7. [PMID: 25491078 DOI: 10.1007/s00415-014-7608-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/27/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
Primary progressive aphasia (PPA) may be the onset of several neurodegenerative diseases. This study evaluates a cohort of patients with PPA to assess their progression to different clinical syndromes, associated factors that modulate this progression, and patterns of cerebral metabolism linked to different clinical evolutionary forms. Thirty-five patients meeting PPA criteria underwent a clinical and neuroimaging (18)F-Fluorodeoxyglucose PET evaluation. Survival analysis was performed using time from clinical onset to the development of a non-language symptom or deficit (PPA-plus). Cerebral metabolism was analyzed using Statistical Parametric Mapping. Patients classified into three PPA variants evolved to atypical parkinsonism, behavioral disorder and motor neuron disease in the agrammatic variant; to behavioral disorder in the semantic; and to memory impairment in the logopenic. Median time from the onset of symptoms to PPA-plus was 36 months (31-40, 95 % confidence interval). Right laterality, and years of education were associated to a lower risk of progression, while logopenic variant to a higher risk. Different regions of hypometabolism were identified in agrammatic PPA with parkinsonism, motor neuron disease and logopenic PPA-plus. Clinical course of PPA differs according to each variant. Left anterior temporal and frontal medial hypometabolism in agrammatic variant is linked to motor neuron disease and atypical parkinsonism, respectively. PPA variant, laterality and education may be associated to the risk of progression. These results suggest the possibility that clinical and imaging data could help to predict the clinical course of PPA.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Prof. Martin Lagos St., 28040, Madrid, Spain,
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125
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Clinical phenotypes and radiological findings in frontotemporal dementia related to TARDBP mutations. J Neurol 2014; 262:375-84. [DOI: 10.1007/s00415-014-7575-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/02/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022]
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126
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Babiak MC. Right Temporal Variant of Frontotemporal Dementia: A Clinical Introduction. ACTA ACUST UNITED AC 2014. [DOI: 10.1044/nnsld24.4.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Frontotemporal dementia (FTD) is a progressive, neurodegenerative syndrome that results in changes in personality, behavior, and language. The right temporal variant, a relatively under-studied and perhaps under-diagnosed clinical subtype of FTD, manifests as behavioral changes, loss of person-specific knowledge, and eventual deficits in word-finding and semantic knowledge. Thorough assessment is necessary in order to distinguish right temporal variant FTD from other dementias. Speech-language pathologists (SLPs) play an essential role in accurate diagnosis, provision of appropriate resources and referrals, and administration of effective treatments.
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Affiliation(s)
- Miranda C. Babiak
- Department of Neurology, Memory and Aging Center, University of California San FranciscoSan Francisco, CA
- Department of Communication Science and Disorders, University of PittsburghPittsburgh, PA
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127
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Kim EJ, Park KW, Lee JH, Choi S, Jeong JH, Yoon SJ, Kim BC, Kwon JC, Ku BD, Kim SH, Choi BO, Na DL. Clinical and Neuropsychological Characteristics of a Nationwide Hospital-Based Registry of Frontotemporal Dementia Patients in Korea: A CREDOS-FTD Study. Dement Geriatr Cogn Dis Extra 2014; 4:242-51. [PMID: 25177333 PMCID: PMC4132251 DOI: 10.1159/000360278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We investigated the demographic, clinical, and neuropsychological characteristics of frontotemporal dementia (FTD) from the Clinical Research Center for Dementia of South Korea (CREDOS)-FTD registry. METHODS A total of 200 consecutive patients with FTD recruited from 16 neurological clinics in Korea were evaluated by cognitive and functional assessments, a screening test for aphasia, behavioral questionnaires, motor assessments, and brain MRI or PET. RESULTS In our registry, 78 patients were classified as having been diagnosed with behavioral-variant FTD (bvFTD), 70 with semantic dementia (SD), 33 with progressive nonfluent aphasia (PNFA), and 8 with motor neuron disease plus syndrome (MND-plus). The patients with language variants of dementia were older than those with bvFTD. There were no differences in sex ratio, duration of illness, or level of education among the four subgroups. Overall, the patients with bvFTD showed a significantly better performance in cognitive tests. A higher frequency of motor symptoms and a lower frequency of behavioral symptoms were found in PNFA than in bvFTD and SD. The Global Language Index was significantly lower in SD than in bvFTD and PNFA. The MND-plus group had a poorer performance than all the others in all cognitive domains. CONCLUSION The neuropsychological, behavioral, motor, and language characteristics of the four subtypes are comparable with those from other series. However, the proportion of SD (37.0%), which was similar to that of bvFTD (41.3%), was higher in our registry than in other series.
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Affiliation(s)
- Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Seoul, Korea
| | - Kyung-Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - SeongHye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Jee H Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Jay C Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Bon D Ku
- Department of Neurology, College of Medicine, Kwandong University Myongji Hospital, Goyang, Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Golimstok A, Cámpora N, Rojas JI, Fernandez MC, Elizondo C, Soriano E, Cristiano E. Cardiovascular risk factors and frontotemporal dementia: a case-control study. Transl Neurodegener 2014; 3:13. [PMID: 24995127 PMCID: PMC4080770 DOI: 10.1186/2047-9158-3-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/13/2014] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular risk factors (CRF) were widely described as related to dementia. There are very few studies regarding this association in FTD. The objective of the study was to compare the frequency of CRF in our population with FTD and controls. 100 consecutive subjects with FTD diagnosis according to Lund-Manchester clinical criteria and 200 controls matched by age and sex were included between January 2003 to February 2007 at the Cognitive and Behavior Unit of Hospital Italiano de Buenos Aires. Clinical evaluation, laboratory tests, brain images (CT/MRI), neuropsychological and neuropsychiatric assessment were performed. Multiple regression analysis was performed to analyze the association in CRF between FTD patients vs. controls. The mean age in FTD was 69.7 ± 0.9 vs. 70.1 ± 0.8 in controls (p 0.12). No difference in gender was observed between cases and controls. No differences were identified between patients and controls regarding hypertension (HTA) (65% vs. 67,3% p 0.44); dyslipidemia (57% vs. 54.7% p 0.74); obesity (39% vs. 27.6% p 0.14) and hypothyroidism (26% vs. 17.1% p 0.1). A significant difference was observed for Diabetes Mellitus (39% vs. 22.6% p 0.001). In our population, Diabetes Mellitus was associated as an independent risk factor for FTD. To our knowledge this is the first report in which CRF were evaluated prospectively in FTD patients. More studies are needed to confirm this finding in larger populations.
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Affiliation(s)
- Angel Golimstok
- Cognitive and Behavior Unit, Department of Neurology, Hospital Italiano de Buenos Aires, Perón 4272, 1411 Buenos Aires, Argentina
| | - Nuria Cámpora
- Cognitive and Behavior Unit, Department of Neurology, Hospital Italiano de Buenos Aires, Perón 4272, 1411 Buenos Aires, Argentina
| | - Juan I Rojas
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María C Fernandez
- Cognitive and Behavior Unit, Department of Neurology, Hospital Italiano de Buenos Aires, Perón 4272, 1411 Buenos Aires, Argentina
| | - Cristina Elizondo
- Epidemiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Enrique Soriano
- Epidemiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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La Joie R, Landeau B, Perrotin A, Bejanin A, Egret S, Pélerin A, Mézenge F, Belliard S, de La Sayette V, Eustache F, Desgranges B, Chételat G. Intrinsic connectivity identifies the hippocampus as a main crossroad between Alzheimer's and semantic dementia-targeted networks. Neuron 2014; 81:1417-1428. [PMID: 24656258 DOI: 10.1016/j.neuron.2014.01.026] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 11/17/2022]
Abstract
Alzheimer's disease (AD) and semantic dementia (SD) are both characterized by severe atrophy in the hippocampus, a brain region underlying episodic memory; paradoxically, episodic memory is relatively preserved in SD. Here, we used intrinsic connectivity analyses and showed that the brain networks differentially vulnerable to each disease converge to the hippocampus in the healthy brain. As neurodegeneration is thought to spread within preexisting networks, the common hippocampal atrophy in both diseases is likely due to its location at the crossroad between both vulnerable networks. Yet, we showed that in the normal brain, these networks harbor different functions, with episodic memory relying on the AD-vulnerable network only. Overall, disease-associated cognitive deficits seem to reflect the disruption of targeted networks more than atrophy in specific brain regions: in AD, over hippocampal atrophy, episodic memory deficits are likely due to disconnection within a memory-related network.
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Affiliation(s)
- Renaud La Joie
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France.
| | - Brigitte Landeau
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Audrey Perrotin
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Alexandre Bejanin
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Stéphanie Egret
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Alice Pélerin
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Florence Mézenge
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Serge Belliard
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU Pontchaillou, Service de Neurologie, 35000 Rennes, France
| | - Vincent de La Sayette
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, Service de Neurologie, 14000 Caen, France
| | - Francis Eustache
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Béatrice Desgranges
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
| | - Gaël Chételat
- INSERM U1077, 14000 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, 14000 Caen, France; CHU de Caen, U1077, 14000 Caen, France
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Nilsson C, Landqvist Waldö M, Nilsson K, Santillo A, Vestberg S. Age-related incidence and family history in frontotemporal dementia: data from the Swedish Dementia Registry. PLoS One 2014; 9:e94901. [PMID: 24722237 PMCID: PMC3983262 DOI: 10.1371/journal.pone.0094901] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/20/2014] [Indexed: 01/21/2023] Open
Abstract
Objectives Frontotemporal dementia (FTD) is considered to be a mainly early-onset neurodegenerative disorder with a strong hereditary component. The aim of the study was to investigate age-related incidence and family history in FTD compared to other dementia disorders, especially Alzheimer's disease (AD). Methods The Swedish Dementia Registry (SveDem) registers all new cases of dementia diagnosed by the participating centres, including data on demographics, diagnosis, and investigations used. Data for the period 2008–2011 were extracted and compared with age-related population data on a regional and national level. Results There were 20 305 patients registered in SveDem during 2008–2011, whereof 352 received a diagnosis of FTD. Mean age at diagnosis for FTD was 69.6 years and almost 70% of FTD cases were 65 years or older at the time of diagnosis. Both FTD and AD showed an increased incidence with age, which reached a maximum in the age group 80–84 years at 6.04 and 202 cases per 100 000 person-years, respectively. The proportion of cases with a positive family history was significantly lower in FTD than in AD. Conclusions Contrary to general opinion within the field, data from SveDem show that the incidence of FTD increases with age, and that the majority of cases are diagnosed after the age of 65 years. In addition, data from SveDem might suggest that the importance of hereditary factors in general is similar in FTD and AD. The recognition of these findings has important consequences for the diagnosis, treatment and care of patients with FTD.
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Affiliation(s)
- Christer Nilsson
- Department of Memory Disorders, Skåne University Hospital, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
| | - Maria Landqvist Waldö
- Department of Memory Disorders, Skåne University Hospital, Lund, Sweden
- Geriatric Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Nilsson
- Department of Memory Disorders, Skåne University Hospital, Lund, Sweden
- Geriatric Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Alexander Santillo
- Department of Memory Disorders, Skåne University Hospital, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Susanna Vestberg
- Geriatric Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Psychology, Lund University, Lund, Sweden
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131
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Kertesz A, Harciarek M. Primary progressive aphasia. Scand J Psychol 2014; 55:191-201. [DOI: 10.1111/sjop.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/05/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Kertesz
- Department of Clinical Neurological Sciences; Western University; London Ontario Canada
| | - Michał Harciarek
- Division of Clinical Psychology and Neuropsychology; Institute of Psychology; University of Gdańsk; Gdańsk Poland
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Abstract
25% of all people aged 55 years and older have a family history of dementia. For most, the family history is due to genetically complex disease, where many genetic variations of small effect interact to increase risk of dementia. The lifetime risk of dementia for these families is about 20%, compared with 10% in the general population. A small proportion of families have an autosomal dominant family history of early-onset dementia, which is often due to mendelian disease, caused by a mutation in one of the dementia genes. Each family member has a 50% chance of inheriting the mutation, which confers a lifetime dementia risk of over 95%. In this Review, we focus on the evidence for, and the approach to, genetic testing in Alzheimer's disease (APP, PSEN1, and PSEN2 genes), frontotemporal dementia (MAPT, GRN, C9ORF72, and other genes), and other familial dementias. We conclude by discussing the practical aspects of genetic counselling.
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Affiliation(s)
- Clement T Loy
- School of Public Health, University of Sydney, Sydney, NSW, Australia; Neuroscience Research Australia, Randwick, NSW, Australia; Huntington Disease Service, Westmead Hospital, Westmead, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Kensington, NSW, Australia
| | - Anne M Turner
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - John B J Kwok
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Kensington, NSW, Australia.
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Sakakibara R, Tateno F, Kishi M, Tsuyusaki Y, Terada H, Inaoka T. MIBG myocardial scintigraphy in pre-motor Parkinson's disease: A review. Parkinsonism Relat Disord 2014; 20:267-73. [DOI: 10.1016/j.parkreldis.2013.11.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 01/02/2023]
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Factors determining disease duration in Alzheimer's disease: a postmortem study of 103 cases using the Kaplan-Meier estimator and Cox regression. BIOMED RESEARCH INTERNATIONAL 2014; 2014:623487. [PMID: 24579083 PMCID: PMC3919116 DOI: 10.1155/2014/623487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 11/05/2013] [Accepted: 11/24/2013] [Indexed: 12/04/2022]
Abstract
Factors associated with duration of dementia in a consecutive series of 103 Alzheimer's disease (AD) cases were studied using the Kaplan-Meier estimator and Cox regression analysis (proportional hazard model). Mean disease duration was 7.1 years (range: 6 weeks–30 years, standard deviation = 5.18); 25% of cases died within four years, 50% within 6.9 years, and 75% within 10 years. Familial AD cases (FAD) had a longer duration than sporadic cases (SAD), especially cases linked to presenilin (PSEN) genes. No significant differences in duration were associated with age, sex, or apolipoprotein E (Apo E) genotype. Duration was reduced in cases with arterial hypertension. Cox regression analysis suggested longer duration was associated with an earlier disease onset and increased senile plaque (SP) and neurofibrillary tangle (NFT) pathology in the orbital gyrus (OrG), CA1 sector of the hippocampus, and nucleus basalis of Meynert (NBM). The data suggest shorter disease duration in SAD and in cases with hypertensive comorbidity. In addition, degree of neuropathology did not influence survival, but spread of SP/NFT pathology into the frontal lobe, hippocampus, and basal forebrain was associated with longer disease duration.
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135
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Abstract
Semantic dementia impairs semantic autobiographical memory, but tends to spare its episodic components that are critical for the sense of self. Investigators have recently discovered disturbances in the "future self" in semantic dementia. We report a 63-year-old man with semantic dementia who was hospitalized after suicide attempts that he attributed to his loss of a sense of future self. He complained of a decreased sense of being human, because he could not imagine doing things in the future that he had done in the past. Suicidal thinking and inability to place himself in future tasks persisted despite resolution of depression. Clinical assessment revealed a crossmodal loss of semantic knowledge, and neuroimaging showed bilateral anterior temporal atrophy and hypometabolism. On specific tests of autobiographical memory, identity, attribute knowledge, and future projection, the patient could return to the past and visualize himself in familiar scenarios, but he could not visualize himself even passively in these scenarios in the future. His future self was impaired not from seeing himself disabled; it was from an absence of semantic details of potential experiences, associated with impaired semantic autobiographical memory. His self-representations were concrete and specific rather than abstract and generalizable. This patient and recent publications indicate that semantic dementia impairs the ability to imagine oneself as capable in the future, leading some patients to suicidal behavior. We discuss possible mechanisms for these findings, including the potential role of abstract construals for future thinking.
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136
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Alonso P, Orbegozo A, Pujol J, López-Solà C, Fullana MÀ, Segalàs C, Real E, Subirà M, Martínez-Zalacaín I, Menchón JM, Harrison BJ, Cardoner N, Soriano-Mas C. Neural correlates of obsessive-compulsive related dysfunctional beliefs. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:25-32. [PMID: 23911440 DOI: 10.1016/j.pnpbp.2013.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/30/2022]
Abstract
There have been few attempts to integrate neurobiological and cognitive models of obsessive-compulsive disorder (OCD), although this might constitute a key approach to clarify the complex etiology of the disorder. Our study aimed to explore the neural correlates underlying dysfunctional beliefs hypothesized by cognitive models to be involved in the development and maintenance of OCD. We obtained a high-resolution magnetic resonance image from fifty OCD patients and 30 healthy controls, and correlated them, voxel-wise, with the severity of OC-related dysfunctional beliefs assessed by the Obsessive Beliefs Questionnaire-44. In healthy controls, significant negative correlations were observed between anterior temporal lobe (ATL) volume and scores on perfectionism/intolerance of uncertainty and overimportance/need to control thoughts. No significant correlations between OBQ-44 domains and regional gray matter volumes were observed in OCD patients. A post-hoc region-of-interest analysis detected that the ATLs was bilaterally smaller in OCD patients. On splitting subjects into high- and low-belief subgroups, we observed that such brain structural differences between OCD patients and healthy controls were explained by significantly larger ATL volumes among healthy subjects from the low-belief subgroup. Our results suggest a significant correlation between OC-related dysfunctional beliefs and morphometric variability in the anterior temporal lobe, a brain structure related to socio-emotional processing. Future studies should address the interaction of these correlations with environmental factors to fully characterize the bases of OC-related dysfunctional beliefs and to advance in the integration of biological and cognitive models of OCD.
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Affiliation(s)
- Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Spain; CRC-Hospital del Mar, Barcelona, Spain.
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Belliard S, Merck C, Jonin P, Vérin M. Semantic dementia: Aspects of the early diagnosis. Rev Neurol (Paris) 2013; 169:806-10. [DOI: 10.1016/j.neurol.2013.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/10/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
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Borroni B, Benussi A, Cosseddu M, Archetti S, Padovani A. Cerebrospinal fluid tau levels predict prognosis in non-inherited frontotemporal dementia. NEURODEGENER DIS 2013; 13:224-9. [PMID: 24029600 DOI: 10.1159/000353280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The course of frontotemporal dementia (FTD) is heterogeneous and no predictors of survival are currently available. Cerebrospinal fluid (CSF) tau dosage has been demonstrated to be useful in predicting outcome over time in a number of neurological disorders. OBJECTIVE To assess CSF tau levels in FTD and to evaluate their prognostic value. METHODS Seventy-seven FTD patients with no mutations in known causative genes were consecutively enrolled, and CSF tau and phospho-tau levels analysed. Each patient was reassessed over time, and survival (i.e. death/bedridden and otherwise) was evaluated. The survival analysis was carried out by Cox proportional hazards regression models. RESULTS Patients with high CSF tau levels (≥400 pg/ml) had shorter survival than those with low CSF tau levels [hazard ratio (HR) = 3.406; 95% CI: 1.151-10.077; Wald χ(2) = 4.902; d.f. = 1; p = 0.027]. The association between tau levels and survival probability was confirmed after adjusting for age, gender, clinical phenotype and FTD clinical dementia rating at enrolment (HR = 3.769; 95% CI: 1.143-12.433; Wald χ(2) = 4.748; d.f. = 1; p = 0.029). Neither demographic or clinical characteristics nor CSF phospho-tau levels or apolipoprotein E genotype were significantly associated with prognosis. CONCLUSIONS This study argues that CSF tau levels may be considered in FTD to predict patients' outcome. Establishing in vivo prognostic biomarkers is mandatory to define homogeneous groups for inclusion in future clinical trials and to monitor the effectiveness of future therapeutic approaches.
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Affiliation(s)
- Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
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Sabodash V, Mendez MF, Fong S, Hsiao JJ. Suicidal behavior in dementia: a special risk in semantic dementia. Am J Alzheimers Dis Other Demen 2013; 28:592-9. [PMID: 23821774 PMCID: PMC10852574 DOI: 10.1177/1533317513494447] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some studies report a low suicide risk in general dementia and in Alzheimer's disease (AD). OBJECTIVE To evaluate suicidal behavior among patients with semantic dementia (SD), a disorder that impairs semantic knowledge. METHODS We reviewed the presence of active suicidal behavior and related factors among 25 patients with SD compared to 111 age-matched patients with early-onset AD. RESULTS In all, 5 (20%) patients with SD had suicidal behavior (2 successfully killed themselves) compared to 1 (0.9%) with AD (P < .001). There was significantly more depression and greater premorbid history of suicidal behavior among the patients with SD compared to those with AD. Among the patients with SD, those with suicidal behavior, compared to those without, had more depression and greater insight into their deficits. CONCLUSIONS Patients with SD are at special risk of committing suicide, particularly if they have depression and preserved insight. Possible mechanisms include an impaired sense of semantic competence with increased impulsivity.
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Affiliation(s)
- Valeriy Sabodash
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Neurobehavior Unit (691/116AF), V.A. Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Neurobehavior Unit (691/116AF), V.A. Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sylvia Fong
- Neurobehavior Unit (691/116AF), V.A. Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Julia J. Hsiao
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Neurobehavior Unit (691/116AF), V.A. Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
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Miller ZA, Rankin KP, Graff-Radford NR, Takada LT, Sturm VE, Cleveland CM, Criswell LA, Jaeger PA, Stan T, Heggeli KA, Hsu SC, Karydas A, Khan BK, Grinberg LT, Gorno-Tempini ML, Boxer AL, Rosen HJ, Kramer JH, Coppola G, Geschwind DH, Rademakers R, Seeley WW, Wyss-Coray T, Miller BL. TDP-43 frontotemporal lobar degeneration and autoimmune disease. J Neurol Neurosurg Psychiatry 2013; 84:956-62. [PMID: 23543794 PMCID: PMC3840954 DOI: 10.1136/jnnp-2012-304644] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aetiology and pathogenesis of non-genetic forms of frontotemporal dementia (FTD) is unknown and even with the genetic forms of FTD, pathogenesis remains elusive. Given the association between systemic inflammation and other neurodegenerative processes, links between autoimmunity and FTD need to be explored. OBJECTIVE To describe the prevalence of systemic autoimmune disease in semantic variant primary progressive aphasia (svPPA), a clinical cohort, and in progranulin (PGRN) mutation carriers compared with neurologically healthy normal controls (NC) and Alzheimer's disease (AD) as dementia controls. DESIGN Case control. SETTING Academic medical centres. PARTICIPANTS 129 svPPA, 39 PGRN, 186 NC and 158 AD patients underwent chart review for autoimmune conditions. A large subset of svPPA, PGRN and NC cohorts underwent serum analysis for tumour necrosis factor α (TNF-α) levels. OUTCOME MEASURES χ(2) Comparison of autoimmune prevalence and follow-up logistic regression. RESULTS There was a significantly increased risk of autoimmune disorders clustered around inflammatory arthritides, cutaneous disorders and gastrointestinal conditions in the svPPA and PGRN cohorts. Elevated TNF-α levels were observed in svPPA and PGRN compared with NC. CONCLUSIONS svPPA and PGRN are associated with increased prevalence of specific and related autoimmune diseases compared with NC and AD. These findings suggest a unique pattern of systemic inflammation in svPPA and PGRN and open new research avenues for understanding and treating disorders associated with underlying transactive response DNA-binding protein 43 aggregation.
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Affiliation(s)
- Zachary A Miller
- UCSF Memory and Aging Center, University of California San Francisco, San Francisco, California 94143-1207, USA.
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Hsieh S, Irish M, Daveson N, Hodges JR, Piguet O. When one loses empathy: its effect on carers of patients with dementia. J Geriatr Psychiatry Neurol 2013; 26:174-84. [PMID: 23857888 DOI: 10.1177/0891988713495448] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of empathy loss in frontotemporal dementia (FTD) and Alzheimer disease (AD) on carer symptomatology were investigated. Carers of patients with 2 clinical subtypes of FTD (behavioral-variant FTD [bvFTD] = 18; semantic dementia [SD] = 14) and AD (n = 18) completed the Interpersonal Reactivity Index (IRI), a standardized questionnaire of empathy as well as a measure of perceived burden (Zarit Burden Interview) and the quality of the marital relationship (Intimate Bond Measure). Patient ratings were also obtained on the IRI. Loss of empathy was most striking in the bvFTD group with a marked discrepancy observed between carer and patient ratings for change in emotional warmth and the ability to take the perspective of others. Empathy loss in bvFTD was associated with a loss of a caring marital relationship. Empathic deficits in SD were milder by comparison to bvFTD and correlated with disease severity and increased perceived carer burden. The behavioral pattern observed in AD differed from the FTD syndromes; deficits were observed only for measures of personal distress with carers reporting that patients were less able to handle emotionally evocative situations. Results highlight that changes in aspects of empathy differ across dementia syndromes and are associated with differing carer and clinical variables. These findings might be explained by the progression of atrophy in regions that are known to be critical for empathy and social behavior and has implications for the delivery and planning of services in dementia.
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Affiliation(s)
- Sharpley Hsieh
- Neuroscience Research Australia, Hospital Road, Randwick, Australia
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142
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Afasia progresiva primaria: del síndrome a la enfermedad. Neurologia 2013; 28:366-74. [DOI: 10.1016/j.nrl.2012.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 04/06/2012] [Indexed: 12/12/2022] Open
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Abstract
Frontotemporal dementia, a heterogeneous neurodegenerative disorder, is a common cause of young onset dementia (i.e. dementia developing in midlife or earlier). The estimated point prevalence is 15-22/100,000, and incidence 2.7-4.1/100,000. Some 25% are late-life onset cases. Population studies show nearly equal distribution by gender, which contrasts with myriad clinical and neuropathology reports. FTD is frequently familial and hereditary; five genetic loci for causal mutations have been identified, all showing 100% penetrance. Non-genetic risk factors are yet to be identified. FTD shows poor life expectancy but with survival comparable to that of Alzheimer's disease. Recent progress includes the formulation of up-to-date diagnostic criteria for the behavioural and language variants, and the development of new and urgently needed instruments for monitoring and staging the illness. There is still need for descriptive population studies to fill gaps in our knowledge about minority groups and developing regions. More pressing, however, is the need for reliable physiological markers for disease. There is a present imperative to develop a translational science to form the conduit for transferring neurobiological discoveries and insights from bench to bedside.
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Affiliation(s)
- Chiadi U. Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Janine Diehl-Schmid
- Center for Cognitive Disorders, Department of Psychiatry at Technische Universität München, München DE, Germany
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145
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Senaha MLH, Caramelli P, Brucki SMD, Smid J, Takada LT, Porto CS, César KG, Matioli MNP, Soares RT, Mansur LL, Nitrini R. Primary progressive aphasia: classification of variants in 100 consecutive Brazilian cases. Dement Neuropsychol 2013; 7:110-121. [PMID: 29213827 PMCID: PMC5619553 DOI: 10.1590/s1980-57642013dn70100017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome
characterized primarily by progressive language impairment. Recently, consensus
diagnostic criteria were published for the diagnosis and classification of
variants of PPA. The currently recognized variants are nonfluent/agrammatic
(PPA-G), logopenic (PPA-L) and semantic (PPA-S).
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Affiliation(s)
- Mirna Lie Hosogi Senaha
- PhD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Paulo Caramelli
- MD, PhD, Professor, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais MG, Brazil
| | - Sonia M D Brucki
- MD, PhD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Jerusa Smid
- MD, PhD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Leonel T Takada
- MD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Claudia S Porto
- PhD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Karolina G César
- MD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Maria Niures P Matioli
- MD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Roger T Soares
- MD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Letícia L Mansur
- PhD, Member of Behavioral and Cognitive Neurology Unit of Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, PhD, Professor, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
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146
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Josephs KA, Whitwell JL, Murray ME, Parisi JE, Graff-Radford NR, Knopman DS, Boeve BF, Senjem ML, Rademakers R, Jack CR, Petersen RC, Dickson DW. Corticospinal tract degeneration associated with TDP-43 type C pathology and semantic dementia. ACTA ACUST UNITED AC 2013; 136:455-70. [PMID: 23358603 DOI: 10.1093/brain/aws324] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Four subtypes of frontotemporal lobar degeneration with TDP-43 immunoreactive inclusions have been described (types A-D). Of these four subtypes, motor neuron disease is more commonly associated with type B pathology, but has also been reported with type A pathology. We have noted, however, the unusual occurrence of cases of type C pathology having corticospinal tract degeneration. We aimed to assess the severity of corticospinal tract degeneration in a large cohort of cases with type C (n = 31). Pathological analysis included semi-quantitation of myelin loss of fibres of the corticospinal tract and associated macrophage burden, as well as axonal loss, at the level of the medullary pyramids. We also assessed for motor cortex degeneration and fibre loss of the medial lemniscus/olivocerebellar tract. All cases were subdivided into three groups based on the degree of corticospinal tract degeneration: (i) no corticospinal tract degeneration; (ii) equivocal corticospinal tract degeneration; and (iii) moderate to very severe corticospinal tract degeneration. Clinical, genetic, pathological and imaging comparisons were performed across groups. Eight cases had no corticospinal tract degeneration, and 14 cases had equivocal to mild corticospinal tract degeneration. Nine cases, however, had moderate to very severe corticospinal tract degeneration with myelin and axonal loss. In these nine cases, there was degeneration of the motor cortex without lower motor neuron degeneration or involvement of other brainstem tracts. These cases most commonly presented as semantic dementia, and they had longer disease duration (mean: 15.3 years) compared with the other two groups (10.8 and 9.9 years; P = 0.03). After adjusting for disease duration, severity of corticospinal tract degeneration remained significantly different across groups. Only one case, without corticospinal tract degeneration, was found to have a hexanucleotide repeat expansion in the C9ORF72 gene. All three groups were associated with anterior temporal lobe atrophy on MRI; however, the cases with moderate to severe corticospinal tract degeneration showed right-sided temporal lobe asymmetry and greater involvement of the right temporal lobe and superior motor cortices than the other groups. In contrast, the cases with no or equivocal corticospinal tract degeneration were more likely to show left-sided temporal lobe asymmetry. For comparison, the corticospinal tract was assessed in 86 type A and B cases, and only two cases showed evidence of corticospinal tract degeneration without lower motor neuron degeneration. These findings confirm that there exists a unique association between frontotemporal lobar degeneration with type C pathology and corticospinal tract degeneration, with this entity showing a predilection to involve the right temporal lobe.
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Affiliation(s)
- Keith A Josephs
- Behavioural Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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147
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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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148
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Abstract
Frontotemporal lobar degeneration (FTLD) describes a spectrum of clinically, pathologically and genetically heterogeneous neurodegenerative disorders of unknown aetiology. FTLD spectrum disorders collectively represent a leading cause of early-onset dementia, with most cases presenting between 45 and 64 years of age. FTLD is characterized by progressive changes in behaviour, executive dysfunction and/or language impairment and can be differentiated clinically into three frontotemporal dementia (FTD) syndromes as follows: (i) behavioural variant (bvFTD); (ii) semantic dementia (SD); and (iii) progressive nonfluent aphasia (PNFA). Additionally, there is a significant clinical, pathological and genetic overlap between FTD and motor neuron disease/amyotrophic lateral sclerosis (FTD-ALS) and the atypical parkinsonian syndromes, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). bvFTD is characterized by progressive behavioural impairment and a decline in executive function with frontal lobe-predominant atrophy, SD by a loss of object knowledge with prominent anomia and asymmetrical atrophy of the anterior temporal lobes and PNFA by expressive or motor speech deficits with predominantly left peri-sylvian atrophy. Recent advances in molecular biology and immunohistochemical staining techniques have further classified the FTLD spectrum disorders based upon the predominant neuropathological protein into three main categories: (i) microtubule-associated protein tau (FTLD-TAU); (ii) TAR DNA-binding protein-43 (FTLD-TDP); and (iii) fused in sarcoma protein (FTLD-FUS). Up to 40% of FTD patients report a family history of neurodegenerative illness, and one-third to one-half of familial cases of FTD follow an autosomal dominant inheritance pattern. Mutations in MAPT, PGRN, TARDBP, VCP and CHMP2B have been described, along with a recently identified C9ORF72 hexanucleotide repeat expansion. To date, there are no US FDA-approved treatments or disease-modifying therapies for FTD. Pharmacological strategies have focused on neurotransmitter replacement and modulation for the treatment of behavioural, motor and cognitive symptoms of FTD, and include selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotics, acetylcholinesterase inhibitors and glutamate NMDA receptor antagonists. At present, adequate management of FTD symptoms involves a combination of pharmacological therapy with behavioural, physical and environmental modification techniques.
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149
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Dobson-Stone C, Hallupp M, Bartley L, Shepherd CE, Halliday GM, Schofield PR, Hodges JR, Kwok JBJ. C9ORF72 repeat expansion in clinical and neuropathologic frontotemporal dementia cohorts. Neurology 2012; 79:995-1001. [PMID: 22875086 DOI: 10.1212/wnl.0b013e3182684634] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the frequency of a hexanucleotide repeat expansion in C9ORF72, a gene of unknown function implicated in frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS), in Australian FTD patient cohorts and to examine the clinical and neuropathologic phenotypes associated with this expansion. METHODS We examined a clinically ascertained FTD cohort (n = 89) and a neuropathologically ascertained cohort of frontotemporal lobar degeneration cases with TDP-43 pathology (FTLD-TDP) (n = 22) for the C9ORF72 hexanucleotide repeat expansion using a repeat primed PCR assay. All expansion-positive patients were genotyped for rs3849942, a surrogate marker for the chromosome 9p21 risk haplotype previously associated with FTD and ALS. RESULTS The C9ORF72 repeat expansion was detected in 10% of patients in the clinically diagnosed cohort, rising to 29% in those with a positive family history of early-onset dementia or ALS. The prevalence of psychotic features was significantly higher in expansion-positive cases (56% vs 14%). In the pathology cohort, 41% of TDP-43-positive cases harbored the repeat expansion, and all exhibited type B pathology. One of the 17 expansion-positive probands was homozygous for the "nonrisk" G allele of rs3849942. CONCLUSIONS The C9ORF72 repeat expansion is a relatively common cause of FTD in Australian populations, and is especially common in those with FTD-ALS, psychotic features, and a strong family history. Detection of a repeat expansion on the 9p21 putative "nonrisk" haplotype suggests that not all mutation carriers are necessarily descended from a common founder and indicates that the expansion may have occurred on multiple haplotype backgrounds.
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150
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Abstract
Variant syndromes of Alzheimer disease (AD), led by deficits that extend beyond memory dysfunction, are of considerable clinical and neurobiological importance. Such syndromes present major challenges for both diagnosis and monitoring of disease, and serve to illustrate the apparent paradox of a clinically diverse group of disorders underpinned by a common histopathological substrate. This Review focuses on the most common variant AD phenotypes: posterior cortical atrophy, logopenic variant primary progressive aphasia and frontal variant AD. The neuroanatomical, molecular and pathological correlates of these phenotypes are highlighted, and the heterogeneous clinical presentations of the syndromes are discussed in the context of the emerging network paradigm of neurodegenerative disease. We argue that these apparently diverse clinical phenotypes reflect the differential involvement of a common core temporoparietofrontal network that is vulnerable to AD. According to this interpretation, the network signatures corresponding to AD variant syndromes are produced by genetic and other modulating factors that have yet to be fully characterized. The clinical and neurobiological implications of this network paradigm in the quest for disease-modifying treatments are also explored.
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