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Brown JA, Lee AJ, Fernhoff K, Pistone T, Pasquini L, Wise AB, Staffaroni AM, Luisa Mandelli M, Lee SE, Boxer AL, Rankin KP, Rabinovici GD, Luisa Gorno Tempini M, Rosen HJ, Kramer JH, Miller BL, Seeley WW. Functional network collapse in neurodegenerative disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.01.569654. [PMID: 38106054 PMCID: PMC10723363 DOI: 10.1101/2023.12.01.569654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Cognitive and behavioral deficits in Alzheimer's disease (AD) and frontotemporal dementia (FTD) result from brain atrophy and altered functional connectivity. However, it is unclear how atrophy relates to functional connectivity disruptions across dementia subtypes and stages. We addressed this question using structural and functional MRI from 221 patients with AD (n=82), behavioral variant FTD (n=41), corticobasal syndrome (n=27), nonfluent (n=34) and semantic (n=37) variant primary progressive aphasia, and 100 cognitively normal individuals. Using partial least squares regression, we identified three principal structure-function components. The first component showed overall atrophy correlating with primary cortical hypo-connectivity and subcortical/association cortical hyper-connectivity. Components two and three linked focal syndrome-specific atrophy to peri-lesional hypo-connectivity and distal hyper-connectivity. Structural and functional component scores predicted global and domain-specific cognitive deficits. Anatomically, functional connectivity changes reflected alterations in specific brain activity gradients. Eigenmode analysis identified temporal phase and amplitude collapse as an explanation for atrophy-driven functional connectivity changes.
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Affiliation(s)
- Jesse A. Brown
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Alex J. Lee
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Kristen Fernhoff
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Taylor Pistone
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Lorenzo Pasquini
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Amy B. Wise
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Adam M. Staffaroni
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Maria Luisa Mandelli
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Suzee E. Lee
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Adam L. Boxer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Katherine P. Rankin
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Gil D. Rabinovici
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Maria Luisa Gorno Tempini
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Howard J. Rosen
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Joel H. Kramer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Bruce L. Miller
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
| | - William W. Seeley
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, San Francisco, CA, USA
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Mesulam MM, Coventry CA, Bigio EH, Sridhar J, Gill N, Fought AJ, Zhang H, Thompson CK, Geula C, Gefen T, Flanagan M, Mao Q, Weintraub S, Rogalski EJ. Neuropathological fingerprints of survival, atrophy and language in primary progressive aphasia. Brain 2022; 145:2133-2148. [PMID: 35441216 PMCID: PMC9246707 DOI: 10.1093/brain/awab410] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023] Open
Abstract
Primary progressive aphasia is a neurodegenerative disease that selectively impairs language without equivalent impairment of speech, memory or comportment. In 118 consecutive autopsies on patients with primary progressive aphasia, primary diagnosis was Alzheimer's disease neuropathological changes (ADNC) in 42%, corticobasal degeneration or progressive supranuclear palsy neuropathology in 24%, Pick's disease neuropathology in 10%, transactive response DNA binding proteinopathy type A [TDP(A)] in 10%, TDP(C) in 11% and infrequent entities in 3%. Survival was longest in TDP(C) (13.2 ± 2.6 years) and shortest in TDP(A) (7.1 ± 2.4 years). A subset of 68 right-handed participants entered longitudinal investigations. They were classified as logopenic, agrammatic/non-fluent or semantic by quantitative algorithms. Each variant had a preferred but not invariant neuropathological correlate. Seventy-seven per cent of logopenics had ADNC, 56% of agrammatics had corticobasal degeneration/progressive supranuclear palsy or Pick's disease and 89% of semantics had TDP(C). Word comprehension impairments had strong predictive power for determining underlying neuropathology positively for TDP(C) and negatively for ADNC. Cortical atrophy was smallest in corticobasal degeneration/progressive supranuclear palsy and largest in TDP(A). Atrophy encompassed posterior frontal but not temporoparietal cortex in corticobasal degeneration/progressive supranuclear palsy, anterior temporal but not frontoparietal cortex in TDP(C), temporofrontal but not parietal cortex in Pick's disease and all three lobes with ADNC or TDP(A). There were individual deviations from these group patterns, accounting for less frequent clinicopathologic associations. The one common denominator was progressive asymmetric atrophy overwhelmingly favouring the left hemisphere language network. Comparisons of ADNC in typical amnestic versus atypical aphasic dementia and of TDP in type A versus type C revealed fundamental biological and clinical differences, suggesting that members of each pair may constitute distinct clinicopathologic entities despite identical downstream proteinopathies. Individual TDP(C) participants with unilateral left temporal atrophy displayed word comprehension impairments without additional object recognition deficits, helping to dissociate semantic primary progressive aphasia from semantic dementia. When common and uncommon associations were considered in the set of 68 participants, one neuropathology was found to cause multiple clinical subtypes, and one subtype of primary progressive aphasia to be caused by multiple neuropathologies, but with different probabilities. Occasionally, expected clinical manifestations of atrophy sites were absent, probably reflecting individual peculiarities of language organization. The hemispheric asymmetry of neurodegeneration and resultant language impairment in primary progressive aphasia reflect complex interactions among the cellular affinities of the degenerative disease, the constitutive biology of language cortex, familial or developmental vulnerabilities of this network and potential idiosyncrasies of functional anatomy in the affected individual.
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Affiliation(s)
- M Marsel Mesulam
- Correspondence to: M. Mesulam 330 East Superior St, Tarry-8 Chicago, IL 60611, USA E-mail:
| | - Christina A Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nathan Gill
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Angela J Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Cynthia K Thompson
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,School of Communication, Northwestern University, Evanston, IL 60208, USA
| | - Changiz Geula
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Margaret Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qinwen Mao
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
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Robinaugh G, Henry ML. Behavioral interventions for primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:221-240. [PMID: 35078600 DOI: 10.1016/b978-0-12-823384-9.00011-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by a gradual loss of communication ability. Due to the centrality of communication deficits, speech-language pathologists play a prominent role in the provision of care for individuals with PPA. In this chapter, we outline a person-centered approach to the management of PPA that aims to preserve independence for as long as possible while anticipating future decline in communication and other domains. A growing evidence base supports the utility of speech-language treatment approaches in PPA, including restitutive, compensatory, and communication partner-focused techniques. Restitutive interventions aim to rebuild lost communication skills, such as naming or fluent speech production. Compensatory approaches include training with high- and low-tech augmentative and alternative communication systems that provide complementary means of communication beyond speech. Communication partner interventions focus on education and strategy training in order to equip conversation partners as skilled communication facilitators. Throughout intervention, clinicians should aim to provide treatment that impacts functional communication and promotes social engagement. Given the documented benefits of speech-language intervention in PPA, we are optimistic that such treatment will become the standard of care and that additional research will continue to improve the quality and accessibility of behavioral interventions.
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Affiliation(s)
- Gary Robinaugh
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States.
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Disorders of vocal emotional expression and comprehension: The aprosodias. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:63-98. [PMID: 34389126 DOI: 10.1016/b978-0-12-822290-4.00005-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Europa E, Iaccarino L, Perry DC, Weis E, Welch AE, Rabinovici GD, Miller BL, Gorno-Tempini ML, Henry ML. Diagnostic Assessment in Primary Progressive Aphasia: An Illustrative Case Example. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1833-1849. [PMID: 32910678 PMCID: PMC8740567 DOI: 10.1044/2020_ajslp-20-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Purpose Diagnosis and classification of primary progressive aphasia (PPA) requires confirmation of specific speech and language symptoms, highlighting the important role of speech-language pathologists in the evaluation process. The purpose of this case report is to inform speech-language pathologists regarding current practices for diagnostic assessment in PPA, describing standard approaches as well as complementary, state-of-the-art procedures that may improve diagnostic precision. Method We describe the diagnostic evaluation of a 49-year-old woman with complaints of progressive word-finding difficulty. She completed standard neurological, neuropsychological, and speech-language evaluations, as well as magnetic resonance and positron emission tomography imaging of her brain. In addition, a history of developmental speech, language, and learning abilities was obtained, as well as genetic testing and assessment of cerebrospinal fluid biomarkers. We discuss the evaluation results in the context of the most current research related to PPA diagnosis. Conclusion Detailed behavioral assessment, thorough intake of symptom history and neurodevelopmental differences, multimodal neuroimaging, and comprehensive examination of genes and biomarkers are of paramount importance for detecting and characterizing PPA, with ramifications for early behavioral and/or pharmacological intervention. Supplemental Material https://doi.org/10.23641/asha.12771113.
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Affiliation(s)
- Eduardo Europa
- Memory and Aging Center, University of California, San Francisco
| | | | - David C. Perry
- Memory and Aging Center, University of California, San Francisco
| | - Elizabeth Weis
- Memory and Aging Center, University of California, San Francisco
| | - Ariane E. Welch
- Memory and Aging Center, University of California, San Francisco
| | | | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco
- Dyslexia Center, University of California, San Francisco
| | - Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
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DeMarco AT, Turkeltaub PE. Functional anomaly mapping reveals local and distant dysfunction caused by brain lesions. Neuroimage 2020; 215:116806. [PMID: 32278896 DOI: 10.1016/j.neuroimage.2020.116806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 01/28/2023] Open
Abstract
The lesion method has been important for understanding brain-behavior relationships in humans, but has previously used maps based on structural damage. Lesion measurement based on structural damage may label partly damaged but functional tissue as abnormal, and moreover, ignores distant dysfunction in structurally intact tissue caused by deafferentation, diaschisis, and other processes. A reliable method to map functional integrity of tissue throughout the brain would provide a valuable new approach to measuring lesions. Here, we use machine learning on four dimensional resting state fMRI data obtained from left-hemisphere stroke survivors in the chronic period of recovery and control subjects to generate graded maps of functional anomaly throughout the brain in individual patients. These functional anomaly maps identify areas of obvious structural lesions and are stable across multiple measurements taken months and even years apart. Moreover, the maps identify functionally anomalous regions in structurally intact tissue, providing a direct measure of remote effects of lesions on the function of distant brain structures. Multivariate lesion-behavior mapping using functional anomaly maps replicates classic behavioral localization, identifying inferior frontal regions related to speech fluency, lateral temporal regions related to auditory comprehension, parietal regions related to phonology, and the hand area of motor cortex and descending corticospinal pathways for hand motor function. Further, this approach identifies relationships between tissue function and behavior distant from the structural lesions, including right premotor dysfunction related to ipsilateral hand movement, and right cerebellar regions known to contribute to speech fluency. Brain-wide maps of the functional effects of focal lesions could have wide implications for lesion-behavior association studies and studies of recovery after brain injury.
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Affiliation(s)
- Andrew T DeMarco
- Department of Neurology, Georgetown University, Washington, DC, 20057, United States.
| | - Peter E Turkeltaub
- Department of Neurology, Georgetown University, Washington, DC, 20057, United States; MedStar National Rehabilitation Hospital, Washington, DC, 20010, United States
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Luzzatti C, Mauri I, Castiglioni S, Zuffi M, Spartà C, Somalvico F, Franceschi M. Evaluating Semantic Knowledge Through a Semantic Association Task in Individuals With Dementia. Am J Alzheimers Dis Other Demen 2020; 35:1533317520917294. [PMID: 32308008 PMCID: PMC10623912 DOI: 10.1177/1533317520917294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Conceptual knowledge is supported by multiple semantic systems that are specialized for the analysis of different properties associated with object concepts. Various types of semantic association between concrete concepts-categorical (CA), encyclopedic (EA), functional (FA), and visual-encyclopedic (VEA) associations-were tested through a new picture-to-picture matching task (semantic association task, SAT). Forty individuals with Alzheimer's disease (AD), 13 with behavioral variant of frontotemporal dementia (bv-FTD), 6 with primary progressive aphasia (PPA), and 37 healthy participants were tested with the SAT. Within-group comparisons highlighted a global impairment of all types of semantic association in bv-FTD individuals but a disproportionate impairment of EA and FA, with relative sparing of CA and VEA, in AD individuals. Single-case analyses detected dissociations in all dementia groups. Conceptual knowledge can be selectively impaired in various types of neurodegenerative disease on the basis of the specific cognitive process that is disrupted.
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Affiliation(s)
- Claudio Luzzatti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Ilaria Mauri
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Marta Zuffi
- Department of Neurology, MultiMedica Hospital, Castellanza, Italy
| | - Chiara Spartà
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
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Casoli T, Paolini S, Fabbietti P, Fattoretti P, Paciaroni L, Fabi K, Gobbi B, Galeazzi R, Rossi R, Lattanzio F, Pelliccioni G. Cerebrospinal fluid biomarkers and cognitive status in differential diagnosis of frontotemporal dementia and Alzheimer's disease. J Int Med Res 2019; 47:4968-4980. [PMID: 31524025 PMCID: PMC6833432 DOI: 10.1177/0300060519860951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to determine the most appropriate cognitive and cerebrospinal fluid (CSF) biomarker setting to distinguish frontotemporal dementia (FTD) from Alzheimer’s disease (AD). Method Patients with FTD, those with AD, and those without dementia were enrolled in this study. CSF amyloid-ß 42 (Aß42), total (t)-tau, and phosphorylated (p)-tau concentrations were determined by enzyme-linked immunosorbent assays. Cognition was evaluated by the Mini-Mental State Examination (MMSE) and its domain scores. The associations of CSF biomarkers with cognitive measures were examined using regression models and the diagnostic value of CSF biomarkers was determined by receiver operating characteristics curves. Results CSF Aß42 levels were lower, whereas t-tau/Aß42 and p-tau/Aß42 ratios were higher in patients with AD compared with those with FTD. Some MMSE domain scores were different in FTD and AD, but they did not improve the ability to distinguish between the two pathologies. Poor temporal orientation scores were associated with low Aß42 levels only in patients with FTD. The p-tau/Aß42 ratio reached sufficient levels of sensitivity and specificity to discriminate FTD with primary progressive aphasia from AD. Conclusions The ratio of CSF p-tau/Aß42 is a sensitive and specific biomarker for discriminating patients with primary progressive aphasia from those with AD.
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Affiliation(s)
- Tiziana Casoli
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Susy Paolini
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Paolo Fabbietti
- Diagnostic Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Cosenza, Italy
| | | | - Lucia Paciaroni
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Katia Fabi
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Beatrice Gobbi
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Roberta Galeazzi
- Clinical Laboratory & Molecular Diagnostics, IRCCS INRCA, Ancona, Italy
| | - Roberto Rossi
- Diagnostic and Interventional Radiology Unit, IRCCS INRCA, Ancona, Italy
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Henry ML, Hubbard HI, Grasso SM, Dial HR, Beeson PM, Miller BL, Gorno-Tempini ML. Treatment for Word Retrieval in Semantic and Logopenic Variants of Primary Progressive Aphasia: Immediate and Long-Term Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2723-2749. [PMID: 31390290 PMCID: PMC6802912 DOI: 10.1044/2018_jslhr-l-18-0144] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/23/2018] [Accepted: 12/16/2018] [Indexed: 05/25/2023]
Abstract
Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.
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Affiliation(s)
- Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - H. Isabel Hubbard
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Communication Science and Disorders, University of Kentucky, Lexington
| | - Stephanie M. Grasso
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Heather R. Dial
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Tonacci A, Billeci L. Olfactory Testing in Frontotemporal Dementia: A Literature Review. Am J Alzheimers Dis Other Demen 2018; 33:342-352. [PMID: 29742909 PMCID: PMC10852515 DOI: 10.1177/1533317518775037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Frontotemporal dementia (FTD) is a heterogeneous disorder featuring language impairment, personality changes, and executive defects, often due to the frontotemporal lobar degeneration (FTLD). Both FTD and FTLD are often associated with olfactory impairment, early biomarker for neurodegeneration, which can be evaluated with different techniques, among which low-cost olfactory tests are widely used. Therefore, we conducted a review of the literature focusing on papers published between January 1, 2007, and June 12, 2017, investigating the usefulness of olfactory testing in FTD/FTLD. A general decrease in the olfactory identification ability was seen in most of the articles and, taken together with a preserved odor discrimination, reveals a higher order impairment, possibly linked to cognitive decrease or language impairments, and not to a specific deficit of the olfactory system. This evidence could represent a useful add-on to the current literature, increasing the diagnostic value of olfactory assessment, particularly in cases where differential diagnosis is difficult.
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Affiliation(s)
- Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Lucia Billeci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
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Abstract
PURPOSE Primary progressive aphasia (PPA) is a neurological syndrome in which language functions become progressively impaired with relative sparing of memory and other instrumental functions. The pathologic causes of PPA are heterogeneous, but studies suggest that logopenic PPA (LPA) is underpinned by Alzheimer disease (AD) pathology in a high proportion of cases. The purposes of this descriptive and retrospective study were to characterize F-florbetapir PET imaging in a group of patients with a clinical syndrome of PPA, to determine the value of clinical characterization based on language phenotype in predicting the underlying pathology of PPA with F-florbetapir, and to quantify amyloid load in PPA subjects classified as "positive" F-florbetapir scans. Then, we compare the quantification and distribution of F-florbetapir uptake with those of typical, predominantly amnestic AD patients. METHODS We conducted a PET study with F-florbetapir in a cohort of 12 right-handed patients diagnosed with PPA: 3 patients with semantic-variant PPA, 5 with nonfluent PPA, 1 with LPA, and 3 unclassifiable patients. We evaluated amyloid deposition between APP groups and 11 patients with typical amnestic AD. RESULTS Among the 12 patients with PPA syndrome, 8 (66.7%) were considered as amyloid positive. One of the 3 patients with semantic-variant PPA was F-florbetapir positive. In contrast, 4 of the 5 nonfluent-variant PPA, 2 of the 3 unclassifiable cases and the single patient with LPA were F-florbetapir positive. A significantly higher F-florbetapir uptake was observed in PPA F-florbetapir-positive patients compared with typical AD patients. This difference was observed in all regions of interest, except in posterior cingulate and temporal cortex. CONCLUSIONS These results suggest that F-florbetapir PET may be useful in a routine clinical procedure to improve the reliability of identifying AD pathology in patients with PPA syndrome, with different clinical subtypes of the PPA syndrome.
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Macoir J, Fossard M, Lefebvre L, Monetta L, Renard A, Tran TM, Wilson MA. Detection Test for Language Impairments in Adults and the Aged-A New Screening Test for Language Impairment Associated With Neurodegenerative Diseases: Validation and Normative Data. Am J Alzheimers Dis Other Demen 2017; 32:382-392. [PMID: 28639484 PMCID: PMC10852687 DOI: 10.1177/1533317517715905] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
To date, there is no quick screening test that could be used during routine office visits to accurately assess language disorders in neurodegenerative diseases. To fill this important gap, we developed the Detection Test for Language impairments in Adults and the Aged (DTLA), a quick, sensitive, standardized screening test designed to assess language disorders in adults and the elderly individuals. In Study 1, we describe the development of the DTLA. In Study 2, we report data on the DTLA's validity and reliability. Finally, in Study 3, we establish normative data for the test. The DTLA has good convergent and discriminant validity as well as good internal consistency and test-retest reliability. Norms for the DTLA obtained from a sample of 545 healthy, community-dwelling, French-speaking adults from 4 French-speaking countries (Belgium, Canada (Quebec), France, and Switzerland) are provided. The development, validation, and standardization of the DTLA constitute a significant effort to meet the need for a language screening test adapted to neurodegenerative diseases.
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Affiliation(s)
- Joël Macoir
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
- Centre de recherche, Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Marion Fossard
- Institut des sciences du langage et de la communication, Université de Neuchâtel, Neuchâtel, Switzerland
| | - Laurent Lefebvre
- Service de Psychologie cognitive et Neuropsychologie, Université de Mons, Mons, Belgium
| | - Laura Monetta
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
- Centre de recherche, Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Antoine Renard
- Centre Leennaards de la Mémoire, Université de Lausanne, CHUv Lausanne, Switzerland
| | - Thi Mai Tran
- Département d’orthophonie, Faculté de Médecine, Université de Lille, France
| | - Maximiliano A. Wilson
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
- Centre de recherche, Institut universitaire en santé mentale de Québec, Québec, Canada
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Faria AV, Liang Z, Miller MI, Mori S. Brain MRI Pattern Recognition Translated to Clinical Scenarios. Front Neurosci 2017; 11:578. [PMID: 29104527 PMCID: PMC5655969 DOI: 10.3389/fnins.2017.00578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022] Open
Abstract
We explored the performance of structure-based computational analysis in four neurodegenerative conditions [Ataxia (AT, n = 16), Huntington's Disease (HD, n = 52), Alzheimer's Disease (AD, n = 66), and Primary Progressive Aphasia (PPA, n = 50)], all characterized by brain atrophy. The independent variables were the volumes of 283 anatomical areas, derived from automated segmentation of T1-high resolution brain MRIs. The segmentation based volumetric quantification reduces image dimensionality from the voxel level [on the order of O(106)] to anatomical structures [O(102)] for subsequent statistical analysis. We evaluated the effectiveness of this approach on extracting anatomical features, already described by human experience and a priori biological knowledge, in specific scenarios: (1) when pathologies were relatively homogeneous, with evident image alterations (e.g., AT); (2) when the time course was highly correlated with the anatomical changes (e.g., HD), an analogy for prediction; (3) when the pathology embraced heterogeneous phenotypes (e.g., AD) so the classification was less efficient but, in compensation, anatomical and clinical information were less redundant; and (4) when the entity was composed of multiple subgroups that had some degree of anatomical representation (e.g., PPA), showing the potential of this method for the clustering of more homogeneous phenotypes that can be of clinical importance. Using the structure-based quantification and simple linear classifiers (partial least square), we achieve 87.5 and 73% of accuracy on differentiating AT and pre-symptomatic HD patents from controls, respectively. More importantly, the anatomical features automatically revealed by the classifiers agreed with the patterns previously described on these pathologies. The accuracy was lower (68%) on differentiating AD from controls, as AD does not display a clear anatomical phenotype. On the other hand, the method identified PPA clinical phenotypes and their respective anatomical signatures. Although most of the data are presented here as proof of concept in simulated clinical scenarios, structure-based analysis was potentially effective in characterizing phenotypes, retrieving relevant anatomical features, predicting prognosis, and aiding diagnosis, with the advantage of being easily translatable to clinics and understandable biologically.
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Affiliation(s)
- Andreia V Faria
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Zifei Liang
- Department of Radiology, New York University, New York, NY, United States
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Susumu Mori
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
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Magerova H, Vyhnalek M, Laczo J, Andel R, Rektorova I, Kadlecova A, Bojar M, Hort J. Odor identification in frontotemporal lobar degeneration subtypes. Am J Alzheimers Dis Other Demen 2014; 29:762-8. [PMID: 24939002 PMCID: PMC10852957 DOI: 10.1177/1533317514539033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Odor identification impairment is a feature of several neurodegenerative disorders. Although neurodegenerative changes in the frontotemporal lobar degeneration (FTLD) subtypes involve areas important for olfactory processing, data on olfactory function in these patients are limited. An 18-item, multiple-choice odor identification test developed at our memory clinic, the Motol Hospital smell test, was administered to 9 patients with behavioral variant frontotemporal dementia, 13 patients with the language variants, primary nonfluent aphasia (n = 7) and semantic dementia (n = 6), and 8 patients with progressive supranuclear palsy. Compared to the control group (n = 15), all FTLD subgroups showed significant impairment of odor identification (P < .05). The differences between the FTLD subgroups were not significant. No correlation between odor identification and neuropsychological tests results was found. Our data suggest that odor identification impairment is a symptom common to FTLD syndromes, and it seems to be based on olfactory structure damage rather than cognitive decline.
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Affiliation(s)
- Hana Magerova
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Laczo
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- University of South Florida, School of Aging Studies, Tampa, FL, USA
| | - Irena Rektorova
- First Department of Neurology, School of Medicine and St Anne's Hospital, Masaryk University, Brno, Czech Republic Applied Neurosciences Research Group, CEITEC, Masaryk University, Brno, Czech Republic
| | - Alexandra Kadlecova
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Martin Bojar
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, Czech Republic International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
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15
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Nalbandian A, Ghimbovschi S, Wang Z, Knoblach S, Llewellyn KJ, Vesa J, Hoffman EP, Kimonis VE. Global gene expression profiling in R155H knock-in murine model of VCP disease. Clin Transl Sci 2014; 8:8-16. [PMID: 25388089 DOI: 10.1111/cts.12241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dominant mutations in the valosin-containing protein (VCP) gene cause inclusion body myopathy associated with Paget disease of bone and frontotemporal dementia, which is characterized by progressive muscle weakness, dysfunction in bone remodeling, and frontotemporal dementia. More recently, VCP has been linked to 2% of familial amyotrophic lateral sclerosis cases. VCP plays a significant role in a plethora of cellular functions including membrane fusion, transcription activation, nuclear envelope reconstruction, postmitotic organelle reassembly, and cell cycle control. To elucidate the pathological mechanisms underlying the VCP disease progression, we have previously generated a VCP(R155H/+) mouse model with the R155H mutation. Histological analyses of mutant muscle showed vacuolization of myofibrils, centrally located nuclei, and disorganized muscle fibers. Global expression profiling of VCP(R155H/+) mice using gene annotations by DAVID identified key dysregulated signaling pathways including genes involved in the physiological system development and function, diseases and disorders, and molecular and cellular functions. There were a total of 212 significantly dysregulated genes, several of which are involved in the regulation of proteasomal function and NF-κB signaling cascade. Findings of the gene expression study were validated by using quantitative reverse transcriptase polymerase chain reaction analyses to test genes involved in various signaling cascades. This investigation reveals the importance of the VCP(R155H/+) mouse model in the understanding of cellular and molecular mechanisms causing VCP-associated neurodegenerative diseases and in the discovery of novel therapeutic advancements and strategies for patients suffering with these debilitating disorders.
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Affiliation(s)
- Angèle Nalbandian
- Department of Pediatrics, Division of Genetics and Metabolism, University of California-Irvine, Irvine, California, USA
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Abstract
BACKGROUND Primary progressive aphasia (PPA) is a progressive disorder of language that is increasingly recognised as an important presentation of a specific spectrum of neurodegenerative conditions. AIMS In an era of etiologically specific treatments for neurodegenerative conditions, it is crucial to establish the histopathologic basis for PPA. In this review, I discuss biomarkers for identifying the pathology underlying PPA. MAIN CONTRIBUTION Clinical syndromes suggest a probabilistic association between a specific PPA variant and an underlying pathology, but there are also many exceptions. A considerable body of work with biomarkers is now emerging as an important addition to clinical diagnosis. I review genetic, neuroimaging and biofluid studies that can help determine the pathologic basis for PPA. CONCLUSIONS Together with careful clinical examination, there is great promise that supplemental biomarker assessments will lead to accurate diagnosis of the pathology associated with PPA during life and serve as the basis for clinical trials in this spectrum of disease.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Abstract
AbstractWe describe a case of primary progressive aphasia (PPA) in a 62 year old right handed Irish woman who had progressive speech and language difficulty over a period of six years. She continued to work for a remarkable length of time and lived independently managing all her activities of daily living. The case posed a diagnostic challenge because initial presentation was suggestive of a conversion disorder. She also displayed signs and symptoms which overlapped with a fronto-temporal dementia and possibly early Alzheimer's disease. In our discussion, we explore the possible reasons for this overlap and the implication for psychiatrists. The need for adequate and sensitive investigations and a multi-disciplinary approach cannot be overemphasised as PPA cases are easily missed depending on the stage at which the patient presents.
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18
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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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Jeong EH, Lee YJ, Kwon M, Kim JS, Na DL, Lee JH. Agrammatic primary progressive aphasia in two dextral patients with right hemispheric involvement. Neurocase 2014; 20:46-52. [PMID: 23058062 DOI: 10.1080/13554794.2012.732084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Agrammatic primary progressive aphasia (PPA-G) has been known to be associated with focal brain atrophy involving the left posterior frontal and anterior insular regions. However, aphasia can also rarely result from right hemispheric lesions in right-handed patients, so-called crossed aphasia in dextrals (CAD). We report two right-handed patients with PPA-G whose 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) showed hypometabolism predominantly in the right hemisphere, implicating "crossed PPA-G."
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Affiliation(s)
- Eun Hye Jeong
- a Department of Neurology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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21
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Grossman M, Powers J, Ash S, McMillan C, Burkholder L, Irwin D, Trojanowski JQ. Disruption of large-scale neural networks in non-fluent/agrammatic variant primary progressive aphasia associated with frontotemporal degeneration pathology. BRAIN AND LANGUAGE 2013; 127:106-20. [PMID: 23218686 PMCID: PMC3610841 DOI: 10.1016/j.bandl.2012.10.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 09/19/2012] [Accepted: 10/18/2012] [Indexed: 05/09/2023]
Abstract
Non-fluent/agrammatic primary progressive aphasia (naPPA) is a progressive neurodegenerative condition most prominently associated with slowed, effortful speech. A clinical imaging marker of naPPA is disease centered in the left inferior frontal lobe. We used multimodal imaging to assess large-scale neural networks underlying effortful expression in 15 patients with sporadic naPPA due to frontotemporal lobar degeneration (FTLD) spectrum pathology. Effortful speech in these patients is related in part to impaired grammatical processing, and to phonologic speech errors. Gray matter (GM) imaging shows frontal and anterior-superior temporal atrophy, most prominently in the left hemisphere. Diffusion tensor imaging reveals reduced fractional anisotropy in several white matter (WM) tracts mediating projections between left frontal and other GM regions. Regression analyses suggest disruption of three large-scale GM-WM neural networks in naPPA that support fluent, grammatical expression. These findings emphasize the role of large-scale neural networks in language, and demonstrate associated language deficits in naPPA.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, University of Pennsylvania, United States.
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22
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Savage S, Hsieh S, Leslie F, Foxe D, Piguet O, Hodges JR. Distinguishing subtypes in primary progressive aphasia: application of the Sydney language battery. Dement Geriatr Cogn Disord 2013; 35:208-18. [PMID: 23467307 DOI: 10.1159/000346389] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Primary progressive aphasia (PPA) comprises three main subtypes, varying in clinical features, patterns of brain atrophy, and underlying pathology. Differentiation of these variants is important for treatment and planning; however, simple, effective cognitive tests to aid diagnosis are lacking. This study introduces a new language battery - the SYDBAT (Sydney Language Battery) - to assist clinicians. METHODS Fifty-seven PPA patients and 54 age- and education-matched healthy controls were compared on naming, repetition, word comprehension, and semantic association subtests. RESULTS Significant group differences were found for all tasks, reflecting different language profiles for each group. Using discriminative function analysis, 80% of PPA cases were correctly classified from three SYDBAT scores, from which a simple diagnostic algorithm was defined. CONCLUSION The SYDBAT is a fast and simple tool which provides a valuable adjunct to clinicians diagnosing PPA.
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Affiliation(s)
- Sharon Savage
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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23
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Irwin DJ, Trojanowski JQ, Grossman M. Cerebrospinal fluid biomarkers for differentiation of frontotemporal lobar degeneration from Alzheimer's disease. Front Aging Neurosci 2013; 5:6. [PMID: 23440936 PMCID: PMC3578350 DOI: 10.3389/fnagi.2013.00006] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/05/2013] [Indexed: 12/12/2022] Open
Abstract
Accurate ante mortem diagnosis in frontotemporal lobar degeneration (FTLD) is crucial to the development and implementation of etiology-based therapies. Several neurodegenerative disease-associated proteins, including the major protein constituents of inclusions in Alzheimer's disease (AD) associated with amyloid-beta (Aβ(1-42)) plaque and tau neurofibrillary tangle pathology, can be measured in cerebrospinal fluid (CSF) for diagnostic applications. Comparative studies using autopsy-confirmed samples suggest that CSF total-tau (t-tau) and Aβ(1-42) levels can accurately distinguish FTLD from AD, with a high t-tau to Aβ(1-42) ratio diagnostic of AD; however, there is also an urgent need for FTLD-specific biomarkers. These analytes will require validation in large autopsy-confirmed cohorts and face challenges of standardization of within- and between-laboratory sources of error. In addition, CSF biomarkers with prognostic utility and longitudinal study of CSF biomarker levels over the course of disease are also needed. Current goals in the field include identification of analytes that are easily and reliably measured and can be used alone or in a multi-modal approach to provide an accurate prediction of underlying neuropathology for use in clinical trials of disease modifying treatments in FTLD. To achieve these goals it will be of the utmost importance to view neurodegenerative disease, including FTLD, as a clinicopathological entity, rather than exclusively a clinical syndrome.
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Affiliation(s)
- David J Irwin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Alzheimer's Disease Core Center, Institute on Aging, University of Pennsylvania Philadelphia, PA, USA ; Department of Neurology, Center for Frontotemporal Dementia, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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Thompson CK, Meltzer-Asscher A, Cho S, Lee J, Wieneke C, Weintraub S, Mesulam MM. Syntactic and morphosyntactic processing in stroke-induced and primary progressive aphasia. Behav Neurol 2013; 26:35-54. [PMID: 22713394 PMCID: PMC3591467 DOI: 10.3233/ben-2012-110220] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 11/15/2022] Open
Abstract
The paper reports findings derived from three experiments examining syntactic and morphosyntactic processing in individuals with agrammatic and logopenic variants of primary progressive aphasia (PPA-G and PPA-L, respectively) and stroke-induced agrammatic and anomic aphasia (StrAg and StrAn, respectively). We examined comprehension and production of canonical and noncanonical sentence structures and production of tensed and nontensed verb forms using constrained tasks in experiments 1 and 2, using the Northwestern Assessment of Verbs and Sentences (NAVS [57]) and the Northwestern Assessment of Verb Inflection (NAVI, Thompson and Lee, experimental version) test batteries, respectively. Experiment 3 examined free narrative samples, focusing on syntactic and morphosyntactic measures, i.e. production of grammatical sentences, noun to verb ratio, open-class to closed-class word production ratio, and the production of correctly inflected verbs. Results indicate that the two agrammatic groups (i.e., PPA-G and StrAg) pattern alike on syntactic and morphosyntactic measures, showing more impaired noncanonical compared to canonical sentence comprehension and production and greater difficulties producing tensed compared to nontensed verb forms. Their spontaneous speech also contained significantly fewer grammatical sentences and correctly inflected verbs, and they produced a greater proportion of nouns compared to verbs, than healthy speakers. In contrast, PPA-L and StrAn individuals did not display these deficits, and performed significantly better than the agrammatic groups on these measures. The findings suggest that agrammatism, whether induced by degenerative disease or stroke, is associated with characteristic deficits in syntactic and morphosyntactic processing. We therefore recommend that linguistically sophisticated tests and narrative analysis procedures be used to systematically evaluate the linguistic ability of individuals with PPA, contributing to our understanding of the language impairments of different PPA variants.
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Affiliation(s)
- Cynthia K. Thompson
- Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonILUSA
- Department of NeurologyNorthwestern UniversityEvanstonILUSA
- Cognitive Neurology and Alzheimer's Disease CenterNorthwestern UniversityEvanstonILUSA
| | - Aya Meltzer-Asscher
- Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonILUSA
| | - Soojin Cho
- Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonILUSA
- Cognitive Neurology and Alzheimer's Disease CenterNorthwestern UniversityEvanstonILUSA
| | - Jiyeon Lee
- Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonILUSA
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer's Disease CenterNorthwestern UniversityEvanstonILUSA
| | - Sandra Weintraub
- Department of NeurologyNorthwestern UniversityEvanstonILUSA
- Cognitive Neurology and Alzheimer's Disease CenterNorthwestern UniversityEvanstonILUSA
- Department of Psychiatry and Behavioral SciencesNorthwestern UniversityEvanstonILUSA
| | - M.-Marsel Mesulam
- Department of NeurologyNorthwestern UniversityEvanstonILUSA
- Cognitive Neurology and Alzheimer's Disease CenterNorthwestern UniversityEvanstonILUSA
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Perfusion SPECT studies with mapping of Brodmann areas in differentiating Alzheimer’s disease from frontotemporal degeneration syndromes. Nucl Med Commun 2012; 33:1267-76. [DOI: 10.1097/mnm.0b013e3283599983] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Nalbandian A, Llewellyn KJ, Badadani M, Yin HZ, Nguyen C, Katheria V, Watts G, Mukherjee J, Vesa J, Caiozzo V, Mozaffar T, Weiss JH, Kimonis VE. A progressive translational mouse model of human valosin-containing protein disease: the VCP(R155H/+) mouse. Muscle Nerve 2012; 47:260-70. [PMID: 23169451 DOI: 10.1002/mus.23522] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Mutations in the valosin-containing protein (VCP) gene cause hereditary inclusion body myopathy (IBM) associated with Paget disease of bone (PDB), and frontotemporal dementia (FTD). More recently, these mutations have been linked to 2% of familial amyotrophic lateral sclerosis (ALS) cases. A knock-in mouse model offers the opportunity to study VCP-associated pathogenesis. METHODS The VCP(R155H/+) knock-in mouse model was assessed for muscle strength and immunohistochemical, Western blot, apoptosis, autophagy, and microPET/CT imaging analyses. RESULTS VCP(R155H/+) mice developed significant progressive muscle weakness, and the quadriceps and brain developed progressive cytoplasmic accumulation of TDP-43, ubiquitin-positive inclusion bodies, and increased LC3-II staining. MicroCT analyses revealed Paget-like lesions at the ends of long bones. Spinal cord demonstrated neurodegenerative changes, ubiquitin, and TDP-43 pathology of motor neurons. CONCLUSIONS VCP(R155H/+) knock-in mice represent an excellent preclinical model for understanding VCP-associated disease mechanisms and future treatments.
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Affiliation(s)
- Angèle Nalbandian
- Department of Pediatrics, Division of Genetics and Metabolism, 2501 Hewitt Hall, University of California, Irvine, Irvine, California 92696, USA
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Woollams AM, Patterson K. The consequences of progressive phonological impairment for reading aloud. Neuropsychologia 2012; 50:3469-77. [PMID: 23000132 DOI: 10.1016/j.neuropsychologia.2012.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 09/09/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
The 'primary systems' view of reading disorders proposes that there are no neural regions devoted exclusively to reading, and therefore that acquired dyslexias should reliably co-occur with deficits in more general underlying capacities. This perspective predicted that surface dyslexia, a selective deficit in reading aloud 'exception' words (those with atypical spelling-sound characteristics), should be a consistent feature of semantic dementia, a progressive disorder of conceptual knowledge, and just such a pattern has been observed in previous research. In a similar vein, one might expect the gradual deterioration of phonological processing seen in the nonfluent forms of progressive aphasia to be accompanied by phonological dyslexia, a selective deficit in reading of unfamiliar letter strings, i.e., nonwords. The present study, reporting a case-series consideration of reading-aloud data from 16 progressive nonfluent aphasic patients, revealed a pattern in which both low-frequency exception word and nonword reading were comparably compromised. The severity of the reading disorder was predicted by scores on the expressive language task of picture naming but not the receptive task of spoken word-to-picture matching. Our hypothesis that a phonological deficit underpins diminished performance for both naming and reading was supported by the finding that reading-aloud performance was predicted specifically by the rate of phonological errors in picture naming. Moreover, the strength of this relationship was similar for low-frequency exception words and nonwords, suggesting that reading deficits for these two types of items in this disorder shared a common cause: a progressive impairment of phonological processing.
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Affiliation(s)
- Anna M Woollams
- University of Manchester, UK & MRC Cognition and Brain Sciences Unit, Cambridge, UK.
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28
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Hurschler MA, Liem F, Jäncke L, Meyer M. Right and left perisylvian cortex and left inferior frontal cortex mediate sentence-level rhyme detection in spoken language as revealed by sparse fMRI. Hum Brain Mapp 2012; 34:3182-92. [PMID: 22711328 DOI: 10.1002/hbm.22134] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 04/27/2012] [Accepted: 05/01/2012] [Indexed: 11/11/2022] Open
Abstract
In this study, we used functional magnetic resonance imaging to investigate the neural basis of auditory rhyme processing at the sentence level in healthy adults. In an explicit rhyme detection task, participants were required to decide whether the ending syllable of a metrically spoken pseudosentence rhymed or not. Participants performing this task revealed bilateral activation in posterior-superior temporal gyri with a much more extended cluster of activation in the right hemisphere. These findings suggest that the right hemisphere primarily supports suprasegmental tasks, such as the segmentation of speech into syllables; thus, our findings are in line with the "asymmetric sampling in time" model suggested by Poeppel (: Speech Commun 41:245-255). The direct contrast between rhymed and nonrhymed trials revealed a stronger BOLD response for rhymed trials in the frontal operculum and the anterior insula of the left hemisphere. Our results suggest an involvement of these frontal regions not only in articulatory rehearsal processes, but especially in the detection of a matching syllable, as well as in the execution of rhyme judgment.
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Affiliation(s)
- Martina A Hurschler
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland; Institute of Psychology, Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), University of Zurich, Zurich, Switzerland
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29
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Thompson CK, Cho S, Hsu CJ, Wieneke C, Rademaker A, Weitner BB, Mesulam MM, Weintraub S. Dissociations Between Fluency And Agrammatism In Primary Progressive Aphasia. APHASIOLOGY 2011; 26:20-43. [PMID: 22199417 PMCID: PMC3244141 DOI: 10.1080/02687038.2011.584691] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND: Classical aphasiology, based on the study of stroke sequelae, fuses speech fluency and grammatical ability. Nonfluent (Broca's) aphasia often is accompanied by agrammatism; whereas in the fluent aphasias grammatical deficits are not typical. The assumption that a similar relationship exists in primary progressive aphasia (PPA) has led to the dichotomization of this syndrome into fluent and nonfluent subtypes. AIMS: This study compared elements of fluency and grammatical production in the narrative speech of individuals with PPA to determine if they can be dissociated from one another. METHOD: Speech samples from 37 individuals with PPA, clinically assigned to agrammatic (N=11), logopenic (N=20) and semantic (N=6) subtypes, and 13 cognitively healthy control participants telling the "Cinderella Story" were analyzed for fluency (i.e., words per minute (WPM) and mean length of utterance in words (MLU-W)) and grammaticality (i.e., the proportion of grammatically correct sentences, open-to-closed-class word ratio, noun-to-verb ratio, and correct production of verb inflection, noun morphology, and verb argument structure.) Between group differences were analyzed for each variable. Correlational analyses examined the relation between WPM and each grammatical variable, and an off-line measure of sentence production. OUTCOMES AND RESULTS: Agrammatic and logopenic groups both had lower scores on the fluency measures and produced significantly fewer grammatical sentences than did semantic and control groups. However, only the agrammatic group evinced significantly impaired production of verb inflection and verb argument structure. In addition, some semantic participants showed abnormal open-to-closed and noun-to-verb ratios in narrative speech. When the sample was divided on the basis of fluency, all the agrammatic participants fell in the nonfluent category. The logopenic participants varied in fluency but those with low fluency showed variable performance on measures of grammaticality. Correlational analyses and scatter plots comparing fluency and each grammatical variable revealed dissociations within PPA participants, with some nonfluent participants showing normal grammatical skill. CONCLUSIONS: Grammatical production is a complex construct comprised of correct usage of several language components, each of which can be selectively affected by disease. This study demonstrates that individuals with PPA show dissociations between fluency and grammatical production in narrative speech. Grammatical ability, and its relationship to fluency, varies from individual to individual, and from one variant of PPA to another, and can even be found in individuals with semantic PPA in whom a fluent aphasia is usually thought to accompany preserved ability to produce grammatical utterances.
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Affiliation(s)
- Cynthia K. Thompson
- Neurolinguistics and Aphasia Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Frances Searle Building, 2240 Campus Drive, Room 3-363, Evanston, IL 60208-2952
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern Feinberg School of Medicine, 320 E. Superior Ste, Searle 11-467, Chicago, Illinois 60611
- Department of Neurology, Northwestern Feinberg School of Medicine, 675 N. St. Clair St., Chicago, Illinois 60611
| | - Soojin Cho
- Neurolinguistics and Aphasia Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Frances Searle Building, 2240 Campus Drive, Room 3-363, Evanston, IL 60208-2952
| | - Chien-Ju Hsu
- Neurolinguistics and Aphasia Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Frances Searle Building, 2240 Campus Drive, Room 3-363, Evanston, IL 60208-2952
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern Feinberg School of Medicine, 320 E. Superior Ste, Searle 11-467, Chicago, Illinois 60611
| | - Alfred Rademaker
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611 Chicago, Illinois
| | - Bing Bing Weitner
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611 Chicago, Illinois
| | - M-Marsel Mesulam
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern Feinberg School of Medicine, 320 E. Superior Ste, Searle 11-467, Chicago, Illinois 60611
- Department of Neurology, Northwestern Feinberg School of Medicine, 675 N. St. Clair St., Chicago, Illinois 60611
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern Feinberg School of Medicine, 320 E. Superior Ste, Searle 11-467, Chicago, Illinois 60611
- Department of Neurology, Northwestern Feinberg School of Medicine, 675 N. St. Clair St., Chicago, Illinois 60611
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, 446 E. Ontario St., 7 Floor, Chicago, Illinois 60611
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Leyton CE, Villemagne VL, Savage S, Pike KE, Ballard KJ, Piguet O, Burrell JR, Rowe CC, Hodges JR. Subtypes of progressive aphasia: application of the international consensus criteria and validation using β-amyloid imaging. Brain 2011; 134:3030-43. [DOI: 10.1093/brain/awr216] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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The Multiple Faces of Valosin-Containing Protein-Associated Diseases: Inclusion Body Myopathy with Paget’s Disease of Bone, Frontotemporal Dementia, and Amyotrophic Lateral Sclerosis. J Mol Neurosci 2011; 45:522-31. [DOI: 10.1007/s12031-011-9627-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 08/08/2011] [Indexed: 12/11/2022]
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Harciarek M, Kertesz A. Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship. Neuropsychol Rev 2011; 21:271-87. [PMID: 21809067 PMCID: PMC3158975 DOI: 10.1007/s11065-011-9175-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 07/25/2011] [Indexed: 12/12/2022]
Abstract
Primary progressive aphasia (PPA), typically resulting from a neurodegenerative disease such as frontotemporal dementia/Pick Complex or Alzheimer's disease, is a heterogeneous clinical condition characterized by a progressive loss of specific language functions with initial sparing of other cognitive domains. Based on the constellation of symptoms, PPA has been classified into a nonfluent, semantic, or logopenic variant. This review of the literature aims to characterize the speech and language impairment, cognition, neuroimaging, pathology, genetics, and epidemiology associated with each of these variants. Some therapeutic recommendations, theoretical implications, and directions for future research have been also provided.
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Affiliation(s)
- Michał Harciarek
- Department of Social Sciences, Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Bażyńskiego 4, 80-952 Gdańsk, Poland.
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Kremen SA, Mendez MF, Tsai PH, Teng E. Extrapyramidal signs in the primary progressive aphasias. Am J Alzheimers Dis Other Demen 2011; 26:72-7. [PMID: 21282281 DOI: 10.1177/1533317510391239] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extrapyramidal signs (EPS) may vary across 3 major subtypes of primary progressive aphasia (PPA): progressive nonfluent aphasia (PNFA), semantic dementia (SD), and progressive logopenic aphasia (PLA). METHODS We reviewed initial neurological examinations from a clinical PPA cohort (PNFA = 49, SD = 26, PLA = 28) to determine the prevalence of specific categories of EPS. RESULTS The presence of any EPS was more common in PNFA (38.8%) and PLA (35.7%) than in SD (3.8%). The PNFA group exhibited the highest prevalence of bradykinesia (PNFA: 22.4%, SD: 3.8%, PLA: 0.0%) and rigidity (PNFA: 30.6%, SD: 0.0%, PLA: 10.7%). Calculated positive likelihood ratios indicated bradykinesia (12.1) or rigidity (5.5) was more strongly associated with PNFA than other PPAs. CONCLUSION These findings suggest that on initial presentation, specific EPS may help distinguish PPA subtypes when linguistic and/or neuroimaging profiles are indistinct. Moreover, EPS could represent a marker of underlying tauopathy, linking clinical presentation to neuropathology in PPA.
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Affiliation(s)
- Sarah A Kremen
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Ratnavalli E. Progress in the last decade in our understanding of primary progressive aphasia. Ann Indian Acad Neurol 2011; 13:S109-15. [PMID: 21369415 PMCID: PMC3039160 DOI: 10.4103/0972-2327.74255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/27/2010] [Indexed: 12/05/2022] Open
Abstract
Primary progressive aphasia (PPA) is a focal neurodegeneration of the brain affecting the language network. Patients can have isolated language impairment for years without impairment in other areas. PPA is classified as primary progressive nonfluent aphasia (PNFA), semantic dementia (SD), and logopenic aphasia, which have distinct patterns of atrophy on neuroimaging. PNFA and SD are included under frontotemporal lobar degenerations. PNFA patients have effortful speech with agrammatism, which is frequently associated with apraxia of speech and demonstrate atrophy in the left Broca’s area and surrounding region on neuroimaging. Patients with SD have dysnomia with loss of word and object (or face) meaning with asymmetric anterior temporal lobe atrophy. Logopenic aphasics have word finding difficulties with frequent pauses in conversation, intact grammar, and word comprehension but impaired repetition for sentences. The atrophy is predominantly in the left posterior temporal and inferior parietal regions. Recent studies have described several progranulin mutations on chromosome 17 in PNFA. The three clinical syndromes have a less robust relationship to the underlying pathology, which is heterogeneous and includes tauopathy, ubiquitinopathy, Pick’s disease, corticobasal degeneration, progressive supranuclear palsy, and Alzheimer’s disease. Recent studies, however, seem to indicate that a better characterization of the clinical phenotype (apraxic, agrammatic, semantic, logopenic, jargon) increases the predictive value of the underlying pathology. Substantial advances have been made in our understanding of PPAs but developing new biomarkers is essential in making accurate causative diagnoses in individual patients. This is critically important in the development and evaluation of disease-modifying drugs.
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Badadani M, Nalbandian A, Watts GD, Vesa J, Kitazawa M, Su H, Tanaja J, Dec E, Wallace DC, Mukherjee J, Caiozzo V, Warman M, Kimonis VE. VCP associated inclusion body myopathy and paget disease of bone knock-in mouse model exhibits tissue pathology typical of human disease. PLoS One 2010; 5:e13183. [PMID: 20957154 PMCID: PMC2950155 DOI: 10.1371/journal.pone.0013183] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 09/06/2010] [Indexed: 11/19/2022] Open
Abstract
Dominant mutations in the valosin containing protein (VCP) gene cause inclusion body myopathy associated with Paget's disease of bone and frontotemporal dementia (IBMPFD). We have generated a knock-in mouse model with the common R155H mutation. Mice demonstrate progressive muscle weakness starting approximately at the age of 6 months. Histology of mutant muscle showed progressive vacuolization of myofibrils and centrally located nuclei, and immunostaining shows progressive cytoplasmic accumulation of TDP-43 and ubiquitin-positive inclusion bodies in quadriceps myofibrils and brain. Increased LC3-II staining of muscle sections representing increased number of autophagosomes suggested impaired autophagy. Increased apoptosis was demonstrated by elevated caspase-3 activity and increased TUNEL-positive nuclei. X-ray microtomography (uCT) images show radiolucency of distal femurs and proximal tibiae in knock-in mice and uCT morphometrics shows decreased trabecular pattern and increased cortical wall thickness. Bone histology and bone marrow derived macrophage cultures in these mice revealed increased osteoclastogenesis observed by TRAP staining suggestive of Paget bone disease. The VCP(R155H/+) knock-in mice replicate the muscle, bone and brain pathology of inclusion body myopathy, thus representing a useful model for preclinical studies.
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Affiliation(s)
- Mallikarjun Badadani
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Angèle Nalbandian
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Giles D. Watts
- Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Cell Biology and Biochemistry, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Jouni Vesa
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Masashi Kitazawa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California, United States of America
| | - Hailing Su
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Jasmin Tanaja
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Eric Dec
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
| | - Douglas C. Wallace
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
- Center for Molecular and Mitochondrial Medicine and Genetics, University of California Irvine, Irvine, California, United States of America
- Departments of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, United States of America
- Department of Biological Chemistry, University of California Irvine, Irvine, California, United States of America
| | - Jogeshwar Mukherjee
- Department of Psychiatry & Human Behavior, University of California Irvine, Irvine, California, United States of America
| | - Vincent Caiozzo
- Departments of Physiology and Biophysics, and Orthopedics, University of California Irvine, Irvine, California, United States of America
| | - Matthew Warman
- Department of Genetics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Virginia E. Kimonis
- Department of Pediatrics, University of California Irvine, Irvine, California, United States of America
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Abstract
Primary progressive aphasia (PPA) is a disorder of declining language that is a frequent presentation of neurodegenerative diseases such as frontotemporal lobar degeneration. Three variants of PPA are recognized: progressive nonfluent aphasia, semantic dementia, and logopenic progressive aphasia. In an era of etiology-specific treatments for neurodegenerative conditions, determining the histopathological basis of PPA is crucial. Clinicopathological correlations in PPA emphasize the contributory role of dementia with Pick bodies and other tauopathies, TDP-43 proteinopathies, and Alzheimer disease. These data suggest an association between a specific PPA variant and an underlying pathology, although many cases of PPA are associated with an unexpected pathology. Neuroimaging and biofluid biomarkers are now emerging as important adjuncts to clinical diagnosis. There is great hope that the addition of biomarker assessments to careful clinical examination will enable accurate diagnosis of the pathology associated with PPA during a patient's life, and that such findings will serve as the basis for clinical trials in this spectrum of disease.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, 2 Gibson, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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37
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Weintraub S, Mesulam MM, Wieneke C, Rademaker A, Rogalski EJ, Thompson CK. The northwestern anagram test: measuring sentence production in primary progressive aphasia. Am J Alzheimers Dis Other Demen 2009; 24:408-16. [PMID: 19700669 DOI: 10.1177/1533317509343104] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) is a clinical dementia syndrome with early symptoms of language dysfunction. Postmortem findings are varied and include Alzheimer disease and frontotemporal lobar degeneration (FTLD), both tauopathies and TAR DNA binding protein (TDP-43) proteinopathies. Clinical-pathological correlations in PPA are complex but the presence in the clinical profile of agrammatism has a high association with tauopathy. Grammatical competence is difficult to assess in the clinical setting with available methods. This article describes the Northwestern Anagram Test (NAT), a new clinical measure of sentence production. A total of 16 patients with PPA and their controls assembled single printed words to create sentences describing pictures. Northwestern Anagram Test performance was significantly correlated with a measure of sentence production and with aphasia severity but not with measures of naming, single word comprehension, object recognition, or motor speech. The NAT can be used to assess syntax competence when patients cannot be tested with measures that require intact speech production.
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Affiliation(s)
- Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Cognitive Neurology and Alzheimer's Disease Center, Chicago, Illinois 60611, USA.
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38
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Knibb JA, Woollams AM, Hodges JR, Patterson K. Making sense of progressive non-fluent aphasia: an analysis of conversational speech. Brain 2009; 132:2734-46. [PMID: 19696033 DOI: 10.1093/brain/awp207] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The speech of patients with progressive non-fluent aphasia (PNFA) has often been described clinically, but these descriptions lack support from quantitative data. The clinical classification of the progressive aphasic syndromes is also debated. This study selected 15 patients with progressive aphasia on broad criteria, excluding only those with clear semantic dementia. It aimed to provide a detailed quantitative description of their conversational speech, along with cognitive testing and visual rating of structural brain imaging, and to examine which, if any features were consistently present throughout the group; as well as looking for sub-syndromic associations between these features. A consistent increase in grammatical and speech sound errors and a simplification of spoken syntax relative to age-matched controls were observed, though telegraphic speech was rare; slow speech was common but not universal. Almost all patients showed impairments in picture naming, syntactic comprehension and executive function. The degree to which speech was affected was independent of the severity of the other cognitive deficits. A partial dissociation was also observed between slow speech with simplified grammar on the one hand, and grammatical and speech sound errors on the other. Overlap between these sets of impairments was however, the rule rather than the exception, producing continuous variation within a single consistent syndrome. The distribution of atrophy was remarkably variable, with frontal, temporal and medial temporal areas affected, either symmetrically or asymmetrically. The study suggests that PNFA is a coherent, well-defined syndrome and that varieties such as logopaenic progressive aphasia and progressive apraxia of speech may be seen as points in a space of continuous variation within progressive non-fluent aphasia.
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Affiliation(s)
- Jonathan A Knibb
- Department of Neurology, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, UK.
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Ash S, Moore P, Vesely L, Gunawardena D, McMillan C, Anderson C, Avants B, Grossman M. Non-Fluent Speech in Frontotemporal Lobar Degeneration. JOURNAL OF NEUROLINGUISTICS 2009; 22:370-383. [PMID: 22180700 PMCID: PMC3238501 DOI: 10.1016/j.jneuroling.2008.12.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We investigated the cognitive and neural bases of impaired speech fluency, a central feature of primary progressive aphasia. Speech fluency was assessed in 35 patients with frontotemporal lobar degeneration (FTLD) who presented with progressive non-fluent aphasia (PNFA, n=11), semantic dementia (SemD, n=12), or a social and executive disorder without aphasia (SOC/EXEC, n=12). Fluency was quantified as the number of words per minute in an extended, semi-structured speech sample. This was related to language characteristics of the speech sample and to neuropsychological measures. PNFA patients were significantly less fluent than controls and other FTLD patients. Fluency correlated with grammatical expression but not with speech errors or executive difficulty. SemD and SOC/EXEC patients were also less fluent than controls. In SemD, fluency was associated with semantically limited content. In SOC/EXEC, fluency was associated with executive limitations. Voxel-based morphometry analyses of high-resolution MRI related fluency to gray matter volume in left inferior frontal, insula, and superior temporal regions for the entire cohort of FTLD patients. This region overlapped partially distinct atrophic areas in each FTLD subgroup. It thus appears to play a crucial role in speech fluency, which can be interrupted in different ways in different FTLD subgroups.
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Affiliation(s)
- Sharon Ash
- Department of Neurology, University of Pennsylvania School of Medicine
| | - Peachie Moore
- Department of Neurology, University of Pennsylvania School of Medicine
| | - Luisa Vesely
- Department of Neurology, University of Pennsylvania School of Medicine
| | | | - Corey McMillan
- Department of Neurology, University of Pennsylvania School of Medicine
| | - Chivon Anderson
- Department of Neurology, University of Pennsylvania School of Medicine
| | - Brian Avants
- Department of Radiology, University of Pennsylvania School of Medicine
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania School of Medicine
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Rogalski E, Rademaker A, Mesulam M, Weintraub S. Covert processing of words and pictures in nonsemantic variants of primary progressive aphasia. Alzheimer Dis Assoc Disord 2008; 22:343-51. [PMID: 18580588 PMCID: PMC2757061 DOI: 10.1097/wad.0b013e31816c92f7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The inability to name objects (anomia) is one of the most common findings in the neurologic examination of primary progressive aphasia (PPA). In the semantic variant of PPA, the anomia is profound and reflects a combination of object naming and word comprehension deficits. In contrast, nonsemantic variants of PPA display a more selective impairment of object naming, without corresponding impairments of word comprehension. The aim of the present study was to explore the nature of the anomia in nonsemantic variants of PPA with a sensitive chronometric test of covert word/picture association. We tested priming effects in 12 patients with nonsemantic variant of PPA and 18 controls. Stimuli consisted of written words and line pictures of concrete objects. Within-format (word-word and picture-picture) and cross-format (word-picture and picture-word) priming effects were assessed by measuring the shortening of response times to the second versus initial presentation of corresponding stimulus pairs. In addition to the expected impairment of picture-to-word priming, a condition simulating object naming, the nonsemantic PPA patients also showed unexpected impairments of word-to-picture and word-to-word priming. Picture-to-picture priming was preserved, demonstrating the selectivity of the deficit for lexical processing. These findings show that the information processing bottleneck in patients with nonsemantic variants of PPA is not confined to the stage of lexical access but that it also extends into the prior levels of lexical semantics. The boundaries between the semantic and nonsemantic variants are therefore far from rigid.
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Affiliation(s)
- Emily Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Department of Preventative Medicine, Northwestern University, Chicago, IL 60612, USA.
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Peelle JE, Troiani V, Gee J, Moore P, McMillan C, Vesely L, Grossman M. Sentence comprehension and voxel-based morphometry in progressive nonfluent aphasia, semantic dementia, and nonaphasic frontotemporal dementia. JOURNAL OF NEUROLINGUISTICS 2008; 21:418-432. [PMID: 19727332 PMCID: PMC2598754 DOI: 10.1016/j.jneuroling.2008.01.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
To investigate the basis for impaired sentence comprehension in patients with frontotemporal dementia (FTD) we assessed grammatical comprehension and verbal working memory in 88 patients with three distinct presentations: progressive nonfluent aphasia (PNFA), semantic dementia (SD), and nonaphasic patients with a disorder of social comportment and executive processing (SOC/EXEC). We related sentence comprehension and working memory performance to regional cortical volume in a subgroup of 29 patients with structural MRI scans using voxel-based morphometry. PNFA patients exhibited the greatest difficulty with sentence comprehension and were especially impaired with grammatically complex sentences, which correlated with atrophy in left inferior frontal cortex. Working memory performance in these same patients correlated with a proximal but distinct left inferior frontal region. SD patients' sentence comprehension scores correlated with left inferolateral temporal lobe damage, which we hypothesize and reflect impairments in lexical processing. We did not observe any consistent relationship between cortical atrophy and sentence comprehension impairment in SOC/EXEC patients, suggesting the deficits in this subgroup may be due to more variable declines in executive resources.
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Affiliation(s)
- Jonathan E. Peelle
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Vanessa Troiani
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - James Gee
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Peachie Moore
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Corey McMillan
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Luisa Vesely
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
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42
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Mesulam M, Wicklund A, Johnson N, Rogalski E, Léger GC, Rademaker A, Weintraub S, Bigio EH. Alzheimer and frontotemporal pathology in subsets of primary progressive aphasia. Ann Neurol 2008; 63:709-19. [PMID: 18412267 DOI: 10.1002/ana.21388] [Citation(s) in RCA: 331] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify predictors of Alzheimer's disease (AD) versus frontotemporal lobar degeneration pathology in primary progressive aphasia (PPA), and determine whether the AD pathology is atypically distributed to fit the aphasic phenotype. METHODS Neuropsychological and neuropathological analyses of 23 consecutive PPA autopsies. All had qualitative determination of neurofibrillary tangle (NFT) density. Additional quantitation was done in four of the PPA/AD cases and four AD cases with the typical amnestic dementia of the Alzheimer type. RESULTS The sample contained mostly logopenic, agrammatic, and mixed forms of PPA. All six agrammatics had frontotemporal lobar degeneration (five of six with tauopathy). Seven of the 11 logopenics had AD. In logopenics, lower memory scores increased the probability of AD, but there were exceptions. The PPA/AD group showed predominance of entorhinal NFT typical of the amnestic dementia of the Alzheimer type. In the small subgroup examined quantitatively, neocortical NFTs were more numerous in the left hemisphere of PPA/AD. However, the asymmetry was low and inconsistent. Neuritic plaques did not display consistent asymmetry. Apolipoprotein E4, a major risk factor for typical AD, did not predict AD pathology in PPA. INTERPRETATION Subtyping PPA helps to predict AD versus frontotemporal lobar degeneration pathology at the group level. However, our results and the literature also indicate that no clinical predictor is completely reliable in individual patients. The inconsistent concordance of NFT distribution with the asymmetric atrophy and the nonamnestic phenotype also raises the possibility that the AD markers encountered at autopsy in PPA may not always reflect the nature of the initiating neurodegenerative process.
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Affiliation(s)
- Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Diagnostic value of CSF biomarker profile in frontotemporal lobar degeneration. Alzheimer Dis Assoc Disord 2008; 22:47-53. [PMID: 18317246 DOI: 10.1097/wad.0b013e3181610fea] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) biomarkers have been increasingly studied in dementia clinical and differential diagnosis. METHODS We assessed levels of total tau protein (tauT), tau phosphorylated at threonine 181 (tau P-181), and beta-amyloid1-42 (A beta 42) in 34 patients with frontotemporal lobar degeneration (FTLD), 76 Alzheimer disease (AD) cases, and 93 controls (CTRL). Double sandwich enzyme-linked immunosorbent assays (Innogenetics) were used for measurements. RESULTS Total tau was significantly increased and A beta 42 decreased in FTLD and AD patients as compared with CTRL. CSF tau P-181 levels were significantly increased only in AD. The tauT/A beta 42 ratio successfully discriminated FTLD from CTRL with a 86.7% specificity and 80.6% sensitivity, whereas the tauT alone was more specific (95.7%) but less sensitive (64.75%). For the discrimination of FTLD from AD, tauT/A beta 42 ratio was better (90.3% sensitivity and 64.5% specificity) compared with the other biomarkers alone or in combination, whereas tau P-181 was less sensitive but more specific (68.4% and 85.7%, respectively). Subtype analysis revealed that the most AD-like profile of biomarkers were observed in FTLD with motor neuron signs, whereas the most non-AD profile were observed in patients with primary progressive aphasia. CONCLUSIONS Combined analysis of CSF biomarkers may be useful for the best possible antemortem discrimination of FTLD from AD.
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Rogalski E, Johnson N, Weintraub S, Mesulam M. Increased frequency of learning disability in patients with primary progressive aphasia and their first-degree relatives. ACTA ACUST UNITED AC 2008; 65:244-8. [PMID: 18268195 DOI: 10.1001/archneurol.2007.34] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although risk factors for Alzheimer disease have been well studied, much less is known about risk factors for primary progressive aphasia (PPA). OBJECTIVE To demonstrate that learning disabilities (LDs) are more common in patients with PPA and their first-degree family members. DESIGN, SETTING, AND PATIENTS Self-report endorsement of an individual and family history of an LD in a sample of 699 subjects from the Northwestern Alzheimer's Disease Center registry. We compared 3 dementia groups (PPA, typical amnestic Alzheimer disease, and the behavioral variant of frontotemporal dementia) and 1 elderly control group. A retrospective medical record review in the PPA probands was used to obtain additional information. MAIN OUTCOME MEASURE Prevalence of LDs among probands and their first-degree relatives. RESULTS The patients with PPA and their first-degree family members had a significantly higher frequency of LD compared with the other dementia groups and the controls. Some of the families of patients with PPA displayed unusual concentrations of LD, especially dyslexia. CONCLUSION These results suggest that LD may constitute a risk factor for PPA, providing additional clues concerning the determinants for the selective vulnerability of the language network in this syndrome.
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Affiliation(s)
- Emily Rogalski
- Neurological Sciences, Rush University Medical Center, 1735 W. Harrison Street, Chicago, IL 60612, USA.
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Performance in specific language tasks correlates with regional volume changes in progressive aphasia. Cogn Behav Neurol 2008; 20:203-11. [PMID: 18091068 DOI: 10.1097/wnn.0b013e31815e6265] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patterns of language impairment have long been used clinically to localize brain damage in stroke patients. The same approach might be useful in the differential diagnosis of progressive aphasia owing to neurodegenerative disease. OBJECTIVE To investigate whether scores on 4 widely used language tasks correlate with regional gray matter loss in 51 patients with progressive language impairment owing to neurodegenerative disease. METHOD Scores in the Boston Naming Test and in the "repetition" "sequential commands" and the "language fluency," subtests of the Western Aphasia Battery were correlated with voxel-wise gray matter volumes using voxel-based morphometry. RESULTS Significant positive correlations were found between each language task and regional brain volumes: (1) naming and the bilateral temporal lobes; (2) sentence repetition and the left posterior portion of the superior temporal gyrus; (3) sentence comprehension and the left dorsal middle and inferior frontal gyri; and (4) fluency of language production and the left ventral middle and inferior frontal gyri. DISCUSSION Performance on specific language tasks corresponds to regional anatomic damage in aphasia owing to neurodegenerative disorders. These language tests might be useful in the differential diagnosis of primary progressive aphasia variants that have been previously associated with damage to corresponding anatomic regions.
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Mesulam M, Weintraub S. Primary progressive aphasia and kindred disorders. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:573-87. [PMID: 18631780 DOI: 10.1016/s0072-9752(07)01254-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Rabinovici GD, Rascovsky K, Miller BL. Frontotemporal lobar degeneration: clinical and pathologic overview. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:343-64. [PMID: 18631759 DOI: 10.1016/s0072-9752(07)01233-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Progressive Nonfluent Aphasia and Its Characteristic Motor Speech Deficits. Alzheimer Dis Assoc Disord 2007; 21:S23-30. [DOI: 10.1097/wad.0b013e31815d19fe] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Primary progressive aphasia is a neurodegenerative syndrome characterized by a relentless dissolution of language but relative sparing of other cognitive domains during the initial stages of the disease. Substantial progress has been made in understanding the clinical characteristics, imaging, genetics, and neuropathology of this syndrome. This article reviews the clinical criteria for diagnosing primary progressive aphasia and some of the more recent research advances in this field.
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Affiliation(s)
- Emily Rogalski
- Cognitive Neurology and Alzheimer's Disease Center and Department of Neurology, Northwestern University, 320 E. Superior Street, Searle Building 11-453, Chicago, IL 60657, USA.
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