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Keith CM, Lindberg KE, Wilhelmsen K, Mehta RI, Vieira Ligo Teixeira C, Miller M, Ward M, Navia RO, McCuddy WT, Miller L, Bryant K, Coleman M, D'Haese PF, Haut MW. Cortical Thickness Correlates of Go/No-go and Motor Sequencing in Mild Cognitive Impairment and Suspected Alzheimer Disease Dementia. Cogn Behav Neurol 2024; 37:144-153. [PMID: 39069962 DOI: 10.1097/wnn.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND While the cognitive hallmark of typical Alzheimer disease (AD) is impaired memory consolidation, increasing evidence suggests that the frontal lobes and associated executive functions are also impacted. OBJECTIVE We examined two neurobehavioral executive function tasks and associations with cortical thickness in patients diagnosed with mild cognitive impairment (MCI), suspected AD dementia, and a healthy control group. METHODS First, we compared group performances on a go/no-go (GNG) task and on Luria's Fist-Edge-Palm (FEP) motor sequencing task. We then examined correlations between neurobehavioral task performance and the thickness of frontal cortical regions, AD signature regions, broader unbiased brain regions, and white matter hyperintensities (WMH). RESULTS Participants with MCI performed worse than healthy controls, but better than participants with suspected AD dementia on both tasks. Both GNG and FEP (to a slightly greater extent) tasks showed diffuse associations with most AD signature regions and multiple additional regions within the temporal, parietal, and occipital cortices. Similarly, both tasks showed significant associations with all other cognitive tasks examined. Of the frontal regions examined, only the middle frontal gyrus and pars opercularis were associated with performance on these tasks. Interactions between the precuneus and transtemporal gyri were most predictive of GNG task performance, while the interaction between superior temporal and lingual gyri was most predictive of FEP task performance. CONCLUSION This study replicates difficulties with both GNG and FEP tasks in participants with MCI and AD dementia. Both tasks showed widespread associations with the cortical thickness of various brain structures rather than localizing to frontal regions, consistent with the diffuse nature of AD.
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Affiliation(s)
- Cierra M Keith
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Katharine E Lindberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Kirk Wilhelmsen
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Neurology, West Virginia University, Morgantown, West Virginia
| | - Rashi I Mehta
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Neuroradiology, West Virginia University, Morgantown, West Virginia
| | | | - Mark Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Melanie Ward
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Neurology, West Virginia University, Morgantown, West Virginia
| | - R Osvaldo Navia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - William T McCuddy
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Liv Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Kirk Bryant
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
| | - Michelle Coleman
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Neuroradiology, West Virginia University, Morgantown, West Virginia
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
- Department of Neurology, West Virginia University, Morgantown, West Virginia
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2
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Saraceno C, Cervellati C, Trentini A, Crescenti D, Longobardi A, Geviti A, Bonfiglio NS, Bellini S, Nicsanu R, Fostinelli S, Mola G, Riccetti R, Moretti DV, Zanetti O, Binetti G, Zuliani G, Ghidoni R. Serum Beta-Secretase 1 Activity Is a Potential Marker for the Differential Diagnosis between Alzheimer's Disease and Frontotemporal Dementia: A Pilot Study. Int J Mol Sci 2024; 25:8354. [PMID: 39125924 PMCID: PMC11313328 DOI: 10.3390/ijms25158354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the two major neurodegenerative diseases causing dementia. Due to similar clinical phenotypes, differential diagnosis is challenging without specific biomarkers. Beta-site Amyloid Precursor Protein cleaving enzyme 1 (BACE1) is a β-secretase pivotal in AD pathogenesis. In AD and mild cognitive impairment subjects, BACE1 activity is increased in brain/cerebrospinal fluid, and plasma levels appear to reflect those in the brain. In this study, we aim to evaluate serum BACE1 activity in FTD, since, to date, there is no evidence about its role. The serum of 30 FTD patients and 30 controls was analyzed to evaluate (i) BACE1 activity, using a fluorescent assay, and (ii) Glial Fibrillary Acid Protein (GFAP) and Neurofilament Light chain (NfL) levels, using a Simoa kit. As expected, a significant increase in GFAP and NfL levels was observed in FTD patients compared to controls. Serum BACE1 activity was not altered in FTD patients. A significant increase in serum BACE1 activity was shown in AD vs. FTD and controls. Our results support the hypothesis that serum BACE1 activity is a potential biomarker for the differential diagnosis between AD and FTD.
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Affiliation(s)
- Claudia Saraceno
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
| | - Carlo Cervellati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy; (C.C.); (G.M.); (G.Z.)
| | - Alessandro Trentini
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.T.); (R.R.)
| | - Daniela Crescenti
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
| | - Antonio Longobardi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
| | - Andrea Geviti
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (A.G.); (N.S.B.)
| | - Natale Salvatore Bonfiglio
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (A.G.); (N.S.B.)
| | - Sonia Bellini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
| | - Roland Nicsanu
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
| | - Silvia Fostinelli
- MAC–Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (S.F.); (G.B.)
| | - Gianmarco Mola
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy; (C.C.); (G.M.); (G.Z.)
| | - Raffaella Riccetti
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.T.); (R.R.)
| | - Davide Vito Moretti
- Alzheimer’s Rehabilitation Operative Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy;
| | - Orazio Zanetti
- Alzheimer’s Research Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy;
| | - Giuliano Binetti
- MAC–Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (S.F.); (G.B.)
| | - Giovanni Zuliani
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy; (C.C.); (G.M.); (G.Z.)
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy; (C.S.); (D.C.); (A.L.); (S.B.); (R.N.)
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3
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Brown A, Salo SK, Savage G. Frontal variant Alzheimer's disease: A systematic narrative synthesis. Cortex 2023; 166:121-153. [PMID: 37356113 DOI: 10.1016/j.cortex.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Frontal variant Alzheimer's disease (fvAD) is considered a rare form of Alzheimer's disease (AD) which may be misdiagnosed as behavioural variant frontotemporal dementia (bvFTD). The literature has tended to conflate behavioural and executive dysfunction in fvAD cohorts and uses both AD diagnostic criteria and bvFTD diagnostic criteria to classify fvAD cohorts. The primary aim of this narrative synthesis was to summarise neuropsychological findings in fvAD cohorts in the context of established AD pathology. METHODS EMBASE, PsycINFO, PROQUEST and MEDLINE databases were searched for studies eligible for inclusion. Studies with both neuropsychological and biomarker evidence were included in the final narrative synthesis. RESULTS Ten studies were reviewed, including samples totalling 342 fvAD participants, 178 typical AD participants and 250 bvFTD participants. The review revealed areas worthy of further investigation that may aid differential diagnosis, including the degree of executive dysfunction in fvAD cohorts relative to bvFTD cohorts, the onset of behavioural and cognitive symptomatology, and similarities between fvAD and typical AD cognitive profiles. CONCLUSION There was insufficient neuropsychological evidence to clearly differentiate fvAD and bvFTD cognitive phenotypes, however, the review has highlighted distinctive features of the two disorders that may guide differential diagnosis in future research. Moreover, the review has highlighted issues involving disparate diagnostic criteria used to classify fvAD cohorts, contributing to variation in findings.
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Affiliation(s)
- Andrea Brown
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Sarah K Salo
- Department of Psychology, Swansea University, Swansea, UK; School of Psychology, University of Plymouth, Plymouth, UK
| | - Greg Savage
- School of Psychological Sciences, Macquarie University, Sydney, Australia.
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Donato L, Mordà D, Scimone C, Alibrandi S, D'Angelo R, Sidoti A. How Many Alzheimer-Perusini's Atypical Forms Do We Still Have to Discover? Biomedicines 2023; 11:2035. [PMID: 37509674 PMCID: PMC10377159 DOI: 10.3390/biomedicines11072035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Alzheimer-Perusini's (AD) disease represents the most spread dementia around the world and constitutes a serious problem for public health. It was first described by the two physicians from whom it took its name. Nowadays, we have extensively expanded our knowledge about this disease. Starting from a merely clinical and histopathologic description, we have now reached better molecular comprehension. For instance, we passed from an old conceptualization of the disease based on plaques and tangles to a more modern vision of mixed proteinopathy in a one-to-one relationship with an alteration of specific glial and neuronal phenotypes. However, no disease-modifying therapies are yet available. It is likely that the only way to find a few "magic bullets" is to deepen this aspect more and more until we are able to draw up specific molecular profiles for single AD cases. This review reports the most recent classifications of AD atypical variants in order to summarize all the clinical evidence using several discrimina (for example, post mortem neurofibrillary tangle density, cerebral atrophy, or FDG-PET studies). The better defined four atypical forms are posterior cortical atrophy (PCA), logopenic variant of primary progressive aphasia (LvPPA), behavioral/dysexecutive variant and AD with corticobasal degeneration (CBS). Moreover, we discuss the usefulness of such classifications before outlining the molecular-genetic aspects focusing on microglial activity or, more generally, immune system control of neuroinflammation and neurodegeneration.
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Affiliation(s)
- Luigi Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Domenico Mordà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Concetta Scimone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Simona Alibrandi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166 Messina, Italy
| | - Rosalia D'Angelo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Antonina Sidoti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
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5
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Perez SD, Phillips JS, Norise C, Kinney NG, Vaddi P, Halpin A, Rascovsky K, Irwin DJ, McMillan CT, Xie L, Wisse LE, Yushkevich PA, Kallogjeri D, Grossman M, Cousins KA. Neuropsychological and Neuroanatomical Features of Patients with Behavioral/Dysexecutive Variant Alzheimer’s disease (AD): A Comparison to Behavioral Variant Frontotemporal Dementia and Amnestic AD Groups. J Alzheimers Dis 2022; 89:641-658. [PMID: 35938245 PMCID: PMC10117623 DOI: 10.3233/jad-215728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: An understudied variant of Alzheimer’s disease (AD), the behavioral/dysexecutive variant of AD (bvAD), is associated with progressive personality, behavior, and/or executive dysfunction and frontal atrophy. Objective: This study characterizes the neuropsychological and neuroanatomical features associated with bvAD by comparing it to behavioral variant frontotemporal dementia (bvFTD), amnestic AD (aAD), and subjects with normal cognition. Methods: Subjects included 16 bvAD, 67 bvFTD, and 18 aAD patients, and 26 healthy controls. Neuropsychological assessment and MRI data were compared between these groups. Results: Compared to bvFTD, bvAD showed more significant visuospatial impairments (Rey Figure copy and recall), more irritability (Neuropsychological Inventory), and equivalent verbal memory (Philadelphia Verbal Learning Test). Compared to aAD, bvAD indicated more executive dysfunction (F-letter fluency) and better visuospatial performance. Neuroimaging analysis found that bvAD showed cortical thinning relative to bvFTD posteriorly in left temporal-occipital regions; bvFTD had cortical thinning relative to bvAD in left inferior frontal cortex. bvAD had cortical thinning relative to aAD in prefrontal and anterior temporal regions. All patient groups had lower volumes than controls in both anterior and posterior hippocampus. However, bvAD patients had higher average volume than aAD patients in posterior hippocampus and higher volume than bvFTD patients in anterior hippocampus after adjustment for age and intracranial volume. Conclusion: Findings demonstrated that underlying pathology mediates disease presentation in bvAD and bvFTD.
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Affiliation(s)
- Sophia Dominguez Perez
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jeffrey S. Phillips
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Norise
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikolas G. Kinney
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Prerana Vaddi
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Halpin
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, University of Maine, Orono, ME, USA
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Irwin
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Long Xie
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Image Computing and Science Lab & Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura E.M. Wisse
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Image Computing and Science Lab & Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Paul A. Yushkevich
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Image Computing and Science Lab & Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University, St. Louis, MO, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katheryn A.Q. Cousins
- Penn Frontotemporal Degeneration Center (FTDC), University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Ossenkoppele R, Singleton EH, Groot C, Dijkstra AA, Eikelboom WS, Seeley WW, Miller B, Laforce RJ, Scheltens P, Papma JM, Rabinovici GD, Pijnenburg YAL. Research Criteria for the Behavioral Variant of Alzheimer Disease: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 79:48-60. [PMID: 34870696 PMCID: PMC8649917 DOI: 10.1001/jamaneurol.2021.4417] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The behavioral variant of Alzheimer disease (bvAD) is characterized by early and predominant behavioral deficits caused by AD pathology. This AD phenotype is insufficiently understood and lacks standardized clinical criteria, limiting reliability and reproducibility of diagnosis and scientific reporting. Objective To perform a systematic review and meta-analysis of the bvAD literature and use the outcomes to propose research criteria for this syndrome. Data Sources A systematic literature search in PubMed/MEDLINE and Web of Science databases (from inception through April 7, 2021) was performed in duplicate. Study Selection Studies reporting on behavioral, neuropsychological, or neuroimaging features in bvAD and, when available, providing comparisons with typical amnestic-predominant AD (tAD) or behavioral variant frontotemporal dementia (bvFTD). Data Extraction and Synthesis This analysis involved random-effects meta-analyses on group-level study results of clinical data and systematic review of the neuroimaging literature. The study was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Main Outcomes and Measures Behavioral symptoms (neuropsychiatric symptoms and bvFTD core clinical criteria), cognitive function (global cognition, episodic memory, and executive functioning), and neuroimaging features (structural magnetic resonance imaging, [18F]fluorodeoxyglucose-positron emission tomography, perfusion single-photon emission computed tomography, amyloid positron emission tomography, and tau positron emission tomography). Results The search led to the assessment of 83 studies, including 13 suitable for meta-analysis. Data were collected for 591 patients with bvAD. There was moderate to substantial heterogeneity and moderate risk of bias across studies. Cases with bvAD showed more severe behavioral symptoms than tAD (standardized mean difference [SMD], 1.16 [95% CI, 0.74-1.59]; P < .001) and a trend toward less severe behavioral symptoms compared with bvFTD (SMD, -0.22 [95% CI, -0.47 to 0.04]; P = .10). Meta-analyses of cognitive data indicated worse executive performance in bvAD vs tAD (SMD, -1.03 [95% CI, -1.74 to -0.32]; P = .008) but not compared with bvFTD (SMD, -0.61 [95% CI, -1.75 to 0.53]; P = .29). Cases with bvAD showed a nonsignificant difference of worse memory performance compared with bvFTD (SMD, -1.31 [95% CI, -2.75 to 0.14]; P = .08) but did not differ from tAD (SMD, 0.43 [95% CI, -0.46 to 1.33]; P = .34). The neuroimaging literature revealed 2 distinct bvAD neuroimaging phenotypes: an AD-like pattern with relative frontal sparing and a relatively more bvFTD-like pattern characterized by additional anterior involvement, with the AD-like pattern being more prevalent. Conclusions and Relevance These data indicate that bvAD is clinically most similar to bvFTD, while it shares most pathophysiological features with tAD. Based on these insights, we propose research criteria for bvAD aimed at improving the consistency and reliability of future research and aiding the clinical assessment of this AD phenotype.
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Affiliation(s)
- Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Ellen H Singleton
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Colin Groot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anke A Dijkstra
- Department of Pathology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location VUMC, Amsterdam, the Netherlands
| | - Willem S Eikelboom
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.,Associate Editor, JAMA Neurology
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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7
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Abstract
Further understanding of older age bipolar disorder (OABD) may lead to more specific recommendations for treatment adjusted to the specific characteristics and needs caused by age-related somatic and cognitive changes. Late-onset mania has a broad differential diagnosis and requires full psychiatric and somatic work-up, including brain imaging. Research on pharmacotherapy in OABD is limited. First-line treatment of OABD is similar to that for adult bipolar disorder (BD), with specific attention to vulnerability to side effects and somatic comorbidity. Because findings in younger adults with BD cannot be extrapolated to OABD, more research in OABD is warranted.
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Affiliation(s)
- Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Aartjan Beekman
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Department of Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands
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8
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Shea YF, Pan Y, Mak HKF, Bao Y, Lee SC, Chiu PKC, Chan HWF. A systematic review of atypical Alzheimer's disease including behavioural and psychological symptoms. Psychogeriatrics 2021; 21:396-406. [PMID: 33594793 DOI: 10.1111/psyg.12665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) is the commonest cause of dementia, characterized by the clinical presentation of progressive anterograde episodic memory impairment. However, atypical presentation of patients is increasingly recognized. These atypical AD include logopenic aphasia, behavioural variant AD, posterior cortical atrophy, and corticobasal syndrome. These atypical AD are more common in patients with young onset AD before the age of 65 years old. Since medical needs (including the behavioural and psychological symptoms of dementia) of atypical AD patients could be different from typical AD patients, it is important for clinicians to be aware of these atypical forms of AD. In addition, disease modifying treatment may be available in the future. This review aims at providing an update on various important subtypes of atypical AD including behavioural and psychological symptoms.
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Affiliation(s)
- Yat-Fung Shea
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yining Pan
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yiwen Bao
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Shui-Ching Lee
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Patrick Ka-Chun Chiu
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Hon-Wai Felix Chan
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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9
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Dynamic Changes of Brain Networks during Working Memory Tasks in Schizophrenia. Neuroscience 2020; 453:187-205. [PMID: 33249224 DOI: 10.1016/j.neuroscience.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022]
Abstract
Electroencephalograph (EEG) signals and graph theory measures have been widely used to characterize the brain functional networks of healthy individuals and patients by calculating the correlations between different electrodes over an entire time series. Although EEG signals have a high temporal resolution and can provide relatively stable results, the process of constructing and analyzing brain functional networks is inevitably complicated by high time complexity. Our goal in this research was to distinguish the brain function networks of schizophrenia patients from those of healthy participants during working memory tasks. Consequently, we utilized a method involving microstates, which are each characterized by a unique topography of electric potentials over an entire channel array, to reduce the dimension of the EEG signals during working memory tasks and then compared and analyzed the brain functional networks using the microstates time series (MTS) and original time series (OTS) of the schizophrenia patients and healthy individuals. We found that the right frontal and parietal-occipital regions neurons of the schizophrenia patients were less active than those of the healthy participants during working memory tasks. Notably, compared with OTS, the time needed to construct the brain functional networks was significantly reduced by using MTS. In conclusion, our results show that, like OTS, MTS can well distinguish the brain functional network of schizophrenia patients from those of healthy individuals during working memory tasks while greatly decreasing time complexity. MTS can thus provide a method for characterizing the original time series for the construction and analysis of EEG brain functional networks.
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10
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Update on PET in neurodegenerative and neuroinflammatory disorders manifesting on a behavioural level: imaging for differential diagnosis. Curr Opin Neurol 2020; 32:548-556. [PMID: 31107281 DOI: 10.1097/wco.0000000000000706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To give an update on recent findings concerning the use of PET for differential diagnosis in neurodegenerative and neuroinflammatory disorders manifesting on a behavioural level. RECENT FINDINGS Although accurate differential diagnosis of dementia can be achieved by imaging disease-specific patterns of cerebral glucose metabolism with [F]fluorodeoxyglucose ([F]FDG)-PET, the diagnostic impact of [F]FDG-PET in primary psychiatric disorders is limited. Amyloid-beta PET provides an incremental value beyond [F]FDG-PET in the differential diagnosis of dementia and was proposed as a biomarker defining the so-called Alzheimer continuum. Recently developed tau-specific tracers might also aid in the diagnostic process (biological definition of Alzheimer's disease together with amyloid-beta). Surpassing the diagnostic accuracy of other techniques, such as MRI, [F]FDG-PET has also gained widespread clinical use for diagnosis and follow-up of paraneoplastic and autoimmune disorders of the central nervous system (CNS) as an important differential diagnosis for rapid progressive dementia and subacute onset of psychiatric syndromes. SUMMARY Molecular neuroimaging with PET is an established method for the differential diagnosis of neurodegenerative and autoimmune CNS disorders manifesting on a behavioural level with significant therapeutic and prognostic impact. Future prospective studies are needed to define the value of tau imaging for diagnosis and prognosis in neurodegenerative disorders.
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11
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Turcano P, Stang CD, Mielke MM, Martin PR, Upadhyaya SG, Josephs KA, Boeve BF, Knopman DS, Petersen RC, Savica R. Incidence of frontotemporal disorders in Olmsted County: A population-based study. Alzheimers Dement 2020; 16:482-490. [PMID: 31784373 PMCID: PMC7067641 DOI: 10.1016/j.jalz.2019.08.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Frontotemporal dementia disorders (FTDs) are heterogeneous phenotypical behavioral and language disorders usually associated with frontal and/or temporal lobe degeneration. We investigated their incidence in a population-based cohort. METHODS Using a records-linkage system, we identified all patients with a diagnostic code for dementia in Olmsted County, MN, 1995-2010, and confirmed the diagnosis of FTD. A behavioral neurologist verified the clinical diagnosis and determined phenotypes. RESULTS We identified 35 FTDs cases. Overall, the incidence of FTDs was 4.3/100,000/year (95% CI: 2.9, 5.7). Incidence was higher in men (6.3/100,000, 95% CI 3.6, 9.0) than women (2.9/100,000; 95% CI: 1.3, 4.5); we observed an increased trend over time (B = 0.83, 95% CI: 0.54, 1.11, P < .001). At autopsy, clinical diagnosis was confirmed in eight (72.7%) cases. DISCUSSION We observed an increased incidence and trends of FTDs over time. This may reflect a better recognition by clinicians and improvement of clinical criteria and diagnostic tools.
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Affiliation(s)
| | | | - Michelle M. Mielke
- Mayo Clinic Department of Health Sciences Research,
Rochester, MN 55905 USA
| | - Peter R. Martin
- Mayo Clinic Department of Health Sciences Research,
Rochester, MN 55905 USA
| | | | | | | | | | | | - Rodolfo Savica
- Mayo Clinic Department of Neurology
- Mayo Clinic Department of Health Sciences Research,
Rochester, MN 55905 USA
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12
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Kiselica AM, Benge JF. Quantitative and qualitative features of executive dysfunction in frontotemporal and Alzheimer's dementia. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:449-463. [PMID: 31424275 DOI: 10.1080/23279095.2019.1652175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Behavioral variant fronto-temporal degeneration (bvFTD) is typically distinguished from Alzheimer's disease (AD) by early, prominent dysexecutive findings, in addition to other clinical features. However, differences in executive functioning between these groups are not consistently found. The current study sought to investigate quantitative and qualitative differences in executive functioning between those with bvFTD and AD in a large sample, while controlling for dementia severity and demographic variables. Secondary data analyses were completed on a subset of cases from the National Alzheimer's Coordinating Center collected from 36 Alzheimer's Disease Research Centers and consisting of 1,577 individuals with AD and 406 individuals with bvFTD. Groups were compared on 1) ability to complete three commonly administered executive tasks (letter fluency, Trail Making Test Part B [TMTB], and digits backward); 2) quantitative test performance; and 3) errors on these tasks. Findings suggested that individuals with bvFTD were less likely to complete letter fluency, χ2(2) = 178.62, p < .001, and number span tasks, χ2(1) = 11.49, p < .001), whereas individuals with AD were less likely to complete TMTB, χ2(2) = 460.38, p < .001. Individuals with bvFTD performed more poorly on letter fluency, F(1) = 28.06, p = .013, but there were not group differences in TMTB lines per second or number span backwards. Errors generally did not differentiate the diagnostic groups. In summary, there is substantial overlap in executive dysfunction between those with bvFTD and AD, though individuals with bvFTD tend to demonstrate worse letter fluency performance.
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Affiliation(s)
- Andrew M Kiselica
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA
| | - Jared F Benge
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA.,Plummer Movement Disorders Center, Baylor Scott and White Health, Dallas, TX, USA.,Texas A&M College of Medicine, Bryan, TX, USA
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13
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Wong S, Strudwick J, Devenney E, Hodges JR, Piguet O, Kumfor F. Frontal variant of Alzheimer's disease masquerading as behavioural-variant frontotemporal dementia: a case study comparison. Neurocase 2019; 25:48-58. [PMID: 31044682 DOI: 10.1080/13554794.2019.1609523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current clinical diagnostic criteria for Alzheimer's disease (AD) recognize an atypical, non-amnestic presentation of AD, characterized by prominent executive dysfunction. Increasing evidence, however, indicates that the clinical phenotype of this so-called "frontal-variant" of AD (fv-AD) includes behavioral symptoms and deficits in social cognition, together with disproportionate frontal lobe atrophy. As these features resemble those characteristic of behavioral-variant frontotemporal dementia (bvFTD), differential diagnosis can be challenging. Here, we report a case of fv-AD who met clinical diagnostic criteria bvFTD, but had in vivo amyloid neuroimaging evidence of AD pathology. We compare this case against two individuals who were clinically diagnosed with bvFTD and early-onset AD, with in vivo amyloid neuroimaging confirmation of pathology. We highlight the challenges in differential diagnosis by contrasting their behavioral, cognitive and structural neuroimaging findings.
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Affiliation(s)
- Stephanie Wong
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,b School of Psychology , The University of Sydney , Sydney , Australia.,c ARC Centre of Excellence in Cognition and its Disorders , Sydney , Australia
| | - Jessica Strudwick
- b School of Psychology , The University of Sydney , Sydney , Australia
| | - Emma Devenney
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,d Sydney Medical School , The University of Sydney , Sydney , Australia
| | - John R Hodges
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,d Sydney Medical School , The University of Sydney , Sydney , Australia
| | - Olivier Piguet
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,b School of Psychology , The University of Sydney , Sydney , Australia.,c ARC Centre of Excellence in Cognition and its Disorders , Sydney , Australia
| | - Fiona Kumfor
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,b School of Psychology , The University of Sydney , Sydney , Australia.,c ARC Centre of Excellence in Cognition and its Disorders , Sydney , Australia
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14
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Frontal Variant Alzheimer Disease or Frontotemporal Lobe Degeneration With Incidental Amyloidosis? Alzheimer Dis Assoc Disord 2018; 30:183-5. [PMID: 26583500 DOI: 10.1097/wad.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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15
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Abstract
Further understanding of older age bipolar disorder (OABD) may lead to more specific recommendations for treatment adjusted to the specific characteristics and needs caused by age-related somatic and cognitive changes. Late-onset mania has a broad differential diagnosis and requires full psychiatric and somatic work-up, including brain imaging. Research on pharmacotherapy in OABD is limited. First-line treatment of OABD is similar to that for adult bipolar disorder (BD), with specific attention to vulnerability to side effects and somatic comorbidity. Because findings in younger adults with BD cannot be extrapolated to OABD, more research in OABD is warranted.
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Affiliation(s)
- Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Aartjan Beekman
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Department of Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands
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16
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Du L, Liu K, Zhang T, Yao X, Yan J, Risacher SL, Han J, Guo L, Saykin AJ, Shen L. A novel SCCA approach via truncated ℓ1-norm and truncated group lasso for brain imaging genetics. Bioinformatics 2018; 34:278-285. [PMID: 28968815 PMCID: PMC5860211 DOI: 10.1093/bioinformatics/btx594] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/21/2017] [Accepted: 09/15/2017] [Indexed: 02/06/2023] Open
Abstract
MOTIVATION Brain imaging genetics, which studies the linkage between genetic variations and structural or functional measures of the human brain, has become increasingly important in recent years. Discovering the bi-multivariate relationship between genetic markers such as single-nucleotide polymorphisms (SNPs) and neuroimaging quantitative traits (QTs) is one major task in imaging genetics. Sparse Canonical Correlation Analysis (SCCA) has been a popular technique in this area for its powerful capability in identifying bi-multivariate relationships coupled with feature selection. The existing SCCA methods impose either the ℓ1-norm or its variants to induce sparsity. The ℓ0-norm penalty is a perfect sparsity-inducing tool which, however, is an NP-hard problem. RESULTS In this paper, we propose the truncated ℓ1-norm penalized SCCA to improve the performance and effectiveness of the ℓ1-norm based SCCA methods. Besides, we propose an efficient optimization algorithms to solve this novel SCCA problem. The proposed method is an adaptive shrinkage method via tuning τ. It can avoid the time intensive parameter tuning if given a reasonable small τ. Furthermore, we extend it to the truncated group-lasso (TGL), and propose TGL-SCCA model to improve the group-lasso-based SCCA methods. The experimental results, compared with four benchmark methods, show that our SCCA methods identify better or similar correlation coefficients, and better canonical loading profiles than the competing methods. This demonstrates the effectiveness and efficiency of our methods in discovering interesting imaging genetic associations. AVAILABILITY AND IMPLEMENTATION The Matlab code and sample data are freely available at http://www.iu.edu/∼shenlab/tools/tlpscca/. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Lei Du
- Department of Control and Information, School of Automation, Northwestern Polytechnical University, Xi’an, China
| | - Kefei Liu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
| | - Tuo Zhang
- Department of Control and Information, School of Automation, Northwestern Polytechnical University, Xi’an, China
| | - Xiaohui Yao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
| | - Jingwen Yan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
| | - Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
| | - Junwei Han
- Department of Control and Information, School of Automation, Northwestern Polytechnical University, Xi’an, China
| | - Lei Guo
- Department of Control and Information, School of Automation, Northwestern Polytechnical University, Xi’an, China
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
| | - Li Shen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IN, USA
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17
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Guo H, Liu L, Chen J, Xu Y, Jie X. Alzheimer Classification Using a Minimum Spanning Tree of High-Order Functional Network on fMRI Dataset. Front Neurosci 2017; 11:639. [PMID: 29249926 PMCID: PMC5717514 DOI: 10.3389/fnins.2017.00639] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/03/2017] [Indexed: 12/22/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is one of the most useful methods to generate functional connectivity networks of the brain. However, conventional network generation methods ignore dynamic changes of functional connectivity between brain regions. Previous studies proposed constructing high-order functional connectivity networks that consider the time-varying characteristics of functional connectivity, and a clustering method was performed to decrease computational cost. However, random selection of the initial clustering centers and the number of clusters negatively affected classification accuracy, and the network lost neurological interpretability. Here we propose a novel method that introduces the minimum spanning tree method to high-order functional connectivity networks. As an unbiased method, the minimum spanning tree simplifies high-order network structure while preserving its core framework. The dynamic characteristics of time series are not lost with this approach, and the neurological interpretation of the network is guaranteed. Simultaneously, we propose a multi-parameter optimization framework that involves extracting discriminative features from the minimum spanning tree high-order functional connectivity networks. Compared with the conventional methods, our resting-state fMRI classification method based on minimum spanning tree high-order functional connectivity networks greatly improved the diagnostic accuracy for Alzheimer's disease.
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Affiliation(s)
- Hao Guo
- Department of Software Engineering, College of Computer Science and Technology, Taiyuan University of Technology, Taiyuan, China.,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Lei Liu
- Department of Software Engineering, College of Computer Science and Technology, Taiyuan University of Technology, Taiyuan, China
| | - Junjie Chen
- Department of Software Engineering, College of Computer Science and Technology, Taiyuan University of Technology, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiang Jie
- Department of Software Engineering, College of Computer Science and Technology, Taiyuan University of Technology, Taiyuan, China
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18
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Krudop WA, Dols A, Kerssens CJ, Eikelenboom P, Prins ND, Möller C, Schouws S, Rhebergen D, van Exel E, van der Flier WM, Sikkes S, Scheltens P, Stek ML, Pijnenburg YA. The Pitfall of Behavioral Variant Frontotemporal Dementia Mimics Despite Multidisciplinary Application of the FTDC Criteria. J Alzheimers Dis 2017; 60:959-975. [DOI: 10.3233/jad-170608] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Welmoed A. Krudop
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Cora J. Kerssens
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
| | - Piet Eikelenboom
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D. Prins
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - Christiane Möller
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
| | - Didi Rhebergen
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric van Exel
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Sietske Sikkes
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L. Stek
- Department of Old Age Psychiatry, GGZInGeest/ VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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19
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Abstract
PURPOSE OF REVIEW The population over age 60 is growing more rapidly than the general population. Given the projected increase and need for data that can inform treatment, this review provides a brief description of newer publications focused on mania in older-age bipolar disorder (OABD), including epidemiology, diagnosis, and treatments. RECENT FINDINGS Age cutoffs to define OABD range from 50 to 65 years. OABD clinical presentation and course of illness is highly variable, often characterized by mood episode recurrence, medical comorbidity, cognitive deficits, and impaired functioning. There is little pharmacotherapy data on mania in OABD. Lithium and valproate have been tested in a single randomized controlled trial and there is data of more limited quality with other compounds. Treating OABD is challenging due to medical complexity, comorbidity, diminished tolerance to treatment, and a limited evidence base. More data is needed to keep pace with clinical demand.
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20
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Agreement among neuropsychological and behavioral data and PiB findings in diagnosing Frontotemporal Dementia. J Clin Neurosci 2017; 44:128-132. [PMID: 28601570 DOI: 10.1016/j.jocn.2017.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022]
Abstract
Diagnostic inaccuracies have been reported in Alzheimer's disease (AD) and Frontotemporal Dementia (FTD) using clinical data alone. The [11C]-PiB PET scan offers a new method of identifying AD based on the detection of amyloid deposits. Our study investigated whether there was an agreement between neuropsychological and behavioral data and PiB findings in the diagnosis of FTD. Participants were 32 patients diagnosed with suspected FTD by clinical consensus. All participants underwent neuropsychological testing and PiB imaging. In addition, caregivers completed behavioral ratings of participants' memory, frontal behaviors, and mood. Seventeen participants were classified as PiB positive (+). Results of MANOVA and subsequent ANOVA analyses showed a significant difference on memory performance between the PiB- and PiB+groups, with the PiB- group performing better than the PiB+group. There were no significant differences between the groups on cognitive or behavioral measures of executive/frontal impairment, mood. Both groups showed similar severity of dementia. These findings provide evidence for the utility of the [11C]-PiB PET scan in distinguishing between AD and FTD, with evaluation of memory at clinical diagnosis serving as a valuable indicator of the absence of FTD and consideration for an AD diagnosis. Our results would support the concern that patients who may present with primary behavioral or executive dysfunction may not necessarily have FTD, particularly if memory deficits are evident.
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21
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Abstract
Early-onset Alzheimer disease (EOAD), with onset in individuals younger than 65 years, although overshadowed by the more common late-onset AD (LOAD), differs significantly from LOAD. EOAD comprises approximately 5% of AD and is associated with delays in diagnosis, aggressive course, and age-related psychosocial needs. One source of confusion is that a substantial percentage of EOAD are phenotypic variants that differ from the usual memory-disordered presentation of typical AD. The management of EOAD is similar to that for LOAD, but special emphasis should be placed on targeting the specific cognitive areas involved and more age-appropriate psychosocial support and education.
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Affiliation(s)
- Mario F Mendez
- Behavioral Neurology Program, David Geffen School of Medicine at UCLA, 300 Westwood Plaza, Suite B-200, Box 956975, Los Angeles, CA 90095, USA; Neurobehavior Unit, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 206, Los Angeles, CA 90073, USA.
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22
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Suhonen NM, Hallikainen I, Hänninen T, Jokelainen J, Krüger J, Hall A, Pikkarainen M, Soininen H, Remes AM. The Modified Frontal Behavioral Inventory (FBI-mod) for Patients with Frontotemporal Lobar Degeneration, Alzheimer’s Disease, and Mild Cognitive Impairment. J Alzheimers Dis 2017; 56:1241-1251. [DOI: 10.3233/jad-160983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Noora-Maria Suhonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Maria Pikkarainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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23
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Wong S, Bertoux M, Savage G, Hodges JR, Piguet O, Hornberger M. Comparison of Prefrontal Atrophy and Episodic Memory Performance in Dysexecutive Alzheimer's Disease and Behavioral-Variant Frontotemporal Dementia. J Alzheimers Dis 2016; 51:889-903. [PMID: 26923025 DOI: 10.3233/jad-151016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) sometimes presents with prominent executive dysfunction and associated prefrontal cortex atrophy. The impact of such executive deficits on episodic memory performance as well as their neural correlates in AD, however, remains unclear. The aim of the current study was to investigate episodic memory and brain atrophy in AD patients with relatively spared executive functioning (SEF-AD; n = 12) and AD patients with relatively impaired executive functioning (IEF-AD; n = 23). We also compared the AD subgroups with a group of behavioral-variant frontotemporal dementia patients (bvFTD; n = 22), who typically exhibit significant executive deficits, and age-matched healthy controls (n = 38). On cognitive testing, the three patient groups showed comparable memory profiles on standard episodic memory tests, with significant impairment relative to controls. Voxel-based morphometry analyses revealed extensive prefrontal and medial temporal lobe atrophy in IEF-AD and bvFTD, whereas this was limited to the middle frontal gyrus and hippocampus in SEF-AD. Moreover, the additional prefrontal atrophy in IEF-AD and bvFTD correlated with memory performance, whereas this was not the case for SEF-AD. These findings indicate that IEF-AD patients show prefrontal atrophy in regions similar to bvFTD, and suggest that this contributes to episodic memory performance. This has implications for the differential diagnosis of bvFTD and subtypes of AD.
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Affiliation(s)
- Stephanie Wong
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Maxime Bertoux
- Department of Clinical Neurosciences, Cambridge University, UK
| | - Greg Savage
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - John R Hodges
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, the University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, the University of New South Wales, Sydney, Australia
| | - Michael Hornberger
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,Norwich Medical School, University of East Anglia, UK
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Krudop WA, Dols A, Kerssens CJ, Prins ND, Möller C, Schouws S, Barkhof F, van Berckel BNM, Teunissen CE, van der Flier WM, Scheltens P, Sikkes SAM, Stek ML, Pijnenburg YAL. Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort. Dement Geriatr Cogn Disord 2016; 41:16-26. [PMID: 26473985 DOI: 10.1159/000441023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease. AIMS We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF). METHODS We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change. RESULTS Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses. CONCLUSION Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Malignant progression in parietal-dominant atrophy subtype of Alzheimer's disease occurs independent of onset age. Neurobiol Aging 2016; 47:149-156. [PMID: 27592283 DOI: 10.1016/j.neurobiolaging.2016.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
Abstract
Recently, we reported that earlier stages of Alzheimer's disease (AD) can be categorized into 3 following anatomical subtypes using a hierarchical cluster analysis of cortical thickness across the entire brain: medial temporal-dominant (MT), parietal-dominant (P), and diffuse atrophy (D). The goal of this study was to investigate the rates of cognitive decline in these anatomical subtypes. Of the patients included in the prior study, 100 AD patients (MT, n = 36; P, n = 20; D, n = 44) who underwent follow-up neuropsychological assessments over a 3-year period were included. A linear mixed model analysis was performed to compare the longitudinal changes in neuropsychological test scores. The P subtype exhibited the most rapid cognitive decline in attention, language, visuospatial, memory, and frontal executive function, whereas MT and D subtypes did not differ in their longitudinal decline. When repeating the analyses with early-onset AD, which is known to progress faster than late-onset AD, only the P subtype showed such rapid progression. The P subtype appears to be a unique subtype of AD characterized by an aggressive rate of progression.
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Leslie FVC, Foxe D, Daveson N, Flannagan E, Hodges JR, Piguet O. FRONTIER Executive Screen: a brief executive battery to differentiate frontotemporal dementia and Alzheimer's disease. J Neurol Neurosurg Psychiatry 2016; 87:831-5. [PMID: 26420887 DOI: 10.1136/jnnp-2015-311917] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Executive dysfunctions are a key clinical feature of behavioural-variant frontotemporal dementia (bvFTD). Such deficits are also found in Alzheimer's disease (AD), making the differentiation between these two diseases difficult at times, particularly in the absence of extensive cognitive assessments. To address this issue, we developed the FRONTIER Executive Screen (FES), which combines three abbreviated measures of verbal fluency, inhibitory control and working memory. METHODS We administered the FES to 28 patients with dementia (14 bvFTD, 14 AD) matched for disease severity and 33 age-matched and education-matched healthy controls. We also administered traditional tests of executive function to establish the concurrent validity of the FES. RESULTS Both patient groups obtained lower FES scores (total and subscores) compared to controls. Correct classification into patient or control groups was reached in over 90% of study participants based on the FES total score. Only two patients with bvFTD obtained FES scores within 2 SDs of the control group. Receiver operating characteristic analyses on the patient groups showed that a cut-off FES total score of 7/15 achieved 71% sensitivity and 73% specificity for a diagnosis of bvFTD. In addition, the FES showed high correlations with traditional measures of executive function. CONCLUSIONS The FES is a brief (5-10 min) bedside screening measure which is simple to administer and score, and demonstrates good discriminative validity to differentiate bvFTD from AD. It is a useful addendum to general cognitive screening measures and can help with the differential diagnosis of dementia.
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Affiliation(s)
- F V C Leslie
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Science, University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - D Foxe
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - N Daveson
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - E Flannagan
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - J R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Science, University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - O Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Science, University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
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The Prevalence and Incidence of Frontotemporal Dementia: a Systematic Review. Can J Neurol Sci 2016; 43 Suppl 1:S96-S109. [DOI: 10.1017/cjn.2016.25] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractBackgroundPopulation-based prevalence and incidence studies are essential for understanding the burden of frontotemporal dementia (FTD).MethodsThe MEDLINE and EMBASE databases were searched to identify population-based publications from 1985 to 2012, addressing the incidence and/or prevalence of FTD. References of included articles and prior systematic reviews were searched for additional studies. Two reviewers screened all abstracts and full-text reviews, abstracted data and performed quality assessments.ResultsTwenty-six studies were included. Methodological limitations led to wide ranges in the estimates for prevalence (point prevalence 0.01-4.6 per 1000 persons; period prevalence 0.16-31.04 per 1000 persons) and incidence (0.0-0.3 per 1000 person-years). FTD accounted for an average of 2.7% (range 0-9.1%) of all dementia cases among prevalence studies that included subjects 65 and older compared to 10.2% (range 2.8-15.7%) in studies restricted to those aged less than 65. The cumulative numbers of male (373 [52.5%]) and female (338 [47.5%]) cases from studies reporting this information were nearly equal (p=0.18). The behavioural variant FTD (bvFTD) was almost four times as common as the primary progressive aphasias.ConclusionsPopulation-based estimates for the epidemiology of FTD varied widely in the included studies. Refinements in the diagnostic process, possibly by the use of validated biomarkers or limiting case ascertainment to specialty services, are needed to obtain more precise estimates of the prevalence and incidence of FTD.
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Behavioural and psychological symptoms of dementia in Down syndrome: Early indicators of clinical Alzheimer's disease? Cortex 2015; 73:36-61. [DOI: 10.1016/j.cortex.2015.07.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
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Krudop WA, Kerssens CJ, Dols A, Prins ND, Möller C, Schouws S, van der Flier WM, Scheltens P, Sikkes S, Stek ML, Pijnenburg YAL. Identifying bvFTD Within the Wide Spectrum of Late Onset Frontal Lobe Syndrome: A Clinical Approach. Am J Geriatr Psychiatry 2015; 23:1056-66. [PMID: 25921226 DOI: 10.1016/j.jagp.2015.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The behavioral variant of frontotemporal dementia (bvFTD) can be difficult to diagnose because of the extensive differential diagnosis, including many other diseases presenting with a frontal lobe syndrome. We aimed to identify the diagnostic spectrum causing a late onset frontal lobe syndrome and examine the quality of commonly used instruments to distinguish between bvFTD and non-bvFTD patients, within this syndrome. METHODS A total of 137 patients fulfilling the criteria of late onset frontal lobe syndrome, aged 45 to 75 years, were included in a prospective observational study. Diagnoses were made after clinical and neuropsychological examination, and neuroimaging and cerebral spinal fluid results were taken into account. Baseline characteristics and the scores on the Mini-Mental State Exam (MMSE), frontal assessment battery (FAB), Frontal Behavioral Inventory (FBI), and Stereotypy Rating Inventory (SRI) were compared between the bvFTD and the non-bvFTD group. RESULTS Fifty-five (40%) of the patients received a bvFTD diagnosis (33% probable and 7% possible bvFTD). Fifty-one patients (37%) had a psychiatric disorder, including 20 with major depressive disorder. Thirty-one patients received an alternative neurological, including neurodegenerative, diagnosis. MMSE and FAB scores were unspecific for a particular diagnosis. A score above 12 on the positive FBI subscale or a score above 5 on the SRI were indicative of a bvFTD diagnosis. CONCLUSION A broad spectrum of both neurological and psychiatric disorders underlies late onset frontal lobe syndrome, of which bvFTD was the most prevalent diagnosis in our cohort. The commonly used MMSE and the FAB could not successfully distinguish between bvFTD and non-bvFTD, but this could be achieved with the more specific FBI and SRI.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands.
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Niels D Prins
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Christiane Möller
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sietske Sikkes
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
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Paterson RW, Toombs J, Slattery CF, Nicholas JM, Andreasson U, Magdalinou NK, Blennow K, Warren JD, Mummery CJ, Rossor MN, Lunn MP, Crutch SJ, Fox NC, Zetterberg H, Schott JM. Dissecting IWG-2 typical and atypical Alzheimer's disease: insights from cerebrospinal fluid analysis. J Neurol 2015; 262:2722-30. [PMID: 26410752 DOI: 10.1007/s00415-015-7904-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
Abstract
Pathobiological factors underlying phenotypic diversity in Alzheimer's disease (AD) are incompletely understood. We used an extended cerebrospinal fluid (CSF) panel to explore differences between "typical" with "atypical" AD and between amnestic, posterior cortical atrophy, logopenic aphasia and frontal variants. We included 97 subjects fulfilling International Working Group-2 research criteria for AD of whom 61 had "typical" AD and 36 "atypical" syndromes, and 30 controls. CSF biomarkers included total tau (T-tau), phosphorylated tau (P-tau), amyloid β1-42, amyloid βX-38/40/42, YKL-40, neurofilament light (NFL), and amyloid precursor proteins α and β. The typical and atypical groups were matched for age, sex, severity and rate of cognitive decline and had similar biomarker profiles, with the exception of NFL which was higher in the atypical group (p = 0.03). Sub-classifying the atypical group into its constituent clinical syndromes, posterior cortical atrophy was associated with the lowest T-tau [604.4 (436.8-675.8) pg/mL], P-tau (79.8 ± 21.8 pg/L), T-tau/Aβ1-42 ratio [2.3 (1.4-2.6)], AβX-40/X-42 ratio (22.1 ± 5.8) and rate of cognitive decline [1.9 (0.75-4.25) MMSE points/year]. Conversely, the frontal variant group had the highest levels of T-tau [1185.4 (591.7-1329.3) pg/mL], P-tau (116.4 ± 45.4 pg/L), T-tau/Aβ1-42 ratio [5.2 (3.3-6.9)] and AβX-40/X-42 ratio (27.9 ± 7.5), and rate of cognitive decline. Whilst on a group level IWG-2 "typical" and "atypical" AD share similar CSF profiles, which are very different from controls, atypical AD is a heterogeneous entity with evidence for subtle differences in amyloid processing and neurodegeneration between different clinical syndromes. These findings also have practical implications for the interpretation of clinical CSF biomarker results.
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Affiliation(s)
- Ross W Paterson
- Dementia Research Centre, UCL Institute of Neurology, London, UK.
| | - Jamie Toombs
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | | | - Jennifer M Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Cath J Mummery
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Michael P Lunn
- Department of Clinical Neuroimmunology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.,Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, London, UK. .,Box 16 National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Hafkemeijer A, Möller C, Dopper EGP, Jiskoot LC, Schouten TM, van Swieten JC, van der Flier WM, Vrenken H, Pijnenburg YAL, Barkhof F, Scheltens P, van der Grond J, Rombouts SARB. Resting state functional connectivity differences between behavioral variant frontotemporal dementia and Alzheimer's disease. Front Hum Neurosci 2015; 9:474. [PMID: 26441584 PMCID: PMC4561903 DOI: 10.3389/fnhum.2015.00474] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/13/2015] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are the most common types of early-onset dementia. Early differentiation between both types of dementia may be challenging due to heterogeneity and overlap of symptoms. Here, we apply resting state functional magnetic resonance imaging (fMRI) to study functional brain connectivity differences between AD and bvFTD. METHODS We used resting state fMRI data of 31 AD patients, 25 bvFTD patients, and 29 controls from two centers specialized in dementia. We studied functional connectivity throughout the entire brain, applying two different analysis techniques, studying network-to-region and region-to-region connectivity. A general linear model approach was used to study group differences, while controlling for physiological noise, age, gender, study center, and regional gray matter volume. RESULTS Given gray matter differences, we observed decreased network-to-region connectivity in bvFTD between (a) lateral visual cortical network and lateral occipital and cuneal cortex, and (b) auditory system network and angular gyrus. In AD, we found decreased network-to-region connectivity between the dorsal visual stream network and lateral occipital and parietal opercular cortex. Region-to-region connectivity was decreased in bvFTD between superior temporal gyrus and cuneal, supracalcarine, intracalcarine cortex, and lingual gyrus. CONCLUSION We showed that the pathophysiology of functional brain connectivity is different between AD and bvFTD. Our findings support the hypothesis that resting state fMRI shows disease-specific functional connectivity differences and is useful to elucidate the pathophysiology of AD and bvFTD. However, the group differences in functional connectivity are less abundant than has been shown in previous studies.
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Affiliation(s)
- Anne Hafkemeijer
- Department of Methodology and Statistics, Institute of Psychology, Leiden UniversityLeiden, Netherlands
- Department of Radiology, Leiden University Medical CenterLeiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden UniversityLeiden, Netherlands
| | - Christiane Möller
- Alzheimer Center and Department of Neurology, VU University Medical CenterAmsterdam, Netherlands
| | - Elise G. P. Dopper
- Department of Radiology, Leiden University Medical CenterLeiden, Netherlands
- Alzheimer Center and Department of Neurology, VU University Medical CenterAmsterdam, Netherlands
- Alzheimer Center and Department of Neurology, Erasmus Medical CenterRotterdam, Netherlands
| | - Lize C. Jiskoot
- Department of Radiology, Leiden University Medical CenterLeiden, Netherlands
- Alzheimer Center and Department of Neurology, Erasmus Medical CenterRotterdam, Netherlands
- Department of Neuropsychology, Erasmus Medical CenterRotterdam, Netherlands
| | - Tijn M. Schouten
- Department of Methodology and Statistics, Institute of Psychology, Leiden UniversityLeiden, Netherlands
- Department of Radiology, Leiden University Medical CenterLeiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden UniversityLeiden, Netherlands
| | - John C. van Swieten
- Alzheimer Center and Department of Neurology, Erasmus Medical CenterRotterdam, Netherlands
- Department of Clinical Genetics, VU University Medical CenterAmsterdam, Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center and Department of Neurology, VU University Medical CenterAmsterdam, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical CenterAmsterdam, Netherlands
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, VU University Medical CenterAmsterdam, Netherlands
- Department of Physics and Medical Technology, VU University Medical CenterAmsterdam, Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center and Department of Neurology, VU University Medical CenterAmsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical CenterAmsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU University Medical CenterAmsterdam, Netherlands
| | | | - Serge A. R. B. Rombouts
- Department of Methodology and Statistics, Institute of Psychology, Leiden UniversityLeiden, Netherlands
- Department of Radiology, Leiden University Medical CenterLeiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden UniversityLeiden, Netherlands
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Bott NT, Radke A, Stephens ML, Kramer JH. Frontotemporal dementia: diagnosis, deficits and management. Neurodegener Dis Manag 2015; 4:439-54. [PMID: 25531687 DOI: 10.2217/nmt.14.34] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Frontotemporal dementia (FTD) is a progressive neurologic syndrome with diverse clinical presentations and attendant underlying pathologies. Psychiatric prodrome, neuropsychiatric symptoms and language difficulties are common in FTD, but the diversity of presentation raises unique diagnostic challenges that can significantly impact patient care and counsel for caregivers regarding clinical status and prognosis. While neuropsychiatric symptom measures are helpful, more sensitive assessments delineating the specific behavioral and linguistic deficits accompanying FTD are needed. Comprehensive clinical assessment in combination with evaluation of language, socio-emotional functioning, cognition and neuroimaging aid in accurate and early diagnosis and treatment planning. In what follows, we review each of the FTD syndromes, highlight current research investigating the cognitive, behavioral and socio-emotional deficits observed with this disease, address common diagnostic challenges and summarize best practices associated with management of FTD.
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Affiliation(s)
- Nicholas T Bott
- Department of Neurology, Memory & Aging Center, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158, USA
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Ossenkoppele R, Pijnenburg YAL, Perry DC, Cohn-Sheehy BI, Scheltens NME, Vogel JW, Kramer JH, van der Vlies AE, La Joie R, Rosen HJ, van der Flier WM, Grinberg LT, Rozemuller AJ, Huang EJ, van Berckel BNM, Miller BL, Barkhof F, Jagust WJ, Scheltens P, Seeley WW, Rabinovici GD. The behavioural/dysexecutive variant of Alzheimer's disease: clinical, neuroimaging and pathological features. Brain 2015; 138:2732-49. [PMID: 26141491 DOI: 10.1093/brain/awv191] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/05/2015] [Indexed: 12/12/2022] Open
Abstract
A 'frontal variant of Alzheimer's disease' has been described in patients with predominant behavioural or dysexecutive deficits caused by Alzheimer's disease pathology. The description of this rare Alzheimer's disease phenotype has been limited to case reports and small series, and many clinical, neuroimaging and neuropathological characteristics are not well understood. In this retrospective study, we included 55 patients with Alzheimer's disease with a behavioural-predominant presentation (behavioural Alzheimer's disease) and a neuropathological diagnosis of high-likelihood Alzheimer's disease (n = 17) and/or biomarker evidence of Alzheimer's disease pathology (n = 44). In addition, we included 29 patients with autopsy/biomarker-defined Alzheimer's disease with a dysexecutive-predominant syndrome (dysexecutive Alzheimer's disease). We performed structured chart reviews to ascertain clinical features. First symptoms were more often cognitive (behavioural Alzheimer's disease: 53%; dysexecutive Alzheimer's disease: 83%) than behavioural (behavioural Alzheimer's disease: 25%; dysexecutive Alzheimer's disease: 3%). Apathy was the most common behavioural feature, while hyperorality and perseverative/compulsive behaviours were less prevalent. Fifty-two per cent of patients with behavioural Alzheimer's disease met diagnostic criteria for possible behavioural-variant frontotemporal dementia. Overlap between behavioural and dysexecutive Alzheimer's disease was modest (9/75 patients). Sixty per cent of patients with behavioural Alzheimer's disease and 40% of those with the dysexecutive syndrome carried at least one APOE ε4 allele. We also compared neuropsychological test performance and brain atrophy (applying voxel-based morphometry) with matched autopsy/biomarker-defined typical (amnestic-predominant) Alzheimer's disease (typical Alzheimer's disease, n = 58), autopsy-confirmed/Alzheimer's disease biomarker-negative behavioural variant frontotemporal dementia (n = 59), and controls (n = 61). Patients with behavioural Alzheimer's disease showed worse memory scores than behavioural variant frontotemporal dementia and did not differ from typical Alzheimer's disease, while executive function composite scores were lower compared to behavioural variant frontotemporal dementia and typical Alzheimer's disease. Voxel-wise contrasts between behavioural and dysexecutive Alzheimer's disease patients and controls revealed marked atrophy in bilateral temporoparietal regions and only limited atrophy in the frontal cortex. In direct comparison with behavioural and those with dysexecutive Alzheimer's disease, patients with behavioural variant frontotemporal dementia showed more frontal atrophy and less posterior involvement, whereas patients with typical Alzheimer's disease were slightly more affected posteriorly and showed less frontal atrophy (P < 0.001 uncorrected). Among 24 autopsied behavioural Alzheimer's disease/dysexecutive Alzheimer's disease patients, only two had primary co-morbid FTD-spectrum pathology (progressive supranuclear palsy). In conclusion, behavioural Alzheimer's disease presentations are characterized by a milder and more restricted behavioural profile than in behavioural variant frontotemporal dementia, co-occurrence of memory dysfunction and high APOE ε4 prevalence. Dysexecutive Alzheimer's disease presented as a primarily cognitive phenotype with minimal behavioural abnormalities and intermediate APOE ε4 prevalence. Both behavioural Alzheimer's disease and dysexecutive Alzheimer's disease presentations are distinguished by temporoparietal-predominant atrophy. Based on the relative sparing of frontal grey matter, we propose to redefine these clinical syndromes as 'the behavioural/dysexecutive variant of Alzheimer's disease' rather than frontal variant Alzheimer's disease. Further work is needed to determine whether behavioural and dysexecutive-predominant presentations of Alzheimer's disease represent distinct phenotypes or a single continuum.
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Affiliation(s)
- Rik Ossenkoppele
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA 2 Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands 4 Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - David C Perry
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Brendan I Cohn-Sheehy
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Nienke M E Scheltens
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacob W Vogel
- 2 Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
| | - Joel H Kramer
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Annelies E van der Vlies
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Renaud La Joie
- 2 Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
| | - Howard J Rosen
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Wiesje M van der Flier
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands 5 Department of Epidemiology and Biostatistics VU University Medical Center, Amsterdam, The Netherlands
| | - Lea T Grinberg
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA 6 Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Annemieke J Rozemuller
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric J Huang
- 6 Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Bart N M van Berckel
- 4 Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Bruce L Miller
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Frederik Barkhof
- 4 Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - William J Jagust
- 2 Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
| | - Philip Scheltens
- 3 Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - William W Seeley
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA 6 Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Gil D Rabinovici
- 1 Memory and Aging Center, University of California San Francisco, San Francisco, USA 2 Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
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Inekci D, Jonesco DS, Kennard S, Karsdal MA, Henriksen K. The potential of pathological protein fragmentation in blood-based biomarker development for dementia - with emphasis on Alzheimer's disease. Front Neurol 2015; 6:90. [PMID: 26029153 PMCID: PMC4426721 DOI: 10.3389/fneur.2015.00090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/10/2015] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of dementia is challenging and early stages are rarely detected limiting the possibilities for early intervention. Another challenge is the overlap in the clinical features across the different dementia types leading to difficulties in the differential diagnosis. Identifying biomarkers that can detect the pre-dementia stage and allow differential diagnosis could provide an opportunity for timely and optimal intervention strategies. Also, such biomarkers could help in selection and inclusion of the right patients in clinical trials of both Alzheimer’s disease and other dementia treatment candidates. The cerebrospinal fluid (CSF) has been the most investigated source of biomarkers and several candidate proteins have been identified. However, looking solely at protein levels is too simplistic to provide enough detailed information to differentiate between dementias, as there is a significant crossover between the proteins involved in the different types of dementia. Additionally, CSF sampling makes these biomarkers challenging for presymptomatic identification. We need to focus on disease-specific protein fragmentation to find a fragment pattern unique for each separate dementia type – a form of protein fragmentology. Targeting protein fragments generated by disease-specific combinations of proteins and proteases opposed to detecting the intact protein could reduce the overlap between diagnostic groups as the extent of processing as well as which proteins and proteases constitute the major hallmark of each dementia type differ. In addition, the fragments could be detectable in blood as they may be able to cross the blood–brain barrier due to their smaller size. In this review, the potential of the fragment-based biomarker discovery for dementia diagnosis and prognosis is discussed, especially highlighting how the knowledge from CSF protein biomarkers can be used to guide blood-based biomarker development.
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Affiliation(s)
- Dilek Inekci
- Nordic Bioscience, Biomarkers and Research , Herlev , Denmark ; Systems Biology, Technical University of Denmark , Lyngby , Denmark
| | | | - Sophie Kennard
- Nordic Bioscience, Biomarkers and Research , Herlev , Denmark
| | | | - Kim Henriksen
- Nordic Bioscience, Biomarkers and Research , Herlev , Denmark
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Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, DeKosky ST, Gauthier S, Selkoe D, Bateman R, Cappa S, Crutch S, Engelborghs S, Frisoni GB, Fox NC, Galasko D, Habert MO, Jicha GA, Nordberg A, Pasquier F, Rabinovici G, Robert P, Rowe C, Salloway S, Sarazin M, Epelbaum S, de Souza LC, Vellas B, Visser PJ, Schneider L, Stern Y, Scheltens P, Cummings JL. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol 2014; 13:614-29. [PMID: 24849862 DOI: 10.1016/s1474-4422(14)70090-0] [Citation(s) in RCA: 2227] [Impact Index Per Article: 222.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD.
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Affiliation(s)
- Bruno Dubois
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France.
| | - Howard H Feldman
- Division of Neurology, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada
| | - Claudia Jacova
- UBC Division of Neurology, S152 UBC Hospital, BC, Canada
| | - Harald Hampel
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, IDIBAPS Hospital Clinici Universitari, Barcelona, Spain; BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Steven T DeKosky
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Serge Gauthier
- McGill Center for Studies in Aging, Douglas Hospital, Montreal, Quebec, QC, Canada
| | - Dennis Selkoe
- Harvard Medical School Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Randall Bateman
- Washington University School of Medicine, St Louis, Missouri, MO, USA
| | - Stefano Cappa
- Vita-Salute San Raffaele University, Milan, Italy; Department of Clinical Neurosciences, Cognitive Neurorehabilitation, Milan, Italy
| | - Sebastian Crutch
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London, London, UK; Dementia Research Centre, National Hospital, London, UK
| | - Sebastiaan Engelborghs
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA), Middelheim and Hoge Beuken, Antwerp, Belgium; Reference Centre for Biological Markers of Dementia, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Giovanni B Frisoni
- Hopitaux Universitaires et Université de Genève, Geneva, Switzerland; IRCCS Fatebenefratelli, Brescia, Italy; HUG Belle-Idée, bâtiment les Voirons, Chêne-Bourg, France
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London, London, UK
| | - Douglas Galasko
- Department of Neurosciences, -University of California, San Diego, CA, USA
| | - Marie-Odile Habert
- INSERM UMR, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - Gregory A Jicha
- University of Kentucky Alzheimer's Disease Center, Lexington, KY, USA
| | - Agneta Nordberg
- Karolinska Institutet, Karolinska University Hospital Huddinge, Alzheimer Neurobiology Center, Stockholm, Sweden
| | - Florence Pasquier
- Université Lille Nord de France, Lille, France; CHRU, Clinique Neurologique, Hôpital Roger Salengro, Lille, France
| | - Gil Rabinovici
- UCSF Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Philippe Robert
- EA CoBTeK and Memory Center, CHU University of Nice, UNSA, Hôpital de Cimiez 4 av Victoria, Nice, France
| | - Christopher Rowe
- FRACP, Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Melbourne, VIC, Australia
| | - Stephen Salloway
- Neurology and the Memory and Aging Program, Butler Hospital, Department of Neurology and Psychiatry, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Centre Hospitalier Sainte-Anne, Paris Cedex, France; Université Paris 5, Paris, France
| | - Stéphane Epelbaum
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - Leonardo C de Souza
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France; Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Vellas
- Gerontopole, Pavillon Junod, University Toulouse 3, Toulouse, France
| | - Pieter J Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Neurology and Alzheimer Center, Amsterdam, Netherlands
| | - Lon Schneider
- Department of Psychiatry, Neurology, and Gerontology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute, Presbyterian Hospital, New York, NY, USA
| | - Philip Scheltens
- Alzheimer Centrum Vrije Universiteit Medical Center, VU University, Amsterdam, Netherlands
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Abstract
Alzheimer's disease (AD) is thought to progress in a fairly stereotyped manner, with episodic memory loss being the first and most salient domain of impairment, reflecting the early disease in structures supporting this function. However, there is considerable heterogeneity in the relative involvement of different cognitive domains, and at the extreme are three syndromes associated with AD: (1) logopenic progressive aphasia, (2) posterior cortical atrophy, and (3) frontal variant of AD. As each of these syndromes is variably associated with non-AD dementia and clinically overlaps with other presentations more commonly associated with different causes of neurodegeneration (e.g., progressive nonfluent aphasia), the use of amyloid imaging for detection of the molecular pathologic features of AD is of significant clinical value. This article reviews several amyloid imaging studies of these populations which support autopsy case series and reveal a dissociation between the spatial distribution of amyloid plaques and clinical phenotype.
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Fukuda K, Hattori H. Unclassified cases of behavioral variant of major frontotemporal neurocognitive disorder in theDiagnostic and Statistical Manual of Mental Disorders, 5th edition. Geriatr Gerontol Int 2014; 14 Suppl 2:35-44. [DOI: 10.1111/ggi.12249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Koji Fukuda
- Department of Psychiatry; National Center for Geriatrics and Gerontology; Obu Japan
| | - Hideyuki Hattori
- Department of Psychiatry; National Center for Geriatrics and Gerontology; Obu Japan
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Abstract
Frontotemporal dementias are neurodegenerative diseases in which symptoms of frontal and/or temporal lobe disease are the first signs of the illness, and as the diseases progress, they resemble a focal left hemisphere process such as stroke or traumatic brain injury, even more than a neurodegenerative disease. Over time, some patients develop a more generalized dementia. Four clinical subtypes characterize the predominant presentations of this illness: behavioral or frontal variant FTD, progressive nonfluent aphasia, semantic dementia, and logopenic primary progressive aphasia. These clinical variants correlate with regional patterns of atrophy on brain imaging studies such as MRI and PET scanning, as well as with biochemical and molecular genetic variants of the disorder. The treatment is as yet only symptomatic, but advances in molecular genetics promise new therapies.
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Affiliation(s)
- Howard S Kirshner
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Léger GC, Banks SJ. Neuropsychiatric symptom profile differs based on pathology in patients with clinically diagnosed behavioral variant frontotemporal dementia. Dement Geriatr Cogn Disord 2014; 37:104-12. [PMID: 24135712 PMCID: PMC4041327 DOI: 10.1159/000354368] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) is pathologically heterogeneous. With emerging therapeutics, determining underlying pathology during life is increasingly important. Neuropsychiatric symptoms are prevalent and diagnostic in bvFTD. METHODS We assessed the neuropsychiatric profile of patients with clinically diagnosed bvFTD as a function of pathology at autopsy. Patients with a clinical diagnosis of bvFTD at the initial visit were selected from the National Alzheimer's Coordinating Center (NACC) database. Neuropsychiatric symptoms endorsed on the Neuropsychiatric Inventory Questionnaire (NPI-Q) were analyzed. RESULTS Of 149 patients with clinically diagnosed bvFTD, pathology was primarily Alzheimer's disease (AD) in 20.5%. These patients differed from those with underlying frontotemporal lobar degeneration: patients with AD pathology (plaques and tangles) were more likely to have hallucinations, delusions, or agitation. Patients were further differentiated into tau-positive (30% of cases, including Pick's disease, FTD and parkinsonism with tau-positive or argyrophilic inclusions, and other tauopathies) or tau-negative cases (70% of cases, including bvFTD tau-negative ubiquitin-positive inclusions). These patients also differed in some of the neuropsychiatric symptoms seen. Tau-negative cases were more likely to demonstrate depression, delusions, and changes in appetite and eating. CONCLUSIONS These preliminary findings contribute to our increasing ability to predict, using simple clinical tools, the neuropathological underpinnings of bvFTD during life.
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Affiliation(s)
- Gabriel C Léger
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
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Riudavets MA, Bartoloni L, Troncoso JC, Pletnikova O, St. George‐Hyslop P, Schultz M, Sevlever G, Allegri RF. Familial dementia with frontotemporal features associated with M146V presenilin-1 mutation. Brain Pathol 2013; 23:595-600. [PMID: 23489366 PMCID: PMC4007155 DOI: 10.1111/bpa.12051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/02/2013] [Indexed: 12/28/2022] Open
Abstract
Most of the mutations in the presenilin-1 gene (PS-1) are associated with familial Alzheimer's disease (AD). However, certain examples can be associated with frontotemporal dementia (FTD). We performed a clinical evaluation of individuals belonging to a family with the FTD phenotype, and additional molecular studies and neuropathological assessment of the proband. The PS-1 M146V mutation was found in the 50-year-old subject (the proband) with family history of early-onset FTD. Neuropathological examination showed abundant amyloid plaques, widespread neurofibrillary pathology, Pick bodies in the hippocampus and cortex, cortical globose tangles and ubiquitin-positive nuclear inclusions in white matter oligodendrocytes. We report a kindred with clinical features of FTD, whose proband bore the PS-1 M146V mutation and showed diffuse Alzheimer's type pathology and Pick bodies on post-mortem neuropathological examination. As with other mutations within the same codon, this substitution may predispose to both diseases by affecting APP and/or tau processing.
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Affiliation(s)
| | - Leonardo Bartoloni
- Department of Internal MedicineHospital ZubizarretaBuenos AiresArgentina
| | - Juan C. Troncoso
- Neuropathology DivisionPathology DepartmentJohns Hopkins University School of MedicineBaltimoreMD
| | - Olga Pletnikova
- Neuropathology DivisionPathology DepartmentJohns Hopkins University School of MedicineBaltimoreMD
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Beattie E, Fielding E, O’’Reilly M, Graham F, Neville C. Conference Scene: Current dementia research in Australia: a report from the Alzheimer’s Australia 15th National Conference. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Alzheimer’s Australia 15th National Conference held on 14–17 May 2013 in Hobart (Tasmania, Australia) attracted a wide range of attendees, including people living with dementia, family caregivers, health professionals and researchers. The conference theme, The Tiles of Life Coloring the Future, invoking a vision of a better future for those affected by dementia, had seven subthemes: liberation, rehabilitation, leisure, service, creativity, wellbeing and research.
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Affiliation(s)
- Elizabeth Beattie
- Dementia Collaborative Research Centre, School of Nursing, Queensland University of Technology, Queensland, Australia
| | - Elaine Fielding
- Dementia Collaborative Research Centre, School of Nursing, Queensland University of Technology, Queensland, Australia
| | - Maria O’’Reilly
- Dementia Collaborative Research Centre, School of Nursing, Queensland University of Technology, Queensland, Australia
| | - Fred Graham
- Dementia Collaborative Research Centre, School of Nursing, Queensland University of Technology, Queensland, Australia
| | - Christine Neville
- School of Nursing & Midwifery, University of Queensland, Queensland, Australia
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Abstract
BACKGROUND During the course of Alzheimer's disease (AD), cognitive processes, including language and communication, become increasingly impaired. The aim of this review was to highlight the impact of communication deficits in AD, and discuss the need for effective treatments. METHOD PubMed was searched for studies relating to language and communication in AD. The publications identified were used as a basis for the commentary in this paper. Studies relating to the clinical effectiveness of pharmacological treatment for language and communication issues were identified systematically. RESULTS Communication deficits are common in AD. From the earliest disease stage, the patient's capacity for communication declines as problems develop with the use of language and all aspects of functional communication. There is a loss of the ability to communicate thoughts and needs, and it becomes increasingly difficult to interact socially and sustain personal relationships with caregivers, family, and friends. It is unsurprising that patients become frustrated at their loss of self-expression, and studies have demonstrated that impaired communication is strongly linked with the development of significant behavioral concerns. Overall, poor communication contributes to caregiver strain, and adds notably to the burden of disease. Clinical data and post-hoc analyses provide preliminary indications that anti-AD therapies (memantine and the cholinesterase inhibitors, ChEIs) and non-pharmacological cognitive-linguistic stimulation techniques may be helpful in addressing communication difficulties. CONCLUSIONS The capacity to treat or slow the progression of communication deficits in AD would prolong patient independence, and have a profound impact on the quality of life of patients and caregivers. The use of pharmacological (anti-AD therapies) and non-pharmacological (cognitive-linguistic stimulation) treatments may be useful management methods and warrant further investigation.
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Abstract
BACKGROUND Mibampator, an amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor potentiator, was evaluated for treatment of agitation and aggression (A/A) in Alzheimer's disease (AD). METHODS Outpatients (n = 132) with probable AD and A/A randomized to 12 weeks of double-blind treatment with 3-mg po mibampator or placebo were assessed using the 4-domain A/A subscale of the Neuropsychiatric Inventory (NPI-4-A/A) derived from the Neuropsychiatric Inventory. Secondary measures included the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Frontal Systems Behavior Inventory (FrSBe), and Alzheimer's Disease Assessment Scale-Cognitive. Efficacy was analyzed using mixed-effects model repeated measures from baseline to endpoint. Adverse events (AEs), labs, vital signs, and electrocardiograms were monitored. RESULTS Baseline characteristics were comparable between groups. Both groups improved on the NPI-4-A/A, but without group differences. Among secondaries, mibampator was significantly better (p = 0.007) than placebo only on the FrSBe. AEs were similar between groups. One death occurred in the placebo group. CONCLUSION Possible explanations for no significant group differences include caregiver, drug target engagement, and design issues. This trial is registered on ClinicalTrials.gov; ID: NCT00843518.
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Harciarek M, Cosentino S. Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. Int Rev Psychiatry 2013; 25:178-96. [PMID: 23611348 PMCID: PMC4481322 DOI: 10.3109/09540261.2013.763340] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer's disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.
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Affiliation(s)
- Michał Harciarek
- Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Poland.
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Abstract
BACKGROUND The correlation of clinical presentation to pathology in dementia syndromes is important to correctly classify and ultimately treat these conditions. However, despite careful clinical characterization, it remains difficult to accurately predict an underlying causative pathology in some cases. Alzheimer disease is a well-defined clinical entity having established diagnostic criteria and characteristic neuropathologic findings. Alzheimer pathology, however, can cause varying clinical syndromes, including both atypical motor and behavioral presentations. REVIEW SUMMARY Atypical clinical presentations of Alzheimer disease are reviewed in a case-based format. Corticobasal syndrome, with asymmetric Parkinsonism, dystonia, and apraxia, is increasingly recognized as a presentation of Alzheimer pathology. Frontal variant Alzheimer, clinically indistinguishable from behavioral variant frontotemporal dementia (bv-FTD), can present with difficulties in executive function, poor attention, and behavioral issues. Posterior cortical atrophy (the "visual variant" of Alzheimer) has predominant visuospatial dysfunction and can be an Alzheimer presentation. Finally, Alzheimer can present as logopenic progressive aphasia with word-finding difficulty. CONCLUSIONS Clinicopathologic correlation may be more complex than previously realized, and the location of the microscopic changes may have as much to do with the clinical presentation as the nature of the changes themselves. Recognizing these clinical syndromes can lead to greater accuracy in diagnosis and treatment.
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Martyr A, Clare L. Executive function and activities of daily living in Alzheimer's disease: a correlational meta-analysis. Dement Geriatr Cogn Disord 2012; 33:189-203. [PMID: 22572810 DOI: 10.1159/000338233] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer's disease. METHODS Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. RESULTS Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer's disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. CONCLUSION The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia.
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Affiliation(s)
- Anthony Martyr
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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Abstract
Variant syndromes of Alzheimer disease (AD), led by deficits that extend beyond memory dysfunction, are of considerable clinical and neurobiological importance. Such syndromes present major challenges for both diagnosis and monitoring of disease, and serve to illustrate the apparent paradox of a clinically diverse group of disorders underpinned by a common histopathological substrate. This Review focuses on the most common variant AD phenotypes: posterior cortical atrophy, logopenic variant primary progressive aphasia and frontal variant AD. The neuroanatomical, molecular and pathological correlates of these phenotypes are highlighted, and the heterogeneous clinical presentations of the syndromes are discussed in the context of the emerging network paradigm of neurodegenerative disease. We argue that these apparently diverse clinical phenotypes reflect the differential involvement of a common core temporoparietofrontal network that is vulnerable to AD. According to this interpretation, the network signatures corresponding to AD variant syndromes are produced by genetic and other modulating factors that have yet to be fully characterized. The clinical and neurobiological implications of this network paradigm in the quest for disease-modifying treatments are also explored.
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Abstract
BACKGROUND The frontal assessment battery (FAB) is reported to be a useful tool for assessing frontal dysfunction. However, the neural substrates involved in patients with Alzheimer's disease (AD) remain to be elucidated. The aim of the present study was to identify the regional perfusion patterns of the brain associated with performance scores on the FAB of patients with AD using brain perfusion assessed by single photon emission computed tomography (SPECT). METHODS Twenty-four AD patients with high scores and 24 age- and sex-matched AD patients with low scores on the FAB were selected from 470 consecutive Japanese patients of the Memory Clinic of Okayama University Hospital. All 48 participants underwent brain SPECT with 99mTc-ethylcysteinate dimer, and the SPECT images were analyzed by statistical parametric mapping. RESULTS No significant differences were found between high and low FAB scoring groups with respect to Addenbrooke's Cognitive Examination scores, Mini-Mental State Examination scores, or the depression score of the Neuropsychiatric Inventory subscale. Compared with patients with high scores on the FAB, AD patients with low scores showed significant hypoperfusion in the left middle frontal gyrus (MFG) and the right superior frontal gyrus (SFG) extending to the left SFG. CONCLUSION Our results suggest that functional activity of the SFG and MFG is closely related to the FAB score. The FAB might be a promising strategy to detect early stages of AD with low SFG and MFG function.
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Comparing the Neuropsychiatric Profile of Patients with Alzheimer Disease Who Present Spared versus Impaired Executive Functioning. Curr Gerontol Geriatr Res 2011; 2011:514059. [PMID: 22110501 PMCID: PMC3205715 DOI: 10.1155/2011/514059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 12/12/2022] Open
Abstract
Background. A “dysexecutive” group of patients with Alzheimer disease (AD) has been previously identified, and these patients have been found to present higher frequency of psychiatric symptoms and more pronounced functional impact. This study aimed at evaluating the frequency of neuropsychiatric symptoms in patients with early AD who present with impaired executive functioning.
Methods. Thirty patients with early AD diagnosis were divided into a spared (SEF) and an impaired (IEF) executive functioning group according to their performance scores on neuropsychological tests. Their closest relatives or caregivers completed the Cambridge behavioral inventory (CBI), which assesses behavioral symptoms grouped into 13 categories. Results. A significant difference was exclusively found between SEF and IEF in terms of the frequency of stereotypies and repetitive motor behavior (U = 60.5, P = .024).
Conclusions. The presence of stereotypies could be associated with a dysexecutive profile in AD patients. These results shed light on the role of frontal circuitry in the expression of motor symptoms in AD and prompt for further research that will contribute to the differential diagnosis both of different subtypes of AD and other types of dementia.
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Patients in Australian Memory Clinics: baseline characteristics and predictors of decline at six months. Int Psychogeriatr 2011; 23:1086-96. [PMID: 21489344 DOI: 10.1017/s1041610211000688] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Prospective Research In MEmory clinics (PRIME) is a three-year non-prescriptive, observational study identifying and measuring relationships among predictor and outcome variables. METHODS Patients from nine memory clinics, diagnosed with dementia or mild cognitive impairment (MCI), living in the community with <40 hours/week nursing care were divided into diagnostic groups defined at baseline as Alzheimer's disease (AD) early or late onset, frontotemporal dementia (FTD), vascular dementia (VaD), mixed (AD and VaD) and other dementia. To achieve outcome measures, baseline and change over six months in all measures by diagnostic group, and predictors of change at six months were examined. RESULTS Of the 970 patients enrolled, 967 were eligible for analysis. The most common disorder was AD (late onset) accounting for 46.5% of this population. Patients had an overall slight worsening on all assessment scales over the six-month period. Patients with FTD had a more marked change (decline) in cognition, function and behavior over six months compared to other diagnostic groups. However, in the regression analysis the difference was not significant between groups. Predictors of decline in Mini-Mental State Examination (MMSE) scores were not robust at six months, and longer follow-up is required. Patients with FTD were more likely to be prescribed psychotropics. CONCLUSION The PRIME study is continuing and will provide important data on predictors of decline along with differences between diagnosis groups on the rate of change.
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