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Tahedl M, Tan EL, Kleinerova J, Delaney S, Hengeveld JC, Doherty MA, Mclaughlin RL, Pradat PF, Raoul C, Ango F, Hardiman O, Chang KM, Lope J, Bede P. Progressive Cerebrocerebellar Uncoupling in Sporadic and Genetic Forms of Amyotrophic Lateral Sclerosis. Neurology 2024; 103:e209623. [PMID: 38900989 DOI: 10.1212/wnl.0000000000209623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is predominantly associated with motor cortex, corticospinal tract (CST), brainstem, and spinal cord degeneration, and cerebellar involvement is much less well characterized. However, some of the cardinal clinical features of ALS, such as dysarthria, dysphagia, gait impairment, falls, and impaired dexterity, are believed to be exacerbated by coexisting cerebellar pathology. Cerebellar pathology may also contribute to cognitive, behavioral, and pseudobulbar manifestations. Our objective was to systematically assess both intracerebellar pathology and cerebrocerebellar connectivity alterations in a genetically stratified cohort of ALS. METHODS A prospective, multimodal neuroimaging study was conducted to evaluate the longitudinal evolution of intracerebellar pathology and cerebrocerebellar connectivity, using structural and functional measures. RESULTS A total of 113 healthy controls and 212 genetically stratified individuals with ALS were included: (1) C9orf72 hexanucleotide carriers ("C9POS"), (2) sporadic patients who tested negative for ALS-associated genetic variants, and (3) intermediate-length CAG trinucleotide carriers in ATXN2 ("ATXN2"). Flocculonodular lobule (padj = 0.014, 95% CI -5.06e-5 to -3.98e-6) and crura (padj = 0.031, 95% CI -1.63e-3 to -5.55e-5) volume reductions were detected at baseline in sporadic patients. Cerebellofrontal and cerebelloparietal structural connectivity impairment was observed in both C9POS and sporadic patients at baseline, and both projections deteriorated further over time in sporadic patients (padj = 0.003, t(249) = 3.04 and padj = 0.05, t(249) = 1.93). Functional cerebelloparietal uncoupling was evident in sporadic patients at baseline (padj = 0.004, 95% CI -0.19 to -0.03). ATXN2 patients exhibited decreased cerebello-occipital functional connectivity at baseline (padj = 0.004, 95% CI -0.63 to -0.06), progressive cerebellotemporal functional disconnection (padj = 0.025, t(199) = -2.26), and progressive flocculonodular lobule degeneration (padj = 0.017, t(249) = -2.24). C9POS patients showed progressive ventral dentate atrophy (padj = 0.007, t(249) = -2.75). The CSTs (padj < 0.001, 95% CI 4.89e-5 to 1.14e-4) and transcallosal interhemispheric fibers (padj < 0.001, 95% CI 5.21e-5 to 1.31e-4) were affected at baseline in C9POS and exhibited rapid degeneration over the 4 time points. The rate of decline in CST and corpus callosum integrity was faster than the rate of cerebrocerebellar disconnection (padj = 0.001, t(190) = 6.93). DISCUSSION ALS is associated with accruing intracerebellar disease burden as well as progressive corticocerebellar uncoupling. Contrary to previous suggestions, we have not detected evidence of compensatory structural or functional changes in response to supratentorial degeneration. The contribution of cerebellar disease burden to dysarthria, dysphagia, gait impairment, pseudobulbar affect, and cognitive deficits should be carefully considered in clinical assessments, monitoring, and multidisciplinary interventions.
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Affiliation(s)
- Marlene Tahedl
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Ee Ling Tan
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jana Kleinerova
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Siobhan Delaney
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jennifer C Hengeveld
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Mark A Doherty
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Russell L Mclaughlin
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Pierre-Francois Pradat
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Cédric Raoul
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Fabrice Ango
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Orla Hardiman
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Kai Ming Chang
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jasmin Lope
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Peter Bede
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
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Riva N, Domi T, Pozzi L, Lunetta C, Schito P, Spinelli EG, Cabras S, Matteoni E, Consonni M, Bella ED, Agosta F, Filippi M, Calvo A, Quattrini A. Update on recent advances in amyotrophic lateral sclerosis. J Neurol 2024:10.1007/s00415-024-12435-9. [PMID: 38802624 DOI: 10.1007/s00415-024-12435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
In the last few years, our understanding of disease molecular mechanisms underpinning ALS has advanced greatly, allowing the first steps in translating into clinical practice novel research findings, including gene therapy approaches. Similarly, the recent advent of assistive technologies has greatly improved the possibility of a more personalized approach to supportive and symptomatic care, in the context of an increasingly complex multidisciplinary line of actions, which remains the cornerstone of ALS management. Against this rapidly growing background, here we provide an comprehensive update on the most recent studies that have contributed towards our understanding of ALS pathogenesis, the latest results from clinical trials as well as the future directions for improving the clinical management of ALS patients.
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Affiliation(s)
- Nilo Riva
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy.
| | - Teuta Domi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, 20138, Milan, Italy
| | - Paride Schito
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Gioele Spinelli
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Cabras
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Matteoni
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Consonni
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Eleonora Dalla Bella
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Federica Agosta
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Andrea Calvo
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Katerelos A, Alexopoulos P, Economou P, Polychronopoulos P, Chroni E. Cognitive function in amyotrophic lateral sclerosis: a cross-sectional and prospective pragmatic clinical study with review of the literature. Neurol Sci 2024; 45:2075-2085. [PMID: 38105306 PMCID: PMC11021277 DOI: 10.1007/s10072-023-07262-1] [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: 11/19/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) can present with either bulbar or spinal symptoms, and in some cases, both types of symptoms may be present. In addition, cognitive impairment has been observed in ALS. The study aimed to evaluate the frontal and general cognitive performance in ALS not only cross-sectionally but also longitudinally. METHODS AND MATERIALS The Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) were employed to assess cognitive function in 52 adults with ALS and 52 cognitively healthy individuals. The statistical analyses encompassed the Pearson Chi square test, the Skillings-Mack test, the Spearman's rank correlation coefficient, and the Proportional Odds Logistic Regression Model (POLR). RESULTS Cross-sectionally, lower cognitive performance was associated with ALS diagnosis, older age, and motor functional decline. The cognitive impairment of individuals with bulbar and spinal-bulbar symptoms showed faster deterioration compared to those with spinal symptoms. The spinal subgroup consistently performed worst in delayed recall and attention, while the spinal-bulbar and bulbar subgroups exhibited inferior scores in delayed recall, attention, visuospatial skills, orientation, and verbal fluency. CONCLUSION The incorporation of cognitive screening in the diagnostic workup of ALS may be beneficial, as early detection can enhance symptom management and improve the quality of life for both individuals with ALS and their care partners.
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Affiliation(s)
- Adamantios Katerelos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece.
- Department of Neurology, Patras University General Hospital, Rio, Greece.
| | - Panagiotis Alexopoulos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Mental Health Services, Patras University General Hospital, Rio, Greece
- Medical School, Trinity College Dublin, Global Brain Health Institute, The University of Dublin, Dublin, Republic of Ireland
- Faculty of Medicine, Klinikum Rechts Der Isar, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
- Patras Dementia Day Care Centre, Patras, Greece
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
| | - Panagiotis Polychronopoulos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Neurology, Patras University General Hospital, Rio, Greece
| | - Elisabeth Chroni
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Neurology, Patras University General Hospital, Rio, Greece
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Pota V, Sansone P, De Sarno S, Aurilio C, Coppolino F, Barbarisi M, Barbato F, Fiore M, Cosenza G, Passavanti MB, Pace MC. Amyotrophic Lateral Sclerosis and Pain: A Narrative Review from Pain Assessment to Therapy. Behav Neurol 2024; 2024:1228194. [PMID: 38524401 PMCID: PMC10960655 DOI: 10.1155/2024/1228194] [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: 04/28/2023] [Revised: 02/11/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive muscle weakness, spasticity, atrophy, and respiratory failure, with a life expectancy of 2-5 years after symptom onset. In addition to motor symptoms, patients with ALS have a multitude of nonmotor symptoms; in fact, it is currently considered a multisystem disease. The purpose of our narrative review is to evaluate the different types of pain, the correlation between pain and the disease's stages, the pain assessment tools in ALS patients, and the available therapies focusing above all on the benefits of cannabis use. Pain is an underestimated and undertreated symptom that, in the last few years, has received more attention from research because it has a strong impact on the quality of life of these patients. The prevalence of pain is between 15% and 85% of ALS patients, and the studies on the type and intensity of pain are controversial. The absence of pain assessment tools validated in the ALS population and the dissimilar study designs influence the knowledge of ALS pain and consequently the pharmacological therapy. Several studies suggest that ALS is associated with changes in the endocannabinoid system, and the use of cannabis could slow the disease progression due to its neuroprotective action and act on pain, spasticity, cramps, sialorrhea, and depression. Our research has shown high patients' satisfaction with the use of cannabis for the treatment of spasticity and related pain. However, especially due to the ethical problems and the lack of interest of pharmaceutical companies, further studies are needed to ensure the most appropriate care for ALS patients.
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Affiliation(s)
- Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Sara De Sarno
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Caterina Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Francesco Coppolino
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Manlio Barbarisi
- Multidisciplinary Department of Medical, Surgical and Dental Specialties, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Marco Fiore
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianluigi Cosenza
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
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Jia H, Li Z, Guo F, Hua Z, Zhou X, Li X, Li R, Liu Q, Liu Y, Dong H. Cortical structure and the risk of amyotrophic lateral sclerosis: A bidirectional Mendelian randomization study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110872. [PMID: 37827425 DOI: 10.1016/j.pnpbp.2023.110872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Current observational studies indicate progressive brain atrophy is closely associated with the clinical feature of amyotrophic lateral sclerosis. However, it is unclear whether the changes in cortical structure are the cause or result of ALS. Our study aimed to investigate the causal relationship between cortical structure and ALS risk using a bidirectional two-sample MR study. METHODS We collected publicly available genome-wide association studies' summary statistics for cortical structure from UK Biobank and ENIGMA consortium (n = 33,992) and ALS from the Project MinE (n = 138,086). We used the inverse variance weighted method (IVW) as primary analysis in order to evaluate the causal effects. In addition, the weighted median and MR Egger methods were performed to ensure the robustness and reliability of the IVW results. RESULTS We found the decreased surface of the paracentral lobule and thickness of the frontal pole and middle temporal lobe were suggestively associated with an increased risk of ALS as well as the increased surface of medial orbitofrontal and middle temporal lobe. In another aspect, the causalities between the susceptibility to ALS and the volume of the transverse temporal gyrus and superior temporal gyrus were negative. Besides, the susceptibility to ALS might also contribute to an increased thickness of the postcentral gyrus and superior parietal gyrus. CONCLUSION In this two-sample MR analysis, we observed that multiple cortical brain regions are associated with a higher ALS risk. Further research into the underlying mechanisms is required to back up our findings.
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Affiliation(s)
- Hongning Jia
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China; Department of Neurology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Zhiguang Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Xingtai Third Hospital, Xingtai, China
| | - Fei Guo
- Department of Basic Medicine, Xingtai Medical College, Xingtai, China
| | - Zixin Hua
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaomeng Zhou
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China
| | - Xin Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China
| | - Rui Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China
| | - Qi Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China
| | - Yaling Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China.
| | - Hui Dong
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; The Key Laboratory of Clinical Neurology, Ministry of Education, Shijiazhuang, Hebei, China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, China.
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Ai Y, Li F, Hou Y, Li X, Li W, Qin K, Suo X, Lei D, Shang H, Gong Q. Differential cortical gray matter changes in early- and late-onset patients with amyotrophic lateral sclerosis. Cereb Cortex 2024; 34:bhad426. [PMID: 38061694 DOI: 10.1093/cercor/bhad426] [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: 06/25/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 01/19/2024] Open
Abstract
Age at onset may be an important feature associated with distinct subtypes of amyotrophic lateral sclerosis (ALS). Little is known about the neuropathological mechanism of early-onset ALS (EO-ALS) and late-onset ALS (LO-ALS). Ninety ALS patients were divided into EO-ALS and LO-ALS group, and 128 healthy controls were matched into young controls(YCs) and old controls (OCs). A voxel-based morphometry approach was employed to investigate differences in gray matter volume (GMV). Significant age at onset-by-diagnosis interactions were found in the left parietal operculum, left precentral gyrus, bilateral postcentral gyrus, right occipital gyrus, and right orbitofrontal cortex. Post hoc analysis revealed a significant decrease in GMV in all affected regions of EO-ALS patients compared with YCs, with increased GMV in 5 of the 6 brain regions, except for the right orbitofrontal cortex, in LO-ALS patients compared with OCs. LO-ALS patients had a significantly increased GMV than EO-ALS patients after removing the aging effect. Correspondingly, GMV of the left postcentral gyrus correlated with disease severity in the 2 ALS groups. Our findings suggested that the pathological mechanisms in ALS patients with different ages at onset might differ. These findings provide unique insight into the clinical and biological heterogeneity of the 2 ALS subtypes.
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Affiliation(s)
- Yuan Ai
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Fei Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Xiuli Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Wenbin Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Kun Qin
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Xueling Suo
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Du Lei
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, 699 Jinyuan Xi Road, Jimei District, Xiamen, Fujian 361021, China
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Abrahams S. Neuropsychological impairment in amyotrophic lateral sclerosis-frontotemporal spectrum disorder. Nat Rev Neurol 2023; 19:655-667. [PMID: 37828358 DOI: 10.1038/s41582-023-00878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a rapid course, characterized by motor neuron dysfunction, leading to progressive disability and death. This Review, which is aimed at neurologists, psychologists and other health professionals who follow evidence-based practice relating to ALS and frontotemporal dementia (FTD), examines the neuropsychological evidence that has driven the reconceptualization of ALS as a spectrum disorder ranging from a pure motor phenotype to ALS-FTD. It focuses on changes in cognition and behaviour, which vary in severity across the spectrum: around 50% individuals with ALS are within the normal range, 15% meet the criteria for ALS-FTD, and the remaining 35% are in the mid-spectrum range with milder and more focal impairments. The cognitive impairments include deficits in verbal fluency, executive functions, social cognition and language, and apathy is the most prevalent behavioural change. The pattern and severity of cognitive and behavioural change predicts underlying regional cerebral dysfunction from brain imaging and post-mortem pathology. Our increased recognition of cognition and behaviour as part of the ALS phenotype has led to the development and standardization of assessment tools, which have been incorporated into research and clinical care. Measuring change over the course of the disease is vital for clinical trials, and neuropsychology is proving to be a biomarker for the earliest preclinical changes.
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Affiliation(s)
- Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK.
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK.
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Bede P, Lulé D, Müller HP, Tan EL, Dorst J, Ludolph AC, Kassubek J. Presymptomatic grey matter alterations in ALS kindreds: a computational neuroimaging study of asymptomatic C9orf72 and SOD1 mutation carriers. J Neurol 2023; 270:4235-4247. [PMID: 37178170 PMCID: PMC10421803 DOI: 10.1007/s00415-023-11764-5] [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: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The characterisation of presymptomatic disease-burden patterns in asymptomatic mutation carriers has a dual academic and clinical relevance. The understanding of disease propagation mechanisms is of considerable conceptual interests, and defining the optimal time of pharmacological intervention is essential for improved clinical trial outcomes. METHODS In a prospective, multimodal neuroimaging study, 22 asymptomatic C9orf72 GGGGCC hexanucleotide repeat carriers, 13 asymptomatic subjects with SOD1, and 54 "gene-negative" ALS kindreds were enrolled. Cortical and subcortical grey matter alterations were systematically appraised using volumetric, morphometric, vertex, and cortical thickness analyses. Using a Bayesian approach, the thalamus and amygdala were further parcellated into specific nuclei and the hippocampus was segmented into anatomically defined subfields. RESULTS Asymptomatic GGGGCC hexanucleotide repeat carriers in C9orf72 exhibited early subcortical changes with the preferential involvement of the pulvinar and mediodorsal regions of the thalamus, as well as the lateral aspect of the hippocampus. Volumetric approaches, morphometric methods, and vertex analyses were anatomically consistent in capturing focal subcortical changes in asymptomatic C9orf72 hexanucleotide repeat expansion carriers. SOD1 mutation carriers did not exhibit significant subcortical grey matter alterations. In our study, none of the two asymptomatic cohorts exhibited cortical grey matter alterations on either cortical thickness or morphometric analyses. DISCUSSION The presymptomatic radiological signature of C9orf72 is associated with selective thalamic and focal hippocampal degeneration which may be readily detectable before cortical grey matter changes ensue. Our findings confirm selective subcortical grey matter involvement early in the course of C9orf72-associated neurodegeneration.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin, D02 RS90, Ireland.
- Department of Neurology, St James's Hospital, Dublin, Ireland.
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Ee Ling Tan
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin, D02 RS90, Ireland
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
- German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
- German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany
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Castelnovo V, Canu E, De Mattei F, Filippi M, Agosta F. Basal ganglia alterations in amyotrophic lateral sclerosis. Front Neurosci 2023; 17:1133758. [PMID: 37090799 PMCID: PMC10113480 DOI: 10.3389/fnins.2023.1133758] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/09/2023] [Indexed: 04/09/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) has traditionally been associated with brain damage involving the primary motor cortices and corticospinal tracts. In the recent decades, most of the research studies in ALS have focused on extra-motor and subcortical brain regions. The aim of these studies was to detect additional biomarkers able to support the diagnosis and to predict disease progression. The involvement of the frontal cortices, mainly in ALS cases who develop cognitive and/or behavioral impairment, is amply recognized in the field. A potential involvement of fronto-temporal and fronto-striatal connectivity changes in the disease evolution has also been reported. On this latter regard, there is still a shortage of studies which investigated basal ganglia (BG) alterations and their role in ALS clinical manifestation and progression. The present review aims to provide an overview on the magnetic resonance imaging studies reporting structural and/or functional BG alterations in patients with ALS, to clarify the role of BG damage in the disease clinical evolution and to propose potential future developments in this field.
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Affiliation(s)
- Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo De Mattei
- ALS Center, SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- *Correspondence: Federica Agosta,
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Tan HHG, Westeneng H, Nitert AD, van Veenhuijzen K, Meier JM, van der Burgh HK, van Zandvoort MJE, van Es MA, Veldink JH, van den Berg LH. MRI Clustering Reveals Three ALS Subtypes With Unique Neurodegeneration Patterns. Ann Neurol 2022; 92:1030-1045. [PMID: 36054734 PMCID: PMC9826424 DOI: 10.1002/ana.26488] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to identify subtypes of amyotrophic lateral sclerosis (ALS) by comparing patterns of neurodegeneration using brain magnetic resonance imaging (MRI) and explore their phenotypes. METHODS We performed T1-weighted and diffusion tensor imaging in 488 clinically well-characterized patients with ALS and 338 control subjects. Measurements of whole-brain cortical thickness and white matter connectome fractional anisotropy were adjusted for disease-unrelated variation. A probabilistic network-based clustering algorithm was used to divide patients into subgroups of similar neurodegeneration patterns. Clinical characteristics and cognitive profiles were assessed for each subgroup. In total, 512 follow-up scans were used to validate clustering results longitudinally. RESULTS The clustering algorithm divided patients with ALS into 3 subgroups of 187, 163, and 138 patients. All subgroups displayed involvement of the precentral gyrus and are characterized, respectively, by (1) pure motor involvement (pure motor cluster [PM]), (2) orbitofrontal and temporal involvement (frontotemporal cluster [FT]), and (3) involvement of the posterior cingulate cortex, parietal white matter, temporal operculum, and cerebellum (cingulate-parietal-temporal cluster [CPT]). These subgroups had significantly distinct clinical profiles regarding male-to-female ratio, age at symptom onset, and frequency of bulbar symptom onset. FT and CPT revealed higher rates of cognitive impairment on the Edinburgh cognitive and behavioral ALS screen (ECAS). Longitudinally, clustering remained stable: at 90.4% of their follow-up visits, patients clustered in the same subgroup as their baseline visit. INTERPRETATION ALS can manifest itself in 3 main patterns of cerebral neurodegeneration, each associated with distinct clinical characteristics and cognitive profiles. Besides the pure motor and frontotemporal dementia (FTD)-like variants of ALS, a new neuroimaging phenotype has emerged, characterized by posterior cingulate, parietal, temporal, and cerebellar involvement. ANN NEUROL 2022;92:1030-1045.
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Affiliation(s)
- Harold H. G. Tan
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Henk‐Jan Westeneng
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Abram D. Nitert
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Kevin van Veenhuijzen
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Jil M. Meier
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Hannelore K. van der Burgh
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Martine J. E. van Zandvoort
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Experimental PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Michael A. van Es
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Jan H. Veldink
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, UMC Utrecht Brain Center University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Meo G, Ferraro PM, Cillerai M, Gemelli C, Cabona C, Zaottini F, Roccatagliata L, Villani F, Schenone A, Caponnetto C. MND Phenotypes Differentiation: The Role of Multimodal Characterization at the Time of Diagnosis. Life (Basel) 2022; 12:life12101506. [PMID: 36294940 PMCID: PMC9604895 DOI: 10.3390/life12101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pure/predominant upper motor neuron (pUMN) and lower motor neuron (pLMN) diseases have significantly better prognosis compared to amyotrophic lateral sclerosis (ALS), but their early differentiation is often challenging. We therefore tested whether a multimodal characterization approach embedding clinical, cognitive/behavioral, genetic, and neurophysiological data may improve the differentiation of pUMN and pLMN from ALS already by the time of diagnosis. Dunn’s and chi-squared tests were used to compare data from 41 ALS, 34 pLMN, and 19 pUMN cases with diagnoses confirmed throughout a 2-year observation period. Area under the curve (AUC) analyses were implemented to identify the finest tools for phenotypes discrimination. Relative to ALS, pLMN showed greater lower limbs weakness, lower UMN burden, and progression rate (p < 0.001−0.04). PUMN showed a greater frequency of lower limbs onset, higher UMN burden, lower ALSFRS-r and MRC progression rates (p < 0.001−0.03), and greater ulnar compound muscle action potential (CMAP) amplitude and tibial central motor conduction time (CMCT) (p = 0.05−0.03). The UMN progression rate was the finest measure to identify pLMN cases (AUC = 90%), while the MRC progression rate was the finest tool to identify pUMN (AUC = 82%). Detailed clinical and neurophysiological examinations may significantly improve MNDs differentiation, facilitating prognosis estimation and ameliorating stratification strategies for clinical trials enrollment.
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Affiliation(s)
- Giuseppe Meo
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Pilar M. Ferraro
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-01-0353-7040
| | - Marta Cillerai
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Chiara Gemelli
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Corrado Cabona
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Federico Zaottini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy
| | - Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Angelo Schenone
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Claudia Caponnetto
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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12
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Schönecker S, Martinez-Murcia FJ, Rauchmann BS, Franzmeier N, Prix C, Wlasich E, Loosli SV, Bochmann K, Gorriz Saez JM, Laforce R, Ducharme S, Tartaglia MC, Finger E, de Mendonça A, Santana I, Sanchez-Valle R, Moreno F, Sorbi S, Tagliavini F, Borroni B, Otto M, Synofzik M, Galimberti D, Vandenberghe R, van Swieten J, Butler C, Gerhard A, Graff C, Danek A, Rohrer JD, Masellis M, Rowe J, Levin J. Frequency and Longitudinal Course of Motor Signs in Genetic Frontotemporal Dementia. Neurology 2022; 99:e1032-e1044. [PMID: 35948443 PMCID: PMC9519250 DOI: 10.1212/wnl.0000000000200828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Frontotemporal dementia (FTD) is a highly heritable disorder. The majority of genetic cases are caused by autosomal dominant pathogenic variants in the chromosome 9 open reading frame 72 (c9orf72), progranulin (GRN), and microtubule-associated protein tau (MAPT) gene. As motor disorders are increasingly recognized as part of the clinical spectrum, the current study aimed to describe motor phenotypes caused by genetic FTD, quantify their temporal association, and investigate their regional association with brain atrophy. METHODS We analyzed baseline visit data of known carriers of a pathogenic variant in the c9orf72, GRN, or MAPT gene from the Genetic Frontotemporal Dementia Initiative cohort study. Principal component analysis with varimax rotation was performed to identify motor sign clusters that were compared with respect to frequency and severity between groups. Associations with cross-sectional atrophy patterns were determined using voxel-wise regression. We applied linear mixed effects models to assess whether groups differed in the association between motor signs and estimated time to symptom onset. RESULTS A total of 322 pathogenic variant carriers were included in the analysis: 122 c9orf72 (79 presymptomatic), 143 GRN (112 presymptomatic), and 57 MAPT (43 presymptomatic) pathogenic variant carriers. Principal component analysis revealed 5 motor clusters, which we call progressive supranuclear palsy (PSP)-like, bulbar amyotrophic lateral sclerosis (ALS)-like, mixed/ALS-like, Parkinson disease (PD) like, and corticobasal syndrome-like motor phenotypes. There was no significant group difference in the frequency of signs of different motor phenotypes. However, mixed/ALS-like motor signs were most frequent, followed by PD-like motor signs. Although the PSP-like phenotype was associated with mesencephalic atrophy, the mixed/ALS-like phenotype was associated with motor cortex and corticospinal tract atrophy. The PD-like phenotype was associated with widespread cortical and subcortical atrophy. Estimated time to onset, genetic group and their interaction influenced motor signs. In c9orf72 pathogenic variant carriers, motor signs could be detected up to 25 years before expected symptom onset. DISCUSSION These results indicate the presence of multiple natural clusters of motor signs in genetic FTD, each correlated with specific atrophy patterns. Their motor severity depends on time and the affected gene. These clinicogenetic associations can guide diagnostic evaluations and the design of clinical trials for new disease-modifying and preventive treatments.
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Affiliation(s)
- Sonja Schönecker
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Francisco J Martinez-Murcia
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Boris-Stephan Rauchmann
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Nicolai Franzmeier
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Catharina Prix
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Elisabeth Wlasich
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Sandra V Loosli
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Katja Bochmann
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Juan-Manuel Gorriz Saez
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Robert Laforce
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Simon Ducharme
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Maria Carmela Tartaglia
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Elizabeth Finger
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Alexandre de Mendonça
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Isabel Santana
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Raquel Sanchez-Valle
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Fermin Moreno
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Sandro Sorbi
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Fabrizio Tagliavini
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Barbara Borroni
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Markus Otto
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Matthis Synofzik
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Daniela Galimberti
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Rik Vandenberghe
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - John van Swieten
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Christopher Butler
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Alexander Gerhard
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Caroline Graff
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Adrian Danek
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Jonathan D Rohrer
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Mario Masellis
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - James Rowe
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany
| | - Johannes Levin
- From the Department of Neurology (S. Schönecker, C.P., E.W., S.V.L., A.D., J.L.), Ludwig-Maximilians-Universität München, Germany; Department of Signal Theory Networking and Communications (F.J.M.-M., J.-M.G.S.), Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Spain; Institute for Clinical Radiology (B.-S.R.), Institute for Stroke and Dementia Research (N.F.), and Institute of Neuroradiology (K.B.), Ludwig-Maximilians-Universität München, Germany; Département des Sciences Neurologiques (R.L.), Clinique Interdisciplinaire de Mémoire (CIME); McConnell Brain Imaging Centre (S.D.), Montreal Neurological Institute, McGill University; Department of Psychiatry (S.D.), McGill University Health Centre, McGill University, Montreal, Quebec; Tanz Centre for Research in Neurodegenerative Diseases (M.C.T.), University of Toronto; Department of Clinical Neurological Sciences (E.F.), University of Western Ontario, London, Canada; Department of Neurology and Laboratory of Neurosciences (A.M.), Faculty of Medicine, University of Lisbon; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra; Center for Neuroscience and Cell Biology (I.S.), Faculty of Medicine, University of Coimbra, Portugal; Alzheimer's Disease and Other Cognitive Disorders Unit (R.S.-V.), Neurology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer; Institut d'Investigació Biomèdica August Pi I Sunyer (R.S.-V.), Barcelona; Department of Neurology (F.M.), Donostio University Hospital, San Sebastian; Neuroscience Area (F.M.), Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain; Department of Neuroscience, Psychology, Drug Research and Child Health (S. Sorbi), University of Florence; IRCCS Fondazione Don Carlo Gnocchi (S. Sorbi), Florence; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta (F.T.), Milano; Centre for Neurodegenerative Disorders (B.B.), Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurology (M.O.), University Hospital Ulm; Department of Neurology (M.O.), Martin-Luther-University Halle-Wittenberg, Germany Department of Neurodegenerative Diseases (M.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; Center for Neurodegenerative Diseases (M.S.), Tübingen, Germany; Fondazione IRCCS Ospediale Policlinico (D.G.), Milan; Centro Dino Ferrari (D.G.), University of Milan, Italy; Leuven Brain Institute (LBI) (R.V.), KU Leuven; Laboratory for Cognitive Neurology (R.V.), Department of Neurosciences, KU Leuven; Neurology Department (R.V.), UZ Leuven, Belgium; Department of Neurology (J.S.), Erasmus Medical Centre, Rotterdam, the Netherlands; Nuffield Department of Clinical Neurosciences (C.B.), Medical Sciences Division, University of Oxford; Department of Brain Sciences (C.B.), Imperial College London; Wolfson Molecular Imaging Centre (A.G.), Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine (A.G.), Essen University Hospital, Germany; Swedish FTD Initiative (C.G.), Stockholm; Division of Neurogeriatrics (C.G.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Solna; Unit for Hereditary Dementias (C.G.), Theme Aging, Karolinska University Hospital, Stockholm, Sweden; Dementia Research Centre (J.D.R.), University College London, United Kingdom; Hurvitz Brain Sciences Program (M.M.), Sunnybrook Research Institute, University of Toronto; Division of Neurology (M.M.), Department of Medicine, University of Toronto; Cognitive and Movement Disorders Clinic (M.M.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cognition and Brain Sciences Unit (J.R.), Medical Research Council; Department of Clinical Neurosciences (J.R.), University of Cambridge; Cambridge University Hospitals NHS Trust (J.R.), United Kingdom; German Center for Neurodegenerative Diseases (DZNE) (J.L.); Munich Cluster for Systems Neurology (SyNergy) (J.L.); and European Reference Network for Rare Neurological Diseases (ERN-RND) (J.L.), Munich, Germany.
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13
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Temp AGM, Kasper E, Machts J, Vielhaber S, Teipel S, Hermann A, Prudlo J. Cognitive reserve protects ALS-typical cognitive domains: A longitudinal study. Ann Clin Transl Neurol 2022; 9:1212-1223. [PMID: 35866289 PMCID: PMC9380174 DOI: 10.1002/acn3.51623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives To determine whether cognitive reserve (CR) as measured by verbal intelligence quotient, educational length, and achievement protects amyotrophic lateral sclerosis (ALS) patients' verbal fluency, executive functioning, and memory against brain volume loss over a period of 12 months. Methods This cohort study was completed between 2013 and 2016 with a follow‐up duration of 12 months. ALS patients were recruited from two specialist out‐patient clinics in Rostock and Magdeburg in Germany. Participants underwent cognitive testing and magnetic resonance imaging both at baseline and again after 12 months. The cognitive domains assessed included verbal memory in addition to executive functions such as verbal fluency, working memory, shifting and selective attention. Results Thirty‐eight ALS patients took part; 25 patients had no cognitive impairment (ALSni), and 13 were cognitively impaired (ALSci). On average, patients lost 294 mm3 in their superior frontal gyri, 225 mm3 in their orbitofrontal gyri, and 15.97 mm3 in their hippocampi over 12 months. There was strong evidence that CR protected letter fluency from further decline (Bayes factor [BF] >10) and moderate evidence that it supported learning effects in letter flexibility (BF >3). However, there is a lack of evidence supporting the notion that working memory, shifting, selective attention or verbal memory (BF = 1) are protected. Discussion As CR is easily determined and protects ALS‐specific cognitive domains over time, it should be regarded as a valuable predictive marker.
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Affiliation(s)
- Anna G M Temp
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald, Germany.,Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Centre, Rostock, Germany.,Department of Neurology, University Medical Centre, Rostock, Germany.,Neurozentrum, Berufsgenossenschaftliches Klinikum Hamburg, Hamburg, Germany
| | - Elisabeth Kasper
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald, Germany.,Department of Neurology, University Medical Centre, Rostock, Germany
| | - Judith Machts
- German Centre for Neurodegenerative Diseases, Site Magdeburg, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefan Vielhaber
- German Centre for Neurodegenerative Diseases, Site Magdeburg, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald, Germany.,Department of Psychosomatic Medicine, University Medical Centre, Rostock, Germany
| | - Andreas Hermann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald, Germany.,Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Centre, Rostock, Germany
| | - Johannes Prudlo
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald, Germany.,Department of Neurology, University Medical Centre, Rostock, Germany
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14
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Romano A, Trosi Lopez E, Liparoti M, Polverino A, Minino R, Trojsi F, Bonavita S, Mandolesi L, Granata C, Amico E, Sorrentino G, Sorrentino P. The progressive loss of brain network fingerprints in Amyotrophic Lateral Sclerosis predicts clinical impairment. Neuroimage Clin 2022; 35:103095. [PMID: 35764029 PMCID: PMC9241102 DOI: 10.1016/j.nicl.2022.103095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 10/25/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterised by functional connectivity alterations in both motor and extra-motor brain regions. Within the framework of network analysis, fingerprinting represents a reliable approach to assess subject-specific connectivity features within a given population (healthy or diseased). Here, we applied the Clinical Connectome Fingerprint (CCF) analysis to source-reconstructed magnetoencephalography (MEG) signals in a cohort of seventy-eight subjects: thirty-nine ALS patients and thirty-nine healthy controls. We set out to develop an identifiability matrix to assess the extent to which each patient was recognisable based on his/her connectome, as compared to healthy controls. The analysis was performed in the five canonical frequency bands. Then, we built a multilinear regression model to test the ability of the "clinical fingerprint" to predict the clinical evolution of the disease, as assessed by the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-r), the King's disease staging system, and the Milano-Torino Staging (MiToS) disease staging system. We found a drop in the identifiability of patients in the alpha band compared to the healthy controls. Furthermore, the "clinical fingerprint" was predictive of the ALSFRS-r (p = 0.0397; β = 32.8), the King's (p = 0.0001; β = -7.40), and the MiToS (p = 0.0025; β = -4.9) scores. Accordingly, it negatively correlated with the King's (Spearman's rho = -0.6041, p = 0.0003) and MiToS scales (Spearman's rho = -0.4953, p = 0.0040). Our results demonstrated the ability of the CCF approach to predict the individual motor impairment in patients affected by ALS. Given the subject-specificity of our approach, we hope to further exploit it to improve disease management.
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Affiliation(s)
- Antonella Romano
- Department of Motor Sciences and Wellness - University of Naples "Parthenope", via Medina 40, 80133 Naples, Italy
| | - Emahnuel Trosi Lopez
- Department of Motor Sciences and Wellness - University of Naples "Parthenope", via Medina 40, 80133 Naples, Italy
| | - Marianna Liparoti
- Department of Social and Developmental Psychology, University of Rome "Sapienza", Italy
| | - Arianna Polverino
- Institute of Diagnosis and Treatment Hermitage Capodimonte, via Cupa delle Tozzole 2, 80131 Naples, Italy
| | - Roberta Minino
- Department of Motor Sciences and Wellness - University of Naples "Parthenope", via Medina 40, 80133 Naples, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Laura Mandolesi
- Department of Humanistic Studies, University of Naples Federico II, via Porta di Massa 1, 80133, Naples, Italy
| | - Carmine Granata
- Institute of Applied Sciences and Intelligent Systems, CNR, via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy
| | - Enrico Amico
- Institute of Bioengineering, Center for Neuroprosthetics, EPFL, Geneva, Switzerland; Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Giuseppe Sorrentino
- Department of Motor Sciences and Wellness - University of Naples "Parthenope", via Medina 40, 80133 Naples, Italy; Institute of Diagnosis and Treatment Hermitage Capodimonte, via Cupa delle Tozzole 2, 80131 Naples, Italy; Institute of Applied Sciences and Intelligent Systems, CNR, via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy.
| | - Pierpaolo Sorrentino
- Institute of Applied Sciences and Intelligent Systems, CNR, via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy; Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
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15
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Cividini C, Basaia S, Spinelli EG, Canu E, Castelnovo V, Riva N, Cecchetti G, Caso F, Magnani G, Falini A, Filippi M, Agosta F. Amyotrophic Lateral Sclerosis-Frontotemporal Dementia: Shared and Divergent Neural Correlates Across the Clinical Spectrum. Neurology 2022; 98:e402-e415. [PMID: 34853179 PMCID: PMC8793105 DOI: 10.1212/wnl.0000000000013123] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/19/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A significant overlap between amyotrophic lateral sclerosis (ALS) and behavioral variant of frontotemporal dementia (bvFTD) has been observed at clinical, genetic, and pathologic levels. Within this continuum of presentations, the presence of mild cognitive or behavioral symptoms in patients with ALS has been consistently reported, although it is unclear whether this is to be considered a distinct phenotype or rather a natural evolution of ALS. Here, we used mathematical modeling of MRI connectomic data to decipher common and divergent neural correlates across the ALS-frontotemporal dementia (FTD) spectrum. METHODS We included 83 patients with ALS, 35 patients with bvFTD, and 61 healthy controls, who underwent clinical, cognitive, and MRI assessments. Patients with ALS were classified according to the revised Strong criteria into 54 ALS with only motor deficits (ALS-cn), 21 ALS with cognitive or behavioral involvement (ALS-ci/bi), and 8 ALS with bvFTD (ALS-FTD). First, we assessed the functional and structural connectivity patterns across the ALS-FTD spectrum. Second, we investigated whether and where MRI connectivity alterations of patients with ALS with any degree of cognitive impairment (i.e., ALS-ci/bi and ALS-FTD) resembled more the pattern of damage of one (ALS-cn) or the other end (bvFTD) of the spectrum, moving from group-level to single-subject analysis. RESULTS As compared with controls, extensive structural and functional disruption of the frontotemporal and parietal networks characterized bvFTD (bvFTD-like pattern), while a more focal structural damage within the sensorimotor-basal ganglia areas characterized ALS-cn (ALS-cn-like pattern). ALS-ci/bi patients demonstrated an ALS-cn-like pattern of structural damage, diverging from ALS-cn with similar motor impairment for the presence of enhanced functional connectivity within sensorimotor areas and decreased functional connectivity within the bvFTD-like pattern. On the other hand, patients with ALS-FTD resembled both structurally and functionally the bvFTD-like pattern of damage with, in addition, the structural ALS-cn-like damage in the motor areas. DISCUSSION Our findings suggest a maladaptive role of functional rearrangements in ALS-ci/bi concomitantly with similar structural alterations compared to ALS-cn, supporting the hypothesis that ALS-ci/bi might be considered as a phenotypic variant of ALS, rather than a consequence of disease worsening.
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Affiliation(s)
- Camilla Cividini
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Silvia Basaia
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Edoardo G Spinelli
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Elisa Canu
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Veronica Castelnovo
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Nilo Riva
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Giordano Cecchetti
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Francesca Caso
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Giuseppe Magnani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Andrea Falini
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy
| | - Federica Agosta
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., S.B., E.G.S., E.C., V.C., G.C., M.F., F.A.), Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (G.C., F.C., G.M., M.F., F.A.), Neuroradiology Unit (A.F.), CERMAC (A.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (C.C., E.G.S., V.C., G.C., A.F., M.F., F.A.), Milan, Italy.
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16
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Reyes-Leiva D, Dols-Icardo O, Sirisi S, Cortés-Vicente E, Turon-Sans J, de Luna N, Blesa R, Belbin O, Montal V, Alcolea D, Fortea J, Lleó A, Rojas-García R, Illán-Gala I. Pathophysiological Underpinnings of Extra-Motor Neurodegeneration in Amyotrophic Lateral Sclerosis: New Insights From Biomarker Studies. Front Neurol 2022; 12:750543. [PMID: 35115992 PMCID: PMC8804092 DOI: 10.3389/fneur.2021.750543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) lie at opposing ends of a clinical, genetic, and neuropathological continuum. In the last decade, it has become clear that cognitive and behavioral changes in patients with ALS are more frequent than previously recognized. Significantly, these non-motor features can impact the diagnosis, prognosis, and management of ALS. Partially overlapping neuropathological staging systems have been proposed to describe the distribution of TAR DNA-binding protein 43 (TDP-43) aggregates outside the corticospinal tract. However, the relationship between TDP-43 inclusions and neurodegeneration is not absolute and other pathophysiological processes, such as neuroinflammation (with a prominent role of microglia), cortical hyperexcitability, and synaptic dysfunction also play a central role in ALS pathophysiology. In the last decade, imaging and biofluid biomarker studies have revealed important insights into the pathophysiological underpinnings of extra-motor neurodegeneration in the ALS-FTLD continuum. In this review, we first summarize the clinical and pathophysiological correlates of extra-motor neurodegeneration in ALS. Next, we discuss the diagnostic and prognostic value of biomarkers in ALS and their potential to characterize extra-motor neurodegeneration. Finally, we debate about how biomarkers could improve the diagnosis and classification of ALS. Emerging imaging biomarkers of extra-motor neurodegeneration that enable the monitoring of disease progression are particularly promising. In addition, a growing arsenal of biofluid biomarkers linked to neurodegeneration and neuroinflammation are improving the diagnostic accuracy and identification of patients with a faster progression rate. The development and validation of biomarkers that detect the pathological aggregates of TDP-43 in vivo are notably expected to further elucidate the pathophysiological underpinnings of extra-motor neurodegeneration in ALS. Novel biomarkers tracking the different aspects of ALS pathophysiology are paving the way to precision medicine approaches in the ALS-FTLD continuum. These are essential steps to improve the diagnosis and staging of ALS and the design of clinical trials testing novel disease-modifying treatments.
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Affiliation(s)
- David Reyes-Leiva
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Oriol Dols-Icardo
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Sonia Sirisi
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Janina Turon-Sans
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Noemi de Luna
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Olivia Belbin
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Victor Montal
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
- *Correspondence: Ignacio Illán-Gala
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17
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Pasniceanu IS, Atwal MS, Souza CDS, Ferraiuolo L, Livesey MR. Emerging Mechanisms Underpinning Neurophysiological Impairments in C9ORF72 Repeat Expansion-Mediated Amyotrophic Lateral Sclerosis/Frontotemporal Dementia. Front Cell Neurosci 2022; 15:784833. [PMID: 34975412 PMCID: PMC8715728 DOI: 10.3389/fncel.2021.784833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are characterized by degeneration of upper and lower motor neurons and neurons of the prefrontal cortex. The emergence of the C9ORF72 hexanucleotide repeat expansion mutation as the leading genetic cause of ALS and FTD has led to a progressive understanding of the multiple cellular pathways leading to neuronal degeneration. Disturbances in neuronal function represent a major subset of these mechanisms and because such functional perturbations precede degeneration, it is likely that impaired neuronal function in ALS/FTD plays an active role in pathogenesis. This is supported by the fact that ALS/FTD patients consistently present with neurophysiological impairments prior to any apparent degeneration. In this review we summarize how the discovery of the C9ORF72 repeat expansion mutation has contributed to the current understanding of neuronal dysfunction in ALS/FTD. Here, we discuss the impact of the repeat expansion on neuronal function in relation to intrinsic excitability, synaptic, network and ion channel properties, highlighting evidence of conserved and divergent pathophysiological impacts between cortical and motor neurons and the influence of non-neuronal cells. We further highlight the emerging association between these dysfunctional properties with molecular mechanisms of the C9ORF72 mutation that appear to include roles for both, haploinsufficiency of the C9ORF72 protein and aberrantly generated dipeptide repeat protein species. Finally, we suggest that relating key pathological observations in C9ORF72 repeat expansion ALS/FTD patients to the mechanistic impact of the C9ORF72 repeat expansion on neuronal function will lead to an improved understanding of how neurophysiological dysfunction impacts upon pathogenesis.
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Affiliation(s)
- Iris-Stefania Pasniceanu
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Manpreet Singh Atwal
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Cleide Dos Santos Souza
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Laura Ferraiuolo
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matthew R Livesey
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
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18
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Poletti B, Solca F, Carelli L, Diena A, Colombo E, Torre S, Maranzano A, Greco L, Cozza F, Lizio A, Ferrucci R, Girotti F, Verde F, Morelli C, Lunetta C, Silani V, Ticozzi N. Association of Clinically Evident Eye Movement Abnormalities With Motor and Cognitive Features in Patients With Motor Neuron Disorders. Neurology 2021; 97:e1835-e1846. [PMID: 34504031 DOI: 10.1212/wnl.0000000000012774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although oculomotor abnormalities (OMAs) are not usually considered prominent features of amyotrophic lateral sclerosis (ALS), they may represent potential clinical markers of neurodegeneration, especially when investigated together with cognitive and behavioral alterations. The aim of our study was to identify patterns of clinically evident OMAs in patients with ALS and to correlate such findings with cognitive-behavioral data. METHODS Three consecutive inpatient cohorts of Italian patients with ALS and controls were retrospectively evaluated to assess the frequency of OMAs and cognitive-behavioral alterations. The ALS population was divided into a discovery cohort and a replication cohort. Controls included a cohort of cognitively impaired individuals and patients with Alzheimer disease (AD). Participants underwent bedside eye movement evaluation to determine the presence and pattern of OMAs. Cognitive assessment was performed with a standard neuropsychological battery (discovery ALS cohort and AD cohort) and the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS) (replication ALS cohort). RESULTS We recruited 864 individuals with ALS (635 discovery, 229 replication), 798 who were cognitively unimpaired and 171 with AD. OMAs were detected in 10.5% of our ALS cohort vs 1.6% of cognitively unimpaired controls (p = 1.2 × 10-14) and 11.4% of patients with AD (p = NS). The most frequent deficits were smooth pursuit and saccadic abnormalities. OMA frequency was higher in patients with bulbar onset, prominent upper motor neuron signs, and advanced disease stages. Cognitive dysfunction was significantly more frequent in patients with OMAs in both ALS cohorts (p = 1.1 × 10-25). Furthermore, OMAs significantly correlated with the severity of cognitive impairment and with pathologic scores at the ECAS ALS-specific domains. Last, OMAs could be observed in 35.0% of cognitively impaired patients with ALS vs 11.4% of patients with AD (p = 6.4 × 10-7), suggesting a possible involvement of frontal oculomotor areas in ALS. CONCLUSION Patients with ALS showed a range of clinically evident OMAs, and these alterations were significantly correlated with cognitive, but not behavioral, changes. OMAs may be a marker of neurodegeneration, and bedside assessment represents a rapid, highly specific tool for detecting cognitive impairment in ALS.
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Affiliation(s)
- Barbara Poletti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Solca
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Laura Carelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alberto Diena
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Eleonora Colombo
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Silvia Torre
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alessio Maranzano
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Lucia Greco
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Cozza
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Andrea Lizio
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Roberta Ferrucci
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Floriano Girotti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federico Verde
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Claudia Morelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Christian Lunetta
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Vincenzo Silani
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Nicola Ticozzi
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy.
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19
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Pathological neural networks and artificial neural networks in ALS: diagnostic classification based on pathognomonic neuroimaging features. J Neurol 2021; 269:2440-2452. [PMID: 34585269 PMCID: PMC9021106 DOI: 10.1007/s00415-021-10801-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022]
Abstract
The description of group-level, genotype- and phenotype-associated imaging traits is academically important, but the practical demands of clinical neurology centre on the accurate classification of individual patients into clinically relevant diagnostic, prognostic and phenotypic categories. Similarly, pharmaceutical trials require the precision stratification of participants based on quantitative measures. A single-centre study was conducted with a uniform imaging protocol to test the accuracy of an artificial neural network classification scheme on a cohort of 378 participants composed of patients with ALS, healthy subjects and disease controls. A comprehensive panel of cerebral volumetric measures, cortical indices and white matter integrity values were systematically retrieved from each participant and fed into a multilayer perceptron model. Data were partitioned into training and testing and receiver-operating characteristic curves were generated for the three study-groups. Area under the curve values were 0.930 for patients with ALS, 0.958 for disease controls, and 0.931 for healthy controls relying on all input imaging variables. The ranking of variables by classification importance revealed that white matter metrics were far more relevant than grey matter indices to classify single subjects. The model was further tested in a subset of patients scanned within 6 weeks of their diagnosis and an AUC of 0.915 was achieved. Our study indicates that individual subjects may be accurately categorised into diagnostic groups in an observer-independent classification framework based on multiparametric, spatially registered radiology data. The development and validation of viable computational models to interpret single imaging datasets are urgently required for a variety of clinical and clinical trial applications.
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20
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McKenna MC, Corcia P, Couratier P, Siah WF, Pradat PF, Bede P. Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging. Front Neurol 2021; 12:723450. [PMID: 34484106 PMCID: PMC8415268 DOI: 10.3389/fneur.2021.723450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023] Open
Abstract
Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Philippe Corcia
- Department of Neurology-Neurophysiology, CRMR ALS, Tours, France.,UMR 1253 iBrain, University of Tours, Tours, France.,LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France
| | - Philippe Couratier
- LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France.,ALS Centre, Limoges University Hospital (CHU de Limoges), Limoges, France
| | - We Fong Siah
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
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21
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Trojsi F, Di Nardo F, Caiazzo G, Siciliano M, D'Alvano G, Ferrantino T, Passaniti C, Ricciardi D, Esposito S, Lavorgna L, Russo A, Bonavita S, Cirillo M, Santangelo G, Esposito F, Tedeschi G. Hippocampal connectivity in Amyotrophic Lateral Sclerosis (ALS): more than Papez circuit impairment. Brain Imaging Behav 2021; 15:2126-2138. [PMID: 33095382 PMCID: PMC8413176 DOI: 10.1007/s11682-020-00408-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
Emerging evidence suggests that memory deficit in amyotrophic lateral sclerosis (ALS), a neurodegenerative disease with varying impairment of motor abilities and cognitive profile, may be independent from executive dysfunction. Our multimodal magnetic resonance imaging (MRI) approach, including resting state functional MRI (RS-fMRI), diffusion tensor imaging (DTI) and voxel-based morphometry (VBM), aimed to investigate structural and functional changes within and beyond the Papez circuit in non-demented ALS patients (n = 32) compared with healthy controls (HCs, n = 21), and whether these changes correlated with neuropsychological measures of verbal and non-verbal memory. We revealed a decreased functional connectivity between bilateral hippocampus, bilateral parahippocampal gyri and cerebellum in ALS patients compared with HCs. Between-group comparisons revealed white matter abnormalities in the genu and body of the corpus callosum and bilateral cortico-spinal tracts, superior longitudinal and uncinate fasciculi in ALS patients (p < .05, family-wise error corrected). Interestingly, changes of Digit Span forward performance were inversely related to RS-fMRI signal fluctuations in the cerebellum, while changes of both episodic and visual memory scores were inversely related to mean and radial diffusivity abnormalities in several WM fiber tracts, including middle cerebellar peduncles. Our findings revealed that ALS patients showed significant functional and structural connectivity changes across the regions comprising the Papez circuit, as well as more extended areas including cerebellum and frontal, temporal and parietal areas, supporting the theory of a multi-system pathology in ALS that spreads from cortical to subcortical structures.
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Affiliation(s)
- Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Department of Psychology, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Giulia D'Alvano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Teresa Ferrantino
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Ricciardi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sabrina Esposito
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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22
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Neuroanatomical associations of the Edinburgh cognitive and Behavioural ALS screen (ECAS). Brain Imaging Behav 2021; 15:1641-1654. [PMID: 33155172 DOI: 10.1007/s11682-020-00359-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cognitive impairment is now recognized in a subset of patients with amyotrophic lateral sclerosis (ALS). The objective of the study was to identify group differences and neuroanatomical correlates of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) in participants ALS. Fifty-three ALS patients and 43 healthy controls recruited as a part of our multicentre study (CALSNIC) were administered the ECAS and underwent an MRI scan. Voxel-based morphometry and tract based spatial statistics (TBSS) was performed to identify structural changes and associations with impaired ECAS scores. Lower performance in the ECAS verbal fluency and executive domains were noted in ALS patients as compared to controls (p < 0.01). Extensive white matter degeneration was noted in the corticospinal tract in all ALS patients, while ALS patients with impaired verbal fluency or executive domains (ALS-exi, n = 22), displayed additional degeneration in the corpus callosum, cingulum and superior longitudinal fasciculus as compared to controls (p < 0.05, TFCE corrected). Mild grey matter changes and associations with ECAS verbal fluency or executive performance were noted at lenient statistical thresholds (p < 0.001, uncorrected). Executive impairment was detected using the ECAS in our multicentre sample of Canadian ALS patients. White matter degeneration in motor regions was revealed in ALS patients with extensive spread to frontal regions in the ALS-exi sub-group. Mild associations between ECAS verbal fluency, executive function scores and MRI metrics suggest that reduced performance may be associated with widespread structural integrity.
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23
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Benbrika S, Doidy F, Carluer L, Mondou A, Pélerin A, Eustache F, Viader F, Desgranges B. Longitudinal Study of Cognitive and Emotional Alterations in Amyotrophic Lateral Sclerosis: Clinical and Imaging Data. Front Neurol 2021; 12:620198. [PMID: 34305771 PMCID: PMC8296637 DOI: 10.3389/fneur.2021.620198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Extra-motor manifestations occur in 50% of patients with amyotrophic lateral sclerosis (ALS). These mainly concern cognition, emotional processing and behavior. Depression and anxiety are less frequent. Little is known about how these manifestations change as the disease progresses. Similarly, although cortical thinning has been well-documented at disease onset, there are scant data about cortical thinning over time and how this correlates with extra-motor manifestations. The present study therefore assessed cognitive, emotional and psychological state and cortical thinning in a group of patients with ALS at baseline and after a follow-up period. Methods: We assessed executive functions, facial emotion recognition, depressive and anxious symptoms, and cortical thinning in 43 patients with ALS at baseline, comparing them with 28 healthy controls, and 21 of them 9 months later. We looked for links among the extra-motor manifestations and correlations with cortical thickness. Results: At baseline, patients had poor executive function and recognition of complex emotions from the eyes, and more anxious and depressive symptoms than controls. At follow-up, only inhibition abilities had worsened. Cortical thinning was observed in bilateral pre-central regions and other parts of the cerebral cortex at baseline. Over time, it worsened in motor and extra-motor areas. Executive functions correlated with thinning in the middle and inferior frontal gyrus and orbitofrontal cortex. Conclusions: During follow-up, there was little deterioration in extra-motor manifestations and psychological state, despite continuing cortical thinning. Patients with affective Theory of Mind (ToM) changes seemed less depressed than the others. Impaired mental flexibility was subtended by prefrontal regions with cortical thinning.
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Affiliation(s)
- Soumia Benbrika
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Franck Doidy
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Laurence Carluer
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Audrey Mondou
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Alice Pélerin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Béatrice Desgranges
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
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24
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Temp AGM, Dyrba M, Büttner C, Kasper E, Machts J, Kaufmann J, Vielhaber S, Teipel S, Prudlo J. Cognitive Profiles of Amyotrophic Lateral Sclerosis Differ in Resting-State Functional Connectivity: An fMRI Study. Front Neurosci 2021; 15:682100. [PMID: 34248485 PMCID: PMC8261303 DOI: 10.3389/fnins.2021.682100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Half of all amyotrophic lateral sclerosis-frontotemporal spectrum disorder (ALS-FTSD) patients are classified as cognitively impaired, of which 10% have frontotemporal dementia (FTD), and an additional 40% suffer from a frontotemporal syndrome not severe enough to be described as dementia (cognitively impaired/ALSci). As changes in cerebral function measured by resting-state magnet resonance imaging (rs-fMRI) are known in ALS, we investigated whether group differences in resting-state functional connectivity (RSFC) networks could be observed between ALS patients with different cognitive profiles against healthy controls (HC). Furthermore, we correlated cognition and motor functioning with network connectivity. Methods Healthy controls, 69, and 97 ALS patients underwent functional MRI scanning and cognitive assessment. The ALS patients were categorized as non-impaired (ALSni; n = 68), cognitively impaired (ALSci; n = 21), and ALS-FTD (n = 8). Group differences in connectivity of the default mode network (DMN), motor network (MN), and ventral attention network (VAN) were investigated using a full-factorial model; correlations between global cognitive performance, shifting, and motor symptom severity were established using Pearson’s correlation. Results At a liberal alpha level of uncorrected p < 0.005 and a cluster size exceeding 20 voxels, we found widespread decreases in functional connectivity in all three networks when comparing ALS patients to HC. Similar patterns of hypoconnectivity in the bilateral motor cortices and frontotemporal emerged when comparing the ALSci and ALS-FTD patients to those not cognitively impaired. Hyperconnectivity in the DMN temporal gyrus correlated with worse global cognition; moreover, hyperconnectivity in the VAN thalamus, insula, and putamen correlated with worse shifting ability. Better-preserved motor function correlated with higher MN connectivity. Only the motor-related effects prevailed at a more conservative significance level of pFDR< 0.001. Conclusion Resting-state functional connectivity differs between cognitive profiles of ALS and is directly associated with clinical presentation, specifically with motor function, and cognitive shifting.
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Affiliation(s)
- Anna G M Temp
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Charlotte Büttner
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Elisabeth Kasper
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Judith Machts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Vielhaber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Johannes Prudlo
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, Rostock University Medical Center, Rostock, Germany
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25
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Temp AGM, Dyrba M, Kasper E, Teipel S, Prudlo J. Case Report: Cognitive Conversion in a Non-brazilian VAPB Mutation Carrier (ALS8). Front Neurol 2021; 12:668772. [PMID: 34149599 PMCID: PMC8208309 DOI: 10.3389/fneur.2021.668772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022] Open
Abstract
Amyotrophic lateral sclerosis 8 (ALS8) is a predominantly lower motor neuron syndrome originally described in a Portuguese–Brazilian family, which originated from a common founder. ALS8 is caused by a VAPB mutation and extremely rare in Central Europe. We present a 51-year-old German man with ALS8 who had the P56S VAPB mutation independently of the founder effect. In the final 4 years of his life (disease duration 10 years), the patient had five MRI scans and four in-depth neuropsychological assessments. This paper addresses the course of the patient's cognitive status and relates cognitive performance to structural brain changes in order to determine whether this ALS8 case showed a different pattern of cognitive decline compared with sporadic ALS. The executive functions, verbal fluency, and memory of the patient and 17 age-, sex-, and education-matched controls were assessed on four different occasions. His cognitive performance and decline were investigated for abnormality using cross-sectional and longitudinal matched case–control analysis. We obtained five T1-weighted MRI, which we analyzed using voxel-wise non-parametric analysis with statistical non-parametric mapping in Matlab. Moreover, we conducted a single-subject correlation between cognitive performance and brain atrophy. The cognitive profile of the index patient featured executive dysfunction. Notably, his working memory and shifting ability declined from a healthy baseline to an impaired performance, leading to a transition from cognitively non-impaired (ALSni) to cognitively impaired (ALSci). The correlations we observed between cerebellar atrophy and verbal fluency in addition to fusiform gyrus atrophy and shifting are novel findings. We found that the conversion from ALSni to ALSci was associated with widespread cerebral atrophy, which extended beyond the primary motor and premotor cortex and affected, among others, the cerebellum and left fusiform gyrus. The index patients' cognitive profile resembles that of other ALS phenotypes, but the extensive atrophy beyond extra-motor areas has not yet been described.
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Affiliation(s)
- Anna G M Temp
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Elisabeth Kasper
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Johannes Prudlo
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, Rostock University Medical Center, Rostock, Germany
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26
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Abstract
OBJECTIVE Advanced neuroimaging techniques may offer the potential to monitor disease progression in amyotrophic lateral sclerosis (ALS), a neurodegenerative, multisystem disease that still lacks therapeutic outcome measures. We aim to investigate longitudinal functional and structural magnetic resonance imaging (MRI) changes in a cohort of patients with ALS monitored for one year after diagnosis. METHODS Resting state functional MRI, diffusion tensor imaging (DTI), and voxel-based morphometry analyses were performed in 22 patients with ALS examined by six-monthly MRI scans over one year. RESULTS During the follow-up period, patients with ALS showed reduced functional connectivity only in some extramotor areas, such as the middle temporal gyrus in the left frontoparietal network after six months and in the left middle frontal gyrus in the default mode network after one year without showing longitudinal changes of cognitive functions. Moreover, after six months, we reported in the ALS group a decreased fractional anisotropy (P = .003, Bonferroni corrected) in the right uncinate fasciculus. Conversely, we did not reveal significant longitudinal changes of functional connectivity in the sensorimotor network, as well as of gray matter (GM) atrophy or of DTI metrics in motor areas, although clinical measures of motor disability showed significant decline throughout the three time points. CONCLUSION Our findings highlighted that progressive impairment of extramotor frontotemporal networks may precede the appearance of executive and language dysfunctions and GM changes in ALS. Functional connectivity changes in cognitive resting state networks might represent candidate radiological markers of disease progression.
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27
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Costello E, Rooney J, Pinto-Grau M, Burke T, Elamin M, Bede P, McMackin R, Dukic S, Vajda A, Heverin M, Hardiman O, Pender N. Cognitive reserve in amyotrophic lateral sclerosis (ALS): a population-based longitudinal study. J Neurol Neurosurg Psychiatry 2021; 92:460-465. [PMID: 33563807 DOI: 10.1136/jnnp-2020-324992] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is often associated with cognitive and/or behavioural impairment. Cognitive reserve (CR) may play a protective role in offsetting cognitive impairment. This study examined the relationship between CR and longitudinal change in cognition in an Irish ALS cohort. METHODS Longitudinal neuropsychological assessment was carried out on 189 patients over 16 months using the Edinburgh cognitive and behavioural ALS screen (ECAS) and an additional battery of neuropsychological tests. CR was measured by combining education, occupation and physical activity data. Joint longitudinal and time-to-event models were fitted to investigate the associations between CR, performance at baseline and decline over time while controlling for non-random drop-out. RESULTS CR was a significant predictor of baseline neuropsychological performance, with high CR patients performing better than those with medium or low CR. Better cognitive performance in high CR individuals was maintained longitudinally for ECAS, social cognition, executive functioning and confrontational naming. Patients displayed little cognitive decline over the course of the study, despite controlling for non-random drop-out. CONCLUSIONS These findings suggest that CR plays a role in the presentation of cognitive impairment at diagnosis but is not protective against cognitive decline. However, further research is needed to examine the interaction between CR and other objective correlates of cognitive impairment in ALS.
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Affiliation(s)
- Emmet Costello
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - James Rooney
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social- and Environmental Medicine, University Hospital, Munich, Germany
| | - Marta Pinto-Grau
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Roisin McMackin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.,Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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28
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Cognitive dysfunction in amyotrophic lateral sclerosis: can we predict it? Neurol Sci 2021; 42:2211-2222. [PMID: 33772353 PMCID: PMC8159827 DOI: 10.1007/s10072-021-05188-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/15/2021] [Indexed: 01/26/2023]
Abstract
Background and aim Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the degeneration of both upper and lower motoneurons in the brain and spinal cord leading to motor and extra-motor symptoms. Although traditionally considered a pure motor disease, recent evidences suggest that ALS is a multisystem disorder. Neuropsychological alterations, in fact, are observed in more than 50% of patients: while executive dysfunctions have been firstly identified, alterations in verbal fluency, behavior, and pragmatic and social cognition have also been described. Detecting and monitoring ALS cognitive and behavioral impairment even at early disease stages is likely to have staging and prognostic implications, and it may impact the enrollment in future clinical trials. During the last 10 years, humoral, radiological, neurophysiological, and genetic biomarkers have been reported in ALS, and some of them seem to potentially correlate to cognitive and behavioral impairment of patients. In this review, we sought to give an up-to-date state of the art of neuropsychological alterations in ALS: we will describe tests used to detect cognitive and behavioral impairment, and we will focus on promising non-invasive biomarkers to detect pre-clinical cognitive decline. Conclusions To date, the research on humoral, radiological, neurophysiological, and genetic correlates of neuropsychological alterations is at the early stage, and no conclusive longitudinal data have been published. Further and longitudinal studies on easily accessible and quantifiable biomarkers are needed to clarify the time course and the evolution of cognitive and behavioral impairments of ALS patients.
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29
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Ferraro PM, Cabona C, Meo G, Rolla-Bigliani C, Castellan L, Pardini M, Inglese M, Caponnetto C, Roccatagliata L. Age at symptom onset influences cortical thinning distribution and survival in amyotrophic lateral sclerosis. Neuroradiology 2021; 63:1481-1487. [PMID: 33660067 DOI: 10.1007/s00234-021-02681-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/25/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The lifetime risk of developing amyotrophic lateral sclerosis (ALS) increases in the elderly, and greater age at symptom onset has been identified as a negative prognostic factor in the disease. However, the underlying neurobiological mechanisms are still poorly investigated. We hypothesized that older age at symptom onset would have been associated with greater extra-motor cortical damage contributing to worse prognosis, so we explored the relationship between age at symptom onset, cortical thinning (CT) distribution, and clinical markers of disease progression. METHODS We included 26 ALS patients and 29 healthy controls with T1-weighted magnetic resonance imaging (MRI). FreeSurfer 6.0 was used to identify regions of cortical atrophy (CA) in ALS, and to relate age at symptom onset to CT distribution. Linear regression analyses were then used to investigate whether MRI metrics of age-related damage were predictive of clinical progression. MRI results were corrected using the Monte Carlo simulation method, and regression analyses were further corrected for disease duration. RESULTS ALS patients exhibited significant CA mainly encompassing motor regions, but also involving the cuneus bilaterally and the right superior parietal cortex (p < 0.05). Older age at symptom onset was selectively associated with greater extra-motor (frontotemporal) CT, including pars opercularis bilaterally, left middle temporal, and parahippocampal cortices (p < 0.05), and CT of these regions was predictive of shorter survival (p = 0.004, p = 0.03). CONCLUSION More severe frontotemporal CT contributes to shorter survival in older ALS patients. These findings have the potential to unravel the neurobiological mechanisms linking older age at symptom onset to worse prognosis in ALS.
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Affiliation(s)
- Pilar M Ferraro
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Corrado Cabona
- Department of Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Meo
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Lucio Castellan
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Claudia Caponnetto
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Agarwal S, Highton-Williamson E, Caga J, Howells J, Dharmadasa T, Matamala JM, Ma Y, Shibuya K, Hodges JR, Ahmed RM, Vucic S, Kiernan MC. Motor cortical excitability predicts cognitive phenotypes in amyotrophic lateral sclerosis. Sci Rep 2021; 11:2172. [PMID: 33500476 PMCID: PMC7838179 DOI: 10.1038/s41598-021-81612-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are well-recognised as an extended disease spectrum. This study hypothesised that cortical hyperexcitability, an early pathophysiological abnormality in ALS, would distinguish cognitive phenotypes, as a surrogate marker of pathological disease burden. 61 patients with ALS, matched for disease duration (pure motor ALS, n = 39; ALS with coexistent FTD, ALS-FTD, n = 12; ALS with cognitive/behavioural abnormalities not meeting FTD criteria, ALS-Cog, n = 10) and 30 age-matched healthy controls. Cognitive function on the Addenbrooke's cognitive examination (ACE) scale, behavioural function on the motor neuron disease behavior scale (MiND-B) and cortical excitability using transcranial magnetic stimulation (TMS) were documented. Cortical resting motor threshold (RMT), lower threshold indicating hyperexcitability, was lower in ALS-FTD (50.2 ± 6.9) compared to controls (64.3 ± 12.6, p < 0.005), while ALS-Cog (63.3 ± 12.7) and ALS (60.8 ± 13.9, not significant) were similar to controls. Short interval intracortical inhibition (SICI) was reduced across all ALS groups compared to controls, indicating hyperexcitability. On receiver operating characteristic curve analysis, RMT differentiated ALS-FTD from ALS (area under the curve AUC = 0.745, p = 0.011). The present study has identified a distinct pattern of cortical excitability across cognitive phenotypes in ALS. As such, assessment of cortical physiology may provide more precise clinical prognostication in ALS.
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Affiliation(s)
- Smriti Agarwal
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia. .,Neurology Unit, A5, Box 165, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
| | | | - Jashelle Caga
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Howells
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thanuja Dharmadasa
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - José M Matamala
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Yan Ma
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kazumoto Shibuya
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steve Vucic
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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31
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Placek K, Benatar M, Wuu J, Rampersaud E, Hennessy L, Van Deerlin VM, Grossman M, Irwin DJ, Elman L, McCluskey L, Quinn C, Granit V, Statland JM, Burns TM, Ravits J, Swenson A, Katz J, Pioro EP, Jackson C, Caress J, So Y, Maiser S, Walk D, Lee EB, Trojanowski JQ, Cook P, Gee J, Sha J, Naj AC, Rademakers R, Chen W, Wu G, Paul Taylor J, McMillan CT. Machine learning suggests polygenic risk for cognitive dysfunction in amyotrophic lateral sclerosis. EMBO Mol Med 2021; 13:e12595. [PMID: 33270986 PMCID: PMC7799365 DOI: 10.15252/emmm.202012595] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disease characterized primarily by progressive muscle weakness. Cognitive dysfunction is commonly observed in patients; however, factors influencing risk for cognitive dysfunction remain elusive. Using sparse canonical correlation analysis (sCCA), an unsupervised machine-learning technique, we observed that single nucleotide polymorphisms collectively associate with baseline cognitive performance in a large ALS patient cohort (N = 327) from the multicenter Clinical Research in ALS and Related Disorders for Therapeutic Development (CReATe) Consortium. We demonstrate that a polygenic risk score derived using sCCA relates to longitudinal cognitive decline in the same cohort and also to in vivo cortical thinning in the orbital frontal cortex, anterior cingulate cortex, lateral temporal cortex, premotor cortex, and hippocampus (N = 90) as well as post-mortem motor cortical neuronal loss (N = 87) in independent ALS cohorts from the University of Pennsylvania Integrated Neurodegenerative Disease Biobank. Our findings suggest that common genetic polymorphisms may exert a polygenic contribution to the risk of cortical disease vulnerability and cognitive dysfunction in ALS.
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32
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Placek K, Benatar M, Wuu J, Rampersaud E, Hennessy L, Van Deerlin VM, Grossman M, Irwin DJ, Elman L, McCluskey L, Quinn C, Granit V, Statland JM, Burns TM, Ravits J, Swenson A, Katz J, Pioro EP, Jackson C, Caress J, So Y, Maiser S, Walk D, Lee EB, Trojanowski JQ, Cook P, Gee J, Sha J, Naj AC, Rademakers R, Chen W, Wu G, Paul Taylor J, McMillan CT. Machine learning suggests polygenic risk for cognitive dysfunction in amyotrophic lateral sclerosis. EMBO Mol Med 2021. [PMID: 33270986 PMCID: PMC7799365 DOI: 10.15252/emmm.202012595|] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disease characterized primarily by progressive muscle weakness. Cognitive dysfunction is commonly observed in patients; however, factors influencing risk for cognitive dysfunction remain elusive. Using sparse canonical correlation analysis (sCCA), an unsupervised machine-learning technique, we observed that single nucleotide polymorphisms collectively associate with baseline cognitive performance in a large ALS patient cohort (N = 327) from the multicenter Clinical Research in ALS and Related Disorders for Therapeutic Development (CReATe) Consortium. We demonstrate that a polygenic risk score derived using sCCA relates to longitudinal cognitive decline in the same cohort and also to in vivo cortical thinning in the orbital frontal cortex, anterior cingulate cortex, lateral temporal cortex, premotor cortex, and hippocampus (N = 90) as well as post-mortem motor cortical neuronal loss (N = 87) in independent ALS cohorts from the University of Pennsylvania Integrated Neurodegenerative Disease Biobank. Our findings suggest that common genetic polymorphisms may exert a polygenic contribution to the risk of cortical disease vulnerability and cognitive dysfunction in ALS.
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Affiliation(s)
- Katerina Placek
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Michael Benatar
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Joanne Wuu
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Evadnie Rampersaud
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - Laura Hennessy
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Vivianna M Van Deerlin
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Murray Grossman
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - David J Irwin
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Lauren Elman
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Leo McCluskey
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Colin Quinn
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Volkan Granit
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Jeffrey M Statland
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Ted M Burns
- Department of NeurologyUniversity of Virginia Health SystemCharlottesvilleVAUSA
| | - John Ravits
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCAUSA
| | | | - Jon Katz
- Forbes Norris ALS CenterCalifornia Pacific Medical CenterSan FranciscoCAUSA
| | - Erik P Pioro
- Department of NeurologyCleveland ClinicClevelandOHUSA
| | - Carlayne Jackson
- Department of NeurologyUniversity of Texas Health Science CenterSan AntonioTXUSA
| | - James Caress
- Department of NeurologyWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Yuen So
- Department of NeurologyStanford University Medical CenterSan JoseCAUSA
| | - Samuel Maiser
- Department of NeurologyUniversity of Minnesota Medical CenterMinneapolisMNUSA
| | - David Walk
- Department of NeurologyUniversity of Minnesota Medical CenterMinneapolisMNUSA
| | - Edward B Lee
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - John Q Trojanowski
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Philip Cook
- Penn Image Computing Science Laboratory (PICSL)Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - James Gee
- Penn Image Computing Science Laboratory (PICSL)Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Jin Sha
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Penn Neurodegeneration Genomics CenterDepartment of Pathology and Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Adam C Naj
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Penn Neurodegeneration Genomics CenterDepartment of Pathology and Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | | | | | - Wenan Chen
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - Gang Wu
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - J Paul Taylor
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA,The Howard Hughes Medical InstituteChevy ChaseMSUSA
| | - Corey T McMillan
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
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Brain Cortical Complexity Alteration in Amyotrophic Lateral Sclerosis: A Preliminary Fractal Dimensionality Study. BIOMED RESEARCH INTERNATIONAL 2021; 2020:1521679. [PMID: 32280675 PMCID: PMC7115147 DOI: 10.1155/2020/1521679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Abstract
Objective Fractal dimensionality (FD) analysis provides a quantitative description of brain structural complexity. The application of FD analysis has provided evidence of amyotrophic lateral sclerosis- (ALS-) related white matter degeneration. This study is aimed at evaluating, for the first time, FD alterations in a gray matter in ALS and determining its association with clinical parameters. Materials and Methods. This study included 22 patients diagnosed with ALS and 20 healthy subjects who underwent high-resolution T1-weighted imaging scanning. Disease severity was assessed using the revised ALS Functional Rating Scale (ALSFRS-R). The duration of symptoms and rate of disease progression were also assessed. The regional FD value was calculated by a computational anatomy toolbox and compared among groups. The relationship between cortical FD values and clinical parameters was evaluated by Spearman correlation analysis. Results ALS patients showed decreased FD values in the left precentral gyrus and central sulcus, left circular sulcus of insula (superior segment), left cingulate gyrus and sulcus (middle-posterior part), right precentral gyrus, and right postcentral gyrus. The FD values in the right precentral gyrus were positively correlated to ALSFRS-R scores (r = 0.44 and P = 0.023), whereas negatively correlated to the rate of disease progression (r = 0.44 and P = 0.023), whereas negatively correlated to the rate of disease progression (r = 0.44 and P = 0.023), whereas negatively correlated to the rate of disease progression ( Conclusions Our results suggest an ALS-related reduction in structural complexity involving the gray matter. FD analysis may shed more light on the pathophysiology of ALS.
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Cortical progression patterns in individual ALS patients across multiple timepoints: a mosaic-based approach for clinical use. J Neurol 2021; 268:1913-1926. [PMID: 33399966 DOI: 10.1007/s00415-020-10368-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The majority of imaging studies in ALS infer group-level imaging signatures from group comparisons, as opposed to estimating disease burden in individual patients. In a condition with considerable clinical heterogeneity, the characterisation of individual patterns of pathology is hugely relevant. In this study, we evaluate a strategy to track progressive cortical involvement in single patients by using subject-specific reference cohorts. METHODS We have interrogated a multi-timepoint longitudinal dataset of 61 ALS patients to demonstrate the utility of estimating cortical disease burden and the expansion of cerebral atrophy over time. We contrast our strategy to the gold-standard approach to gauge the advantages and drawbacks of our method. We modelled the evolution of cortical integrity in a conditional growth model, in which we accounted for age, gender, disability, symptom duration, education and handedness. We hypothesised that the variance associated with demographic variables will be successfully eliminated in our approach. RESULTS In our model, the only covariate which modulated the expansion of atrophy was motor disability as measured by the ALSFRS-r (t(153) = - 2.533, p = 0.0123). Using the standard approach, age also significantly influenced progression of CT change (t(153) = - 2.151, p = 0.033) demonstrating the validity and potential clinical utility of our approach. CONCLUSION Our strategy of estimating the extent of cortical atrophy in individual patients with ALS successfully corrects for demographic factors and captures relevant cortical changes associated with clinical disability. Our approach provides a framework to interpret single T1-weighted images in ALS and offers an opportunity to track cortical propagation patterns both at individual subject level and at cohort level.
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Li Hi Shing S, McKenna MC, Siah WF, Chipika RH, Hardiman O, Bede P. The imaging signature of C9orf72 hexanucleotide repeat expansions: implications for clinical trials and therapy development. Brain Imaging Behav 2021; 15:2693-2719. [PMID: 33398779 DOI: 10.1007/s11682-020-00429-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 01/14/2023]
Abstract
While C9orf72-specific imaging signatures have been proposed by both ALS and FTD research groups and considerable presymptomatic alterations have also been confirmed in young mutation carriers, considerable inconsistencies exist in the literature. Accordingly, a systematic review of C9orf72-imaging studies has been performed to identify consensus findings, stereotyped shortcomings, and unique contributions to outline future directions. A formal literature review was conducted according to the STROBE guidelines. All identified papers were individually reviewed for sample size, choice of controls, study design, imaging modalities, statistical models, clinical profiling, and identified genotype-associated pathological patterns. A total of 74 imaging papers were systematically reviewed. ALS patients with GGGGCC repeat expansions exhibit relatively limited motor cortex involvement and widespread extra-motor pathology. C9orf72 positive FTD patients often show preferential posterior involvement. Reports of thalamic involvement are relatively consistent across the various phenotypes. Asymptomatic hexanucleotide repeat carriers often exhibit structural and functional changes decades prior to symptom onset. Common shortcomings included sample size limitations, lack of disease-controls, limited clinical profiling, lack of genetic testing in healthy controls, and absence of post mortem validation. There is a striking paucity of longitudinal studies and existing presymptomatic studies have not evaluated the predictive value of radiological changes with regard to age of onset and phenoconversion. With the advent of antisense oligonucleotide therapies, the meticulous characterisation of C9orf72-associated changes has gained practical relevance. Neuroimaging offers non-invasive biomarkers for future clinical trials, presymptomatic ascertainment, diagnostic and prognostic applications.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - We Fong Siah
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.
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Sakurai T, Hirano S, Abe M, Uji Y, Shimizu K, Suzuki M, Nakano Y, Ishikawa A, Kojima K, Shibuya K, Murata A, Kuwabara S. Dysfunction of the left angular gyrus may be associated with writing errors in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:267-275. [PMID: 33331163 DOI: 10.1080/21678421.2020.1861021] [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] [Indexed: 10/22/2022]
Abstract
Background: Language dysfunction is a feature of cognitive impairment in amyotrophic lateral sclerosis (ALS) that may compromise communication. Objective: To elucidate language dysfunction in patients with ALS and its relationship with other neuropsychological tests and to identify the brain regions associated with this dysfunction using perfusion image. Methods: Overall, 37 patients with ALS were included in this study. Their neuropsychological function was investigated using the Western Aphasia Battery (WAB), Frontal Assessment Battery and Behavioral Assessment of the Dysexecutive Syndrome. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography was used to examine regional cerebral blood flow and its relationship with WAB scores was investigated using multiple regression analyses, controlled for age, sex and years of education. Results: Frequency of language abnormality in ALS was 8.5% for spontaneous speech, 25.7% for auditory verbal comprehension, 8.8% for repetition, 14.7% for naming, 17.6% for reading and 51.4% for writing. The writing error was mainly omission and substitution of kana letters. Executive tests were correlated with naming (r > 0.5, p < 0.001) and reading (r > 0.4, p < 0.01) scores. With respect to the writing sub-test, positive perfusional relationship was only detected in the left angular gyrus. Conclusions: The left angular gyrus is the region associated with the writing errors observed in ALS.
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Affiliation(s)
- Toru Sakurai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Midori Abe
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | - Yuriko Uji
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | | | - Masahide Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshikazu Nakano
- Department of Neurology, Chiba Saiseikai Narashino Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, Chiba East Hospital, Chiba, Japan
| | - Kazuho Kojima
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Murata
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.,Department of Rehabilitation, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Trojsi F, Siciliano M, Tedeschi G. Selective degeneration of amygdalar nuclei in amyotrophic lateral sclerosis. J Neurol Sci 2020; 417:117038. [DOI: 10.1016/j.jns.2020.117038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
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38
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Häkkinen S, Chu SA, Lee SE. Neuroimaging in genetic frontotemporal dementia and amyotrophic lateral sclerosis. Neurobiol Dis 2020; 145:105063. [PMID: 32890771 DOI: 10.1016/j.nbd.2020.105063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) have a strong clinical, genetic and pathological overlap. This review focuses on the current understanding of structural, functional and molecular neuroimaging signatures of genetic FTD and ALS. We overview quantitative neuroimaging studies on the most common genes associated with FTD (MAPT, GRN), ALS (SOD1), and both (C9orf72), and summarize visual observations of images reported in the rarer genes (CHMP2B, TARDBP, FUS, OPTN, VCP, UBQLN2, SQSTM1, TREM2, CHCHD10, TBK1).
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Affiliation(s)
- Suvi Häkkinen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie A Chu
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Suzee E Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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Bersano E, Sarnelli MF, Solara V, Iazzolino B, Peotta L, De Marchi F, Facchin A, Moglia C, Canosa A, Calvo A, Chiò A, Mazzini L. Decline of cognitive and behavioral functions in amyotrophic lateral sclerosis: a longitudinal study. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:373-379. [PMID: 32484726 DOI: 10.1080/21678421.2020.1771732] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: A cognitive impairment, ranging from frontotemporal dementia (FTD) to milder forms of dysexecutive or behavioral dysfunction, is detected in 30-50% of patients affected by amyotrophic lateral sclerosis (ALS) at diagnosis. Such condition considerably influences the prognosis, and possibly impacts on the decision-making process with regards to end-of-life choices. The aim of our study is to examine the changes of cognitive and behavioral impairment in a large population of ALS from the time of diagnosis to a 6-month follow-up (IQR 5.5-9.0 months), and to examine to what extent the progression of cognitive impairment affects survival time and rate of disease progression.Methods: We recruited 146 ALS patients classified according to revised criteria of ALS and FTD spectrum disorder. In a multidisciplinary setting, during two subsequent visits we examined clinical features with ALSFRS-r score, FVC% and BMI, and cognitive status with an extensive neuropsychological evaluation.Results: At second examination, one-third of patients showed a worsening of cognitive impairment, namely 88% of ALSbi, 27% of ALSci, 40% of ALScbi, and, interestingly, also 24% of cognitive normal ALS developed a significant cognitive dysfunction. We find that those who changed their cognitive status presented a lower ALSFRS-r score at t1 and a shorter survival time compared to those who did not change, regardless of the type of cognitive impairment.Conclusion: We show how cognitive disorders in ALS patients can not only be present at diagnosis, but also manifest during disease and influence the progression of motor deficit and the prognosis.
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Affiliation(s)
- Enrica Bersano
- ALS Center, Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy.,3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Francesca Sarnelli
- ALS Center, Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Valentina Solara
- ALS Center, Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Barbara Iazzolino
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Laura Peotta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Fabiola De Marchi
- ALS Center, Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Alessio Facchin
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Cristina Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy.,1st Neurology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Antonio Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy.,1st Neurology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Andrea Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy.,1st Neurology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Adriano Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy.,1st Neurology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Letizia Mazzini
- ALS Center, Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
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van der Burgh HK, Westeneng HJ, Walhout R, van Veenhuijzen K, Tan HHG, Meier JM, Bakker LA, Hendrikse J, van Es MA, Veldink JH, van den Heuvel MP, van den Berg LH. Multimodal longitudinal study of structural brain involvement in amyotrophic lateral sclerosis. Neurology 2020; 94:e2592-e2604. [PMID: 32414878 PMCID: PMC7455328 DOI: 10.1212/wnl.0000000000009498] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To understand the progressive nature of amyotrophic lateral sclerosis (ALS) by investigating differential brain patterns of gray and white matter involvement in clinically or genetically defined subgroups of patients using cross-sectional, longitudinal, and multimodal MRI. METHODS We assessed cortical thickness, subcortical volumes, and white matter connectivity from T1-weighted and diffusion-weighted MRI in 292 patients with ALS (follow-up: n = 150) and 156 controls (follow-up: n = 72). Linear mixed-effects models were used to assess changes in structural brain measurements over time in patients compared to controls. RESULTS Patients with a C9orf72 mutation (n = 24) showed widespread gray and white matter involvement at baseline, and extensive loss of white matter integrity in the connectome over time. In C9orf72-negative patients, we detected cortical thinning of motor and frontotemporal regions, and loss of white matter integrity of connections linked to the motor cortex. Patients with spinal onset displayed widespread white matter involvement at baseline and gray matter atrophy over time, whereas patients with bulbar onset started out with prominent gray matter involvement. Patients with unaffected cognition or behavior displayed predominantly motor system involvement, while widespread cerebral changes, including frontotemporal regions with progressive white matter involvement over time, were associated with impaired behavior or cognition. Progressive loss of gray and white matter integrity typically occurred in patients with shorter disease durations (<13 months), independent of progression rate. CONCLUSIONS Heterogeneity of phenotype and C9orf72 genotype relates to distinct patterns of cerebral degeneration. We demonstrate that imaging studies have the potential to monitor disease progression and early intervention may be required to limit cerebral degeneration.
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Affiliation(s)
- Hannelore K van der Burgh
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Henk-Jan Westeneng
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Renée Walhout
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Kevin van Veenhuijzen
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Harold H G Tan
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jil M Meier
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Leonhard A Bakker
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Michael A van Es
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jan H Veldink
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Martijn P van den Heuvel
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands.
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Huynh W, Ahmed R, Mahoney CJ, Nguyen C, Tu S, Caga J, Loh P, Lin CSY, Kiernan MC. The impact of cognitive and behavioral impairment in amyotrophic lateral sclerosis. Expert Rev Neurother 2020; 20:281-293. [DOI: 10.1080/14737175.2020.1727740] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- William Huynh
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Rebekah Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Colin J. Mahoney
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Chilan Nguyen
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Sicong Tu
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Jashelle Caga
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Patricia Loh
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Cindy S-Y Lin
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Matthew C. Kiernan
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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Luo C, Hu N, Xiao Y, Zhang W, Gong Q, Lui S. Comparison of Gray Matter Atrophy in Behavioral Variant Frontal Temporal Dementia and Amyotrophic Lateral Sclerosis: A Coordinate-Based Meta-Analysis. Front Aging Neurosci 2020; 12:14. [PMID: 32116647 PMCID: PMC7026505 DOI: 10.3389/fnagi.2020.00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
Background: There is growing evidence supporting behavioral variant frontotemporal dementia (bvFTD) and amyotrophic lateral sclerosis (ALS) as extreme points of a disease spectrum. The aim of this study was to delineate the common and different patterns of gray matter atrophy associated with bvFTD and with ALS by pooling together the results of previous voxel-based morphometry (VBM) studies. Methods: We retrieved VBM studies that investigated gray matter atrophy in bvFTD patients vs. controls and in ALS patients vs. controls. Stereotactic data were extracted from those studies and subsequently tested for convergence and differences using activation likelihood estimation (ALE). A behavioral analysis using the BrainMap database was performed to assess the functional roles of the regions affected by bvFTD and/or ALS. Results: Our study demonstrated a convergence of gray matter atrophy in the frontolimbic structures that involve the bilateral anterior insula and anterior cingulate cortex. Comparing the pattern of GM atrophy in bvFTD and ALS patients revealed greater atrophy in the frontomedial cortex, bilateral caudate, left anterior insula, and right thalamus in those with bvFTD and a higher degree of atrophy in the right motor cortex of those with ALS. Behavioral analysis revealed that the pattern of the affected regions contributed to the dysfunction of emotional and cognitive processing in bvFTD patients and the dysfunction of motor execution in ALS patients. Conclusion: Our results revealed a shared neural basis between bvFTD and ALS subjects, as well as a specific and distinct neural signature that underpinned the clinical manifestations of those two diseases. Those findings outlined the role of the frontomedial-caudate circuit in the development of bvFTD-like deficits in ALS patients.
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Affiliation(s)
- Chunyan Luo
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Na Hu
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
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Benbrika S, Desgranges B, Eustache F, Viader F. Cognitive, Emotional and Psychological Manifestations in Amyotrophic Lateral Sclerosis at Baseline and Overtime: A Review. Front Neurosci 2019; 13:951. [PMID: 31551700 PMCID: PMC6746914 DOI: 10.3389/fnins.2019.00951] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is now well recognized that, in addition to motor impairment, amyotrophic lateral sclerosis (ALS) may cause extra-motor clinical signs and symptoms. These can include the alteration of certain cognitive functions, impaired social cognition, and changes in the perception and processing of emotions. Where these extra-motor manifestations occur in ALS, they usually do so from disease onset. In about 10% of cases, the cognitive and behavioral changes meet the diagnostic criteria for frontotemporal dementia. The timecourse of behavioral and cognitive involvement in ALS is unclear. Whereas longitudinal studies have failed to show cognitive decline over time, some cross-sectional studies have demonstrated poorer cognitive performances in the advanced stages of the disease. Neuroimaging studies show that in ALS, extra-motor signs and symptoms are associated with specific brain lesions, but little is known about how they change over time. Finally, patients with ALS appear less depressed than might be expected, given the prognosis. Moreover, many patients achieve satisfactory psychosocial adjustment throughout the course of the disease, regardless of their degree of motor disability. There are scant longitudinal data on extra-motor impairment in ALS, and to our knowledge, no systematic review on this subject has yet been published. Even so, a better understanding of patients' clinical trajectory is essential if they are to be provided with tailored care and given the best possible support. We therefore undertook to review the evidence for extra-motor changes and their time course in ALS, in both the cognitive, emotional and psychological domains, with a view to identifying mechanisms that may help these patients cope with their disease.
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Affiliation(s)
| | - Béatrice Desgranges
- Neuropsychology and Imaging of Human Memory, Normandy University-PSL Research University-EPHE-INSERM U1077, Caen University Hospital, Caen, France
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Trojsi F, Caiazzo G, Siciliano M, Femiano C, Passaniti C, Russo A, Bisecco A, Monsurrò MR, Cirillo M, Esposito F, Tedeschi G, Santangelo G. Microstructural correlates of Edinburgh Cognitive and Behavioural ALS Screen (ECAS) changes in amyotrophic lateral sclerosis. Psychiatry Res Neuroimaging 2019; 288:67-75. [PMID: 30987770 DOI: 10.1016/j.pscychresns.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed for testing patients with amyotrophic lateral sclerosis (ALS), a multi-system neurodegenerative disease characterized by progressive physical disability. In this study, we aim to explore the potential brain microstructural substrates associated with performance on ECAS in the early stages of ALS, using a whole-brain tract-based spatial statistics diffusion tensor imaging approach. Thirty-six non-demented ALS patients, assessed using ECAS, and 35 age-, sex- and education-matched healthy controls underwent magnetic resonance imaging at 3 Tesla. The ALS patients showed decreased fractional anisotropy (FA) in the cortico-spinal tracts and corpus callosum (CC) and significant association between verbal fluency score, among ALS-specific ECAS scores, and FA measures in several long association fiber tracts in the frontal, temporal and parietal lobes. Furthermore, the ALS non-specific total score was inversely related to axial diffusivity (AD) in the mediodorsal nucleus of the thalamus, with more extended areas of correlation in the CC, when considering only the memory subscore. Our results point towards microstructural degeneration across motor and extra-motor areas in ALS, underlining that alterations in verbal fluency performances may be related to impairment of frontotemporal connectivity, while alterations of memory may be associated with damage of thalamocortical circuits.
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Affiliation(s)
- Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy.
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Cinzia Femiano
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Maria Rosaria Monsurrò
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Baronissi, Salerno, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Consonni M, Dalla Bella E, Nigri A, Pinardi C, Demichelis G, Porcu L, Gellera C, Pensato V, Cappa SF, Bruzzone MG, Lauria G, Ferraro S. Cognitive Syndromes and C9orf72 Mutation Are Not Related to Cerebellar Degeneration in Amyotrophic Lateral Sclerosis. Front Neurosci 2019; 13:440. [PMID: 31133784 PMCID: PMC6524613 DOI: 10.3389/fnins.2019.00440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/17/2019] [Indexed: 01/30/2023] Open
Abstract
Objective The notion that cerebellar pathology may contribute to cognitive impairment in ALS, especially in patients with C9orf72 repeated expansion, has been inconsistently reported. This study aimed exploring the relationship between cerebellar involvement, cognitive impairment and C9orf72 repeated expansion of patients with ALS. Methods Quantitative in vivo assessment of cerebellar lobules has been investigated in 66 non-demented patients with ALS and 28 healthy controls (HCs). Pathologic C9orf72 repeated expansion was found in 13 patients. Mild cognitive and/or behavioral impairment was diagnosed in 22 C9orf72 negative ALS patients. Measures of cortical volume (CV) and cortical thickness (CT) of cerebellar lobules of all participants were used for Principal Component Analysis (PCA) to identify clusters of lobular measures highly correlated with each other. PCA outcomes were used for between group comparisons and correlation analyses with neuropsychological and clinical features. Results Disease severity measured with ALS functional rating scale and index of disease progression rate significantly correlated with CV reduction of the second PCA cluster loading CV measures of anterior lobules. In all patients, cognitive impairment, measured with verbal fluency, was related to CV reduction of the third cluster comprising posterior lobules. No specific cortical thinning or volume reduction of cerebellar clustering patterns could be detected in ALS subgroups. Conclusion Our data show that specific patterns of subregional cerebellar involvement are associated with physical disability or cognitive impairment in ALS, in line with the topographic organization of the cerebellum. However, there was no specific correlation between cerebellar degeneration and cognitive syndromes or C9orf72 mutations.
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Affiliation(s)
- Monica Consonni
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
| | - Chiara Pinardi
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Cinzia Gellera
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Viviana Pensato
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefano F Cappa
- Institute for Advanced Study-IUSS Pavia, Pavia, Italy.,IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Stefania Ferraro
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
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Christidi F, Karavasilis E, Velonakis G, Rentzos M, Zambelis T, Zouvelou V, Xirou S, Ferentinos P, Efstathopoulos E, Kelekis N, Evdokimidis I, Karandreas N. Motor and extra-motor gray matter integrity may underlie neurophysiologic parameters of motor function in amyotrophic lateral sclerosis: a combined voxel-based morphometry and transcranial stimulation study. Brain Imaging Behav 2019; 12:1730-1741. [PMID: 29417490 DOI: 10.1007/s11682-018-9841-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The association between gray matter (GM) density and neurophysiologic changes is still unclear in amyotrophic lateral sclerosis (ALS). We evaluated the relationship between GM density and motor system integrity combining voxel-based morphometry (VBM) and transcranial magnetic stimulation (TMS) in ALS. We included 17 ALS patients and 22 healthy controls (HC) who underwent 3D-T1-weighted imaging. Among the ALS group, we applied left motor cortex single-pulse TMS. We used whole-brain VBM comparing ALS and HC in GM density. We also conducted regression analysis to examine correlations between GM density and the following TMS parameters: motor evoked potential (MEP)/M ratio and central motor conduction time (CMCT). We found significantly decreased GM density in ALS patients in several frontal, temporal, parietal/occipital and cerebellar regions (p < 0.001 uncorrected; cluster-extent threshold k = 100 voxels per cluster). With regards to TMS parameters, ALS patients showed mostly increased MEP/M ratio and modest prolongation of CMCT. MEP/M ratio was associated with GM density in (a) rolandic operculum/inferior frontal gyrus/precentral gyrus; anterior cingulate gyrus; inferior temporal gyrus; superior parietal lobule; cuneus; superior occipital gyrus and cerebellum (positive association) and (b) paracentral lobule/supplementary motor area (negative association). CMCT was associated with GM density in (a) inferior frontal gyrus and middle cingulated gyrus (positive association) and (b) superior parietal lobule; cuneus and cerebellum (negative association). Our findings support a significant interaction between motor and extra-motor structural and functional changes and highlight that motor and extra-motor GM integrity may underlie TMS parameters of motor function in ALS patients.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece.
| | - Efstratios Karavasilis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
| | - Thomas Zambelis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
| | - Sophia Xirou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, Attikon University Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
| | - Nikolaos Karandreas
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, 72-74 Vas. Sophias Avenue, Athens, 11528, Greece
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47
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Consonni M, Cappa SF, Dalla Bella E, Contarino VE, Lauria G. Cortical correlates of behavioural change in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:380-386. [PMID: 30322899 DOI: 10.1136/jnnp-2018-318619] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Behavioural changes in amyotrophic lateral sclerosis (ALS) are heterogeneous. The study aim was to identify the behavioural profiles of non-demented patients with ALS and their neuroimaging correlates and to elucidate if they are comparable to those reported in studies of the behavioural-variant of frontotemporal dementia (bvFTD). METHODS Behavioural changes of 102 non-demented patients with ALS were assessed through the Frontal Behavioural Inventory (FBI), a 24-item scale assessing different behavioural modifications, mainly chosen from the core clinical features of FTD. Principal component analysis (PCA) was used to detect distinct clusters of behavioural changes based on FBI subscores. The cortical thinning related to each behavioural profile was analysed in 29 patients with ALS. Cronbach's α was used to test the reliability of bvFTD-related FBI clustering in our cohort. RESULTS Sixty patients with ALS had FBI score≥1. PCA identified three phenotypic clusters loading on disinhibited/hostile, dysexecutive and apathetic FBI subscores. Imaging analyses revealed that the thinning of bilateral orbitofrontal cortex was related to apathy, the right frontotemporal and cingular cortex to the disinhibited/hostile profile and the left precuneus cortex to the dysexecutive behaviours. The bvFTD-associated aggressive profile reliably applied to our cohort. CONCLUSIONS In non-demented patients with ALS, different behavioural profiles could be identified. The right frontotemporal and cingular cortex thinning was the hallmark of the behavioural profile mostly overlapping that described in bvFTD. Our findings provide the unbiased identification of determinants relevant for a novel stratification of patients with ALS based on their behavioural impairment, which might be useful as proxy of cognitive decline.
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Affiliation(s)
- Monica Consonni
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefano F Cappa
- Institute for Advanced Study-IUSS Pavia, Pavia, Italy.,IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valeria Elisa Contarino
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy .,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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48
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Spinelli EG, Agosta F, Ferraro PM, Querin G, Riva N, Bertolin C, Martinelli I, Lunetta C, Fontana A, Sorarù G, Filippi M. Brain MRI shows white matter sparing in Kennedy's disease and slow-progressing lower motor neuron disease. Hum Brain Mapp 2019; 40:3102-3112. [PMID: 30924230 DOI: 10.1002/hbm.24583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 01/18/2023] Open
Abstract
The extent of central nervous system involvement in Kennedy's disease (KD) relative to other motor neuron disease (MND) phenotypes still needs to be clarified. In this study, we investigated cortical and white matter (WM) MRI alterations in 25 patients with KD, compared with 24 healthy subjects, 25 patients with sporadic amyotrophic lateral sclerosis (ALS), and 35 cases with lower motor neuron-predominant disease (LMND). LMND patients were clinically differentiated into 24 fast and 11 slow progressors. Whole-brain cortical thickness, WM tract-based spatial statistics and corticospinal tract (CST) tractography analyses were performed. No significant difference in terms of cortical thickness was found between groups. ALS patients showed widespread decreased fractional anisotropy and increased mean (MD) and radial diffusivity (radD) in the CST, corpus callosum and fronto-temporal extra-motor tracts, compared with healthy controls and other patient groups. CST tractography showed significant alterations of DT MRI metrics in ALS and LMND-fast patients whereas KD and LMND-slow patients were comparable with healthy controls. Our study demonstrated the absence of WM abnormalities in patients with KD and LMND-slow, in contrast with diffuse WM damage in ALS and focal CST degeneration in LMND-fast, supporting the use of DT MRI measures as powerful tools to differentiate fast- and slow-progressing MND syndromes, including KD.
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Affiliation(s)
- Edoardo G Spinelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pilar M Ferraro
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgia Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Cinzia Bertolin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | | | - Andrea Fontana
- Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Unit of Biostatistics, Foggia, Italy
| | - Gianni Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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49
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Basaia S, Filippi M, Spinelli EG, Agosta F. White Matter Microstructure Breakdown in the Motor Neuron Disease Spectrum: Recent Advances Using Diffusion Magnetic Resonance Imaging. Front Neurol 2019; 10:193. [PMID: 30891004 PMCID: PMC6413536 DOI: 10.3389/fneur.2019.00193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Motor neuron disease (MND) is a fatal progressive neurodegenerative disorder characterized by the breakdown of the motor system. The clinical spectrum of MND encompasses different phenotypes classified according to the relative involvement of the upper or lower motor neurons (LMN) and the presence of genetic or cognitive alterations, with clear prognostic implications. However, the pathophysiological differences of these phenotypes remain largely unknown. Recently, magnetic resonance imaging (MRI) has been recognized as a helpful in-vivo MND biomarker. An increasing number of studies is applying advanced neuroimaging techniques in order to elucidate the pathophysiological processes and to identify quantitative outcomes to be used in clinical trials. Diffusion tensor imaging (DTI) is a non-invasive method to detect white matter alterations involving the upper motor neuron and extra-motor white matter tracts. According to this background, the aim of this review is to highlight the key role of MRI and especially DTI, summarizing cross-sectional and longitudinal results of different approaches applied in MND. Current literature suggests that DTI is a promising tool in order to define anatomical “signatures” of the different phenotypes of MND and to track in vivo the progressive spread of pathological proteins aggregates.
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Affiliation(s)
- Silvia Basaia
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo G Spinelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
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50
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Christidi F, Karavasilis E, Riederer F, Zalonis I, Ferentinos P, Velonakis G, Xirou S, Rentzos M, Argiropoulos G, Zouvelou V, Zambelis T, Athanasakos A, Toulas P, Vadikolias K, Efstathopoulos E, Kollias S, Karandreas N, Kelekis N, Evdokimidis I. Gray matter and white matter changes in non-demented amyotrophic lateral sclerosis patients with or without cognitive impairment: A combined voxel-based morphometry and tract-based spatial statistics whole-brain analysis. Brain Imaging Behav 2019; 12:547-563. [PMID: 28425061 DOI: 10.1007/s11682-017-9722-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The phenotypic heterogeneity in amyotrophic lateral sclerosis (ALS) implies that patients show structural changes within but also beyond the motor cortex and corticospinal tract and furthermore outside the frontal lobes, even if frank dementia is not detected. The aim of the present study was to investigate both gray matter (GM) and white matter (WM) changes in non-demented amyotrophic lateral sclerosis (ALS) patients with or without cognitive impairment (ALS-motor and ALS-plus, respectively). Nineteen ALS-motor, 31 ALS-plus and 25 healthy controls (HC) underwent 3D-T1-weighted and 30-directional diffusion-weighted imaging on a 3 T MRI scanner. Voxel-based morphometry and tract-based spatial-statistics analysis were performed to examine GM volume (GMV) changes and WM differences in fractional anisotropy (FA), axial and radial diffusivity (AD, RD, respectively). Compared to HC, ALS-motor patients showed decreased GMV in frontal and cerebellar areas and increased GMV in right supplementary motor area, while ALS-plus patients showed diffuse GMV reduction in primary motor cortex bilaterally, frontotemporal areas, cerebellum and basal ganglia. ALS-motor patients had increased GMV in left precuneus compared to ALS-plus patients. We also found decreased FA and increased RD in the corticospinal tract bilaterally, the corpus callosum and extra-motor tracts in ALS-motor patients, and decreased FA and increased AD and RD in motor and several WM tracts in ALS-plus patients, compared to HC. Multimodal neuroimaging confirms motor and extra-motor GM and WM abnormalities in non-demented cognitively-impaired ALS patients (ALS-plus) and identifies early extra-motor brain pathology in ALS patients without cognitive impairment (ALS-motor).
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece.
| | - Efstratios Karavasilis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Franz Riederer
- Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Ioannis Zalonis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, Attikon University Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Sophia Xirou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Michalis Rentzos
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Argiropoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Thomas Zambelis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Athanasios Athanasakos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Panagiotis Toulas
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | | | - Efstathios Efstathopoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Spyros Kollias
- Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Nikolaos Karandreas
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
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