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Chen Q, Kantarci K. Imaging Biomarkers for Neurodegeneration in Presymptomatic Familial Frontotemporal Lobar Degeneration. Front Neurol 2020; 11:80. [PMID: 32184751 PMCID: PMC7058699 DOI: 10.3389/fneur.2020.00080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/22/2020] [Indexed: 02/05/2023] Open
Abstract
Frontotemporal lobar degeneration (FTLD) is a neurodegenerative disorder characterized by behavioral changes, language abnormality, as well as executive function deficits and motor impairment. In about 30-50% of FTLD patients, an autosomal dominant pattern of inheritance was found with major mutations in the MAPT, GRN, and the C9orf72 repeat expansion. These mutations could lead to neurodegenerative pathology years before clinical symptoms onset. With potential disease-modifying treatments that are under development, non-invasive biomarkers that help determine the early brain changes in presymptomatic FTLD patients will be critical for tracking disease progression and enrolling the right participants into the clinical trials at the right time during the disease course. In recent years, there is increasing evidence that a number of imaging biomarkers show the abnormalities during the presymptomatic stage. Imaging biomarkers of presymptomatic familial FTLD may provide insight into the underlying neurodegenerative process years before symptom onset. Structural magnetic resonance imaging (MRI) has demonstrated cortical degeneration with a mutation-specific neurodegeneration pattern years before onset of clinical symptoms in presymptomatic familial FTLD mutation carriers. In addition, diffusion tensor imaging (DTI) has shown the loss of white matter microstructural integrity in the presymptomatic stage of familial FTLD. Furthermore, proton magnetic resonance spectroscopy (1H MRS), which provides a non-invasive measurement of brain biochemistry, has identified early neurochemical abnormalities in presymptomatic MAPT mutation carriers. Positron emission tomography (PET) imaging with [18F]-fluorodeoxyglucose (FDG) has demonstrated the glucose hypometabolism in the presymptomatic stage of familial FTLD. Also, a novel PET ligand, 18F-AV-1451, has been used in this group to evaluate tau deposition in the brain. Promising imaging biomarkers for presymptomatic familial FTLD have been identified and assessed for specificity and sensitivity for accurate prediction of symptom onset and tracking disease progression during the presymptomatic stage when clinical measures are not useful. Furthermore, identifying imaging biomarkers for the presymptomatic stage is important for the design of disease-modifying trials. We review the recent progress in imaging biomarkers of the presymptomatic phase of familial FTLD and discuss the imaging techniques and analysis methods, with a focus on the potential implication of these imaging techniques and their utility in specific mutation types.
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Affiliation(s)
- Qin Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.,Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
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Chen Q, Boeve BF, Senjem M, Tosakulwong N, Lesnick TG, Brushaber D, Dheel C, Fields J, Forsberg L, Gavrilova R, Gearhart D, Graff-Radford J, Graff-Radford NR, Jack CR, Jones DT, Knopman DS, Kremers WK, Lapid M, Rademakers R, Syrjanen J, Boxer AL, Rosen H, Wszolek ZK, Kantarci K. Rates of lobar atrophy in asymptomatic MAPT mutation carriers. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:338-346. [PMID: 31388560 PMCID: PMC6675939 DOI: 10.1016/j.trci.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the rates of lobar atrophy in the asymptomatic microtubule-associated protein tau (MAPT) mutation carriers. METHODS MAPT mutation carriers (n = 14; 10 asymptomatic, 4 converters from asymptomatic to symptomatic) and noncarriers (n = 13) underwent structural magnetic resonance imaging and were followed annually with a median of 9.2 years. Longitudinal changes in lobar atrophy were analyzed using the tensor-based morphometry with symmetric normalization algorithm. RESULTS The rate of temporal lobe atrophy in asymptomatic MAPT mutation carriers was faster than that in noncarriers. Although the greatest rate of atrophy was observed in the temporal lobe in converters, they also had increased atrophy rates in the frontal and parietal lobes compared to noncarriers. DISCUSSION Accelerated decline in temporal lobe volume occurs in asymptomatic MAPT mutation carriers followed by the frontal and parietal lobe in those who have become symptomatic. The findings have implications for monitoring the progression of neurodegeneration during clinical trials in asymptomatic MAPT mutation carriers.
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Affiliation(s)
- Qin Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - Matthew Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Danielle Brushaber
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Christina Dheel
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - Julie Fields
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - Ralitza Gavrilova
- Department of Clinical Genomic and Neurology, Mayo Clinic, Rochester, MN, USA
| | - Debra Gearhart
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | | | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - David S. Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | - Walter K. Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Maria Lapid
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Rosa Rademakers
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Jeremy Syrjanen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Adam L. Boxer
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Howie Rosen
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
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Kim SH, Yu MM, Strutt AM. Variably protease-sensitive prionopathy: A differential diagnostic consideration for dementia. Neurol Clin Pract 2019; 9:145-151. [PMID: 31041129 DOI: 10.1212/cpj.0000000000000612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/27/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Prion diseases are rare neurodegenerative diseases that are caused by abnormal pathogenic agents and can affect both humans and animals. These diseases are categorized as sporadic, inherited, or acquired by infection. Clinical manifestations include psychiatric symptoms, cognitive impairment, and parkinsonism, which are similar to those of other prion diseases and frontotemporal dementia variants. Recent findings More recently, scientists discovered a new sporadic prion disease called variably protease-sensitive prionopathy. Summary The following case discusses a patient presenting with sudden onset and rapid decline in cognitive, neurobehavioral, and motor functioning and his clinical journey including treatment interventions and diagnostic confirmation.
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Liss JM, Krein-Jones K, Wszolek ZK, Caviness JN. Speech characteristics of patients with pallido-ponto-nigral degeneration and their application to presymptomatic detection in at-risk relatives. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2006; 15:226-35. [PMID: 16896172 DOI: 10.1044/1058-0360(2006/021)] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE This report describes the speech characteristics of individuals with a neurodegenerative syndrome called pallido-ponto-nigral degeneration (PPND) and examines the speech samples of at-risk, but asymptomatic, relatives for possible preclinical detection. METHOD Speech samples of 9 members of a PPND kindred were subjected to perceptual characterization. Speech deterioration patterns were reported for 2 participants followed longitudinally at 6-month intervals. Cross-sectional findings were reported for 3 participants at various stages of disease. Longitudinal and cross-sectional findings were used to guide the examination of 4 at-risk, but asymptomatic, participants. RESULTS Results revealed a progressive mixed dysarthria with hypokinetic, spastic, and flaccid features. It was characterized primarily by vocal tremor and high-frequency vocal flutter, speaking rate abnormalities most often in the direction of slowing, and a tendency toward monopitch. Dysarthria progression was marked by exacerbation and increasing severity of early features, progressive decrease in spontaneous speech output, verbal perseverations, and eventual mutism. Results for at-risk participants revealed preclinical speech abnormalities that preceded other motor signs. Speech results were examined in light of available autopsy findings for site of lesion associations. CONCLUSION The dysarthria of PPND is an early harbinger of disease onset. It has a mixed presentation, with hypokinetic, spastic, and flaccid features.
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Affiliation(s)
- Julie M Liss
- Motor Speech Disorders Laboratory, Department of Speech & Hearing Science, Arizona State University, Tempe, AZ 85287-0102, USA.
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