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Gallée J, Cartwright J, Grasso S, Jokel R, Lavoie M, McGowan E, Pozzebon M, Beber BC, Duboisdindien G, Montagut N, Norvik M, Sugimoto T, Townsend R, Unger N, Winsnes IE, Volkmer A. Global Perspectives on the Management of Primary Progressive Aphasia. RESEARCH SQUARE 2024:rs.3.rs-4100219. [PMID: 38562789 PMCID: PMC10984010 DOI: 10.21203/rs.3.rs-4100219/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Speech-language therapists/pathologists (SLT/Ps) are key professionals in the management and treatment of primary progressive aphasia (PPA), however, there are gaps in education and training within the discipline, with implications for skills, confidence, and clinical decision-making. This survey aimed to explore the areas of need amongst SLT/Ps working with people living with PPA (PwPPA) internationally to upskill the current and future workforce working with progressive communication disorders. One hundred eighty-five SLT/Ps from 27 countries who work with PwPPA participated in an anonymous online survey about their educational and clinical experiences, clinical decision-making, and self-reported areas of need when working with this population. Best practice principles for SLT/Ps working with PwPPA were used to frame the latter two sections of this survey. Only 40.7% of respondents indicated that their university education prepared them for their current work with PwPPA. Competency areas of "Knowing people deeply," "Practical issues," "Connectedness," and "Preventing disasters" were identified as the basic areas of priority and need. Respondents identified instructional online courses (92.5%), sample tools and activities for interventions (64.8%), and concrete training on providing care for advanced stages and end of life (58.3%) as central areas of need in their current work. This is the first international survey to comprehensively explore the perspectives of SLT/Ps working with PwPPA. Based on survey outcomes, there is a pressing need to enhance current educational and ongoing training opportunities to better promote the well-being of PwPPA and their families, and to ensure appropriate preparation of the current and future SLT/P workforce.
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Affiliation(s)
- Jeanne Gallée
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Stephanie Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Regina Jokel
- Temerty Faculty of Medicine, University of Toronto
| | - Monica Lavoie
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | | | | | - Bárbara Costa Beber
- Department of Speech, Language, and Hearing Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
| | - Guillaume Duboisdindien
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | - Núria Montagut
- Alzheimer's Disease and other Cognitive Disorders Unit, Neurology Service, Hospital Clinic Barcelona
| | - Monica Norvik
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Taiki Sugimoto
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Nina Unger
- Department of Neurology, University Medicine Greifswald
| | - Ingvild E Winsnes
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Anna Volkmer
- Department of Psychology and Language Science, University College London
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Parmera JB, de Godoi Carneiro C, de Almeida IJ, de Oliveira MCB, Barbosa PM, Studart-Neto A, Ono CR, Nitrini R, Buchpiguel CA, Barbosa ER, Brucki SMD, Coutinho AM. Probable 4-Repeat Tauopathy Criteria Predict Brain Amyloid Negativity, Distinct Clinical Features, and FDG-PET/MRI Neurodegeneneration Patterns in Corticobasal Syndrome. Mov Disord Clin Pract 2024; 11:238-247. [PMID: 38155526 DOI: 10.1002/mdc3.13959] [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: 05/25/2023] [Revised: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Corticobasal syndrome (CBS) is associated with diverse underlying pathologies, including the four-repeat (4R)-tauopathies. The Movement Disorders Society (MDS) criteria for progressive supranuclear palsy (PSP) proposed the novel category "probable 4R-tauopathy" to address the phenotypic overlap between PSP and corticobasal degeneration (CBD). OBJECTIVES To investigate the clinical ability of the MDS-PSP criteria for probable 4R-tauopathy in predicting a negative amyloid-PET in CBS. Additionally, this study aims to explore CBS patients classified as 4R-tauopathy concerning their clinical features and neuroimaging degeneration patterns. METHODS Thirty-two patients with probable CBS were prospectively evaluated and split into those who fulfilled or did not fulfill the 4R-tauopathy criteria (CBS-4RT+ vs. CBS-4RT-). All patients underwent positron emission tomographies (PET) with [18 F]fluorodeoxyglucose and [11 C]Pittsburgh Compound-B (PIB) on a hybrid PET-MRI scanner to perform multimodal quantitative comparisons with a control group. RESULTS Eleven patients were clinically classified as CBS-4RT+, and only one had a positive PIB-PET. The CBS-4RT+ classification had 92% specificity, 52% sensitivity, and 69% accuracy in predicting a negative PIB-PET. The CBS-4RT+ group presented with dysarthria and perseveration more often than the CBS-4RT- group. Moreover, the CBS-4RT+ group showed a prominent frontal hypometabolism extending to the supplementary motor area and striatum, and brain atrophy at the anterior cingulate and bilateral striata. CONCLUSIONS The 4R-tauopathy criteria were highly specific in predicting a negative amyloid-PET in CBS. Patients classified as 4R-tauopathy presented distinct clinical aspects, as well as brain metabolism and atrophy patterns previously associated with tauopathies.
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Affiliation(s)
- Jacy Bezerra Parmera
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Camila de Godoi Carneiro
- Laboratory of Nuclear Medicine (LIM 43), Nuclear Medicine Division and Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Isabel Junqueira de Almeida
- Department of Physical Therapy, Speech, and Occupational Therapy, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | | | - Pedro Melo Barbosa
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Adalberto Studart-Neto
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Carla Rachel Ono
- Laboratory of Nuclear Medicine (LIM 43), Nuclear Medicine Division and Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Laboratory of Nuclear Medicine (LIM 43), Nuclear Medicine Division and Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Artur Martins Coutinho
- Laboratory of Nuclear Medicine (LIM 43), Nuclear Medicine Division and Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
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Ducharme S, Pijnenburg Y, Rohrer JD, Huey E, Finger E, Tatton N. Identifying and Diagnosing TDP-43 Neurodegenerative Diseases in Psychiatry. Am J Geriatr Psychiatry 2024; 32:98-113. [PMID: 37741764 DOI: 10.1016/j.jagp.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/25/2023]
Abstract
Neuropsychiatric symptoms (NPS) are common manifestations of neurodegenerative disorders and are often early signs of those diseases. Among those neurodegenerative diseases, TDP-43 proteinopathies are an increasingly recognized cause of early neuropsychiatric manifestations. TDP-43-related diseases include frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS), and Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE). The majority of TDP-43-related diseases are sporadic, but a significant proportion is hereditary, with progranulin (GRN) mutations and C9orf72 repeat expansions as the most common genetic etiologies. Studies reveal that NPS can be the initial manifestation of those diseases or can complicate disease course, but there is a lack of awareness among clinicians about TDP-43-related diseases, which leads to common diagnostic mistakes or delays. There is also emerging evidence that TDP-43 accumulations could play a role in late-onset primary psychiatric disorders. In the absence of robust biomarkers for TDP-43, the diagnosis remains primarily based on clinical assessment and neuroimaging. Given the association with psychiatric symptoms, clinical psychiatrists have a key role in the early identification of patients with TDP-43-related diseases. This narrative review provides a comprehensive overview of the pathobiology of TDP-43, resulting clinical presentations, and associated neuropsychiatric manifestations to help guide clinical practice.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry (SD), Douglas Mental Health University Institute, McGill University, Montreal, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience (YP), Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease (JDR), UCL Queen Square Institute of Neurology, London, UK
| | - Edward Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Psychiatry (EH), Columbia University, New York, NY
| | - Elizabeth Finger
- London Health Sciences Centre Parkwood Institute (EF), London, ON, Canada
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Adams NE, Jafarian A, Perry A, Rouse MA, Shaw AD, Murley AG, Cope TE, Bevan-Jones WR, Passamonti L, Street D, Holland N, Nesbitt D, Hughes LE, Friston KJ, Rowe JB. Neurophysiological consequences of synapse loss in progressive supranuclear palsy. Brain 2023; 146:2584-2594. [PMID: 36514918 PMCID: PMC10232290 DOI: 10.1093/brain/awac471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
Synaptic loss occurs early in many neurodegenerative diseases and contributes to cognitive impairment even in the absence of gross atrophy. Currently, for human disease there are few formal models to explain how cortical networks underlying cognition are affected by synaptic loss. We advocate that biophysical models of neurophysiology offer both a bridge from preclinical to clinical models of pathology and quantitative assays for experimental medicine. Such biophysical models can also disclose hidden neuronal dynamics generating neurophysiological observations such as EEG and magnetoencephalography. Here, we augment a biophysically informed mesoscale model of human cortical function by inclusion of synaptic density estimates as captured by 11C-UCB-J PET, and provide insights into how regional synapse loss affects neurophysiology. We use the primary tauopathy of progressive supranuclear palsy (Richardson's syndrome) as an exemplar condition, with high clinicopathological correlations. Progressive supranuclear palsy causes a marked change in cortical neurophysiology in the presence of mild cortical atrophy and is associated with a decline in cognitive functions associated with the frontal lobe. Using parametric empirical Bayesian inversion of a conductance-based canonical microcircuit model of magnetoencephalography data, we show that the inclusion of regional synaptic density-as a subject-specific prior on laminar-specific neuronal populations-markedly increases model evidence. Specifically, model comparison suggests that a reduction in synaptic density in inferior frontal cortex affects superficial and granular layer glutamatergic excitation. This predicted individual differences in behaviour, demonstrating the link between synaptic loss, neurophysiology and cognitive deficits. The method we demonstrate is not restricted to progressive supranuclear palsy or the effects of synaptic loss: such pathology-enriched dynamic causal models can be used to assess the mechanisms of other neurological disorders, with diverse non-invasive measures of pathology, and is suitable to test the effects of experimental pharmacology.
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Affiliation(s)
- Natalie E Adams
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Amirhossein Jafarian
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Alistair Perry
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Matthew A Rouse
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Alexander D Shaw
- Washington Singer Laboratories, University of Exeter, Exeter EX4 4QG, UK
| | - Alexander G Murley
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Thomas E Cope
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - W Richard Bevan-Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Negin Holland
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - David Nesbitt
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Laura E Hughes
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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de Almeida IJ, Silagi ML, Carthery-Goulart MT, Parmera JB, Cecchini MA, Coutinho AM, Dozzi Brucki SM, Nitrini R, Schochat E. The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach. Brain Sci 2022; 12:brainsci12121705. [PMID: 36552165 PMCID: PMC9775929 DOI: 10.3390/brainsci12121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to characterize the oral discourse of CBS patients and to verify whether measures obtained during a semi-spontaneous speech production could differentiate CBS patients from controls. A second goal was to compare the performance of patients with CBS probably due to Alzheimer's disease (CBS-AD) pathology and CBS not related to AD (CBS-non-AD) in the same measures, based on the brain metabolic status (FDG-PET) and in the presence of amyloid deposition (amyloid-PET). Results showed that CBS patients were significantly different from controls in speech rate, lexical level, informativeness, and syntactic complexity. Discursive measures did not differentiate CBS-AD from CBS-non-AD. However, CBS-AD displayed more lexical-semantic impairments than controls, a profile that is frequently reported in patients with clinical AD and the logopenic variant of primary progressive aphasia (lvPPA). CBS-non-AD presented mainly with impairments related to motor speech disorders and syntactic complexity, as seen in the non-fluent variant of PPA.
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Affiliation(s)
- Isabel Junqueira de Almeida
- Department of Physical Therapy, Speech, and Occupational Therapy, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 05360-160, Brazil
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Correspondence: (I.J.d.A.); (M.T.C.-G.)
| | - Marcela Lima Silagi
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Department of Speech, Language and Hearing Sciences, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Maria Teresa Carthery-Goulart
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Mathematics, Computing and Cognition Center (CMCC), Federal University of ABC (UFABC), Santo André 09210-580, Brazil
- INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), São Carlos 13565-905, Brazil
- Correspondence: (I.J.d.A.); (M.T.C.-G.)
| | - Jacy Bezerra Parmera
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 01246-903, Brazil
| | - Mario Amore Cecchini
- Human Cognitive Neuroscience, Psychology Department, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
| | - Artur Martins Coutinho
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Laboratory of Nuclear Medicine (LIM-43), Nuclear Medicine Center and Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 01246-903, Brazil
| | - Sonia Maria Dozzi Brucki
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 01246-903, Brazil
| | - Ricardo Nitrini
- Cognitive and Behavioral Neurology Research Group, Department of Neurology, University of São Paulo, São Paulo 01246-903, Brazil
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 01246-903, Brazil
| | - Eliane Schochat
- Department of Physical Therapy, Speech, and Occupational Therapy, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 05360-160, Brazil
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Cordella C, Gutz SE, Eshghi M, Stipancic KL, Schliep M, Dickerson BC, Green JR. Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4112-4132. [PMID: 36306508 PMCID: PMC9940887 DOI: 10.1044/2022_jslhr-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21401778.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | | | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Isella V, Licciardo D, Ferri F, Crivellaro C, Morzenti S, Appollonio I, Ferrarese C. Reduced phonemic fluency in progressive supranuclear palsy is due to dysfunction of dominant BA6. Front Aging Neurosci 2022; 14:969875. [PMID: 36158541 PMCID: PMC9492952 DOI: 10.3389/fnagi.2022.969875] [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: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reduced phonemic fluency is extremely frequent in progressive supranuclear palsy (PSP), but its neural correlate is yet to be defined. Objective We explored the hypothesis that poor fluency in PSP might be due to neurodegeneration within a dominant frontal circuit known to be involved in speech fluency, including the opercular area, the superior frontal cortex (BA6), and the frontal aslant tract connecting these two regions. Methods We correlated performance on a letter fluency task (F, A, and S, 60 s for each letter) with brain metabolism as measured with Fluoro-deoxy-glucose Positron Emission Tomography, using Statistical Parametric Mapping, in 31 patients with PSP. Results Reduced letter fluency was associated with significant hypometabolism at the level of left BA6. Conclusion Our finding is the first evidence that in PSP, as in other neurogical disorders, poor self-initiated, effortful verbal retrieval appears to be linked to dysfunction of the dominant opercular-aslant-BA6 circuit.
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Affiliation(s)
- Valeria Isella
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
| | - Daniele Licciardo
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | - Francesca Ferri
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Ildebrando Appollonio
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | - Carlo Ferrarese
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
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The Cognitive Profile of Atypical Parkinsonism: A Meta-Analysis. Neuropsychol Rev 2022; 33:514-543. [PMID: 35960471 DOI: 10.1007/s11065-022-09551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 07/04/2022] [Indexed: 10/15/2022]
Abstract
Atypical Parkinsonism (AP) syndromes are characterized by a wide spectrum of non-motor symptoms including prominent attentional and executive deficits. However, the cognitive profile of AP and its differences and similarities with that of Parkinson's Disease (PD) are still a matter of debate. The present meta-analysis aimed at identifying patterns of cognitive impairment in AP by comparing global cognitive functioning, memory, executive functions, visuospatial abilities, language, non-verbal reasoning, and processing speed test performances of patients with AP relative to healthy controls and patients with PD. All investigated cognitive domains showed a substantial impairment in patients with AP compared to healthy controls. When AP syndromes were considered separately, their cognitive functioning was distributed along a continuum from Multiple Systemic Atrophy at one extreme, with the least impaired cognitive profile (similar to that observed in PD) to Progressive Supranuclear Palsy, with the greatest decline in global cognitive and executive functioning (similar to Corticobasal Syndrome). These findings indicate that widespread cognitive impairment could represent an important clinical indicator to distinguish AP from other movement disorders.
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García AM, Welch AE, Mandelli ML, Henry ML, Lukic S, Torres Prioris MJ, Deleon J, Ratnasiri BM, Lorca-Puls DL, Miller BL, Seeley W, Vogel AP, Gorno-Tempini ML. Automated Detection of Speech Timing Alterations in Autopsy-Confirmed Nonfluent/Agrammatic Variant Primary Progressive Aphasia. Neurology 2022; 99:e500-e511. [PMID: 35914945 PMCID: PMC9421598 DOI: 10.1212/wnl.0000000000200750] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Motor speech function, including speech timing, is a key domain for diagnosing nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard assessments use subjective, specialist-dependent evaluations, undermining reliability and scalability. Moreover, few studies have examined relevant anatomo-clinical alterations in patients with pathologically confirmed diagnoses. This study overcomes such caveats using automated speech timing analyses in a unique cohort of autopsy-proven cases. METHODS In a cross-sectional study, we administered an overt reading task and quantified articulation rate, mean syllable and pause duration, and syllable and pause duration variability. Neuroanatomical disruptions were assessed using cortical thickness and white matter (WM) atrophy analysis. RESULTS We evaluated 22 persons with nfvPPA (mean age: 67.3 years; 13 female patients) and confirmed underlying 4-repeat tauopathy, 15 persons with semantic variant primary progressive aphasia (svPPA; mean age: 66.5 years; 8 female patients), and 10 healthy controls (HCs; 70 years; 5 female patients). All 5 speech timing measures revealed alterations in persons with nfvPPA relative to both the HC and svPPA groups, controlling for dementia severity. The articulation rate robustly discriminated individuals with nfvPPA from HCs (area under the ROC curve [AUC] = 0.95), outperforming specialist-dependent perceptual measures of dysarthria and apraxia of speech severity. Patients with nfvPPA exhibited structural abnormalities in left precentral and middle frontal as well as bilateral superior frontal regions, including their underlying WM. The articulation rate correlated with atrophy of the left pars opercularis and supplementary/presupplementary motor areas. Secondary analyses showed that, controlling for dementia severity, all measures yielded greater deficits in patients with nfvPPA and corticobasal degeneration (nfvPPA-CBD, n = 12) than in those with progressive supranuclear palsy pathology (nfvPPA-PSP, n = 10). The articulation rate robustly discriminated between individuals in each subgroup (AUC = 0.82). More widespread cortical thinning was observed for the nfvPPA-CBD than the nfvPPA-PSP group across frontal regions. DISCUSSION Automated speech timing analyses can capture specific markers of nfvPPA while potentially discriminating between patients with different tauopathies. Thanks to its objectivity and scalability; this approach could support standard speech assessments. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that automated speech analysis can accurately differentiate patients with nonfluent PPA from normal controls and patients with semantic variant PPA.
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Affiliation(s)
- Adolfo M García
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Ariane E Welch
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maria Luisa Mandelli
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maya L Henry
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Sladjana Lukic
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - María José Torres Prioris
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Jessica Deleon
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Buddhika M Ratnasiri
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Diego L Lorca-Puls
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Bruce L Miller
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - William Seeley
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Adam P Vogel
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maria Luisa Gorno-Tempini
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia.
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Ransmayr L, Fuchs A, Ransmayr-Tepser S, Kommenda R, Kögl M, Schwingenschuh P, Fellner F, Guger M, Eggers C, Darkow R, Mangesius S, Ransmayr G. Differences in aphasia syndromes between progressive supranuclear palsy-Richardson's syndrome, behavioral variant frontotemporal dementia and Alzheimer's dementia. J Neural Transm (Vienna) 2022; 129:1039-1048. [PMID: 35821453 DOI: 10.1007/s00702-022-02524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Language impairments, hallmarks of speech/language variant progressive supranuclear palsy, also occur in Richardson's syndrome (PSP-RS). Impaired communication may interfere with daily activities. Therefore, assessment of language functions is crucial. It is uncertain whether the Aachen Aphasia Test (AAT) is practicable in PSP-RS, behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's dementia (AD) and language deficits differ in these disorders. 28 PSP-RS, 24 AD, and 24 bvFTD patients were investigated using the AAT and the CERAD-Plus battery. 16-25% of all patients failed in AAT subtests for various reasons. The AAT syndrome algorithm diagnosed amnestic aphasia in 5 (23%) PSP-RS, 7 (36%) bvFTD and 6 (30%) AD patients, Broca aphasia in 1 PSP-RS and 1 bvFTD patient, Wernicke aphasia in 1 bvFTD and 3 (15%) AD patients. However, aphasic symptoms resembled non-fluent primary progressive aphasia in 14 PSP-RS patients. In up to 46% of PSP-RS patients, 61% of bvFTD and 64% of AD patients significant impairments were found in the AAT subtests spontaneous speech, written language, naming, language repetition, language comprehension and the Token subtest. The CERAD-Plus subtest semantic fluency revealed significant impairment in 81% of PSP-RS, 61% of bvFTD, 44% of AD patients, the phonemic fluency subtest in 31, 40 and 31%, respectively. In contrast to bvFTD and AD, severity of language impairment did not correlate with cognitive decline in PSP-RS. In summary, the patterns of aphasia differ between the diagnoses. Local frontal language networks might be impaired in PSP-RS, whereas in AD and bvFTD, more widespread neuropathology might underly language impairment.
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Affiliation(s)
- Lucia Ransmayr
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria.,Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Alexandra Fuchs
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Sibylle Ransmayr-Tepser
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Romana Kommenda
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Mariella Kögl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Franz Fellner
- Central Institute of Radiology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Guger
- Department of Neurology, Pyhrn-Eisenwurzen Hospital Steyr, Steyr, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Robert Darkow
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria. .,Faculty of Medicine, Johannes Kepler University, Linz, Austria.
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Pillas D, Klein A, Gasalla T, Avbersek A, Thompson A, Wright J, Mellor J, Scowcroft A. The Burden of Progressive Supranuclear Palsy on Patients, Caregivers, and Healthcare Systems by PSP Phenotype: A Cross-Sectional Study. Front Neurol 2022; 13:821570. [PMID: 35865639 PMCID: PMC9295700 DOI: 10.3389/fneur.2022.821570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a rare, relentlessly progressive, ultimately fatal neurodegenerative brain disease. The objective of this study was to assess the burden of PSP on patients, caregivers, and healthcare systems by PSP phenotype. Data were drawn from the Adelphi PSP Disease Specific Programme™, a cross-sectional study of neurologists and people living with PSP in the United States of America, France, Germany, Italy, Spain, and the United Kingdom. All people living with PSP with a reported phenotype were included. PSP phenotype was reported for 242 patients (mean age: 70.2 years, 58% male): PSP-Richardson's syndrome, n = 96; PSP-predominant Parkinsonism, n = 88; PSP-predominant corticobasal syndrome, n = 28; PSP-predominant speech/language disorder, n = 12; PSP-progressive gait freezing, n = 9; PSP-predominant frontal presentation, n = 9. Most patients reported impaired cognitive, motor, behavioral and ocular functionality; 67–100% of patients (across phenotypes) had moderate-to-severe disease at the time of data collection. Post-diagnosis, the majority were provided with a visual and/or mobility aid (55–100%, across phenotypes), and/or required home modification to facilitate their needs (55–78%, across phenotypes). Patients required multiple types of healthcare professionals for disease management (mean 3.6–4.4, across phenotypes), and the majority reported receiving care from at least one caregiver (mean 1.3–1.8, across phenotypes). There is a high burden on patients, caregivers, and healthcare systems across all PSP phenotypes. Although phenotypes manifest different symptoms and are associated with different diagnostic pathways, once diagnosed with PSP, patients typically receive similar care.
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Affiliation(s)
| | | | | | | | | | - Jack Wright
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Jennifer Mellor
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Anna Scowcroft
- UCB Pharma, Brussels, Belgium
- *Correspondence: Anna Scowcroft
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Recent Advances in Frontotemporal Dementia. Neurol Sci 2022:1-10. [DOI: 10.1017/cjn.2022.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mesulam MM, Coventry CA, Bigio EH, Sridhar J, Gill N, Fought AJ, Zhang H, Thompson CK, Geula C, Gefen T, Flanagan M, Mao Q, Weintraub S, Rogalski EJ. Neuropathological fingerprints of survival, atrophy and language in primary progressive aphasia. Brain 2022; 145:2133-2148. [PMID: 35441216 PMCID: PMC9246707 DOI: 10.1093/brain/awab410] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023] Open
Abstract
Primary progressive aphasia is a neurodegenerative disease that selectively impairs language without equivalent impairment of speech, memory or comportment. In 118 consecutive autopsies on patients with primary progressive aphasia, primary diagnosis was Alzheimer's disease neuropathological changes (ADNC) in 42%, corticobasal degeneration or progressive supranuclear palsy neuropathology in 24%, Pick's disease neuropathology in 10%, transactive response DNA binding proteinopathy type A [TDP(A)] in 10%, TDP(C) in 11% and infrequent entities in 3%. Survival was longest in TDP(C) (13.2 ± 2.6 years) and shortest in TDP(A) (7.1 ± 2.4 years). A subset of 68 right-handed participants entered longitudinal investigations. They were classified as logopenic, agrammatic/non-fluent or semantic by quantitative algorithms. Each variant had a preferred but not invariant neuropathological correlate. Seventy-seven per cent of logopenics had ADNC, 56% of agrammatics had corticobasal degeneration/progressive supranuclear palsy or Pick's disease and 89% of semantics had TDP(C). Word comprehension impairments had strong predictive power for determining underlying neuropathology positively for TDP(C) and negatively for ADNC. Cortical atrophy was smallest in corticobasal degeneration/progressive supranuclear palsy and largest in TDP(A). Atrophy encompassed posterior frontal but not temporoparietal cortex in corticobasal degeneration/progressive supranuclear palsy, anterior temporal but not frontoparietal cortex in TDP(C), temporofrontal but not parietal cortex in Pick's disease and all three lobes with ADNC or TDP(A). There were individual deviations from these group patterns, accounting for less frequent clinicopathologic associations. The one common denominator was progressive asymmetric atrophy overwhelmingly favouring the left hemisphere language network. Comparisons of ADNC in typical amnestic versus atypical aphasic dementia and of TDP in type A versus type C revealed fundamental biological and clinical differences, suggesting that members of each pair may constitute distinct clinicopathologic entities despite identical downstream proteinopathies. Individual TDP(C) participants with unilateral left temporal atrophy displayed word comprehension impairments without additional object recognition deficits, helping to dissociate semantic primary progressive aphasia from semantic dementia. When common and uncommon associations were considered in the set of 68 participants, one neuropathology was found to cause multiple clinical subtypes, and one subtype of primary progressive aphasia to be caused by multiple neuropathologies, but with different probabilities. Occasionally, expected clinical manifestations of atrophy sites were absent, probably reflecting individual peculiarities of language organization. The hemispheric asymmetry of neurodegeneration and resultant language impairment in primary progressive aphasia reflect complex interactions among the cellular affinities of the degenerative disease, the constitutive biology of language cortex, familial or developmental vulnerabilities of this network and potential idiosyncrasies of functional anatomy in the affected individual.
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Affiliation(s)
- M Marsel Mesulam
- Correspondence to: M. Mesulam 330 East Superior St, Tarry-8 Chicago, IL 60611, USA E-mail:
| | - Christina A Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nathan Gill
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Angela J Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Cynthia K Thompson
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,School of Communication, Northwestern University, Evanston, IL 60208, USA
| | - Changiz Geula
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Margaret Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qinwen Mao
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
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14
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Zhang Y, Wu KM, Yang L, Dong Q, Yu JT. Tauopathies: new perspectives and challenges. Mol Neurodegener 2022; 17:28. [PMID: 35392986 PMCID: PMC8991707 DOI: 10.1186/s13024-022-00533-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tauopathies are a class of neurodegenerative disorders characterized by neuronal and/or glial tau-positive inclusions. MAIN BODY Clinically, tauopathies can present with a range of phenotypes that include cognitive/behavioral-disorders, movement disorders, language disorders and non-specific amnestic symptoms in advanced age. Pathologically, tauopathies can be classified based on the predominant tau isoforms that are present in the inclusion bodies (i.e., 3R, 4R or equal 3R:4R ratio). Imaging, cerebrospinal fluid (CSF) and blood-based tau biomarkers have the potential to be used as a routine diagnostic strategy and in the evaluation of patients with tauopathies. As tauopathies are strongly linked neuropathologically and genetically to tau protein abnormalities, there is a growing interest in pursuing of tau-directed therapeutics for the disorders. Here we synthesize emerging lessons on tauopathies from clinical, pathological, genetic, and experimental studies toward a unified concept of these disorders that may accelerate the therapeutics. CONCLUSIONS Since tauopathies are still untreatable diseases, efforts have been made to depict clinical and pathological characteristics, identify biomarkers, elucidate underlying pathogenesis to achieve early diagnosis and develop disease-modifying therapies.
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Affiliation(s)
- Yi Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, 12th Wulumuqi Zhong Road, Shanghai, 200040 China
| | - Kai-Min Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, 12th Wulumuqi Zhong Road, Shanghai, 200040 China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, 12th Wulumuqi Zhong Road, Shanghai, 200040 China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, 12th Wulumuqi Zhong Road, Shanghai, 200040 China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, 12th Wulumuqi Zhong Road, Shanghai, 200040 China
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15
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García AM, Ibáñez A, Miller B, Gorno Tempini ML. Editorial: The Unusual Suspects: Linguistic Deficits in Non-Language-Dominant Neurodegenerative Diseases. Front Aging Neurosci 2022; 14:861041. [PMID: 35250552 PMCID: PMC8888668 DOI: 10.3389/fnagi.2022.861041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adolfo M. García
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States; and Trinity College Dublin, Dublin, Ireland
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Agustín Ibáñez
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States; and Trinity College Dublin, Dublin, Ireland
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Luisa Gorno Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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16
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Patel N, Peterson KA, Ingram RU, Storey I, Cappa SF, Catricala E, Halai A, Patterson KE, Lambon Ralph MA, Rowe JB, Garrard P. A 'Mini Linguistic State Examination' to classify primary progressive aphasia. Brain Commun 2021; 4:fcab299. [PMID: 35282164 PMCID: PMC8914496 DOI: 10.1093/braincomms/fcab299] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/27/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
There are few available methods for qualitatively evaluating patients with primary progressive aphasia. Commonly adopted approaches are time-consuming, of limited accuracy or designed to assess different patient populations. This paper introduces a new clinical test-the Mini Linguistic State Examination-which was designed uniquely to enable a clinician to assess and subclassify both classical and mixed presentations of primary progressive aphasia. The adoption of a novel assessment method (error classification) greatly amplifies the clinical information that can be derived from a set of standard linguistic tasks and allows a five-dimensional profile to be defined. Fifty-four patients and 30 matched controls were recruited. Five domains of language competence (motor speech, phonology, semantics, syntax and working memory) were assessed using a sequence of 11 distinct linguistic assays. A random forest classification was used to assess the diagnostic accuracy for predicting primary progressive aphasia subtypes and create a decision tree as a guide to clinical classification. The random forest prediction model was 96% accurate overall (92% for the logopenic variant, 93% for the semantic variant and 98% for the non-fluent variant). The derived decision tree produced a correct classification of 91% of participants whose data were not included in the training set. The Mini Linguistic State Examination is a new cognitive test incorporating a novel and powerful, yet straightforward, approach to scoring. Rigorous assessment of its diagnostic accuracy confirmed excellent matching of primary progressive aphasia syndromes to clinical gold standard diagnoses. Adoption of the Mini Linguistic State Examination by clinicians will have a decisive impact on the consistency and uniformity with which patients can be described clinically. It will also facilitate screening for cohort-based research, including future therapeutic trials, and is suitable for describing, quantifying and monitoring language deficits in other brain disorders.
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Affiliation(s)
- Nikil Patel
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Katie A. Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
| | - Ruth U. Ingram
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Ian Storey
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Stefano F. Cappa
- University Institute for Advanced Studies IUSS, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Ajay Halai
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Karalyn E. Patterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | | | - James B. Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
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17
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Street D, Malpetti M, Rittman T, Ghosh BCP, Murley AG, Coyle-Gilchrist I, Passamonti L, Rowe JB. Clinical progression of progressive supranuclear palsy: impact of trials bias and phenotype variants. Brain Commun 2021; 3:fcab206. [PMID: 34541533 PMCID: PMC8445397 DOI: 10.1093/braincomms/fcab206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/14/2021] [Accepted: 07/20/2021] [Indexed: 01/21/2023] Open
Abstract
Progressive supranuclear palsy causes diverse clinical presentations, including classical Richardson’s syndrome and several variant phenotypes. Clinical trials of disease-modifying therapies have recently been completed, with more planned for the next 2 years. However, many people with progressive supranuclear palsy do not meet eligibility criteria for these clinical trials. Understanding clinical progression with different phenotypes would improve trial design and enhance the accuracy of risk–benefit and cost–benefit assessments of new treatments for progressive supranuclear palsy. We set out to determine rates of motor and cognitive progression of possible, probable and definite progressive supranuclear palsy, with different phenotypes, from a representative cohort in a regional UK healthcare service. Longitudinal clinical data from people with Richardson’s syndrome and variant phenotypes were analysed using linear mixed-modelling, using both the full and modified versions of the Progressive Supranuclear Palsy Rating Scale, Mini-Mental State Examination and the revised Addenbrooke’s Cognitive Examination. Subgroup analyses considered patients meeting recent Phase II trial entry criteria and patients with neuropathological confirmation. Two hundred and twenty-seven patients [male = 59%, mean age (±standard deviation), 71.8 (±7.0) years] were followed for a mean 21.6 (±15.6) months. One hundred and seventy-four (77%) had Richardson’s syndrome at the outset, 25 had cortical variant presentations (13%, frontal, corticobasal, speech and language variants) and 28 had subcortical variant presentations (14%, parkinsonism, postural instability and gait freezing variants). Across all participants, annual progression in Richardson’s syndrome was faster than variant phenotypes on the Mini-Mental State Examination (−1.8 versus −0.9/year, P = 0.005) and revised Addenbrooke’s Cognitive Examination (−5.3 versus −3.0/year, P = 0.01) but not the Progressive Supranuclear Palsy Rating Scale (9.0 versus 7.1/year, P = 0.2) nor the modified Progressive Supranuclear Palsy Rating Scale (2.7 versus 2.3/year, P = 0.4). However, for those with more than 1 years’ follow-up, a significant difference was observed between Richardson’s syndrome and variant phenotypes in Progressive Supranuclear Palsy Rating Scale (8.7 versus 6.3/year, P = 0.04). Survival was longer in variant phenotypes than Richardson’s syndrome [7.3 (±3.9) versus 5.6 (±2.0) years, P = 0.02]. Pathologically confirmed cases (n = 49) supported these findings. Patients meeting basic trial-eligibility criteria (n = 129) progressed faster on the Progressive Supranuclear Palsy Rating Scale than trial-not-eligible patients (10.1 versus 6.1/year, P = 0.001). In conclusion, phenotypes other than Richardson’s syndrome show slower progression and longer survival. Trial criteria do not select representative progressive supranuclear palsy cases. This has implications for trial design, and application of trial results to clinically more diverse patient populations.
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Affiliation(s)
- Duncan Street
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Boyd C P Ghosh
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK.,Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Alexander G Murley
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Ian Coyle-Gilchrist
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK.,Norfolk and Norwich NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK.,Consiglio Nazionale delle Ricerche (CNR), Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Milano, 20090 Segrate (MI), Italy
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SZ, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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18
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Parmera JB, de Almeida IJ, de Oliveira MCB, Silagi ML, de Godoi Carneiro C, Studart-Neto A, Ono CR, Reis Barbosa E, Nitrini R, Buchpiguel CA, Brucki SMD, Coutinho AM. Metabolic and Structural Signatures of Speech and Language Impairment in Corticobasal Syndrome: A Multimodal PET/MRI Study. Front Neurol 2021; 12:702052. [PMID: 34526958 PMCID: PMC8435851 DOI: 10.3389/fneur.2021.702052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Corticobasal syndrome (CBS) is a progressive neurological disorder related to multiple underlying pathologies, including four-repeat tauopathies, such as corticobasal degeneration and progressive supranuclear palsy, and Alzheimer's disease (AD). Speech and language are commonly impaired, encompassing a broad spectrum of deficits. We aimed to investigate CBS speech and language impairment patterns in light of a multimodal imaging approach. Materials and Methods: Thirty-one patients with probable CBS were prospectively evaluated concerning their speech–language, cognitive, and motor profiles. They underwent positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) and [11C]Pittsburgh Compound-B (PIB-PET) on a hybrid PET-MRI machine to assess their amyloid status. PIB-PET images were classified based on visual and semi-quantitative analyses. Quantitative group analyses were performed on FDG-PET data, and atrophy patterns on MRI were investigated using voxel-based morphometry (VBM). Thirty healthy participants were recruited as imaging controls. Results: Aphasia was the second most prominent cognitive impairment, presented in 67.7% of the cases, following apraxia (96.8%). We identified a wide linguistic profile, ranging from nonfluent variant-primary progressive aphasia to lexical–semantic deficits, mostly with impaired verbal fluency. PIB-PET was classified as negative (CBS-A– group) in 18/31 (58%) and positive (CBS-A+ group) in 13/31 (42%) patients. The frequency of dysarthria was significantly higher in the CBS-A– group than in the CBS-A+ group (55.6 vs. 7.7%, p = 0.008). CBS patients with dysarthria had a left-sided hypometabolism at frontal regions, with a major cluster at the left inferior frontal gyrus and premotor cortex. They showed brain atrophy mainly at the opercular frontal gyrus and putamen. There was a positive correlation between [18F]FDG uptake and semantic verbal fluency at the left inferior (p = 0.006, R2 = 0.2326), middle (0.0054, R2 = 0.2376), and superior temporal gyri (p = 0.0066, R2 = 0.2276). Relative to the phonemic verbal fluency, we found a positive correlation at the left frontal opercular gyrus (p = 0.0003, R2 = 0.3685), the inferior (p = 0.0004, R2 = 0.3537), and the middle temporal gyri (p = 0.0001, R2 = 0.3993). Discussion: In the spectrum of language impairment profile, dysarthria might be helpful to distinguish CBS patients not related to AD. Metabolic and structural signatures depicted from this feature provide further insights into the motor speech production network and are also helpful to differentiate CBS variants.
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Affiliation(s)
- Jacy Bezerra Parmera
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isabel Junqueira de Almeida
- Department of Physical Therapy, Speech, and Occupational Therapy, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Castello Barbosa de Oliveira
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Neurology Unit, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Marcela Lima Silagi
- Department of Speech, Language and Hearing Sciences, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila de Godoi Carneiro
- Laboratory of Nuclear Medicine, Nuclear Medicine Center and Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adalberto Studart-Neto
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carla Rachel Ono
- Laboratory of Nuclear Medicine, Nuclear Medicine Center and Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Laboratory of Nuclear Medicine, Nuclear Medicine Center and Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Artur Martins Coutinho
- Laboratory of Nuclear Medicine, Nuclear Medicine Center and Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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19
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Suárez‐González A, Cassani A, Gopalan R, Stott J, Savage S. When it is not primary progressive aphasia: A scoping review of spoken language impairment in other neurodegenerative dementias. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12205. [PMID: 34485677 PMCID: PMC8409087 DOI: 10.1002/trc2.12205] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive difficulties with spoken language occur across the spectrum of degenerative dementia. When not a primary presenting and dominant symptom, language difficulties may be overlooked in favor of more prominent cognitive, behavior, or motor deficits. The aim of this scoping review is to examine the extent and nature of the research evidence describing (1) the spoken language impairments found in non-language led dementias, (2) their impact on everyday living, and (3) the reported language interventions. METHODS We searched PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and SpeechBITE using terms related to spoken language for the following dementia types: Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), cortico-basal syndrome (CBS), behavior variant frontotemporal dementia (bvFTD), early-onset Alzheimer's disease (EOAD), posterior cortical atrophy (PCA), and motor neuron disease associated with FTD (MND+FTD). Risk of bias was assessed with the QualSyst tool. RESULTS Seventy-three eligible studies were included. A wide range of spoken language impairments were reported, involving both linguistic (e.g., syntactic processing) and other cognitive (e.g., sustained attention) underlying mechanisms. Although the severity of these deficits was scarcely reported, in some cases they manifested as non-fluent, dynamic, and global aphasias. No papers in the review described either the impact of these language impairments on everyday living or language therapies to treat them. DISCUSSION There is a need to understand better the level of disability produced by language impairment in people living with non-language-led dementias. Our findings suggest three calls for action: (1) research studies should assess the clinical relevance of any spoken language deficits examined, (2) both linguistic and cognitive underlying mechanisms should be fully described (to inform the design of effective language and behavioral interventions), and (3) trials of language therapy should be conducted in those groups of individuals where significant language impairment is proved.
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Affiliation(s)
- Aida Suárez‐González
- Dementia Research CentreUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Alice Cassani
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Ragaviveka Gopalan
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Joshua Stott
- Research Department of ClinicalEducational and Health PsychologyUniversity College LondonLondonUK
| | - Sharon Savage
- School of PsychologyUniversity of NewcastleNewcastleNew South WalesAustralia
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20
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Wilson D, Le Heron C, Anderson T. Corticobasal syndrome: a practical guide. Pract Neurol 2021. [DOI: 10.1136/practneurol-2020-002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Corticobasal syndrome is a disorder of movement, cognition and behaviour with several possible underlying pathologies, including corticobasal degeneration. It presents insidiously and is slowly progressive. Clinicians should consider the diagnosis in people presenting with any combination of extrapyramidal features (with poor response to levodopa), apraxia or other parietal signs, aphasia and alien-limb phenomena. Neuroimaging showing asymmetrical perirolandic cortical changes supports the diagnosis, while advanced neuroimaging may give insight into the underlying pathology. Identifying corticobasal syndrome carries some management implications (especially if protein-based treatments arise in the future) and prognostic significance. Its treatment is largely symptomatic and is best undertaken within a multidisciplinary setting, including a neurologist, physiotherapist, occupational therapist, speech language therapist, psychiatrist and, ultimately, a palliative care clinician. Corticobasal syndrome can be a confusing entity for neurologists, not least because it has over time evolved from being considered predominantly as a movement disorder to a condition spanning a wide range of cognitive and motor manifestations. In this practical review, we attempt to disentangle this syndrome and provide clarity around diagnosis, its underlying pathological substrates, key clinical features and potential treatments.
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21
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Caregiver strain in progressive supranuclear palsy and corticobasal syndromes. J Neural Transm (Vienna) 2021; 128:1611-1621. [PMID: 34296340 PMCID: PMC8528777 DOI: 10.1007/s00702-021-02379-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) progress relentlessly and lead to a need for care. Caregiving is often burdensome. Little is known about the course of caregiver burden (CB) in PSP and CBS patients. Longitudinal analysis of CB in family members caring for PSP and CBS patients. Single-center longitudinal pilot study in 68 newly diagnosed patients with probable PSP and CBS (52 Richardson’s syndrome; 1 progressive gait freezing of PSP; 15 CBS). Demographic, educational, occupational parameters, family status, motor functions (UPDRSIII, Hoehn and Yahr Score, Tinetti) and neuropsychological performance (CERAD Plus, Frontal Assessment Battery) were assessed, as well as behavioral and neuropsychiatric impairments (Frontal Behavioral Inventory, Neuropsychiatric Inventory), activities of daily living (ADL) and caregiver burden using the Caregiver Strain Index (CSI), in most patients also the Zarit Burden Interview (ZBI). Patients were followed up every 6 months for up to 2 years. Caregivers reported mild to moderate CB at baseline, which increased by 25–30% in 2 years and was significantly greater in PSP than in CBS. Risk for mental health problems increased over time, especially in female caregivers (depression). Important patient-related factors were apathy, aspontaneity, depression, irritability, disorganization, poor judgment, impairment of language, impairments in ADL, a high educational level of the patient and close family relationship. Behavioral symptoms and impaired ADL are the main patient-related factors of CB in PSP and CBS. CB can be severe and needs to be assessed repeatedly from the time of diagnosis to provide comprehensive support.
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22
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Berthier ML, Hoet F, Beltrán-Corbellini Á, Santana-Moreno D, Edelkraut L, Dávila G. Case Report: Barely Able to Speak, Can't Stop Echoing: Echolalic Dynamic Aphasia in Progressive Supranuclear Palsy. Front Aging Neurosci 2021; 13:635896. [PMID: 34017242 PMCID: PMC8129544 DOI: 10.3389/fnagi.2021.635896] [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: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
The diagnostic criteria for progressive supranuclear palsy (PSP) incorporate two speech-language disturbances (SLDs), non-fluent/agrammatic primary progressive aphasia and progressive apraxia of speech, but overlook the inclusion of other SLDs, including dynamic aphasia (DA). Thus, there is a need to reappraise the broad spectrum of SLDs in PSP to include other presenting phenotypes. Here we report findings from the study of two elderly patients with PSP presenting with DA and irrepressible echolalia. Both patients had markedly impoverished verbal production, but their performance in other tasks (repetition and naming) and auditory comprehension were preserved or only mildly impaired. Experimental tests of DA revealed impaired word and sentence generation in response to verbal and non-verbal stimuli. Additional language and cognitive testing revealed different types of echolalia (mitigated, automatic, and echoing approval) as well as impaired inhibitory control and social cognition (mentalizing). Both patients had negative neuropsychiatric alterations (i.e., apathy, aspontaneity, and indifference/emotional flatness). Brain magnetic resonance imaging in both patients showed atrophy of the midbrain tegmentum and superior medial frontal cortex suggestive of PSP, yet further evaluation of the neural correlates using multimodal neuroimaging and neuropathological data was not performed. However, based on the already known neural basis of DA and echolalia in PSP and stroke, we suggest that, in the present cases, neurodegeneration in the midbrain tegmentum, superior medial frontal lobe, and caudate nucleus was responsible for DA and that decreased activity in these regions may play a permissive role for eliciting verbal echoing via disinhibition of the perisylvian speech-language network.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain
| | - Florencia Hoet
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Servicio de Otorrinolaringología, Sección Fonoaudiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Lisa Edelkraut
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain
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23
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de Almeida IJ, Silagi ML, Parmera JB, Brucki SMD, Schochat E. Language in corticobasal syndrome: a systematic review. Dement Neuropsychol 2021; 15:16-27. [PMID: 33907594 PMCID: PMC8049581 DOI: 10.1590/1980-57642021dn15-010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Language is commonly impacted in corticobasal syndrome (CBS). However, the
profile and type of language assessment in CBS are poorly studied.
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Affiliation(s)
- Isabel Junqueira de Almeida
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo - São Paulo SP, Brazil
| | - Marcela Lima Silagi
- Department of Human Communication Sciences, Universidade Federal de São Paulo - São Paulo, SP, Brazil
| | - Jacy Bezerra Parmera
- Department of Neurology, School of Medicine, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | - Eliane Schochat
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo - São Paulo SP, Brazil
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24
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Peterson KA, Jones PS, Patel N, Tsvetanov KA, Ingram R, Cappa SF, Lambon Ralph MA, Patterson K, Garrard P, Rowe JB. Language Disorder in Progressive Supranuclear Palsy and Corticobasal Syndrome: Neural Correlates and Detection by the MLSE Screening Tool. Front Aging Neurosci 2021; 13:675739. [PMID: 34381350 PMCID: PMC8351757 DOI: 10.3389/fnagi.2021.675739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) affect speech and language as well as motor functions. Clinical and neuropathological data indicate a close relationship between these two disorders and the non-fluent variant of primary progressive aphasia (nfvPPA). We use the recently developed Mini Linguistic State Examination tool (MLSE) to study speech and language disorders in patients with PSP, CBS, and nfvPPA, in combination with structural magnetic resonance imaging (MRI). Methods: Fifty-one patients (PSP N = 13, CBS N = 19, nfvPPA N = 19) and 30 age-matched controls completed the MLSE, the short form of the Boston Diagnostic Aphasia Examination (BDAE), and the Addenbrooke's Cognitive Examination III. Thirty-eight patients and all controls underwent structural MRI at 3 Tesla, with T1 and T2-weighted images processed by surface-based and subcortical segmentation within FreeSurfer 6.0.0 to extract cortical thickness and subcortical volumes. Morphometric differences were compared between groups and correlated with the severity of speech and language impairment. Results: CBS and PSP patients showed impaired MLSE performance, compared to controls, with a similar language profile to nfvPPA, albeit less severe. All patient groups showed reduced cortical thickness in bilateral frontal regions and striatal volume. PSP and nfvPPA patients also showed reduced superior temporal cortical thickness, with additional thalamic and amygdalo-hippocampal volume reductions in nfvPPA. Multivariate analysis of brain-wide cortical thickness and subcortical volumes with MLSE domain scores revealed associations between performance on multiple speech and language domains with atrophy of left-lateralised fronto-temporal cortex, amygdala, hippocampus, putamen, and caudate. Conclusions: The effect of PSP and CBS on speech and language overlaps with nfvPPA. These three disorders cause a common anatomical pattern of atrophy in the left frontotemporal language network and striatum. The MLSE is a short clinical screening tool that can identify the language disorder of PSP and CBS, facilitating clinical management and patient access to future clinical trials.
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Affiliation(s)
- Katie A. Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
| | - Nikil Patel
- Department of Neurosciences, St. George’s, University of London, London, United Kingdom
| | - Kamen A. Tsvetanov
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Ingram
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Stefano F. Cappa
- IUSS Cognitive Neuroscience Center (ICoN), University Institute for Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Karalyn Patterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Peter Garrard
- Department of Neurosciences, St. George’s, University of London, London, United Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: James B. Rowe
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25
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VandeVrede L, Ljubenkov PA, Rojas JC, Welch AE, Boxer AL. Four-Repeat Tauopathies: Current Management and Future Treatments. Neurotherapeutics 2020; 17:1563-1581. [PMID: 32676851 PMCID: PMC7851277 DOI: 10.1007/s13311-020-00888-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Four-repeat tauopathies are a neurodegenerative disease characterized by brain parenchymal accumulation of a specific isoform of the protein tau, which gives rise to a wide breadth of clinical syndromes encompassing diverse symptomatology, with the most common syndromes being progressive supranuclear palsy-Richardson's and corticobasal syndrome. Despite the lack of effective disease-modifying therapies, targeted treatment of symptoms can improve quality of life for patients with 4-repeat tauopathies. However, managing these symptoms can be a daunting task, even for those familiar with the diseases, as they span motor, sensory, cognitive, affective, autonomic, and behavioral domains. This review describes current approaches to symptomatic management of common clinical symptoms in 4-repeat tauopathies with a focus on practical patient management, including pharmacologic and nonpharmacologic strategies, and concludes with a discussion of the history and future of disease-modifying therapeutics and clinical trials in this population.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
| | - Peter A Ljubenkov
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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26
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Vasilevskaya A, Taghdiri F, Multani N, Anor C, Misquitta K, Houle S, Burke C, Tang-Wai D, Lang AE, Fox S, Slow E, Rusjan P, Tartaglia MC. PET Tau Imaging and Motor Impairments Differ Between Corticobasal Syndrome and Progressive Supranuclear Palsy With and Without Alzheimer's Disease Biomarkers. Front Neurol 2020; 11:574. [PMID: 32754109 PMCID: PMC7366127 DOI: 10.3389/fneur.2020.00574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Frontotemporal lobar degeneration (FTLD)-related syndrome includes progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). PSP is usually caused by a tauopathy but can have associated Alzheimer's disease (AD) while CBS can be caused by tauopathy, transactive response DNA binding protein 43 kDa, or AD pathology. Our aim was to compare the parkinsonian syndromes presenting without AD biomarkers (CBS/PSP-non-AD) to parkinsonian syndromes with AD biomarkers (CBS/PSP-AD). Materials and Methods: Twenty-four patients [11 males, 13 females; age (68.46 ± 7.23)] were recruited for this study. The whole cohort was divided into parkinsonian syndromes without AD biomarkers [N = 17; diagnoses (6 CBS, 11 PSP)] and parkinsonian syndromes with AD biomarkers [N = 7; diagnoses (6 CBS-AD, 1 PSP-AD)]. Anatomical MRI and PET imaging with tau ligand [18F]-AV1451 tracer was completed. Cerebrospinal fluid analysis or [18F]-AV1451 PET imaging was used to assess for the presence of AD biomarkers. Progressive supranuclear palsy rating scale (PSPRS) and unified Parkinson's disease rating scale (UPDRS) motor exam were implemented to assess for motor disturbances. Language and cognitive testing were completed. Results: The CBS/PSP-non-AD group [age (70.18 ± 6.65)] was significantly older (p = 0.028) than the CBS/PSP-AD group [age (64.29 ± 7.32)]. There were no differences between the groups in terms of gender, education, years of disease duration, and disease severity as measured with the Clinical Dementia Rating scale. The CBS/PSP-non-AD group had significantly lower PET Tau Standard Volume Uptake Ratio (SUVR) values compared to the CBS/PSP-AD group in multiple frontal and temporal areas, and inferior parietal (all p < 0.03). The CBS/PSP-non-AD group had significantly higher scores compared to the CBS/PSP-AD group on PSPRS (p = 0.004) and UPDRS motor exam (p = 0.045). The CBS/PSP-non-AD group had higher volumes of inferior parietal, precuneus, and hippocampus (all p < 0.02), but lower volume of midbrain (p = 0.02), compared to the CBS/PSP-AD group. Discussion: The CBS/PSP-non-AD group had higher motor disturbances compared to the CBS/PSP-AD group; however, both groups performed similarly on neuropsychological measures. The AD biomarker group had increased global uptake of PET Tau SUVR and lower volumes in AD-specific areas. These results show that the presenting phenotype of CBS and PSP syndromes and the distribution of injury are strongly affected by the presence of AD biomarkers.
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Affiliation(s)
- Anna Vasilevskaya
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Cassandra Anor
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Karen Misquitta
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Sylvain Houle
- PET Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Charles Burke
- School of Medicine and Dentistry, Western University, Windsor, ON, Canada
| | - David Tang-Wai
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J. Safra Program for Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Susan Fox
- Edmond J. Safra Program for Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elizabeth Slow
- Edmond J. Safra Program for Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Pablo Rusjan
- PET Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Maria C Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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27
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Murley AG, Coyle-Gilchrist I, Rouse MA, Jones PS, Li W, Wiggins J, Lansdall C, Rodríguez PV, Wilcox A, Tsvetanov KA, Patterson K, Lambon Ralph MA, Rowe JB. Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes. Brain 2020; 143:1555-1571. [PMID: 32438414 PMCID: PMC7241953 DOI: 10.1093/brain/awaa097] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/14/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
The syndromes caused by frontotemporal lobar degeneration have highly heterogeneous and overlapping clinical features. There has been great progress in the refinement of clinical diagnostic criteria in the past decade, but we propose that a better understanding of aetiology, pathophysiology and symptomatic treatments can arise from a transdiagnostic approach to clinical phenotype and brain morphometry. In a cross-sectional epidemiological study, we examined 310 patients with a syndrome likely to be caused by frontotemporal lobar degeneration, including behavioural variant frontotemporal dementia, non-fluent, and semantic variants of primary progressive aphasia (PPA), progressive supranuclear palsy and corticobasal syndrome. We included patients with logopenic PPA and those who met criteria for PPA but not a specific subtype. To date, 49 patients have a neuropathological diagnosis. A principal component analysis identified symptom dimensions that broadly recapitulated the core features of the main clinical syndromes. However, the subject-specific scores on these dimensions showed considerable overlap across the diagnostic groups. Sixty-two per cent of participants had phenotypic features that met the diagnostic criteria for more than one syndrome. Behavioural disturbance was prevalent in all groups. Forty-four per cent of patients with corticobasal syndrome had progressive supranuclear palsy-like features and 30% of patients with progressive supranuclear palsy had corticobasal syndrome-like features. Many patients with progressive supranuclear palsy and corticobasal syndrome had language impairments consistent with non-fluent variant PPA while patients with behavioural variant frontotemporal dementia often had semantic impairments. Using multivariate source-based morphometry on a subset of patients (n = 133), we identified patterns of covarying brain atrophy that were represented across the diagnostic groups. Canonical correlation analysis of clinical and imaging components found three key brain-behaviour relationships, with a continuous spectrum across the cohort rather than discrete diagnostic entities. In the 46 patients with follow-up (mean 3.6 years) syndromic overlap increased with time. Together, these results show that syndromes associated with frontotemporal lobar degeneration do not form discrete mutually exclusive categories from their clinical features or structural brain changes, but instead exist in a multidimensional spectrum. Patients often manifest diagnostic features of multiple disorders while deficits in behaviour, movement and language domains are not confined to specific diagnostic groups. It is important to recognize individual differences in clinical phenotype, both for clinical management and to understand pathogenic mechanisms. We suggest that a transdiagnostic approach to the spectrum of frontotemporal lobar degeneration syndromes provides a useful framework with which to understand disease aetiology, progression, and heterogeneity and to target future treatments to a higher proportion of patients.
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Affiliation(s)
- Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Coyle-Gilchrist
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Matthew A Rouse
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Matthew A Lambon Ralph
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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