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Gatto RG, Pham NTT, Duffy JR, Clark HM, Utianski RL, Botha H, Machulda MM, Lowe VJ, Schwarz CG, Jack CR, Josephs KA, Whitwell JL. Multimodal cross-examination of progressive apraxia of speech by diffusion tensor imaging-based tractography and Tau-PET scans. Hum Brain Mapp 2024; 45:e26704. [PMID: 38825988 PMCID: PMC11144950 DOI: 10.1002/hbm.26704] [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: 01/23/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024] Open
Abstract
Progressive apraxia of speech (PAOS) is a 4R tauopathy characterized by difficulties with motor speech planning. Neurodegeneration in PAOS targets the premotor cortex, particularly the supplementary motor area (SMA), with degeneration of white matter (WM) tracts connecting premotor and motor cortices and Broca's area observed on diffusion tensor imaging (DTI). We aimed to assess flortaucipir uptake across speech-language-related WM tracts identified using DTI tractography in PAOS. Twenty-two patients with PAOS and 26 matched healthy controls were recruited by the Neurodegenerative Research Group (NRG) and underwent MRI and flortaucipir-PET. The patient population included patients with primary progressive apraxia of speech (PPAOS) and non-fluent variant/agrammatic primary progressive aphasia (agPPA). Flortaucipir PET scans and DTI were coregistered using rigid registration with a mutual information cost function in subject space. Alignments between DTI and flortaucipir PET were inspected in all cases. Whole-brain tractography was calculated using deterministic algorithms by a tractography reconstruction tool (DSI-studio) and specific tracts were identified using an automatic fiber tracking atlas-based method. Fractional anisotropy (FA) and flortaucipir standardized uptake value ratios (SUVRs) were averaged across the frontal aslant tract, arcuate fasciculi, inferior frontal-occipital fasciculus, inferior and middle longitudinal fasciculi, as well as the SMA commissural fibers. Reduced FA (p < .0001) and elevated flortaucipir SUVR (p = .0012) were observed in PAOS cases compared to controls across all combined WM tracts. For flortaucipir SUVR, the greatest differentiation of PAOS from controls was achieved with the SMA commissural fibers (area under the receiver operator characteristic curve [AUROC] = 0.83), followed by the left arcuate fasciculus (AUROC = 0.75) and left frontal aslant tract (AUROC = 0.71). Our findings demonstrate that flortaucipir uptake is increased across WM tracts related to speech/language difficulties in PAOS.
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Affiliation(s)
| | | | | | | | | | - Hugo Botha
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Mary M. Machulda
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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Tetzloff KA, Martin PR, Duffy JR, Utianski RL, Clark HM, Botha H, Machulda MM, Thu Pham NT, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Longitudinal flortaucipir, metabolism and volume differ between phonetic and prosodic speech apraxia. Brain 2024; 147:1696-1709. [PMID: 38217867 PMCID: PMC11068100 DOI: 10.1093/brain/awae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/29/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
Progressive apraxia of speech (PAOS) is a neurodegenerative motor-speech disorder that most commonly arises from a four-repeat tauopathy. Recent studies have established that progressive apraxia of speech is not a homogenous disease but rather there are distinct subtypes: the phonetic subtype is characterized by distorted sound substitutions, the prosodic subtype by slow and segmented speech and the mixed subtype by a combination of both but lack of predominance of either. There is some evidence that cross-sectional patterns of neurodegeneration differ across subtypes, although it is unknown whether longitudinal patterns of neurodegeneration differ. We examined longitudinal patterns of atrophy on MRI, hypometabolism on 18F-fluorodeoxyglucose-PET and tau uptake on flortaucipir-PET in a large cohort of subjects with PAOS that had been followed for many years. Ninety-one subjects with PAOS (51 phonetic, 40 prosodic) were recruited by the Neurodegenerative Research Group. Of these, 54 (27 phonetic, 27 prosodic) returned for annual follow-up, with up to seven longitudinal visits (total visits analysed = 217). Volumes, metabolism and flortaucipir uptake were measured for subcortical and cortical regions, for all scans. Bayesian hierarchical models were used to model longitudinal change across imaging modalities with PAOS subtypes being compared at baseline, 4 years from baseline, and in terms of rates of change. The phonetic group showed smaller volumes and worse metabolism in Broca's area and the striatum at baseline and after 4 years, and faster rates of change in these regions, compared with the prosodic group. There was also evidence of faster spread of hypometabolism and flortaucipir uptake into the temporal and parietal lobes in the phonetic group. In contrast, the prosodic group showed smaller cerebellar dentate, midbrain, substantia nigra and thalamus volumes at baseline and after 4 years, as well as faster rates of atrophy, than the phonetic group. Greater hypometabolism and flortaucipir uptake were also observed in the cerebellar dentate and substantia nigra in the prosodic group. Mixed findings were observed in the supplementary motor area and precentral cortex, with no clear differences observed across phonetic and prosodic groups. These findings support different patterns of disease spread in PAOS subtypes, with corticostriatal patterns in the phonetic subtype and brainstem and thalamic patterns in the prosodic subtype, providing insight into the pathophysiology and heterogeneity of PAOS.
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Affiliation(s)
| | - Peter R Martin
- Department of Quantitative Health Sciences (Biostatistics), Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry (Neuropsychology), Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Burnham SC, Iaccarino L, Pontecorvo MJ, Fleisher AS, Lu M, Collins EC, Devous MD. A review of the flortaucipir literature for positron emission tomography imaging of tau neurofibrillary tangles. Brain Commun 2023; 6:fcad305. [PMID: 38187878 PMCID: PMC10768888 DOI: 10.1093/braincomms/fcad305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Alzheimer's disease is defined by the presence of β-amyloid plaques and neurofibrillary tau tangles potentially preceding clinical symptoms by many years. Previously only detectable post-mortem, these pathological hallmarks are now identifiable using biomarkers, permitting an in vivo definitive diagnosis of Alzheimer's disease. 18F-flortaucipir (previously known as 18F-T807; 18F-AV-1451) was the first tau positron emission tomography tracer to be introduced and is the only Food and Drug Administration-approved tau positron emission tomography tracer (Tauvid™). It has been widely adopted and validated in a number of independent research and clinical settings. In this review, we present an overview of the published literature on flortaucipir for positron emission tomography imaging of neurofibrillary tau tangles. We considered all accessible peer-reviewed literature pertaining to flortaucipir through 30 April 2022. We found 474 relevant peer-reviewed publications, which were organized into the following categories based on their primary focus: typical Alzheimer's disease, mild cognitive impairment and pre-symptomatic populations; atypical Alzheimer's disease; non-Alzheimer's disease neurodegenerative conditions; head-to-head comparisons with other Tau positron emission tomography tracers; and technical considerations. The available flortaucipir literature provides substantial evidence for the use of this positron emission tomography tracer in assessing neurofibrillary tau tangles in Alzheimer's disease and limited support for its use in other neurodegenerative disorders. Visual interpretation and quantitation approaches, although heterogeneous, mostly converge and demonstrate the high diagnostic and prognostic value of flortaucipir in Alzheimer's disease.
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Affiliation(s)
| | | | | | | | - Ming Lu
- Avid, Eli Lilly and Company, Philadelphia, PA 19104, USA
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Utianski RL, Meade G, Duffy JR, Clark HM, Botha H, Machulda MM, Dickson DW, Whitwell JL, Josephs KA. Longitudinal characterization of patients with progressive apraxia of speech without clearly predominant phonetic or prosodic speech features. BRAIN AND LANGUAGE 2023; 245:105314. [PMID: 37607419 PMCID: PMC10592101 DOI: 10.1016/j.bandl.2023.105314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Most recent studies of progressive apraxia of speech (PAOS) have focused on patients with phonetic or prosodic predominant PAOS to understand the implications of the presenting clinical phenotype. Patients without a clearly predominating speech quality, or mixed AOS, have been excluded. Given the implications for disease progression, it is important to understand these patients early in the disease course to inform appropriate education and prognostication. The aim of this study was to describe a cohort of ten patients with initially mixed PAOS and how their clinical course evolves. Four patients were rated prosodic predominant later on (mild AOS at first visit); five were later designated phonetic (four with more than mild AOS at first visit); one was judged mixed at all visits. The study suggests patients without a clear predominance of speech featuresshould still be included in PAOS studies and thought of on the continuum of the disease spectrum.
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Affiliation(s)
| | - Gabriela Meade
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
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Haley KL, Jacks A. Three-Dimensional Speech Profiles in Stroke Aphasia and Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1825-1834. [PMID: 36603554 PMCID: PMC10561969 DOI: 10.1044/2022_ajslp-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Behaviorally, acquired apraxia of speech (AOS) is a multidimensional syndrome that the experienced clinician recognizes based on impaired articulation and abnormal temporal prosody. We conducted this study to determine the extent to which three core features of AOS-when defined quantitatively-distinguish categorically among aphasia with no or minimal speech sound involvement, aphasia with AOS, and aphasia with phonemic paraphasia (APP). METHOD The study involved retrospective analysis of 195 participants with stroke-induced aphasia. We used three quantitative measures (phonemic error frequency, distortion error frequency, and word syllable duration [WSD]) to divide the sample into four participant groups according to the most likely speech diagnosis: aphasia with minimal speech sound errors, AOS, APP, and a borderline group with mixed profiles. We then conducted nonparametric comparisons across groups for which the measures were not defined and visualized all three measures in a three-dimensional graph. RESULTS The measures distributed as multidimensional spectra rather than discrete diagnostic entities, and there was considerable behavioral overlap among participant groups. Thirty percent of participants presented with aphasia with minimal sound production difficulties, and they were statistically indistinguishable from the APP group on distortion frequency and WSD. Distortion frequency and WSD were in a borderline region between AOS and APP for 29% of participants. Compared to all other groups, participants with AOS produced significantly more errors that affected listeners' phonemic perception. CONCLUSIONS The results suggest that the current AOS-APP dichotomy has limited validity. We conclude that a continuous multidimensional view of speech variation would be a constructive perspective from which to understand how the left cerebral hemisphere produces speech and that quantitative and normed speech measures should be used to inform differential diagnosis in clinical settings. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21807609.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Utianski RL, Josephs KA. An Update on Apraxia of Speech. Curr Neurol Neurosci Rep 2023; 23:353-359. [PMID: 37269450 PMCID: PMC10629164 DOI: 10.1007/s11910-023-01275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Apraxia of speech (AOS) is a motor speech disorder that has long been recognized to occur secondary to acute neurologic insults and, more recently, to neurodegenerative diseases as a harbinger for progressive supranuclear palsy and corticobasal syndrome. This article reviews recent findings regarding the clinic phenotypes of AOS, neuroimaging correlates, and the underlying disease processes. RECENT FINDINGS Two clinical subtypes of AOS map onto two underlying 4-repeat tauopathies. New imaging techniques have recently been applied to the study of progressive AOS. There is no data on the impact of behavioral intervention, although studies of nonfluent/agrammatic primary progressive aphasia that include patients with AOS suggest some benefit in speech intelligibility and maintenance. While recent findings suggest subtypes of AOS exist that are linked to molecular pathology and have important implications for disease progression, further research is needed to assess outcome of behavioral and other types of intervention.
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Affiliation(s)
- Rene L Utianski
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA.
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Satoh R, Arani A, Senjem ML, Duffy JR, Clark HM, Utianski RL, Botha H, Machulda MM, Jack CR, Whitwell JL, Josephs KA. Spatial patterns of elevated magnetic susceptibility in progressive apraxia of speech. Neuroimage Clin 2023; 38:103394. [PMID: 37003130 PMCID: PMC10102559 DOI: 10.1016/j.nicl.2023.103394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Progressive apraxia of speech (PAOS) is a neurodegenerative disorder affecting the planning or programming of speech. Little is known about its magnetic susceptibility profiles indicative of biological processes such as iron deposition and demyelination. This study aims to clarify (1) the pattern of susceptibility in PAOS patients, (2) the susceptibility differences between the phonetic (characterized by predominance of distorted sound substitutions and additions) and prosodic (characterized by predominance of slow speech rate and segmentation) subtypes of PAOS, and (3) the relationships between susceptibility and symptom severity. METHODS Twenty patients with PAOS (nine phonetic and eleven prosodic subtypes) were prospectively recruited and underwent a 3 Tesla MRI scan. They also underwent detailed speech, language, and neurological evaluations. Quantitative susceptibility maps (QSM) were reconstructed from multi-echo gradient echo MRI images. Region of interest analysis was conducted to estimate susceptibility coefficients in several subcortical and frontal regions. We compared susceptibility values between PAOS and an age-matched control group and performed a correlation analysis between susceptibilities and an apraxia of speech rating scale (ASRS) phonetic and prosodic feature ratings. RESULTS The magnetic susceptibility of PAOS was statistically greater than that of controls in subcortical regions (left putamen, left red nucleus, and right dentate nucleus) (p < 0.01, also survived FDR correction) and in the left white-matter precentral gyrus (p < 0.05, but not survived FDR correction). The prosodic patients showed greater susceptibilities than controls in these subcortical and precentral regions. The susceptibility in the left red nucleus and in the left precentral gyrus correlated with the prosodic sub-score of the ASRS. CONCLUSION Magnetic susceptibility in PAOS patients was greater than controls mainly in the subcortical regions. While larger samples are needed before QSM is considered ready for clinical differential diagnosis, the present study contributes to our understanding of magnetic susceptibility changes and the pathophysiology of PAOS.
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Affiliation(s)
- Ryota Satoh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Tetzloff KA, Duffy JR, Clark HM, Pham NTT, Machulda MM, Botha H, Jack CR, Dickson DW, Lowe VJ, Josephs KA, Whitwell JL, Utianski RL. Amyloid and Tau PET Positivity in Progressive Agrammatic Aphasia and Apraxia of Speech. J Alzheimers Dis 2023; 96:1759-1765. [PMID: 38007664 PMCID: PMC10804396 DOI: 10.3233/jad-230912] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND The agrammatic variant of primary progressive aphasia (PAA), primary progressive apraxia of speech (PPAOS), or a combination of both (AOS-PAA) are neurodegenerative disorders characterized by speech-language impairments and together compose the AOS-PAA spectrum disorders. These patients typically have an underlying 4-repeat tauopathy, although they sometimes show evidence of amyloid-β and tau deposition on PET, suggesting Alzheimer's disease (AD). Given the growing number of pharmacologic treatment options for AD, it is important to better understand the incidence of AD pathology in these patients. OBJECTIVE This study aimed to evaluate the frequency of amyloid-β and tau positivity in AOS-PAA spectrum disorders. Sixty-five patients with AOS-PAA underwent a clinical speech-language battery and PiB PET and flortaucipir PET imaging. METHODS Global PiB PET standardized uptake value ratios (SUVRs) and flortaucipir PET SUVRs from the temporal meta region of interest were compared between patient groups. For 19 patients who had died and undergone autopsy, their PET and pathology findings were also compared. RESULTS The results showed that although roughly half of the patients are positive for at least one biomarker, their clinical symptoms and biomarker status were not related, suggesting that AD is not the primary cause of their neurodegeneration. All but one patient in the autopsy subset had a Braak stage of IV or less, despite four being positive on tau PET imaging. CONCLUSIONS Inclusion criteria for clinical trials should specify clinical presentation or adjust the evaluation of such treatments to be specific to disease diagnosis beyond the presence of certain imaging biomarkers.
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Alosco ML, Su Y, Stein TD, Protas H, Cherry JD, Adler CH, Balcer LJ, Bernick C, Pulukuri SV, Abdolmohammadi B, Coleman MJ, Palmisano JN, Tripodis Y, Mez J, Rabinovici GD, Marek KL, Beach TG, Johnson KA, Huber BR, Koerte I, Lin AP, Bouix S, Cummings JL, Shenton ME, Reiman EM, McKee AC, Stern RA. Associations between near end-of-life flortaucipir PET and postmortem CTE-related tau neuropathology in six former American football players. Eur J Nucl Med Mol Imaging 2023; 50:435-452. [PMID: 36152064 PMCID: PMC9816291 DOI: 10.1007/s00259-022-05963-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Flourine-18-flortaucipir tau positron emission tomography (PET) was developed for the detection for Alzheimer's disease. Human imaging studies have begun to investigate its use in chronic traumatic encephalopathy (CTE). Flortaucipir-PET to autopsy correlation studies in CTE are needed for diagnostic validation. We examined the association between end-of-life flortaucipir PET and postmortem neuropathological measurements of CTE-related tau in six former American football players. METHODS Three former National Football League players and three former college football players who were part of the DIAGNOSE CTE Research Project died and agreed to have their brains donated. The six players had flortaucipir (tau) and florbetapir (amyloid) PET prior to death. All brains from the deceased participants were neuropathologically evaluated for the presence of CTE. On average, the participants were 59.0 (SD = 9.32) years of age at time of PET. PET scans were acquired 20.33 (SD = 13.08) months before their death. Using Spearman correlation analyses, we compared flortaucipir standard uptake value ratios (SUVRs) to digital slide-based AT8 phosphorylated tau (p-tau) density in a priori selected composite cortical, composite limbic, and thalamic regions-of-interest (ROIs). RESULTS Four brain donors had autopsy-confirmed CTE, all with high stage disease (n = 3 stage III, n = 1 stage IV). Three of these four met criteria for the clinical syndrome of CTE, known as traumatic encephalopathy syndrome (TES). Two did not have CTE at autopsy and one of these met criteria for TES. Concomitant pathology was only present in one of the non-CTE cases (Lewy body) and one of the CTE cases (motor neuron disease). There was a strong association between flortaucipir SUVRs and p-tau density in the composite cortical (ρ = 0.71) and limbic (ρ = 0.77) ROIs. Although there was a strong association in the thalamic ROI (ρ = 0.83), this is a region with known off-target binding. SUVRs were modest and CTE and non-CTE cases had overlapping SUVRs and discordant p-tau density for some regions. CONCLUSIONS Flortaucipir-PET could be useful for detecting high stage CTE neuropathology, but specificity to CTE p-tau is uncertain. Off-target flortaucipir binding in the hippocampus and thalamus complicates interpretation of these associations. In vivo biomarkers that can detect the specific p-tau of CTE across the disease continuum are needed.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yi Su
- Banner Alzheimer's Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Hillary Protas
- Banner Alzheimer's Institute, Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Surya Vamsi Pulukuri
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Departments of Neurology, Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
| | - Inga Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
- NICUM (NeuroImaging Core Unit Munich), Ludwig Maximilians University, Munich, Germany
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- VA Boston Healthcare System, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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Josephs KA, Tosakulwong N, Gatto RG, Weigand SD, Ali F, Botha H, Graff‐Radford J, Machulda MM, Savica R, Schwarz CG, Senjem ML, Boeve BF, Kantarci K, Jones DT, Ramanan VK, Fields JA, Reichard RR, Dickson DW, Petersen RC, Jack CR, Lowe VJ, Whitwell JL. Optimum Differentiation of Frontotemporal Lobar Degeneration from Alzheimer Disease Achieved with Cross-Sectional Tau Positron Emission Tomography. Ann Neurol 2022; 92:1016-1029. [PMID: 36054427 PMCID: PMC9804568 DOI: 10.1002/ana.26479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study was undertaken to assess cross-sectional and longitudinal [18 F]-flortaucipir positron emission tomography (PET) uptake in pathologically confirmed frontotemporal lobar degeneration (FTLD) and to compare FTLD to cases with high and low levels of Alzheimer disease (AD) neuropathologic changes (ADNC). METHODS One hundred forty-three participants who had completed at least one flortaucipir PET and had autopsy-confirmed FTLD (n = 52) or high (n = 58) or low ADNC (n = 33) based on Braak neurofibrillary tangle stages 0-IV versus V-VI were included. Flortaucipir standard uptake value ratios (SUVRs) were calculated for 9 regions of interest (ROIs): an FTLD meta-ROI, midbrain, globus pallidum, an AD meta-ROI, entorhinal, inferior temporal, orbitofrontal, precentral, and medial parietal. Linear mixed effects models were used to compare mean baseline SUVRs and annual rate of change in SUVR by group. Sensitivity and specificity to distinguish FTLD from high and low ADNC were calculated. RESULTS Baseline uptake in the FTLD meta-ROI, midbrain, and globus pallidus was greater in FTLD than high and low ADNC. No region showed a greater rate of flortaucipir accumulation in FTLD. Baseline uptake in the AD-related regions and orbitofrontal and precentral cortices was greater in high ADNC, and all showed greater rates of accumulation compared to FTLD. Baseline differences were superior to longitudinal rates in differentiating FTLD from high and low ADNC. A simple baseline metric of midbrain/inferior temporal ratio of flortaucipir uptake provided good to excellent differentiation between FTLD and high and low ADNC (sensitivities/specificities = 94%/95% and 71%/70%). INTERPRETATION There are cross-sectional and longitudinal differences in flortaucipir uptake between FTLD and high and low ADNC. However, optimum differentiation between FTLD and ADNC was achieved with baseline uptake rather than longitudinal rates. ANN NEUROL 2022;92:1016-1029.
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Affiliation(s)
| | | | | | | | - Farwa Ali
- Department of NeurologyMayo ClinicRochesterMNUSA
| | - Hugo Botha
- Department of NeurologyMayo ClinicRochesterMNUSA
| | | | - Mary M. Machulda
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
| | | | | | - Matthew L. Senjem
- Department of RadiologyMayo ClinicRochesterMNUSA
- Department of Information TechnologyMayo ClinicRochesterMNUSA
| | | | | | | | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
| | - Ross R. Reichard
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMNUSA
| | - Dennis W. Dickson
- Department of Neuroscience (Neurogenetics)Mayo ClinicJacksonvilleFLUSA
| | | | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMNUSA
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11
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Valls Carbo A, Reid RI, Tosakulwong N, Weigand SD, Duffy JR, Clark HM, Utianski RL, Botha H, Machulda MM, Strand EA, Schwarz CG, Jack CR, Josephs KA, Whitwell JL. Tractography of supplementary motor area projections in progressive speech apraxia and aphasia. Neuroimage Clin 2022; 34:102999. [PMID: 35395498 PMCID: PMC8987652 DOI: 10.1016/j.nicl.2022.102999] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/11/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022]
Abstract
Degeneration of SMA white matter tracts occurs in progressive apraxia of speech. SMA commissural, putamen and precentral tracts were associated with speech apraxia. Agrammatism was associated with SMA-prefrontal and frontal aslant tracts. Tract profile analysis suggests different disease epicenters across syndromes.
Progressive apraxia of speech (AOS) is a motor speech disorder affecting the ability to produce phonetically or prosodically normal speech. Progressive AOS can present in isolation or co-occur with agrammatic aphasia and is associated with degeneration of the supplementary motor area. We aimed to assess breakdowns in structural connectivity from the supplementary motor area in patients with any combination of progressive AOS and/or agrammatic aphasia to determine which supplementary motor area tracts are specifically related to these clinical symptoms. Eighty-four patients with progressive AOS or progressive agrammatic aphasia were recruited by the Neurodegenerative Research Group and underwent neurological, speech/language, and neuropsychological testing, as well as 3 T diffusion magnetic resonance imaging. Of the 84 patients, 36 had apraxia of speech in isolation (primary progressive apraxia of speech, PPAOS), 40 had apraxia of speech and agrammatic aphasia (AOS-PAA), and eight had agrammatic aphasia in isolation (progressive agrammatic aphasia, PAA). Tractography was performed to identify 5 distinct tracts connecting to the supplementary motor area. Fractional anisotropy and mean diffusivity were assessed at 10 positions along the length of the tracts to construct tract profiles, and median profiles were calculated for each tract. In a case-control comparison, decreased fractional anisotropy and increased mean diffusivity were observed along the supplementary motor area commissural fibers in all three groups compared to controls. PPAOS also had abnormal diffusion in tracts from the supplementary motor area to the putamen, prefrontal cortex, Broca’s area (frontal aslant tract) and motor cortex, with greatest abnormalities observed closest to the supplementary motor area. The AOS-PAA group showed abnormalities in the same set of tracts, but with greater involvement of the supplementary motor area to prefrontal tract compared to PPAOS. PAA showed abnormalities in the left prefrontal and frontal aslant tracts compared to both other groups, with PAA showing greatest abnormalities furthest from the supplementary motor area. Severity of AOS correlated with tract metrics in the supplementary motor area commissural and motor cortex tracts. Severity of aphasia correlated with the frontal aslant and prefrontal tracts. These findings provide insight into how AOS and agrammatism are differentially related to disrupted diffusivity, with progressive AOS associated with abnormalities close to the supplementary motor area, and the frontal aslant and prefrontal tracts being particularly associated with agrammatic aphasia.
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Affiliation(s)
- Adrian Valls Carbo
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Nirubol Tosakulwong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Edythe A Strand
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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12
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Neuropsychological Profiles of Patients with Progressive Apraxia of Speech and Aphasia. J Int Neuropsychol Soc 2022; 28:441-451. [PMID: 34289926 PMCID: PMC8986341 DOI: 10.1017/s1355617721000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize and compare the neuropsychological profiles of patients with primary progressive apraxia of speech (PPAOS) and apraxia of speech with progressive agrammatic aphasia (AOS-PAA). METHOD Thirty-nine patients with PPAOS and 49 patients with AOS-PAA underwent formal neurological, speech, language, and neuropsychological evaluations. Cognitive domains assessed included immediate and delayed episodic memory (Wechsler Memory Scale-Third edition; Logical Memory; Visual Reproduction; Rey Auditory Verbal Learning Test), processing speed (Trail Making Test A), executive functioning (Trail Making Test B; Delis-Kaplan Executive Functioning Scale - Sorting), and visuospatial ability (Rey-Osterrieth Complex Figure copy). RESULTS The PPAOS patients were cognitively average or higher in the domains of immediate and delayed episodic memory, processing speed, executive functioning, and visuospatial ability. Patients with AOS-PAA performed more poorly on tests of immediate and delayed episodic memory and executive functioning compared to those with PPAOS. For every 1 unit increase in aphasia severity (e.g. mild to moderate), performance declined by 1/3 to 1/2 a standard deviation depending on cognitive domain. The degree of decline was stronger within the more verbally mediated domains, but was also notable in less verbally mediated domains. CONCLUSION The study provides neuropsychological evidence further supporting the distinction of PPAOS from primary progressive aphasia and should be used to inform future diagnostic criteria. More immediately, it informs prognostication and treatment planning.
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Young CB, Winer JR, Younes K, Cody KA, Betthauser TJ, Johnson SC, Schultz A, Sperling RA, Greicius MD, Cobos I, Poston KL, Mormino EC. Divergent Cortical Tau Positron Emission Tomography Patterns Among Patients With Preclinical Alzheimer Disease. JAMA Neurol 2022; 79:592-603. [PMID: 35435938 PMCID: PMC9016616 DOI: 10.1001/jamaneurol.2022.0676] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Characterization of early tau deposition in individuals with preclinical Alzheimer disease (AD) is critical for prevention trials that aim to select individuals at risk for AD and halt the progression of disease. Objective To evaluate the prevalence of cortical tau positron emission tomography (PET) heterogeneity in a large cohort of clinically unimpaired older adults with elevated β-amyloid (A+). Design, Setting, and Participants This cross-sectional study examined prerandomized tau PET, amyloid PET, structural magnetic resonance imaging, demographic, and cognitive data from the Anti-Amyloid Treatment in Asymptomatic AD (A4) Study from April 2014 to December 2017. Follow-up analyses used observational tau PET data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Harvard Aging Brain Study (HABS), and the Wisconsin Registry for Alzheimer's Prevention and the Wisconsin Alzheimer's Disease Research Center (together hereinafter referred to as Wisconsin) to evaluate consistency. Participants were clinically unimpaired at the study visit closest to the tau PET scan and had available amyloid and tau PET data (A4 Study, n = 447; ADNI, n = 433; HABS, n = 190; and Wisconsin, n = 328). No participants who met eligibility criteria were excluded. Data were analyzed from May 11, 2021, to January 25, 2022. Main Outcomes and Measures Individuals with preclinical AD with heterogeneous cortical tau PET patterns (A+T cortical+) were identified by examining asymmetrical cortical tau signal and disproportionate cortical tau signal relative to medial temporal lobe (MTL) tau. Voxelwise tau patterns, amyloid, neurodegeneration, cognition, and demographic characteristics were examined. Results The 447 A4 participants (A+ group, 392; and normal β-amyloid group, 55), with a mean (SD) age of 71.8 (4.8) years, included 239 women (54%). A total of 36 individuals in the A+ group (9% of the A+ group) exhibited heterogeneous cortical tau patterns and were further categorized into 3 subtypes: asymmetrical left, precuneus dominant, and asymmetrical right. A total of 116 individuals in the A+ group (30% of the A+ group) showed elevated MTL tau (A+T MTL+). Individuals in the A+T cortical+ group were younger than those in the A+T MTL+ group (t61.867 = -2.597; P = .03). Across the A+T cortical+ and A+T MTL+ groups, increased regional tau was associated with reduced hippocampal volume and MTL thickness but not with cortical thickness. Memory scores were comparable between the A+T cortical+ and A+T MTL+ groups, whereas executive functioning scores were lower for the A+T cortical+ group than for the A+T MTL+ group. The prevalence of the A+T cortical+ group and tau patterns within the A+T cortical+ group were consistent in ADNI, HABS, and Wisconsin. Conclusions and Relevance This study suggests that early tau deposition may follow multiple trajectories during preclinical AD and may involve several cortical regions. Staging procedures, especially those based on neuropathology, that assume a uniform trajectory across individuals are insufficient for disease monitoring with tau imaging.
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Affiliation(s)
- Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Joseph R Winer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Kyan Younes
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Karly A Cody
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael D Greicius
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Inma Cobos
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Elizabeth C Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
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14
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Perani D, Cappa SF. The contribution of positron emission tomography to the study of aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:151-165. [PMID: 35078596 DOI: 10.1016/b978-0-12-823384-9.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniela Perani
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy; In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano F Cappa
- Department of Humanities and Life Sciences, University Institute for Advanced Studies IUSS Pavia, Pavia, Italy; Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy.
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15
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Utianski RL, Martin PR, Duffy JR, Botha H, Clark HM, Josephs KA. Assessing Change in Communication Limitations in Primary Progressive Apraxia of Speech and Aphasia: A 1-Year Follow-Up Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2368-2378. [PMID: 34491800 PMCID: PMC9132068 DOI: 10.1044/2021_ajslp-20-00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/11/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Purpose Individuals with primary progressive apraxia of speech have apraxia of speech (AOS) as the initial and predominant symptom. Many develop aphasia and/or dysarthria later in the disease course. It was previously demonstrated that patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits (Utianski et al., 2020). Measures of disease severity did not necessarily correlate with measures of participation restrictions. The aim of this follow-up study was to describe changes in communication limitations in these patients, again measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA's) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating to determine if there are significant changes in these and other objective speech and language measures at follow-up after 1 year. Method Of the 24 patients reported in the study of Utianski et al. (2020), 17 (10 men, seven women) returned for a second visit approximately 1 year following the first visit. Identical procedures were utilized; the communication measures collected at each visit were statistically compared. Correlations were calculated between the participation ratings and other clinical assessment measures at the second visit and for the change in scores on those measures between the first and second visits. Results There were statistically significant differences in AOS and aphasia severity between visits. There were significant changes in clinical assessments, MSD severity rating, and all ASHA FCMs between visits, but not the CPIB. Correlation analyses suggest the relationships among clinical and participation measures are complex; overall, patients with more severe changes in AOS experienced greater changes in participation restrictions. Conclusions The findings of this study support the use of patient-reported outcome measures as they may better reflect the patient experience, including the influence of factors such as ongoing speech therapy and the emergence of neuropsychiatric features, and associated changes in day-to-day functioning, when other measures may simply index the progression of the disease. Supplemental Material https://doi.org/10.23641/asha.16528512.
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Affiliation(s)
| | - Peter R. Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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16
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Karantzoulis A, Susani E, Ferrarese C, Appollonio I, Tremolizzo L. Coming to Terms with a Conundrum: A Case of Primary Progressive Apraxia of Speech due to Corticobasal Degeneration? Case Rep Neurol 2021; 13:483-489. [PMID: 34413751 PMCID: PMC8339446 DOI: 10.1159/000517367] [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: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Primary progressive apraxia of speech (PPAOS) is a progressive disorder impairing the motor speech act leaving linguistic function unattained. Although apraxia of speech frequently co-occurs with other neurodegenerative conditions, PPAOS defines a clinical syndrome where apraxia of speech is the sole or prominent symptom for much of the disease's natural history. Mounting evidence is beginning to fully define this disease as the epiphenomenon of 4-repeat (4R) tau pathology although other pathologic signatures have been reported. Indeed, PPAOS patients generally present a parkinsonian syndrome late into their natural history mostly qualifying for either corticobasal syndrome (CBS) or progressive supranuclear palsy (PSP). This is starting to be reflected in diagnostic criteria for PSP, namely, in the PSP speech and language (SL) subcategory; however, this inclusion is not reflected for CBS. Here, we present a single case of a patient with PPAOS and her clinical follow-up lasting 6 years, from the time she sought our attention to her death which occurred 8 years into the disease. PPAOS was the only and prominent symptom for most of the illness with extrapyramidal signs overtly presenting in the last months of its course. Clinical evaluation, imaging, genetic, and cerebrospinal fluid biomarkers all pointed toward an underlying CBD pathology, albeit the eventual anatomopathological confirmation was not performed. Had her clinical course been more suggestive of PSP, she would have qualified for criteria as PSP-SL. Our case therefore suggests the hypothetic need to discuss the broadening of the existing CBS criteria to encompass isolated PPAOS.
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Affiliation(s)
| | | | - Carlo Ferrarese
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
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17
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Haley KL, Jacks A, Jarrett J, Ray T, Cunningham KT, Gorno-Tempini ML, Henry ML. Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:754-775. [PMID: 33630653 PMCID: PMC8608203 DOI: 10.1044/2020_jslhr-20-00445] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/19/2020] [Accepted: 11/29/2020] [Indexed: 05/12/2023]
Abstract
Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and-to a limited extent-syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric-the narrative syllable duration-yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Jordan Jarrett
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Taylor Ray
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Kevin T. Cunningham
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | | | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences and Department of Neurology, Dell Medical School, The University of Texas at Austin
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18
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Provost K, Iaccarino L, Soleimani-Meigooni DN, Baker S, Edwards L, Eichenlaub U, Hansson O, Jagust W, Janabi M, La Joie R, Lesman-Segev O, Mellinger TJ, Miller BL, Ossenkoppele R, Pham J, Smith R, Sonni I, Strom A, Mattsson-Carlgren N, Rabinovici GD. Comparing ATN-T designation by tau PET visual reads, tau PET quantification, and CSF PTau181 across three cohorts. Eur J Nucl Med Mol Imaging 2021; 48:2259-2271. [PMID: 33398408 DOI: 10.1007/s00259-020-05152-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare rates of tau biomarker positivity (T-status) per the 2018 Alzheimer's Disease (AD) Research Framework derived from [18F]flortaucipir (FTP) PET visual assessment, FTP quantification, and cerebrospinal fluid (CSF) phosphorylated Tau-181 (PTau181). METHODS We included 351 subjects with varying clinical diagnoses from three cohorts with available FTP PET and CSF PTau181 within 18 months. T-status was derived from (1) FTP visual assessment by two blinded raters; (2) FTP standardized uptake value ratio (SUVR) quantification from a temporal meta-ROI (threshold: SUVR ≥1.27); and (3) Elecsys® Phospho-Tau (181P) CSF (Roche Diagnostics) concentrations (threshold: PTau181 ≥ 24.5 pg/mL). RESULTS FTP visual reads yielded the highest rates of T+, while T+ by SUVR increased progressively from cognitively normal (CN) through mild cognitive impairment (MCI) and AD dementia. T+ designation by CSF PTau181 was intermediate between FTP visual reads and SUVR values in CN, similar to SUVR in MCI, and lower in AD dementia. Concordance in T-status between modality pairs ranged from 68 to 76% and varied by clinical diagnosis, being highest in patients with AD dementia. In discriminating Aβ + MCI and AD subjects from healthy controls and non-AD participants, FTP visual assessment was most sensitive (0.96) but least specific (0.60). Specificity was highest with FTP SUVR (0.91) with sensitivity of 0.89. Sensitivity (0.73) and specificity (0.72) were balanced for PTau181. CONCLUSION The choice of tau biomarker may differ by disease stage and research goals that seek to maximize sensitivity or specificity. Visual interpretations of tau PET enhance sensitivity compared to quantification alone, particularly in early disease stages.
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Affiliation(s)
- Karine Provost
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA.
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - David N Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Suzanne Baker
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - William Jagust
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, UC Berkeley, Berkeley, CA, USA
| | - Mustafa Janabi
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Orit Lesman-Segev
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Taylor J Mellinger
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Ruben Smith
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Ida Sonni
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UC Los Angeles, Los Angeles, CA, USA
| | - Amelia Strom
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94143, USA
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, UC Berkeley, Berkeley, CA, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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19
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Utianski RL, Clark HM, Duffy JR, Botha H, Whitwell JL, Josephs KA. Communication Limitations in Patients With Progressive Apraxia of Speech and Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1976-1986. [PMID: 32755493 PMCID: PMC8758323 DOI: 10.1044/2020_ajslp-20-00012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 05/26/2023]
Abstract
Purpose Individuals with primary progressive apraxia of speech (AOS) have AOS in which disruptions in articulation and prosody predominate the speech pattern. Many develop aphasia and/or dysarthria later in the disease course. The aim of this study was to describe the communication limitations in these patients, as measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating. Method Speech and language evaluations were completed for 24 patients with progressive AOS (n = 7 with isolated AOS; n = 17 with a combination of AOS and aphasia). Descriptive comparisons were utilized to evaluate differences in communication measures among patients with various combinations of MSDs and aphasia. Differences associated with phonetic predominant or prosodic predominant AOS were also examined. Across the entire cohort, correlations were calculated between the participation ratings and other clinical assessment measures. Results The CPIB reflected greater limitations for those with aphasia and AOS compared to isolated AOS, but was not notably different when dysarthria occurred with AOS (n = 9/24). Across the cohort, there were statistically significant correlations between the CPIB and ASHA FCM-Motor Speech and Language Expression ratings and the MSD severity rating. The CPIB did not correlate with the ASHA FCM-Language Comprehension or other speech-language measures. Conclusions Patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits. The study suggests measures of severity cannot be assumed to correlate with measures of participation restrictions and offers a foundation for further research examining the day-to-day sequela of progressive speech and language disorders. Supplemental Material https://doi.org/10.23641/asha.12743252.
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Affiliation(s)
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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20
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Europa E, Iaccarino L, Perry DC, Weis E, Welch AE, Rabinovici GD, Miller BL, Gorno-Tempini ML, Henry ML. Diagnostic Assessment in Primary Progressive Aphasia: An Illustrative Case Example. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1833-1849. [PMID: 32910678 PMCID: PMC8740567 DOI: 10.1044/2020_ajslp-20-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Purpose Diagnosis and classification of primary progressive aphasia (PPA) requires confirmation of specific speech and language symptoms, highlighting the important role of speech-language pathologists in the evaluation process. The purpose of this case report is to inform speech-language pathologists regarding current practices for diagnostic assessment in PPA, describing standard approaches as well as complementary, state-of-the-art procedures that may improve diagnostic precision. Method We describe the diagnostic evaluation of a 49-year-old woman with complaints of progressive word-finding difficulty. She completed standard neurological, neuropsychological, and speech-language evaluations, as well as magnetic resonance and positron emission tomography imaging of her brain. In addition, a history of developmental speech, language, and learning abilities was obtained, as well as genetic testing and assessment of cerebrospinal fluid biomarkers. We discuss the evaluation results in the context of the most current research related to PPA diagnosis. Conclusion Detailed behavioral assessment, thorough intake of symptom history and neurodevelopmental differences, multimodal neuroimaging, and comprehensive examination of genes and biomarkers are of paramount importance for detecting and characterizing PPA, with ramifications for early behavioral and/or pharmacological intervention. Supplemental Material https://doi.org/10.23641/asha.12771113.
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Affiliation(s)
- Eduardo Europa
- Memory and Aging Center, University of California, San Francisco
| | | | - David C. Perry
- Memory and Aging Center, University of California, San Francisco
| | - Elizabeth Weis
- Memory and Aging Center, University of California, San Francisco
| | - Ariane E. Welch
- Memory and Aging Center, University of California, San Francisco
| | | | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco
- Dyslexia Center, University of California, San Francisco
| | - Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
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21
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Ghirelli A, Tosakulwong N, Weigand SD, Clark HM, Ali F, Botha H, Duffy JR, Utianski RL, Buciuc M, Murray ME, Labuzan SA, Spychalla AJ, Pham NTT, Schwarz CG, Senjem ML, Machulda MM, Baker M, Rademakers R, Filippi M, Jack CR, Lowe VJ, Parisi JE, Dickson DW, Josephs KA, Whitwell JL. Sensitivity-Specificity of Tau and Amyloid β Positron Emission Tomography in Frontotemporal Lobar Degeneration. Ann Neurol 2020; 88:1009-1022. [PMID: 32869362 PMCID: PMC7861121 DOI: 10.1002/ana.25893] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine associations between tau and amyloid β (Aβ) molecular positron emission tomography (PET) and both Alzheimer-related pathology and 4-repeat tau pathology in autopsy-confirmed frontotemporal lobar degeneration (FTLD). METHODS Twenty-four patients had [18 F]-flortaucipir-PET and died with FTLD (progressive supranuclear palsy [PSP], n = 10; corticobasal degeneration [CBD], n = 10; FTLD-TDP, n = 3; and Pick disease, n = 1). All but 1 had Pittsburgh compound B (PiB)-PET. Braak staging, Aβ plaque and neurofibrillary tangle counts, and semiquantitative tau lesion scores were performed. Flortaucipir standard uptake value ratios (SUVRs) were calculated in a temporal meta region of interest (meta-ROI), entorhinal cortex and cortical/subcortical regions selected to match the tau lesion analysis. Global PiB SUVR was calculated. Autoradiography was performed in 1 PSP patient, with digital pathology used to quantify tau burden. RESULTS Nine cases (37.5%) had Aβ plaques. Global PiB SUVR correlated with Aβ plaque count, with 100% specificity and 50% sensitivity for diffuse plaques. Twenty-one (87.5%) had Braak stages I to IV. Flortaucipir correlated with neurofibrillary tangle counts in entorhinal cortex, but entorhinal and meta-ROI SUVRs were not elevated in Braak IV or primary age-related tauopathy. Flortaucipir uptake patterns differed across FTLD pathologies and could separate PSP and CBD. Flortaucipir correlated with tau lesion score in red nucleus and midbrain tegmentum across patients, but not in cortical or basal ganglia regions. Autoradiography demonstrated minimal uptake of flortaucipir, although flortaucipir correlated with quantitative tau burden across regions. INTERPRETATION Molecular PET shows expected correlations with Alzheimer-related pathology but lacks sensitivity to detect mild Alzheimer pathology in FTLD. Regional flortaucipir uptake was able to separate CBD and PSP. ANN NEUROL 2020;88:1009-1022.
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Affiliation(s)
- Alma Ghirelli
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
- Università Vita-Salute San Raffaele, Milan,
Italy
| | | | | | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | | | | | - Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | | | | | | | | | | | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN,
USA
- Department of Information Technology, Mayo Clinic,
Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic,
Rochester, MN, USA
| | - Matthew Baker
- Department of Health Sciences Research, Mayo Clinic,
Rochester, MN, USA
| | - Rosa Rademakers
- Department of Health Sciences Research, Mayo Clinic,
Rochester, MN, USA
| | - Massimo Filippi
- Università Vita-Salute San Raffaele, Milan,
Italy
- Neurology and Neurophysiology Units, and Neuroimaging
Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific
Institute, Milan, Italy
| | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN,
USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
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22
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Allison KM, Cordella C, Iuzzini-Seigel J, Green JR. Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2952-2994. [PMID: 32783767 PMCID: PMC7890226 DOI: 10.1044/2020_jslhr-20-00061] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Claire Cordella
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston
| | - Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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23
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Lesman-Segev OH, Edwards L, Rabinovici GD. Chronic Traumatic Encephalopathy: A Comparison with Alzheimer's Disease and Frontotemporal Dementia. Semin Neurol 2020; 40:394-410. [PMID: 32820492 DOI: 10.1055/s-0040-1715134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The clinical diagnosis of chronic traumatic encephalopathy (CTE) is challenging due to heterogeneous clinical presentations and overlap with other neurodegenerative dementias. Depending on the clinical presentation, the differential diagnosis of CTE includes Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), Parkinson's disease, amyotrophic lateral sclerosis, primary mood disorders, posttraumatic stress disorder, and psychotic disorders. The aim of this article is to compare the clinical aspects, genetics, fluid biomarkers, imaging, treatment, and pathology of CTE to those of AD and bvFTD. A detailed clinical evaluation, neurocognitive assessment, and structural brain imaging can inform the differential diagnosis, while molecular biomarkers can help exclude underlying AD pathology. Prospective studies that include clinicopathological correlations are needed to establish tools that can more accurately determine the cause of neuropsychiatric decline in patients at risk for CTE.
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Affiliation(s)
- Orit H Lesman-Segev
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Lauren Edwards
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Gil D Rabinovici
- Department of Neurology, University of California San Francisco, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Weill Neuroscience Institute, University of California San Francisco, San Francisco, California
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24
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Rittman T. Neurological update: neuroimaging in dementia. J Neurol 2020; 267:3429-3435. [PMID: 32638104 PMCID: PMC7578138 DOI: 10.1007/s00415-020-10040-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
Neuroimaging for dementia has made remarkable progress in recent years, shedding light on diagnostic subtypes of dementia, predicting prognosis and monitoring pathology. This review covers some updates in the understanding of dementia using structural imaging, positron emission tomography (PET), structural and functional connectivity, and using big data and artificial intelligence. Progress with neuroimaging methods allows neuropathology to be examined in vivo, providing a suite of biomarkers for understanding neurodegeneration and for application in clinical trials. In addition, we highlight quantitative susceptibility imaging as an exciting new technique that may prove to be a sensitive biomarker for a range of neurodegenerative diseases. There are challenges in translating novel imaging techniques to clinical practice, particularly in developing standard methodologies and overcoming regulatory issues. It is likely that clinicians will need to lead the way if these obstacles are to be overcome. Continued efforts applying neuroimaging to understand mechanisms of neurodegeneration and translating them to clinical practice will complete a revolution in neuroimaging.
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Affiliation(s)
- Timothy Rittman
- Department of Neurosciences, University of Cambridge, Cambridge, UK.
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25
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Duffy JR, Utianski RL, Josephs KA. Primary Progressive Apraxia of Speech: From Recognition to Diagnosis and Care. APHASIOLOGY 2020; 35:560-591. [PMID: 34219857 PMCID: PMC8247786 DOI: 10.1080/02687038.2020.1787732] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Apraxia of speech (AOS) can be caused by neurodegenerative disease and sometimes is its presenting sign (i.e., primary progressive apraxia of speech, PPAOS). During the last several decades our understanding of PPAOS has evolved from clinical recognition to a fuller understanding of its core and associated clinical features, its distinction from but relationship with primary progressive aphasia, its temporal course and eventual progression to include other neurological deficits, and its neuroimaging correlates and underlying pathology. AIMS This paper provides a comprehensive summary of the literature that has built the current knowledge base about PPAOS and progressive AOS as it co-occurs with progressive aphasia. It reviews the history of its emergence as a recognized syndrome; its relationship with the agrammatic/nonfluent variant of primary progressive aphasia; its salient perceptual features and subtypes; the acoustic and structural/physiological imaging measures that index its presence, severity, and distinction from aphasia; and principles and available data regarding its management and care. MAIN CONTRIBUTION A broad summary of what is known about AOS as a manifestation of neurodegenerative disease. CONCLUSIONS Primary progressive apraxia of speech is a recognizable syndrome that can be distinguished from other neurodegenerative conditions that affect speech and language.
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Affiliation(s)
- Joseph R Duffy
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
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26
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Miller HE, Guenther FH. Modelling speech motor programming and apraxia of speech in the DIVA/GODIVA neurocomputational framework. APHASIOLOGY 2020; 35:424-441. [PMID: 34108793 PMCID: PMC8183977 DOI: 10.1080/02687038.2020.1765307] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Directions Into Velocities of Articulators (DIVA) model and its partner, the Gradient Order DIVA (GODIVA) model, provide neurobiologically grounded, computational accounts of speech motor control and motor sequencing, with applications for the study and treatment of neurological motor speech disorders. AIMS In this review, we provide an overview of the DIVA and GODIVA models and how they explain the interface between phonological and motor planning systems to build on previous models and provide a mechanistic accounting of apraxia of speech (AOS), a disorder of speech motor programming. MAIN CONTRIBUTION Combined, the DIVA and GODIVA models account for both the segmental and suprasegmental features that define AOS via damage to (i) a speech sound map, hypothesized to reside in left ventral premotor cortex, (ii) a phonological content buffer hypothesized to reside in left posterior inferior frontal sulcus, and/or (iii) the axonal projections between these regions. This account is in line with a large body of behavioural work, and it unifies several prior theoretical accounts of AOS. CONCLUSIONS The DIVA and GODIVA models provide an integrated framework for the generation and testing of both behavioural and neuroimaging hypotheses about the underlying neural mechanisms responsible for motor programming in typical speakers and in speakers with AOS.
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Affiliation(s)
- Hilary E. Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
| | - Frank H. Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
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27
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Utianski RL, Martin PR, Botha H, Schwarz CG, Duffy JR, Petersen RC, Knopman DS, Clark HM, Butts AM, Machulda MM, Jack CR, Lowe VJ, Whitwell JL, Josephs KA. Longitudinal flortaucipir ([ 18F]AV-1451) PET imaging in primary progressive apraxia of speech. Cortex 2020; 124:33-43. [PMID: 31830664 PMCID: PMC7060829 DOI: 10.1016/j.cortex.2019.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/07/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022]
Abstract
Primary progressive apraxia of speech (PPAOS) is a term used to describe a neurodegenerative condition in which apraxia of speech (AOS; a planning and/or programming deficit) occurs in the absence of aphasia (a language deficit). PPAOS is strongly associated with 4-repeat tau pathology. Elevated flortaucipir ([18F]AV-1451; FTP) uptake has been observed cross-sectionally in patients with PPAOS and those with aphasia. Here, we evaluated longitudinal changes in previously-identified regions of uptake and their relationship with clinical presentation. Thirteen patients who were diagnosed with PPAOS (5 female) at presentation underwent FTP PET imaging at two visits (mean 1 year interval). Median age was 72, with a median of 4 years disease duration at initial testing. Beta-amyloid status was assessed with Pittsburgh Compound B (PiB), where a global PiB ratio>1.48 was deemed amyloid positive (n = 4). FTP uptake was assessed as cortical to cerebellar crus ratios (SUVr) in cortical regions of interest. A single hierarchical linear model (HLM) compared PPAOS patients to 52 cognitively unimpaired controls of similar age and sex. Annualized SUVr change was the outcome, predicted by region, clinical status, and age. Person-specific effects accounted for intra-patient correlations and contralateral regions were included as repeated measures. Changes in clinical measures were assessed using Wilcoxon signed-rank tests; statistically significant changes in the Montreal Cognitive Assessment, MDS-UPDRS, motor section, and PSP Rating Scale were noted between visits. Changes in FTP SUVr were greater for patients than controls. The strongest changes in PPAOS patients were in the precentral gyrus, pallidum, and mid and superior frontal gyri, per the HLM. Qualitatively, larger changes were seen in patients who had developed aphasia by the time of their baseline scan (n = 5). While the biological mechanisms of FTP signal in non-AD tauopathies are unknown, this study demonstrates the utility of FTP in tracking disease progression in 4R tauopathies.
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Affiliation(s)
| | - Peter R Martin
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Alissa M Butts
- Department of Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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28
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Whitwell JL, Tosakulwong N, Botha H, Ali F, Clark HM, Duffy JR, Utianski RL, Stevens CA, Weigand SD, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Ahlskog JE, Dickson DW, Josephs KA. Brain volume and flortaucipir analysis of progressive supranuclear palsy clinical variants. NEUROIMAGE-CLINICAL 2019; 25:102152. [PMID: 31935638 PMCID: PMC6961761 DOI: 10.1016/j.nicl.2019.102152] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/25/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
All PSP variants showed atrophy or flortaucipir uptake in subcortical structures. Speech/language, frontal and corticobasal variants showed cortical involvement. Dentatorubrothalamic tract involvement was only seen in some variants. PSP variants show different patterns of damage to subcortical-cortical circuitry.
Background and purpose Progressive supranuclear palsy (PSP) is a neurodegenerative tauopathy that is associated with different clinical variants, including PSP-Richardson's syndrome (PSP-RS), PSP-parkinsonism (PSP-P), PSP-corticobasal syndrome (PSP-CBS), PSP-frontal (PSP-F), PSP-progressive gait freezing (PSP-PGF) and PSP-speech/language (PSP-SL). While PSP-RS has been well-characterized on neuroimaging, the characteristics of the other atypical variants are less well defined and it is unknown how they compare to each other or relate to neuropathology. We aimed to assess and compare regional atrophy on MRI and [18F]flortaucipir uptake on PET across PSP variants. Materials and methods 105 PSP patients (53 PSP-RS, 23 PSP-SL, 12 PSP-P, 8 PSP-CBS, 5 PSP-F and 4 PSP-PGF) underwent volumetric MRI, with 59 of these also undergoing flortaucipir PET. Voxel-level and region-level analyses were performed comparing PSP variants to 30 controls and to each other. Semi-quantitative tau burden measurements were also performed in 21 patients with autopsy-confirmed PSP. Results All variants showed evidence for atrophy or increased flortaucipir uptake in striatum, globus pallidus and thalamus. Superior cerebellar peduncle volume loss was only observed in PSP-RS, PSP-CBS and PSP-F. Volume loss in the frontal lobes was observed in PSP-SL, PSP-CBS and PSP-F, with these variants also showing highest cortical tau burden at autopsy. The PSP-P and PSP-PGF variants showed more restricted patterns of neurodegeneration predominantly involving striatum, globus pallidus, subthalamic nucleus and thalamus. The PSP-SL variant showed greater volume loss and flortaucipir uptake in supplementary motor area and motor cortex compared to all other variants, but showed less involvement of subthalamic nucleus and midbrain. Compared to PSP-RS, PSP-P had larger midbrain volume and greater flortaucipir uptake in putamen. Conclusion The PSP variants have different patterns of involvement of subcortical circuitry, perhaps suggesting different patterns of disease spread through the brain. These findings will be important in the development of appropriate neuroimaging biomarkers for the different PSP variants.
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Affiliation(s)
| | - Nirubol Tosakulwong
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Chase A Stevens
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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29
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Lesman-Segev OH, La Joie R, Stephens ML, Sonni I, Tsai R, Bourakova V, Visani AV, Edwards L, O'Neil JP, Baker SL, Gardner RC, Janabi M, Chaudhary K, Perry DC, Kramer JH, Miller BL, Jagust WJ, Rabinovici GD. Tau PET and multimodal brain imaging in patients at risk for chronic traumatic encephalopathy. Neuroimage Clin 2019; 24:102025. [PMID: 31670152 PMCID: PMC6831941 DOI: 10.1016/j.nicl.2019.102025] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize individual and group-level neuroimaging findings in patients at risk for Chronic Traumatic Encephalopathy (CTE). METHODS Eleven male patients meeting criteria for Traumatic Encephalopathy Syndrome (TES, median age: 64) underwent neurologic evaluation, 3-Tesla MRI, and PET with [18F]-Flortaucipir (FTP, tau-PET) and [11C]-Pittsburgh compound B (PIB, amyloid-PET). Six patients underwent [18F]-Fluorodeoxyglucose-PET (FDG, glucose metabolism). We assessed imaging findings at the individual patient level, and in group-level comparisons with modality-specific groups of cognitively normal older adults (CN). Tau-PET findings in patients with TES were also compared to a matched group of patients with mild cognitive impairment or dementia due to Alzheimer's disease (AD). RESULTS All patients with TES sustained repetitive head injury participating in impact sports, ten in American football. Three patients met criteria for dementia and eight had mild cognitive impairment. Two patients were amyloid-PET positive and harbored the most severe MRI atrophy, FDG hypometabolism, and FTP-tau PET binding. Among the nine amyloid-negative patients, tau-PET showed either mildly elevated frontotemporal binding, a "dot-like" pattern, or no elevated binding. Medial temporal FTP was mildly elevated in a subset of amyloid-negative patients, but values were considerably lower than in AD. Voxelwise analyses revealed a convergence of imaging abnormalities (higher FTP binding, lower FDG, lower gray matter volumes) in frontotemporal areas in TES compared to controls. CONCLUSIONS Mildly elevated tau-PET binding was observed in a subset of amyloid-negative patients at risk for CTE, in a distribution consistent with CTE pathology stages III-IV. FTP-PET may be useful as a biomarker of tau pathology in CTE but is unlikely to be sensitive to early disease stages.
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Affiliation(s)
- Orit H Lesman-Segev
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States.
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Melanie L Stephens
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Ida Sonni
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Richard Tsai
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Viktoriya Bourakova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Adrienne V Visani
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - James P O'Neil
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Suzanne L Baker
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Raquel C Gardner
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, United States
| | - Mustafa Janabi
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Kiran Chaudhary
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - David C Perry
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - William J Jagust
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720, United States
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States; Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, United States; Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720, United States
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Lagarde J, Olivieri P, Caillé F, Gervais P, Baron JC, Bottlaender M, Sarazin M. [18F]-AV-1451 tau PET imaging in Alzheimer’s disease and suspected non-AD tauopathies using a late acquisition time window. J Neurol 2019; 266:3087-3097. [DOI: 10.1007/s00415-019-09530-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
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Pascual B, Funk Q, Zanotti-Fregonara P, Pal N, Rockers E, Yu M, Spann B, Román GC, Schulz PE, Karmonik C, Appel SH, Masdeu JC. Multimodal 18F-AV-1451 and MRI Findings in Nonfluent Variant of Primary Progressive Aphasia: Possible Insights on Nodal Propagation of Tau Protein Across the Syntactic Network. J Nucl Med 2019; 61:263-269. [PMID: 31350322 DOI: 10.2967/jnumed.118.225508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022] Open
Abstract
Although abnormally folded tau protein has been found to self-propagate from neuron to connected neuron, similar propagation through human brain networks has not been fully documented. We studied tau propagation in the left hemispheric syntactic network, which comprises an anterior frontal node and a posterior temporal node connected by the white matter of the left arcuate fasciculus. This network is affected in the nonfluent variant of primary progressive aphasia, a neurodegenerative disorder with tau accumulation. Methods: Eight patients with the nonfluent variant of primary progressive aphasia (age, 67.0 ± 7.4 y; 4 women) and 8 healthy controls (age, 69.6 ± 7.0 y; 4 women) were scanned with 18F-AV-1451 tau PET to determine tau deposition in the brain and with MRI to determine the fractional anisotropy of the arcuate fasciculus. Normal syntactic network characteristics were confirmed with structural MRI diffusion imaging in our healthy controls and with blood oxygenation level-dependent functional imaging in 35 healthy participants from the Alzheimer Disease Neuroimaging Initiative database. Results: Language scores in patients indicated dysfunction of the anterior node. 18F-AV-1451 deposition was greatest in the 2 nodes of the syntactic network. The left arcuate fasciculus had decreased fractional anisotropy, particularly near the anterior node. Normal MRI structural connectivity from an area similar to the one containing tau in the anterior frontal node projected to an area similar to the one containing tau in the patients in the posterior temporal node. Conclusion: Tau accumulation likely started in the more affected anterior node and, at the disease stage at which we studied these patients, appeared as well in the brain region (in the temporal lobe) spatially separate from but most connected with it. The arcuate fasciculus, connecting both of them, was most severely affected anteriorly, as would correspond to a loss of axons from the anterior node. These findings are suggestive of tau propagation from node to connected node in a natural human brain network and support the idea that neurons that wire together die together.
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Affiliation(s)
- Belen Pascual
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Quentin Funk
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Paolo Zanotti-Fregonara
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Neha Pal
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Elijah Rockers
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Meixiang Yu
- Cyclotron and Radiopharmaceutical Core, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Bryan Spann
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Gustavo C Román
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | | | - Christof Karmonik
- MRI Core, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas; and
| | - Stanley H Appel
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
| | - Joseph C Masdeu
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, Texas
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Whitwell JL. FTD spectrum: Neuroimaging across the FTD spectrum. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:187-223. [PMID: 31481163 DOI: 10.1016/bs.pmbts.2019.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia is a complex and heterogeneous neurodegenerative disease that encompasses many clinical syndromes, pathological diseases, and genetic mutations. Neuroimaging has played a critical role in our understanding of the underlying pathophysiology of frontotemporal dementia and provided biomarkers to aid diagnosis. Early studies defined patterns of neurodegeneration and hypometabolism associated with the clinical, pathological and genetic aspects of frontotemporal dementia, with more recent studies highlighting how the breakdown of structural and functional brain networks define frontotemporal dementia. Molecular positron emission tomography ligands allowing the in vivo imaging of tau proteins have also provided important insights, although more work is needed to understand the biology of the currently available ligands.
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Lagarde J, Hahn V, Sarazin M. Afasia primaria progressiva. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cordella C, Quimby M, Touroutoglou A, Brickhouse M, Dickerson BC, Green JR. Quantification of motor speech impairment and its anatomic basis in primary progressive aphasia. Neurology 2019; 92:e1992-e2004. [PMID: 30944238 PMCID: PMC6511075 DOI: 10.1212/wnl.0000000000007367] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate whether a quantitative speech measure is effective in identifying and monitoring motor speech impairment (MSI) in patients with primary progressive aphasia (PPA) and to investigate the neuroanatomical basis of MSI in PPA. Methods Sixty-four patients with PPA were evaluated at baseline, with a subset (n = 39) evaluated longitudinally. Articulation rate (AR), a quantitative measure derived from spontaneous speech, was measured at each time point. MRI was collected at baseline. Differences in baseline AR were assessed across PPA subtypes, separated by severity level. Linear mixed-effects models were conducted to assess groups differences across PPA subtypes in rate of decline in AR over a 1-year period. Cortical thickness measured from baseline MRIs was used to test hypotheses about the relationship between cortical atrophy and MSI. Results Baseline AR was reduced for patients with nonfluent variant PPA (nfvPPA) compared to other PPA subtypes and controls, even in mild stages of disease. Longitudinal results showed a greater rate of decline in AR for the nfvPPA group over 1 year compared to the logopenic and semantic variant subgroups. Reduced baseline AR was associated with cortical atrophy in left-hemisphere premotor and supplementary motor cortices. Conclusions The AR measure is an effective quantitative index of MSI that detects MSI in mild disease stages and tracks decline in MSI longitudinally. The AR measure also demonstrates anatomic localization to motor speech–specific cortical regions. Our findings suggest that this quantitative measure of MSI might have utility in diagnostic evaluation and monitoring of MSI in PPA.
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Affiliation(s)
- Claire Cordella
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Megan Quimby
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Alexandra Touroutoglou
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Michael Brickhouse
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Bradford C Dickerson
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Jordan R Green
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA.
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Utianski RL, Caviness JN, Worrell GA, Duffy JR, Clark HM, Machulda MM, Whitwell JL, Josephs KA. Electroencephalography in Primary Progressive Aphasia and Apraxia of Speech. APHASIOLOGY 2019; 33:1410-1417. [PMID: 31741547 PMCID: PMC6860920 DOI: 10.1080/02687038.2018.1545991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Past research has demonstrated that electroencephalography (EEG) is sensitive to what we now know as Primary Progressive Aphasia (PPA); however, the EEG profiles of patients with Primary Progressive Apraxia of Speech (PPAOS) and PPA, in the context of current consensus criteria, have not been studied. AIMS The primary goal of this study was to explore the EEG profiles of patients of the nonfluent/ agrammatic variant of PPA (agPPA) and PPAOS. METHODS AND PROCEDURES Three patients with agPPA and five patients with PPAOS (two with aphasia) completed a head MRI scan and clinical EEG recording. Clinical radiologists and electrophysiologists reviewed respective imaging, blinded to clinical diagnosis. OUTCOMES AND RESULTS Patients with PPAOS who did not have aphasia had normal EEGs, while those with aphasia demonstrated theta slowing. Patients with agPPA also showed theta slowing, with one exception. MRI scans showed non-specific, age-related changes across clinical presentations. CONCLUSIONS This preliminary study suggests theta slowing is consistent with neurodegenerative aphasia, but not isolated apraxia of speech. EEG is a low-cost mechanism to identify possible biomarkers for use when clinical severity limits behavioral examinations or expert examiners are unavailable.
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Affiliation(s)
| | | | | | | | | | - Mary M. Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
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Tau PET imaging evidence in patients with cognitive impairment: preparing for clinical use. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Utianski RL, Whitwell JL, Schwarz CG, Duffy JR, Botha H, Clark HM, Machulda MM, Senjem ML, Knopman DS, Petersen RC, Jack CR, Lowe VJ, Josephs KA. Tau uptake in agrammatic primary progressive aphasia with and without apraxia of speech. Eur J Neurol 2018; 25:1352-1357. [PMID: 29935044 DOI: 10.1111/ene.13733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/20/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The non-fluent/agrammatic variant of primary progressive aphasia (agPPA) is a heterogeneous diagnosis wherein some individuals have apraxia of speech (AOS). When agPPA includes AOS, a tauopathy is the likely underlying pathology. Recently, [18F]AV-1451 was developed for the in-vivo assessment of tau. In this study, we compared patterns of tau tracer uptake in patients with agPPA with and without AOS. METHODS Nine patients with agPPA (four without AOS) underwent tau positron emission tomography imaging with [18F]AV-1451. Uptake of [18F]AV-1451 was assessed as cortical to cerebellar crus ratio (standard uptake value ratio) in cortical regions of interest measured using the MCALT atlas and compared voxel-wise in SPM12. Each patient was age- and sex-matched to three controls. RESULTS The agPPA without AOS showed uptake in the left frontal and temporal lobes, whereas agPPA with AOS showed uptake in the bilateral supplementary motor areas, frontal lobes, precuneus and precentral gyrus relative to controls. The left precentral gyrus had uptake in agPPA with AOS relative to those without AOS. CONCLUSIONS This cross-sectional study suggests that [18F]AV-1451 uptake in the precentral gyrus is implicated in AOS in agPPA.
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Affiliation(s)
- R L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - J L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - C G Schwarz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - J R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - H Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - H M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - M M Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - M L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - R C Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - C R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - V J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - K A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Schaeverbeke J, Gabel S, Meersmans K, Bruffaerts R, Liuzzi AG, Evenepoel C, Dries E, Van Bouwel K, Sieben A, Pijnenburg Y, Peeters R, Bormans G, Van Laere K, Koole M, Dupont P, Vandenberghe R. Single-word comprehension deficits in the nonfluent variant of primary progressive aphasia. Alzheimers Res Ther 2018; 10:68. [PMID: 30021613 PMCID: PMC6052568 DOI: 10.1186/s13195-018-0393-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A subset of patients with the nonfluent variant of primary progressive aphasia (PPA) exhibit concomitant single-word comprehension problems, constituting a 'mixed variant' phenotype. This phenotype is rare and currently not fully characterized. The aim of this study was twofold: to assess the prevalence and nature of single-word comprehension problems in the nonfluent variant and to study multimodal imaging characteristics of atrophy, tau, and amyloid burden associated with this mixed phenotype. METHODS A consecutive memory-clinic recruited series of 20 PPA patients (12 nonfluent, five semantic, and three logopenic variants) were studied on neurolinguistic and neuropsychological domains relative to 64 cognitively intact healthy older control subjects. The neuroimaging battery included high-resolution volumetric magnetic resonance imaging processed with voxel-based morphometry, and positron emission tomography with the tau-tracer [18F]-THK5351 and amyloid-tracer [11C]-Pittsburgh Compound B. RESULTS Seven out of 12 subjects who had been classified a priori with nonfluent variant PPA showed deficits on conventional single-word comprehension tasks along with speech apraxia and agrammatism, corresponding to a mixed variant phenotype. These mixed variant cases included three females and four males, with a mean age at onset of 65 years (range 44-77 years). Object knowledge and object recognition were additionally affected, although less severely compared with the semantic variant. The mixed variant was characterized by a distributed atrophy pattern in frontal and temporoparietal regions. A more focal pattern of elevated [18F]-THK5351 binding was present in the supplementary motor area, the left premotor cortex, midbrain, and basal ganglia. This pattern was closely similar to that seen in pure nonfluent variant PPA. At the individual patient level, elevated [18F]-THK5351 binding in the supplementary motor area and premotor cortex was present in six out of seven mixed variant cases and in five and four of these cases, respectively, in the thalamus and midbrain. Amyloid biomarker positivity was present in two out of seven mixed variant cases, compared with none of the five pure nonfluent cases. CONCLUSIONS A substantial proportion of PPA patients with speech apraxia and agrammatism also have single-word comprehension deficits. At the neurobiological level, the mixed variant shows a high degree of similarity with the pure nonfluent variant of PPA. TRIAL REGISTRATION EudraCT, 2014-002976-10 . Registered on 13-01-2015.
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Affiliation(s)
- Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Silvy Gabel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Karen Meersmans
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Antonietta Gabriella Liuzzi
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Charlotte Evenepoel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Anne Sieben
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB, Universiteitsplein 1, 2610 Antwerp, Belgium
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
- Neurology Department, University Hospitals Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Yolande Pijnenburg
- Old Age Psychiatry Department, GGZinGeest, Van Hilligaertstraat 21, 1072 JX Amsterdam, The Netherlands
- Alzheimer Center & Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ronald Peeters
- Radiology Department, University Hospitals Leuven, Herestraat 49, Leuven, 30000 Belgium
| | - Guy Bormans
- Laboratory of Radiopharmaceutical Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Koen Van Laere
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
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Botha H, Duffy JR, Whitwell JL, Strand EA, Machulda MM, Spychalla AJ, Tosakulwong N, Senjem ML, Knopman DS, Petersen RC, Jack CR, Lowe VJ, Josephs KA. Non-right handed primary progressive apraxia of speech. J Neurol Sci 2018; 390:246-254. [PMID: 29801898 PMCID: PMC5986290 DOI: 10.1016/j.jns.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 12/12/2022]
Abstract
In recent years a large and growing body of research has greatly advanced our understanding of primary progressive apraxia of speech. Handedness has emerged as one potential marker of selective vulnerability in degenerative diseases. This study evaluated the clinical and imaging findings in non-right handed compared to right handed participants in a prospective cohort diagnosed with primary progressive apraxia of speech. A total of 30 participants were included. Compared to the expected rate in the population, there was a higher prevalence of non-right handedness among those with primary progressive apraxia of speech (6/30, 20%). Small group numbers meant that these results did not reach statistical significance, although the effect sizes were moderate-to-large. There were no clinical differences between right handed and non-right handed participants. Bilateral hypometabolism was seen in primary progressive apraxia of speech compared to controls, with non-right handed participants showing more right hemispheric involvement. This is the first report of a higher rate of non-right handedness in participants with isolated apraxia of speech, which may point to an increased vulnerability for developing this disorder among non-right handed participants. This challenges prior hypotheses about a relative protective effect of non-right handedness for tau-related neurodegeneration. We discuss potential avenues for future research to investigate the relationship between handedness and motor disorders more generally.
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Affiliation(s)
- Hugo Botha
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer L Whitwell
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN 55905, USA
| | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN 55905, USA
| | - Anthony J Spychalla
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN 55905, USA
| | - Nirubol Tosakulwong
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, 55905, USA
| | - David S Knopman
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology (Nuclear Medicine), Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN 55905, USA; Department of Neurology (Movement Disorders), Mayo Clinic, Rochester, MN 55905, USA.
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Schaeverbeke J, Evenepoel C, Declercq L, Gabel S, Meersmans K, Bruffaerts R, Adamczuk K, Dries E, Van Bouwel K, Sieben A, Pijnenburg Y, Peeters R, Bormans G, Van Laere K, Koole M, Dupont P, Vandenberghe R. Distinct [ 18F]THK5351 binding patterns in primary progressive aphasia variants. Eur J Nucl Med Mol Imaging 2018; 45:2342-2357. [PMID: 29946950 PMCID: PMC6208807 DOI: 10.1007/s00259-018-4075-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the binding of the PET tracer [18F]THK5351 in patients with different primary progressive aphasia (PPA) variants and its correlation with clinical deficits. The majority of patients with nonfluent variant (NFV) and logopenic variant (LV) PPA have underlying tauopathy of the frontotemporal lobar or Alzheimer disease type, respectively, while patients with the semantic variant (SV) have predominantly transactive response DNA binding protein 43-kDa pathology. METHODS The study included 20 PPA patients consecutively recruited through a memory clinic (12 NFV, 5 SV, 3 LV), and 20 healthy controls. All participants received an extensive neurolinguistic assessment, magnetic resonance imaging and amyloid biomarker tests. [18F]THK5351 binding patterns were assessed on standardized uptake value ratio (SUVR) images with the cerebellar grey matter as the reference using statistical parametric mapping. Whole-brain voxel-wise regression analysis was performed to evaluate the association between [18F]THK5351 SUVR images and neurolinguistic scores. Analyses were performed with and without partial volume correction. RESULTS Patients with NFV showed increased binding in the supplementary motor area, left premotor cortex, thalamus, basal ganglia and midbrain compared with controls and patients with SV. Patients with SV had increased binding in the temporal lobes bilaterally and in the right ventromedial frontal cortex compared with controls and patients with NFV. The whole-brain voxel-wise regression analysis revealed a correlation between agrammatism and motor speech impairment, and [18F]THK5351 binding in the left supplementary motor area and left postcentral gyrus. Analysis of [18F]THK5351 scans without partial volume correction revealed similar results. CONCLUSION [18F]THK5351 imaging shows a topography closely matching the anatomical distribution of predicted underlying pathology characteristic of NFV and SV PPA. [18F]THK5351 binding correlates with the severity of clinical impairment.
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Affiliation(s)
- Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Charlotte Evenepoel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lieven Declercq
- Laboratory of Radiopharmaceutical Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Silvy Gabel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Karen Meersmans
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Neurology Department, University Hospitals Leuven, Herestraat 49, box 7003, 3000, Leuven, Belgium
| | - Kate Adamczuk
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Herestraat 49, box 7003, 3000, Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Herestraat 49, box 7003, 3000, Leuven, Belgium
| | - Anne Sieben
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB, Universiteitsplein 1, 2610, Antwerp, Belgium.,Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.,Neurology Department, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Yolande Pijnenburg
- Old Age Psychiatry Department, GGZinGeest, Van Hilligaertstraat 21, 1072 JX, Amsterdam, The Netherlands.,Alzheimer Center & Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Ronald Peeters
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Guy Bormans
- Laboratory of Radiopharmaceutical Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Koen Van Laere
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Neurology Department, University Hospitals Leuven, Herestraat 49, box 7003, 3000, Leuven, Belgium.
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Botha H, Utianski RL, Whitwell JL, Duffy JR, Clark HM, Strand EA, Machulda MM, Tosakulwong N, Knopman DS, Petersen RC, Jack CR, Josephs KA, Jones DT. Disrupted functional connectivity in primary progressive apraxia of speech. Neuroimage Clin 2018; 18:617-629. [PMID: 29845010 PMCID: PMC5964833 DOI: 10.1016/j.nicl.2018.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/13/2018] [Accepted: 02/28/2018] [Indexed: 12/12/2022]
Abstract
Apraxia of speech is a motor speech disorder thought to result from impaired planning or programming of articulatory movements. It can be the initial or only manifestation of a degenerative disease, termed primary progressive apraxia of speech (PPAOS). The aim of this study was to use task-free functional magnetic resonance imaging (fMRI) to assess large-scale brain network pathophysiology in PPAOS. Twenty-two PPAOS participants were identified from a prospective cohort of degenerative speech and language disorders patients. All participants had a comprehensive, standardized evaluation including an evaluation by a speech-language pathologist, examination by a behavioral neurologist and a multimodal imaging protocol which included a task-free fMRI sequence. PPAOS participants were age and sex matched to amyloid-negative, cognitively normal participants with a 1:2 ratio. We chose a set of hypothesis driven, predefined intrinsic connectivity networks (ICNs) from a large, out of sample independent component analysis and then used them to initialize a spatiotemporal dual regression to estimate participant level connectivity within these ICNs. Specifically, we evaluated connectivity within the speech and language, face and hand sensorimotor, left working memory, salience, superior parietal, supramarginal, insular and deep gray ICNs in a multivariate manner. The spatial maps for each ICN were then compared between PPAOS and control participants. We used clinical measures of apraxia of speech severity to assess for clinical-connectivity correlations for regions found to differ between PPAOS and control participants. Compared to controls, PPAOS participants had reduced connectivity of the right supplementary motor area and left posterior temporal gyrus to the rest of the speech and language ICN. The connectivity of the right supplementary motor area correlated negatively with an articulatory error score. PPAOS participants also had reduced connectivity of the left supplementary motor area to the face sensorimotor ICN, between the left lateral prefrontal cortex and the salience ICN and between the left temporal-occipital junction and the left working memory ICN. The latter connectivity correlated with the apraxia of speech severity rating scale, although the finding did not survive correction for multiple comparisons. Increased connectivity was noted in PPAOS participants between the dorsal posterior cingulate and the left working memory ICN. Our results support the importance of the supplementary motor area in the pathophysiology of PPAOS, which appears to be disconnected from speech and language regions. Supplementary motor area connectivity may serve as a biomarker of degenerative apraxia of speech severity.
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Key Words
- AES, Articulatory Error Score
- AOS, Apraxia Of Speech
- AQ, Aphasia Quotient
- ASRS, Apraxia of Speech Severity Rating Scale
- Apraxia of speech
- BNT, Boston Naming Test
- FAB, Frontal Assessment Battery
- FBI, Frontal Behavioral Inventory
- Functional connectivity
- ICN, Intrinsic Connectivity Network
- Intrinsic connectivity networks
- MMSE, Mini-Mental State Examination
- NPI-S, Neuropsychiatric Inventory – Severity
- NVOA, Nonverbal Oral Apraxia
- PCC, Posterior Cingulate Cortex
- PFC, Prefrontal Cortex
- PPA, Primary Progressive Aphasia
- SMA, Supplementary Motor Area
- TOJ, Temporal-Occipital Junction
- TT, Token Test
- UPDRS, Unified Parkinson Disease Rating Scale
- WAB, Western Aphasia Battery
- agPPA, Agrammatic/Nonfluent PPA
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Affiliation(s)
- Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Edythe A Strand
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Nirubol Tosakulwong
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States; Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States.
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