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Panegyres PK. The Clinical Spectrum of Young Onset Dementia Points to Its Stochastic Origins. J Alzheimers Dis Rep 2021; 5:663-679. [PMID: 34632303 PMCID: PMC8461730 DOI: 10.3233/adr-210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dementia is a major global health problem and the search for improved therapies is ongoing. The study of young onset dementia (YOD)-with onset prior to 65 years-represents a challenge owing to the variety of clinical presentations, pathology, and gene mutations. The advantage of the investigation of YOD is the lack of comorbidities that complicate the clinical picture in older adults. Here we explore the origins of YOD. OBJECTIVE To define the clinical diversity of YOD in terms of its demography, range of presentations, neurological examination findings, comorbidities, medical history, cognitive findings, imaging abnormalities both structural and functional, electroencephagraphic (EEG) data, neuropathology, and genetics. METHODS A prospective 20-year study of 240 community-based patients referred to specialty neurology clinics established to elucidate the nature of YOD. RESULTS Alzheimer's disease (AD; n = 139) and behavioral variant frontotemporal (bvFTD; n = 58) were the most common causes with a mean age of onset of 56.5 years for AD (±1 SD 5.45) and 57.1 years for bvFTD (±1 SD 5.66). Neuropathology showed a variety of diagnoses from multiple sclerosis, Lewy body disease, FTD-MND, TDP-43 proteinopathy, adult-onset leukoencephalopathy with axonal steroids and pigmented glia, corticobasal degeneration, unexplained small vessel disease, and autoimmune T-cell encephalitis. Non-amnestic forms of AD and alternative forms of FTD were discovered. Mutations were only found in 11 subjects (11/240 = 4.6%). APOE genotyping was not divergent between the two populations. CONCLUSION There are multiple kinds of YOD, and most are sporadic. These observations point to their stochastic origins.
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Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, Australia
- The University of Western Australia, Nedlands, Australia
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Ganguly J, Jog M. Tauopathy and Movement Disorders-Unveiling the Chameleons and Mimics. Front Neurol 2020; 11:599384. [PMID: 33250855 PMCID: PMC7674803 DOI: 10.3389/fneur.2020.599384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The spectrum of tauopathy encompasses heterogenous group of neurodegenerative disorders characterized by neural or glial deposition of pathological protein tau. Clinically they can present as cognitive syndromes, movement disorders, motor neuron disease, or mixed. The heterogeneity in clinical presentation, genetic background, and underlying pathology make it difficult to classify and clinically approach tauopathy. In the literature, tauopathies are thus mostly highlighted from pathological perspective. From clinical standpoint, cognitive syndromes are often been focussed while reviewing tauopathies. However, the spectrum of tauopathy has also evolved significantly in the domain of movement disorders and has transgressed beyond the domain of primary tauopathies. Secondary tauopathies from neuroinflammation or autoimmune insults and some other "novel" tauopathies are increasingly being reported in the current literature, while some of them are geographically isolated. Because of the overlapping clinical phenotypes, it often becomes difficult for the clinician to diagnose them clinically and have to wait for the pathological confirmation by autopsy. However, each of these tauopathies has some clinical and radiological signatures those can help in clinical diagnosis and targeted genetic testing. In this review, we have exposed the heterogeneity of tauopathy from a movement disorder perspective and have provided a clinical approach to diagnose them ante mortem before confirmatory autopsy. Additionally, phenotypic variability of these disorders (chameleons) and the look-alikes (mimics) have been discussed with potential clinical pointers for each of them. The review provides a framework within which new and as yet undiscovered entities can be classified in the future.
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Affiliation(s)
| | - Mandar Jog
- Movement Disorder Centre, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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Ruggeri M, Biagioli C, Ricci M, Gerace C, Blundo C. Progressive aphasia, apraxia of speech and agraphia in corticobasal degeneration: A 12-case series clinical and neuropsychological descriptive study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:867-874. [PMID: 32725870 DOI: 10.1111/1460-6984.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS), aphasia is now recognized as a frequent feature of this disease. Aphasia in CBS seems clinically overlying to a non-fluent/agrammatic primary progressive aphasia (nfaPPA), which is also a clinical phenotype associated with corticobasal degeneration (CBD) pathology. However, the clinical features of aphasia in CBS still remain poorly delineated, resulting in misjudgements in the differential diagnosis from a PPA presentation of the disease. AIMS To investigate the language disorders of this syndrome, also through a systematic examination of recoding skills (reading, written spelling and repetition) and articulatory disturbances, which have been rarely examined in previous studies. METHODS & PROCEDURES We present a clinical and neuropsychological descriptive study of the language impairments in a case series of 12 aphasic patients with a clinical diagnosis of CBS. Language assessment was conducted by means of the Esame NeuroPsicologico dell'Afasia, a comprehensive Italian battery for language functions, the Token Test, and the Apraxia of Speech Rating Scale. OUTCOMES & RESULTS The language profile of the patients showed a severe expressive language disorder, characterized by non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding and defective sentence repetition. Severe limb apraxia, visual-spatial deficit and alien hand syndrome were also present. Neuroimaging showed bilateral left asymmetric atrophies and hypometabolism in the frontal premotor, parietal posterior and temporal areas. CONCLUSIONS & IMPLICATIONS These findings suggest that aphasia in CBS might present as a 'mixed PPA', instead of an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA, associated with AoS, stuttering and agraphia, which might be additional important cognitive markers for the clinical diagnosis of CBS and discriminating features of an nfaPPA presentation of a CBD. These results might also suggest specific intervention areas in the rehabilitation of patients with CBS. What this paper adds What is already known on the subject Language disorders in CBS patients usually present clinically overlying to an nfaPPA, which is also a clinical phenotype associated with CBD pathology, according to recent diagnostic criteria. However, the clinical features of aphasia in CBS still remain poorly delineated, and this raises difficulties and misjudgements for clinicians in the differential diagnosis from a PPA presentation of the disease. What this paper adds to existing knowledge This study shows that the language profile of our CBS patients was characterized by severe expressive language disorders, with non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding, and defective sentence repetition. These findings suggest that aphasia in CBS might present as a 'mixed PPA', rather than an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA associated with AoS, stuttering and agraphia. What are the potential or actual clinical implications of this work? These results suggest that AoS, stuttering and agraphia might be important additional cognitive markers for the clinical diagnosis of CBS, and discriminating features of an nfaPPA presentation of a CBD. The language disorders exhibited in the present study might also support speech and language therapists in targeting specific intervention areas in the rehabilitation of patients with CBS.
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Affiliation(s)
- Massimiliano Ruggeri
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
- Rehabilitation Center C.A.R., Neuropsychology Unit, Rome, Italy
| | - Clelia Biagioli
- Rehabilitation Center C.A.R., Neuropsychology Unit, Rome, Italy
| | - Monica Ricci
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carmela Gerace
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Blundo
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
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Corticobasal degeneration and corticobasal syndrome: A review. Clin Park Relat Disord 2019; 1:66-71. [PMID: 34316603 PMCID: PMC8288513 DOI: 10.1016/j.prdoa.2019.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Corticobasal degeneration (CBD) is a rare neurodegenerative disorder. The most common presentation of CBD is the corticobasal syndrome (CBS), which is a constellation of cortical and extrapyramidal symptoms and signs. Clinical-pathological studies have illustrated that CBD can present with diverse clinical phenotypes, including a non-fluent, agrammatic primary progressive aphasia syndrome, a behavioral, dysexecutive and visuospatial syndrome, as well as a progressive supranuclear palsy-like syndrome. Conversely, multiple pathologies, such as CBD, Alzheimer's disease and progressive supranuclear palsy may underlie a patient with CBS. This clinical-pathological overlap emphasizes the need for biomarkers that will assist in the accurate diagnosis of patients with CBS. This review presents an overview of the pathological, genetic, clinical and therapeutic characteristics of CBD, with an emphasis on the imaging (structural and functional) and biochemical (cerebrospinal fluid) biomarkers of CBD.
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Abbate C, Trimarchi PD, Manzoni L, Quarenghi AM, Salvi GP, Inglese S, Giunco F, Bagarolo R, Mari D, Arosio B. A posterior variant of corticobasal syndrome: Evidence from a longitudinal study of cognitive and functional status in a single case. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1452868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Pietro Davide Trimarchi
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Laura Manzoni
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | | | - Gian Pietro Salvi
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Fabrizio Giunco
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Renzo Bagarolo
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Daniela Mari
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
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Abe Y, Kimura N, Goto M, Aso Y, Matsubara E. Brain Perfusion in Corticobasal Syndrome with Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2016; 6:133-41. [PMID: 27195001 PMCID: PMC4868931 DOI: 10.1159/000443329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Brain perfusion may differ between patients with corticobasal syndrome (CBS) with and without aphasia. Methods Twenty-six (9 males and 17 females; mean age 76 ± 5.3 years) patients with CBS were enrolled in the study. Brain MRI and single-photon emission computed tomography were performed in all subjects. Language was evaluated using the Standard Language Test of Aphasia. The patients were divided into two subgroups according to the presence or absence of progressive aphasia. Differences in the regional cerebral blood flow (rCBF) between the two groups were detected based on voxel-by-voxel group analysis using Statistical Parametric Mapping 8. Results All patients exhibited asymmetric motor symptoms and signs, including limb apraxia, bradykinesia, and akinetic rigidity. Of 26 patients, 9 had a clinically obvious language disturbance, characterized as nonfluent aphasia. Almost all CBS patients with aphasia exhibited cortical atrophy predominantly in the left frontal and temporal lobes with widening of the Sylvian fissure on MRI. The rCBF in the left middle frontal gyrus differed significantly between CBS patients with and without aphasia. Conclusion CBS patients with aphasia exhibit motor symptoms predominantly on the right side and cortical atrophy mainly in the left perisylvian cortices. In particular, left frontal dysfunction might be related to nonfluent aphasia in CBS.
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Affiliation(s)
- Yoshitake Abe
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Megumi Goto
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yasuhiro Aso
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
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Shin HW, Song SK, Sohn YH. Is progressive upper-body apraxia a corticobasal syndrome? J Clin Neurosci 2012; 20:319-22. [PMID: 23157846 DOI: 10.1016/j.jocn.2012.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 10/27/2022]
Abstract
Corticobasal degeneration (CBD) is characterized by various clinical manifestations including corticobasal syndrome, progressive supranuclear palsy-like syndrome and frontotemporal dementia. Focal cortical atrophy syndrome as the initial manifestation rarely occurs in CBD. Here, we present a 62-year-old man and a 70-year-old man who were admitted due to clumsiness in the arms. On initial neurological examination, they showed asymmetric limb apraxia without parkinsonism or global cognitive dysfunction. Brain MRI showed focal atrophy in the frontal and prefrontal cortices, and brain positron emission tomography scan revealed decreased metabolism in these same brain locations. Although these patients developed parkinsonism and dystonia within several years, the neurological signs were limited to the arms for a long period. "Progressive upper-body apraxia" may be a rare clinical manifestation of CBD which shows a benign clinical outcome. The patients described may enhance our understanding of the clinical heterogeneity of this disease.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
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Stamelou M, Alonso-Canovas A, Bhatia KP. Dystonia in corticobasal degeneration: A review of the literature on 404 pathologically proven cases. Mov Disord 2012; 27:696-702. [DOI: 10.1002/mds.24992] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/23/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022] Open
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Sakai K, Ono K, Harada H, Shima K, Notoya M, Yamada M. Parkinson's disease showing progressive conduction aphasia. Neurol Sci 2011; 33:399-402. [PMID: 21879327 DOI: 10.1007/s10072-011-0751-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
Patients with Parkinson's disease (PD) may develop progressive dementia late in their clinical course. Dementia in PD is mostly related to neuropathological findings of extensive Lewy bodies (LBs), with or without the coexistence of Alzheimer's disease (AD) pathology. Aphasia has been reported in patients with LB diseases with AD pathology; however, there have been no reports of typical PD patients developing progressive aphasia during their clinical course. We describe a female PD patient who later developed progressive conduction aphasia characterized by phonemic paraphasia and disturbance in repetition of short sentences without disturbance in writing or auditory comprehension. No episodes of fluctuations of attention, memory complaints, or planning errors were observed. She experienced episodes of visual hallucination. Her low scores on the Mini-Mental State Examination suggested impairment of orientation and attention, and her scores on Raven's Coloured Progressive Matrices test indicated impaired visuospatial functions. However, her cognitive deficits were not sufficiently severe to impair her daily life. Brain magnetic resonance images revealed atrophy of the left superior temporal gyrus and widening of the left sylvian fissure. [(18)F]-fluorodeoxyglucose positron emission tomography revealed glucose hypometabolism in the left cerebral hemisphere. These findings may be related to conduction aphasia. During the progression of PD lesions, the brainstem LB is assumed to take an upward course, extend to the limbic system, and then extend to the neocortex. Conduction aphasia observed in our patient may be associated with an unusual progression of the LB pathology from the brainstem to the left temporoparietal lobe.
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Affiliation(s)
- Kenji Sakai
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan.
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Abstract
In this paper, a historical overview of the interpretation of conduction aphasia is initially presented. It is emphasized that the name conduction aphasia was proposed by Wernicke and was interpreted as a disconnection between the temporal and frontal brain language areas; this interpretation was re-taken by Geschwind, attributing the arcuate fasciculus the main role in speech repetition disturbances and resulting in the so-called Wernicke-Geschwind model of language. With the introduction of contemporary neuroimaging techniques, this interpretation of conduction aphasia as a disconnection syndrome due to an impairment of the arcuate fasciculus has been challenged. It has been disclosed that the arcuate fasciculus does not really connect Wernicke's and Broca's areas, but Wernicke's and motor/premotor frontal areas. Furthermore, conduction aphasia can be found in cases of cortical damage without subcortical extension. It is concluded that conduction aphasia remains a controversial topic not only from the theoretic point of view, but also from the understanding of its neurologic foundations.
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Atrofie focali. Neurologia 2011. [DOI: 10.1016/s1634-7072(11)70571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lu C, Peng D, Chen C, Ning N, Ding G, Li K, Yang Y, Lin C. Altered effective connectivity and anomalous anatomy in the basal ganglia-thalamocortical circuit of stuttering speakers. Cortex 2010; 46:49-67. [PMID: 19375076 DOI: 10.1016/j.cortex.2009.02.017] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/24/2008] [Accepted: 02/21/2009] [Indexed: 10/21/2022]
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Hassan A, Whitwell JL, Boeve BF, Jack CR, Parisi JE, Dickson DW, Josephs KA. Symmetric corticobasal degeneration (S-CBD). Parkinsonism Relat Disord 2009; 16:208-14. [PMID: 20018548 DOI: 10.1016/j.parkreldis.2009.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 11/23/2009] [Accepted: 11/25/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Corticobasal degeneration (CBD) is a neurodegenerative disease characterized pathologically by neuronal loss, gliosis and tau deposition in neocortex, basal ganglia and brainstem. Typical clinical presentation is known as corticobasal syndrome (CBS) and involves the core features of progressive asymmetric rigidity and apraxia, accompanied by other signs of cortical and extrapyramidal dysfunction. Asymmetry is also emphasized on neuroimaging. OBJECTIVE To describe a series of cases of CBD with symmetric clinical features and to compare clinical and imaging features of these symmetric CBD cases (S-CBD) to typical cases of CBS with CBD pathology. METHODS All cases of pathologically confirmed CBD from the Mayo Clinic Rochester database were identified. Clinical records were reviewed and quantitative volumetric analysis of symmetric atrophy on head MRI using atlas based parcellation was performed. Subjects were classified as S-CBD if no differences had been observed between right- and left-sided cortical or extrapyramidal signs or symptoms. S-CBD cases were compared to 10 randomly selected typical CBS cases. RESULTS Five cases (2 female) met criteria for S-CBD. None had limb dystonia, myoclonus, apraxia or alien limb phenomena. S-CBD cases had significantly less asymmetric atrophy when compared with CBS cases (p=0.009); they were also younger at onset (median 61 versus 66 years, p<0.05) and death (67 versus 73 years, p<0.05). Family history was present in 40% of S-CBD cases. CONCLUSIONS CBD can have a symmetric presentation, clinically and radiologically, in which typical features of CBS, such as limb apraxia, myoclonus, dystonia and alien limb phenomenon, may be absent.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Lu C, Ning N, Peng D, Ding G, Li K, Yang Y, Lin C. The role of large-scale neural interactions for developmental stuttering. Neuroscience 2009; 161:1008-26. [PMID: 19364522 DOI: 10.1016/j.neuroscience.2009.04.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/30/2009] [Accepted: 04/06/2009] [Indexed: 12/21/2022]
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Apraxia of speech and nonfluent aphasia: a new clinical marker for corticobasal degeneration and progressive supranuclear palsy. Curr Opin Neurol 2009; 21:688-92. [PMID: 18989114 DOI: 10.1097/wco.0b013e3283168ddd] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To highlight the fact that patients with corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) can sometimes present with a progressive apraxia of speech, nonfluent aphasia, or a combination of the two disorders. RECENT FINDINGS Corticobasal degeneration and PSP are neurodegenerative diseases characterized by neuronal loss and gliosis in cardinal brain regions, as well as the abnormal deposition of the microtubule associated protein tau in cell bodies and cell processes. The typical presenting features of CBD and PSP are akinesia and rigidity that are levodopa unresponsive, although there has been evidence that both diseases, moreso CBD, can present with a dementia syndrome. Recent clinicopathological studies have now also demonstrated that a subset of patients with CBD and PSP present with a progressive apraxia of speech, nonfluent aphasia, or a combination of the two disorders. SUMMARY Presenting features of progressive apraxia of speech or nonfluent aphasia are strongly associated with a diagnosis of CBD, PSP, or both.
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Zhang W, Zheng R, Wang Z, Yuan Y. The overlap of corticobasal degeneration and Alzheimer changes: an autopsy case. Neuropathology 2009; 29:720-6. [PMID: 19323789 DOI: 10.1111/j.1440-1789.2009.01012.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aspects of various neurodegenerative diseases can be observed overlapping with each other during autopsy. Corticobasal degeneration (CBD) is a rare neurodegenerative disease, whereas Alzheimer disease (AD) is the most common cause of dementia. In this article, we present the combination of CBD and AD in an autopsy case. The patient, an 82-year-old right-handed woman developed asymmetrical parkinsonism, visuospatial dysfunction and memory loss, as well as subsequent non-influent aphasia over the past 10 years. The autopsy revealed characteristic CBD-related pathology, ballooned neurons, globose tangles and astrocytic plaques, mainly in the frontal cortex and basal ganglia. The Alzheimer-related pathology was also present concomitantly. Senile plagues deposited diffusively throughout the hippocampus and neocortices. Neurofibrillary tangles (NFTs) were more confined to the hippocampus. The autopsy demonstrated pathological overlap of CBD and AD, which therefore explained the clinical early development of dementia and parkinsonism. We should suspect the concurrence of various neurodegenerative disorders in any case with atypical or complex clinical manifestations. Tau pathology is a prominent feature in both CBD and AD. Such a combination would be a clue for the pathogenesis of various tauopathies.
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Affiliation(s)
- Wei Zhang
- Department of Neurology, First Hospital, Peking University, Beijing, China
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