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Toprak G, Hanoglu L, Cakir T, Guntekin B, Velioglu HA, Yulug B. DLPF Targeted Repetitive Transcranial Magnetic Stimulation Improves Brain Glucose Metabolism Along with the Clinical and Electrophysiological Parameters in CBD Patients. Endocr Metab Immune Disord Drug Targets 2022; 22:415-424. [PMID: 35100961 DOI: 10.2174/1871530322666220131120349] [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] [Received: 02/10/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Corticobasal Degeneration (CBD) is a rare neurological disease caused by the pathological accumulation of tau protein. The primary pathological features of CBD include progressive neurodegenerative processes resulting in remarkable frontoparietal and basal ganglia atrophy. OBJECTIVE Like in many other neurodegenerative disorders, there is still no effective disease-modifying drug therapy in CBD. Therefore, the development of new treatment methods is of great importance. In this study, we aimed to assess the stimulating effects of high-frequency DLPFC rTMS on the motor, cognitive and behavioral disturbances in four CBD patients. METHODS Four (three females, one male) CBD patients who had been diagnosed as CBD were enrolled in this study. Patients were evaluated before and after the rTMS procedure regarding the motor, neuropsychometric and behavioral tests. The results of statistical analysis of behavioral and neuropsychometric evaluation were assessed via SPSS 18.0 package program. Data are expressed as mean, standard deviation. Before and after values of the groups were compared with the Wilcoxon sign rank test, and p<0.05 was considered significant. RESULTS We have provided strong preliminary evidence that the improvement in clinical parameters was associated with the normalizations of the theta activity and glucose metabolism. CONCLUSION Our current results are consistent with some previous trials showing a strong association between DLPFC targeted rTMS and electrophysiological normalizations in the left DLPFC.
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Affiliation(s)
- Guven Toprak
- Department of Clinical Electrophysiology, Neuroimaging and Neuromodulation, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoglu
- Department of Neurology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Tansel Cakir
- Department of Nuclear Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bahar Guntekin
- Department of Clinical Electrophysiology, Neuroimaging and Neuromodulation, Istanbul Medipol University, Istanbul, Turkey
| | - Halil Aziz Velioglu
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul Medipol University, Istanbul, Turkey
| | - Burak Yulug
- Department of Neurology, Alanya Alaaddin Keykubat University School of Medicine, Alanya/Antalya, Turkey
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Gossink FT, Dols A, Krudop WA, Sikkes SA, Kerssens CJ, Prins ND, Scheltens P, Stek ML, Pijnenburg YAL. Formal Psychiatric Disorders are not Overrepresented in Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis 2016; 51:1249-56. [PMID: 26967225 DOI: 10.3233/jad-151198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While psychiatric misdiagnosis is well-known in behavioral variant frontotemporal dementia (bvFTD), a systematic evaluation of standardized criteria for psychiatric disorders in bvFTD is still missing. Our aim was to define frequency and character of DSM-IV psychiatric disorders among patients with probable and definite bvFTD compared to possible bvFTD, other neurodegenerative diseases, and psychiatric diagnoses, using MINI-International Neuropsychiatric Interview. We additionally compared psychiatric prodromes between these groups. Subjects were participants of the late-onset frontal lobe (LOF) study, a longitudinal multicenter study. In each patient, after baseline diagnostic procedure, a neurologist and geriatric psychiatrist made a joint clinical diagnosis. Independently, a structured diagnostic interview according to DSM-IV and ICD-10 criteria (MINI-Plus) was performed by a trained professional blinded to clinical diagnosis. Out of 91 patients, 23 with probable and definite bvFTD, 3 with possible bvFTD, 25 with a non bvFTD neurodegenerative disease, and 40 with a clinical psychiatric diagnosis were included. Overall frequency of formal current and past psychiatric disorders in probable and definite bvFTD (21.7% current, 8.7% past) did not differ from other neurodegenerative diseases (12.0% current, 16.0% past) or possible bvFTD (66.7% current, 66.7% past), but was less than in patients with a clinical psychiatric diagnosis (57.5% current, 62.5% past; p < 0.01). In probable and definite bvFTD unipolar mood disorders were most common. Formally diagnosed psychiatric disorders are not overrepresented in probable bvFTD, suggesting that psychiatric misdiagnosis in bvFTD can be reduced by strictly applying diagnostic criteria. In suspected bvFTD close collaboration between neurologists and psychiatrists will advance diagnostics and subsequent treatment.
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Affiliation(s)
- Flora T Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Welmoed A Krudop
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sietske A Sikkes
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Barrows RJ, Barsuglia J, Paholpak P, Eknoyan D, Sabodash V, Lee GJ, Mendez MF. Executive Abilities as Reflected by Clock Hand Placement: Frontotemporal Dementia Versus Early-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2015; 28:239-48. [PMID: 26251109 DOI: 10.1177/0891988715598228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The clock-drawing test (CDT) is widely used in clinical practice to diagnose and distinguish patients with dementia. It remains unclear, however, whether the CDT can distinguish among the early-onset dementias. Accordingly, we examined the ability of both quantitative and qualitative CDT analyses to distinguish behavioral variant frontotemporal dementia (bvFTD) and early-onset Alzheimer disease (eAD), the 2 most common neurodegenerative dementias with onset <65 years of age. We hypothesized that executive aspects of the CDT would discriminate between these 2 disorders. The study compared 15 patients with bvFTD and 16 patients with eAD on the CDT using 2 different scales and correlated the findings with neuropsychological testing and magnetic resonance imaging. The total CDT scores did not discriminate bvFTD and eAD; however, specific analysis of executive hand placement items successfully distinguished the groups, with eAD exhibiting greater errors than bvFTD. The performance on those executive hand placement items correlated with measures of naming as well as visuospatial and executive function. On tensor-based morphometry of the magnetic resonance images, executive hand placement correlated with right frontal volume. These findings suggest that lower performance on executive hand placement items occurs with involvement of the right dorsolateral frontal-parietal network for executive control in eAD, a network disproportionately affected in AD of early onset. Rather than the total performance on the clock task, the analysis of specific errors, such as executive hand placement, may be useful for early differentiation of eAD, bvFTD, and other conditions.
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Affiliation(s)
- Robin J Barrows
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Joseph Barsuglia
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Donald Eknoyan
- Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Valeriy Sabodash
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Grace J Lee
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
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Borroni B, Cosseddu M, Pilotto A, Premi E, Archetti S, Gasparotti R, Cappa S, Padovani A. Early stage of behavioral variant frontotemporal dementia: clinical and neuroimaging correlates. Neurobiol Aging 2015; 36:3108-3115. [PMID: 26329689 DOI: 10.1016/j.neurobiolaging.2015.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/11/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
Abstract
The early stages of behavioral variant frontotemporal dementia (bvFTD) are still not completely characterized. In a consecutive series of patients with probable bvFTD diagnosis confirmed by follow-up, we retrospectively evaluated the features at onset. Patients were reclassified according to presenting features and current diagnostic criteria into probable and possible bvFTD. The term "pre-bvFTD" was adopted for patients with cognitive and/or behavioral impairment not fulfilling bvFTD criteria and no deficits in activities of daily living. One hundred ninety-four subjects were included; at first visit, 70% (n = 136) patients were already classified as probable bvFTD. Of the remaining 30% (n = 58), 60% fulfilled criteria for possible bvFTD, while 40% did not, and were classified as pre-FTD. The neuropsychological pattern in possible bvFTD and pre-bvFTD was similar, although possible bvFTD showed more behavioral abnormalities. Pre-bvFTD subjects had frontotemporal gray matter atrophy, although less extensive than possible bvFTD. Conclusively, most bvFTD patients fulfill current diagnostic criteria at first admission, whereas a relatively small group is characterized by mild behavioral and/or cognitive abnormalities in spite of frontotemporal gray matter atrophy. Our preliminary findings will require a validation in prospective studies involving larger samples of patients.
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Affiliation(s)
- Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy.
| | - Maura Cosseddu
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Enrico Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | | | | | - Stefano Cappa
- Institute for Advanced Study IUSS Pavia, Pavia, Italy
| | - Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
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Early onset degenerative dementias: demographic characteristics and etiologic classification in a tertiary referral center. Acta Neurol Belg 2015; 115:27-31. [PMID: 24878660 DOI: 10.1007/s13760-014-0310-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
Early onset dementia (EOD) is a major diagnostic challenge as it often presents with atypical features and may be attributed to treatable diseases. Primary degenerative dementias (Alzheimer's disease-AD, frontotemporal lobar degeneration-FTLD, Lewy body dementia-LBD), although traditionally considered to affect older people, are still a main cause of EOD. 491 demented patients were assessed from January 1, 2003 to December 31, 2010 in the Neurology Department of a tertiary referral center. Patients were classified as AD, behavioral variant frontotemporal dementia (bvFTD), non-fluent agrammatic variant primary progressive aphasia (naPPA), semantic variant PPA (svPPA), corticobasal degeneration (CBD), or progressive supranuclear palsy (PSP) who also met criteria for naPPA and LBD. Finally, their demographic characteristics were analysed, according to age at onset (EOD <65 years, late onset dementia-LOD ≥65 years). From the 491 patients, 137 (27.9 %) were EOD. In the EOD group, 52 (38 %) were diagnosed with bvFTD, 34 (24.8 %) with AD, 27 (19.7 %) with naPPA, 10 (7.2 %) with svPPA, 12 (8.8 %) with CBD or PSP, and 2 (1.5 %) with LBD. Demographic characteristics did not differ significantly among diagnostic categories in the EOD group, while in the LOD group FTLD patients were younger and more frequently men compared to both AD and LBD patients. EOD patients had more years of education than LOD patients. Degenerative disorders as causes of EOD are not rare. High clinical alertness is warranted to achieve correct and timely diagnosis.
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Barsuglia JP, Kaiser NC, Wilkins SS, Karve SJ, Barrows RJ, Paholpak P, Panchal HV, Jimenez EE, Mather MJ, Mendez MF. A scale of socioemotional dysfunction in frontotemporal dementia. Arch Clin Neuropsychol 2014; 29:793-805. [PMID: 25331776 PMCID: PMC4296158 DOI: 10.1093/arclin/acu050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/13/2022] Open
Abstract
Early social dysfunction is a hallmark symptom of behavioral variant frontotemporal dementia (bvFTD); however, validated measures for assessing social deficits in dementia are needed. The purpose of the current study was to examine the utility of a novel informant-based measure of social impairment, the Socioemotional Dysfunction Scale (SDS) in early-onset dementia. Sixteen bvFTD and 18 early-onset Alzheimer's disease (EOAD) participants received standard clinical neuropsychological measures and neuroimaging. Caregiver informants were administered the SDS. Individuals with bvFTD exhibited greater social dysfunction on the SDS compared with the EOAD group; t(32) = 6.32, p < .001. The scale demonstrated preliminary evidence for discriminating these frequently misdiagnosed groups (area under the curve = 0.920, p = <.001) and internal consistency α = 0.977. The SDS demonstrated initial evidence as an effective measure for detecting abnormal social behavior and discriminating bvFTD from EOAD. Future validation is recommended in larger and more diverse patient groups.
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Affiliation(s)
- Joseph P Barsuglia
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Natalie C Kaiser
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Stacy Schantz Wilkins
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Simantini J Karve
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robin J Barrows
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Elvira E Jimenez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michelle J Mather
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mario F Mendez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA Department of Psychiatry & Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
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