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Hardy CJD, Taylor‐Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, O'Shea F, Volkmer A, Crutch SJ, Warren JD. Symptom-based staging for logopenic variant primary progressive aphasia. Eur J Neurol 2024; 31:e16304. [PMID: 38666798 PMCID: PMC11235891 DOI: 10.1111/ene.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND AND PURPOSE Logopenic variant primary progressive aphasia (lvPPA) is a major variant presentation of Alzheimer's disease (AD) that signals the importance of communication dysfunction across AD phenotypes. A clinical staging system is lacking for the evolution of AD-associated communication difficulties that could guide diagnosis and care planning. Our aim was to create a symptom-based staging scheme for lvPPA, identifying functional milestones relevant to the broader AD spectrum. METHODS An international lvPPA caregiver cohort was surveyed on symptom development under an 'exploratory' survey (34 UK caregivers). Feedback from this survey informed the development of a 'consolidation' survey (27 UK, 10 Australian caregivers) in which caregivers were presented with six provisional clinical stages and feedback was analysed using a mixed-methods approach. RESULTS Six clinical stages were endorsed. Early symptoms included word-finding difficulty, with loss of message comprehension and speech intelligibility signalling later-stage progression. Additionally, problems with hearing in noise, memory and route-finding were prominent early non-verbal symptoms. 'Milestone' symptoms were identified that anticipate daily-life functional transitions and care needs. CONCLUSIONS This work introduces a new symptom-based staging scheme for lvPPA, and highlights milestone symptoms that could inform future clinical scales for anticipating and managing communication dysfunction across the AD spectrum.
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Affiliation(s)
- Chris J. D. Hardy
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Cathleen Taylor‐Rubin
- Uniting War Memorial HospitalSydneyNew South WalesAustralia
- Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Beatrice Taylor
- UCL Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | | | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Laura Thompson
- Uniting War Memorial HospitalSydneyNew South WalesAustralia
| | - Rachel Kingma
- Uniting War Memorial HospitalSydneyNew South WalesAustralia
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nuriye Kupeli
- Division of Psychiatry, Marie Curie Palliative Care Research DepartmentUCLLondonUK
| | - Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Paul M. Camic
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Joshua Stott
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
- ADAPTlab, Research Department of Clinical, Educational and Health PsychologyUCLLondonUK
| | | | - Neil P. Oxtoby
- UCL Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Jonathan D. Rohrer
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Frankie O'Shea
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Anna Volkmer
- Psychology and Language Sciences (PALS)UCLLondonUK
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
| | - Jason D. Warren
- Dementia Research Centre, UCL Queen Square Institute of NeurologyUCLLondonUK
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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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Huang M, Landin-Romero R, Matis S, Dalton MA, Piguet O. Longitudinal volumetric changes in amygdala subregions in frontotemporal dementia. J Neurol 2024; 271:2509-2520. [PMID: 38265470 PMCID: PMC11055736 DOI: 10.1007/s00415-023-12172-5] [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: 12/07/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
Amygdala atrophy has been found in frontotemporal dementia (FTD), yet the specific changes of its subregions across different FTD phenotypes remain unclear. The aim of this study was to investigate the volumetric alterations of the amygdala subregions in FTD phenotypes and how they evolve with disease progression. Patients clinically diagnosed with behavioral variant FTD (bvFTD) (n = 20), semantic dementia (SD) (n = 20), primary nonfluent aphasia (PNFA) (n = 20), Alzheimer's disease (AD) (n = 20), and 20 matched healthy controls underwent whole brain structural MRI. The patient groups were followed up annually for up to 3.5 years. Amygdala nuclei were segmented using FreeSurfer, corrected by total intracranial volumes, and grouped into the basolateral, superficial, and centromedial subregions. Linear mixed effects models were applied to identify changes in amygdala subregional volumes over time. At baseline, bvFTD, SD, and AD displayed global amygdala volume reduction, whereas amygdala volume appeared to be preserved in PNFA. Asymmetrical amygdala atrophy (left > right) was most pronounced in SD. Longitudinally, SD and PNFA showed greater rates of annual decline in the right basolateral and superficial subregions compared to bvFTD and AD. The findings provide comprehensive insights into the differential impact of FTD pathology on amygdala subregions, revealing distinct atrophy patterns that evolve over disease progression. The characterization of amygdala subregional involvement in FTD and their potential role as biomarkers carry substantial clinical implications.
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Affiliation(s)
- Mengjie Huang
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Ramon Landin-Romero
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- School of Health Sciences, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Sophie Matis
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- School of Health Sciences, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Marshall A Dalton
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia.
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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Crowley SJ, Iordan AD, Rinna K, Barmada S, Hampstead BM. Comparing high definition transcranial direct current stimulation to left temporoparietal junction and left inferior frontal gyrus for logopenic primary progressive aphasia: A single-case study. Neuropsychol Rehabil 2024:1-26. [PMID: 38358112 DOI: 10.1080/09602011.2024.2314878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024]
Abstract
Logopenic variant primary progressive aphasia (lvPPA) is characterized by word-finding deficits and phonologic errors in fluent speech. Transcranial direct current stimulation (tDCS) targeting either left temporoparietal junction (TPJ) or left inferior frontal gyrus (IFG) show evidence of improving language function in lvPPA. The present case study evaluated the effects of two separate rounds of high definition tDCS (HD-tDCS) (4 mA; 30 sessions) on language and functional neuroimaging in a 57-year-old woman with lvPPA. Stimulation was centred on two different regions across rounds: (1) left TPJ, and (2) left (IFG). Results showed an improved proportion of content to floorholder words during a naturalistic speech task through both rounds as well as change in confrontation naming after TPJ (improvement) and IFG (worsened) stimulation. fMRI connectivity during task showed left lateralized positive correlations following round 1 and anti-correlations with components of the default mode network following round 2. Resting state segregation of a language-associated functional network increased following both rounds, and task-based segregation of the same network increased following IFG stimulation. These results suggest that stimulation to both regions using HD-tDCS may improve language function in lvPPA, while simultaneously eliciting widespread changes beyond the targeted area in neuronal activity and functional connectivity.
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Affiliation(s)
- Samuel J Crowley
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan Medicine, Ann Arbor, MI, USA
- Mental Health Service, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Alexandru D Iordan
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan Medicine, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Kayla Rinna
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan Medicine, Ann Arbor, MI, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Sami Barmada
- Department of Neurology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Benjamin M Hampstead
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan Medicine, Ann Arbor, MI, USA
- Mental Health Service, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Shtyrov Y, Efremov A, Kuptsova A, Wennekers T, Gutkin B, Garagnani M. Breakdown of category-specific word representations in a brain-constrained neurocomputational model of semantic dementia. Sci Rep 2023; 13:19572. [PMID: 37949997 PMCID: PMC10638411 DOI: 10.1038/s41598-023-41922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
The neurobiological nature of semantic knowledge, i.e., the encoding and storage of conceptual information in the human brain, remains a poorly understood and hotly debated subject. Clinical data on semantic deficits and neuroimaging evidence from healthy individuals have suggested multiple cortical regions to be involved in the processing of meaning. These include semantic hubs (most notably, anterior temporal lobe, ATL) that take part in semantic processing in general as well as sensorimotor areas that process specific aspects/categories according to their modality. Biologically inspired neurocomputational models can help elucidate the exact roles of these regions in the functioning of the semantic system and, importantly, in its breakdown in neurological deficits. We used a neuroanatomically constrained computational model of frontotemporal cortices implicated in word acquisition and processing, and adapted it to simulate and explain the effects of semantic dementia (SD) on word processing abilities. SD is a devastating, yet insufficiently understood progressive neurodegenerative disease, characterised by semantic knowledge deterioration that is hypothesised to be specifically related to neural damage in the ATL. The behaviour of our brain-based model is in full accordance with clinical data-namely, word comprehension performance decreases as SD lesions in ATL progress, whereas word repetition abilities remain less affected. Furthermore, our model makes predictions about lesion- and category-specific effects of SD: our simulation results indicate that word processing should be more impaired for object- than for action-related words, and that degradation of white matter should produce more severe consequences than the same proportion of grey matter decay. In sum, the present results provide a neuromechanistic explanatory account of cortical-level language impairments observed during the onset and progress of semantic dementia.
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Affiliation(s)
- Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Aleksei Efremov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
| | - Anastasia Kuptsova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
| | - Thomas Wennekers
- School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Boris Gutkin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- Département d'Etudes Cognitives, École Normale Supérieure, Paris, France
| | - Max Garagnani
- Department of Computing, Goldsmiths - University of London, London, UK.
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Berlin, Germany.
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Muayqil TA. Semantic dementia in Arabic: An assessment of Arabic word reading within sentences. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 37917946 DOI: 10.1080/23279095.2023.2276436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Language impairments have not yet been fully explored in native Arabic speakers with semantic dementia (SD). The aim of this paper is to describe the impairments in language in two Saudi Arabians with SD and to determine if their word reading within a sentence context would result in incorrect responses. METHODS Two patients with semantic dementia (one with right > left and the other with left > right temporal involvement) underwent a reading assessment in Arabic. Patients were asked to read a series of words within a sentence context in which the correct reading of the word was dependent on the context of the sentence. Thirty-four sentences were designed in which 17 Arabic homographs were used. The same homograph would occur in two separate sentences, in which the pronunciation and meaning would differ between sentences. Patients were also assessed using five other sentences that contained irregular pronouns of high frequency. Eighteen healthy controls were used as reference. RESULTS Both patients made errors in reading the target Arabic homographs; this was more pronounced in the patient with left > right variant of SD. The patient with right > left variant of SD also suffered from prosopagnosia. CONCLUSION Correct reading of Arabic words within the sentence context may be impaired from semantic language impairments in semantic dementia. The role of comprehension in the correct reading of words in Arabic sentences is important.
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Affiliation(s)
- Taim A Muayqil
- Neurology division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Neophytou K, Wiley R, Litovsky C, Tsapkini K, Rapp B. The right hemisphere's capacity for language: evidence from primary progressive aphasia. Cereb Cortex 2023; 33:9971-9985. [PMID: 37522277 PMCID: PMC10502784 DOI: 10.1093/cercor/bhad258] [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: 01/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.
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Affiliation(s)
- Kyriaki Neophytou
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Robert Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Celia Litovsky
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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Ding W, Ren P, Yi L, Si Y, Yang F, Li Z, Bao H, Yan S, Zhang X, Li S, Liang X, Yao L. Association of cortical and subcortical microstructure with disease severity: impact on cognitive decline and language impairments in frontotemporal lobar degeneration. Alzheimers Res Ther 2023; 15:58. [PMID: 36941645 PMCID: PMC10029187 DOI: 10.1186/s13195-023-01208-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cortical and subcortical microstructural modifications are critical to understanding the pathogenic changes in frontotemporal lobar degeneration (FTLD) subtypes. In this study, we investigated cortical and subcortical microstructure underlying cognitive and language impairments across behavioral variant of frontotemporal dementia (bvFTD), semantic variant of primary progressive aphasia (svPPA), and nonfluent variant of primary progressive aphasia (nfvPPA) subtypes. METHODS The current study characterized 170 individuals with 3 T MRI structural and diffusion-weighted imaging sequences as portion of the Frontotemporal Lobar Degeneration Neuroimaging Initiative study: 41 bvFTD, 35 nfvPPA, 34 svPPA, and 60 age-matched cognitively unimpaired controls. To determine the severity of the disease, clinical dementia rating plus national Alzheimer's coordinating center behavior and language domains sum of boxes scores were used; other clinical measures, including the Boston naming test and verbal fluency test, were also evaluated. We computed surface-based cortical thickness and cortical and subcortical microstructural metrics using tract-based spatial statistics and explored their relationships with clinical and cognitive assessments. RESULTS Compared with controls, those with FTLD showed substantial cortical mean diffusivity alterations extending outside the regions with cortical thinning. Tract-based spatial statistics revealed that anomalies in subcortical white matter diffusion were widely distributed across the frontotemporal and parietal areas. Patients with bvFTD, nfvPPA, and svPPA exhibited distinct patterns of cortical and subcortical microstructural abnormalities, which appeared to correlate with disease severity, and separate dimensions of language functions. CONCLUSIONS Our findings imply that cortical and subcortical microstructures may serve as sensitive biomarkers for the investigation of neurodegeneration-associated microstructural alterations in FTLD subtypes. Flowchart of the study design (see materials and methods for detailed description).
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Affiliation(s)
- Wencai Ding
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Peng Ren
- Laboratory for Space Environment and Physical Science, Harbin Institute of Technology, Harbin, 150001, China
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Liye Yi
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yao Si
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Fan Yang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Zhipeng Li
- Laboratory for Space Environment and Physical Science, Harbin Institute of Technology, Harbin, 150001, China
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Hongbo Bao
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001, China
| | - Shi Yan
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xinyu Zhang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Siyang Li
- Laboratory for Space Environment and Physical Science, Harbin Institute of Technology, Harbin, 150001, China
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Xia Liang
- Laboratory for Space Environment and Physical Science, Harbin Institute of Technology, Harbin, 150001, China.
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China.
| | - Lifen Yao
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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Hardy CJD, Taylor-Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for primary progressive aphasia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23286972. [PMID: 36993460 PMCID: PMC10055437 DOI: 10.1101/2023.03.13.23286972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The primary progressive aphasias (PPA) present complex and diverse challenges of diagnosis, management and prognosis. A clinically-informed, syndromic staging system for PPA would take a substantial step toward meeting these challenges. This study addressed this need using detailed, multi-domain mixed-methods symptom surveys of people with lived experience in a large international PPA cohort. We administered structured online surveys to caregivers of patients with a canonical PPA syndromic variant (nonfluent/agrammatic (nvPPA), semantic (svPPA) or logopenic (lvPPA)). In an 'exploratory' survey, a putative list and ordering of verbal communication and nonverbal functioning (nonverbal thinking, conduct and wellbeing, physical) symptoms was administered to 118 caregiver members of the UK national PPA Support Group. Based on feedback, we expanded the symptom list and created six provisional clinical stages for each PPA subtype. In a 'consolidation' survey, these stages were presented to 110 caregiver members of UK and Australian PPA Support Groups, and refined based on quantitative and qualitative feedback. Symptoms were retained if rated as 'present' by a majority (at least 50%) of respondents representing that PPA syndrome, and assigned to a consolidated stage based on majority consensus; the confidence of assignment was estimated for each symptom as the proportion of respondents in agreement with the final staging for that symptom. Qualitative responses were analysed using framework analysis. For each PPA syndrome, six stages ranging from 1 ('Very mild') to 6 ('Profound') were identified; earliest stages were distinguished by syndromic hallmark symptoms of communication dysfunction, with increasing trans-syndromic convergence and dependency for basic activities of daily living at later stages. Spelling errors, hearing changes and nonverbal behavioural features were reported at early stages in all syndromes. As the illness evolved, swallowing and mobility problems were reported earlier in nfvPPA than other syndromes, while difficulty recognising familiar people and household items characterised svPPA and visuospatial symptoms were more prominent in lvPPA. Overall confidence of symptom staging was higher for svPPA than other syndromes. Across syndromes, functional milestones were identified as key deficits that predict the sequence of major daily life impacts and associated management needs. Qualitatively, we identified five major themes encompassing 15 subthemes capturing respondents' experiences of PPA and suggestions for staging implementation. This work introduces a prototypical, symptom-led staging scheme for canonical PPA syndromes: the PPA Progression Planning Aid (PPA 2 ). Our findings have implications for diagnostic and care pathway guidelines, trial design and personalised prognosis and treatment for people living with these diseases.
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Affiliation(s)
- Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Cathleen Taylor-Rubin
- Uniting War Memorial Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Beatrice Taylor
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Keir XX Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Josh Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- ADAPTlab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Anna Volkmer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Psychology and Language Sciences (PALS), UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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11
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Breining BL, Faria AV, Tippett DC, Stockbridge MD, Meier EL, Caffo B, Hermann O, Friedman R, Meyer A, Tsapkini K, Hillis AE. Association of Regional Atrophy With Naming Decline in Primary Progressive Aphasia. Neurology 2023; 100:e582-e594. [PMID: 36319108 PMCID: PMC9946192 DOI: 10.1212/wnl.0000000000201491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Primary progressive aphasia (PPA) is a neurodegenerative condition that predominantly impairs language. Most investigations of how focal atrophy affects language consider 1 time point compared with healthy controls. However, true atrophy quantification requires comparing individual brains over time. In this observational cohort study, we identified areas where focal atrophy was associated with contemporaneous decline in naming in the same individuals. METHODS Cross-sectional analyses-related Boston Naming Test (BNT) performance and volume in 22 regions of interests (ROIs) at each time point using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Longitudinal analysis evaluated changes in BNT performance and change in volume in the same ROIs. RESULTS Participants (N = 62; 50% female; mean age = 66.8 ± 7.4 years) with PPA completed the BNT and MRI twice (mean = 343.9 ± 209.0 days apart). In cross-sectional left inferior frontal gyrus pars opercularis, superior temporal pole, middle temporal gyrus, and inferior temporal gyrus were identified as critical for naming at all time points. Longitudinal analysis revealed that increasing atrophy in the left supramarginal gyrus and middle temporal pole predicted greater naming decline, as did female sex and longer intervals between time points. DISCUSSION Although cross-sectional analyses identified classic language areas that were consistently related to poor performance at multiple time points, it was not increasing atrophy in these areas that lead to further decline: longitudinal analysis of each person's atrophy over time instead identified nearby but distinct regions where increased atrophy was related to decreasing performance. The results demonstrate that directly examining atrophy (in each individual) over time furthers understanding of decline in PPA and reveal the importance of left supramarginal gyrus and middle temporal pole in maintaining naming when areas normally critical for language degenerate. The novel results provide insight into how the underlying disease progresses to result in the clinical decline in naming, the deficit most common among all 3 PPA variants.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Argye Elizabeth Hillis
- From the Johns Hopkins University School of Medicine (B.L.B., A.V.F., D.C.T., M.D.S., E.L.M., O.H., K.T., A.E.H.), Baltimore, MD; Johns Hopkins University (B.C.), Bloomberg School of Public Health, Baltimore, MD; and Georgetown University (R.F., A.M.), Washington, DC.
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12
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Younes K, Borghesani V, Montembeault M, Spina S, Mandelli ML, Welch AE, Weis E, Callahan P, Elahi FM, Hua AY, Perry DC, Karydas A, Geschwind D, Huang E, Grinberg LT, Kramer JH, Boxer AL, Rabinovici GD, Rosen HJ, Seeley WW, Miller ZA, Miller BL, Sturm VE, Rankin KP, Gorno-Tempini ML. Right temporal degeneration and socioemotional semantics: semantic behavioural variant frontotemporal dementia. Brain 2022; 145:4080-4096. [PMID: 35731122 PMCID: PMC10200288 DOI: 10.1093/brain/awac217] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
Focal anterior temporal lobe degeneration often preferentially affects the left or right hemisphere. While patients with left-predominant anterior temporal lobe atrophy show severe anomia and verbal semantic deficits and meet criteria for semantic variant primary progressive aphasia and semantic dementia, patients with early right anterior temporal lobe atrophy are more difficult to diagnose as their symptoms are less well understood. Focal right anterior temporal lobe atrophy is associated with prominent emotional and behavioural changes, and patients often meet, or go on to meet, criteria for behavioural variant frontotemporal dementia. Uncertainty around early symptoms and absence of an overarching clinico-anatomical framework continue to hinder proper diagnosis and care of patients with right anterior temporal lobe disease. Here, we examine a large, well-characterized, longitudinal cohort of patients with right anterior temporal lobe-predominant degeneration and propose new criteria and nosology. We identified individuals from our database with a clinical diagnosis of behavioural variant frontotemporal dementia or semantic variant primary progressive aphasia and a structural MRI (n = 478). On the basis of neuroimaging criteria, we defined three patient groups: right anterior temporal lobe-predominant atrophy with relative sparing of the frontal lobes (n = 46), frontal-predominant atrophy with relative sparing of the right anterior temporal lobe (n = 79) and left-predominant anterior temporal lobe-predominant atrophy with relative sparing of the frontal lobes (n = 75). We compared the clinical, neuropsychological, genetic and pathological profiles of these groups. In the right anterior temporal lobe-predominant group, the earliest symptoms were loss of empathy (27%), person-specific semantic impairment (23%) and complex compulsions and rigid thought process (18%). On testing, this group exhibited greater impairments in Emotional Theory of Mind, recognition of famous people (from names and faces) and facial affect naming (despite preserved face perception) than the frontal- and left-predominant anterior temporal lobe-predominant groups. The clinical symptoms in the first 3 years of the disease alone were highly sensitive (81%) and specific (84%) differentiating right anterior temporal lobe-predominant from frontal-predominant groups. Frontotemporal lobar degeneration-transactive response DNA binding protein (84%) was the most common pathology of the right anterior temporal lobe-predominant group. Right anterior temporal lobe-predominant degeneration is characterized by early loss of empathy and person-specific knowledge, deficits that are caused by progressive decline in semantic memory for concepts of socioemotional relevance. Guided by our results, we outline new diagnostic criteria and propose the name, 'semantic behavioural variant frontotemporal dementia', which highlights the underlying cognitive mechanism and the predominant symptomatology. These diagnostic criteria will facilitate early identification and care of patients with early, focal right anterior temporal lobe degeneration as well as in vivo prediction of frontotemporal lobar degeneration-transactive response DNA binding protein pathology.
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Affiliation(s)
- Kyan Younes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94304, USA
| | - Valentina Borghesani
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Elizabeth Weis
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Patrick Callahan
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Fanny M Elahi
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Alice Y Hua
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - David C Perry
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Daniel Geschwind
- Neurogenetics Program, Department of Neurology and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Eric Huang
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Virginia E Sturm
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Dyslexia Center, University of California, San Francisco, CA 94158, USA
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13
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Ramanan S, Irish M, Patterson K, Rowe JB, Gorno-Tempini ML, Lambon Ralph MA. Understanding the multidimensional cognitive deficits of logopenic variant primary progressive aphasia. Brain 2022; 145:2955-2966. [PMID: 35857482 PMCID: PMC9473356 DOI: 10.1093/brain/awac208] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023] Open
Abstract
The logopenic variant of primary progressive aphasia is characterized by early deficits in language production and phonological short-term memory, attributed to left-lateralized temporoparietal, inferior parietal and posterior temporal neurodegeneration. Despite patients primarily complaining of language difficulties, emerging evidence points to performance deficits in non-linguistic domains. Temporoparietal cortex, and functional brain networks anchored to this region, are implicated as putative neural substrates of non-linguistic cognitive deficits in logopenic variant primary progressive aphasia, suggesting that degeneration of a shared set of brain regions may result in co-occurring linguistic and non-linguistic dysfunction early in the disease course. Here, we provide a Review aimed at broadening the understanding of logopenic variant primary progressive aphasia beyond the lens of an exclusive language disorder. By considering behavioural and neuroimaging research on non-linguistic dysfunction in logopenic variant primary progressive aphasia, we propose that a significant portion of multidimensional cognitive features can be explained by degeneration of temporal/inferior parietal cortices and connected regions. Drawing on insights from normative cognitive neuroscience, we propose that these regions underpin a combination of domain-general and domain-selective cognitive processes, whose disruption results in multifaceted cognitive deficits including aphasia. This account explains the common emergence of linguistic and non-linguistic cognitive difficulties in logopenic variant primary progressive aphasia, and predicts phenotypic diversification associated with progression of pathology in posterior neocortex.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre and School of Psychology, Sydney, Australia
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Cambridge University Centre for Frontotemporal Dementia, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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14
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Sintini I, Duffy JR, Clark HM, Utianski RL, Botha H, Machulda MM, Senjem ML, Strand EA, Schwarz CG, Lowe VJ, Jack CR, Josephs KA, Whitwell JL. Functional connectivity to the premotor cortex maps onto longitudinal brain neurodegeneration in progressive apraxia of speech. Neurobiol Aging 2022; 120:105-116. [DOI: 10.1016/j.neurobiolaging.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
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15
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Lukic S, Licata AE, Weis E, Bogley R, Ratnasiri B, Welch AE, Hinkley LBN, Miller Z, Garcia AM, Houde JF, Nagarajan SS, Gorno-Tempini ML, Borghesani V. Auditory Verb Generation Performance Patterns Dissociate Variants of Primary Progressive Aphasia. Front Psychol 2022; 13:887591. [PMID: 35814055 PMCID: PMC9267767 DOI: 10.3389/fpsyg.2022.887591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Primary progressive aphasia (PPA) is a clinical syndrome in which patients progressively lose speech and language abilities. Three variants are recognized: logopenic (lvPPA), associated with phonology and/or short-term verbal memory deficits accompanied by left temporo-parietal atrophy; semantic (svPPA), associated with semantic deficits and anterior temporal lobe (ATL) atrophy; non-fluent (nfvPPA) associated with grammar and/or speech-motor deficits and inferior frontal gyrus (IFG) atrophy. Here, we set out to investigate whether the three variants of PPA can be dissociated based on error patterns in a single language task. We recruited 21 lvPPA, 28 svPPA, and 24 nfvPPA patients, together with 31 healthy controls, and analyzed their performance on an auditory noun-to-verb generation task, which requires auditory analysis of the input, access to and selection of relevant lexical and semantic knowledge, as well as preparation and execution of speech. Task accuracy differed across the three variants and controls, with lvPPA and nfvPPA having the lowest and highest accuracy, respectively. Critically, machine learning analysis of the different error types yielded above-chance classification of patients into their corresponding group. An analysis of the error types revealed clear variant-specific effects: lvPPA patients produced the highest percentage of "not-a-verb" responses and the highest number of semantically related nouns (production of baseball instead of throw to noun ball); in contrast, svPPA patients produced the highest percentage of "unrelated verb" responses and the highest number of light verbs (production of take instead of throw to noun ball). Taken together, our findings indicate that error patterns in an auditory verb generation task are associated with the breakdown of different neurocognitive mechanisms across PPA variants. Specifically, they corroborate the link between temporo-parietal regions with lexical processing, as well as ATL with semantic processes. These findings illustrate how the analysis of pattern of responses can help PPA phenotyping and heighten diagnostic sensitivity, while providing insights on the neural correlates of different components of language.
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Affiliation(s)
- Sladjana Lukic
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY, United States
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Abigail E. Licata
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth Weis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Rian Bogley
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Buddhika Ratnasiri
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Ariane E. Welch
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Leighton B. N. Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Z. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Adolfo M. Garcia
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - John F. Houde
- Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Valentina Borghesani
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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16
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Whitwell JL, Martin PR, Graff-Radford J, Machulda MM, Sintini I, Buciuc M, Senjem ML, Schwarz CG, Botha H, Carrasquillo MM, Ertekin-Taner N, Lowe VJ, Jack CR, Josephs KA. Investigating Heterogeneity and Neuroanatomic Correlates of Longitudinal Clinical Decline in Atypical Alzheimer Disease. Neurology 2022; 98:e2436-e2445. [PMID: 35483899 PMCID: PMC9231842 DOI: 10.1212/wnl.0000000000200336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aims of this work were to compare rates of longitudinal change in neurologic and neuropsychological test performance between the logopenic progressive aphasia (LPA) and posterior cortical atrophy (PCA) variants of atypical Alzheimer disease (AD) and to use unbiased principal component analysis to assess heterogeneity in patterns of change and relationships to demographics and concurrent brain atrophy. METHODS Patients with PCA or LPA who were positive for amyloid and tau AD biomarkers and had undergone serial neurologic and neuropsychological assessments and structural MRI were identified. Rates of change in 13 clinical measures were compared between groups in a case-control design, and principal component analysis was used to assess patterns of clinical change unbiased by clinical phenotype. Components were correlated with rates of regional brain atrophy with tensor-based morphometry. RESULTS Twenty-eight patients with PCA and 27 patients with LPA were identified. Those with LPA showed worse baseline performance and faster rates of decline in naming, repetition, and working memory, as well as faster rates of decline in verbal episodic memory, compared to those with PCA. Conversely, patients with PCA showed worse baseline performance in tests of visuospatial and perceptual function and on the Clinical Dementia Rating Scale and faster rates of decline in visuoperceptual function compared to those with LPA. Principal component analysis showed that patterns of clinical decline were highly heterogeneous across the cohort, with 10 principal components required to explain >90% of the variance. The first principal component reflected overall severity, with higher scores in LPA than PCA reflecting faster decline in LPA, and was related to left temporoparietal atrophy. The second and third principal components were not related to clinical phenotype but showed some relationship to regional atrophy. No relationships were identified between the principal components and age, sex, disease duration, amyloid PET findings, or apolipoprotein genotype. DISCUSSION Longitudinal patterns of clinical decline differ between LPA and PCA but are heterogeneous and related to different patterns of topographic spread. PCA is associated with a more slowly progressive course than LPA.
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Affiliation(s)
- Jennifer L Whitwell
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL.
| | - Peter R Martin
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Irene Sintini
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Marina Buciuc
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Matthew L Senjem
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Christopher G Schwarz
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Minerva M Carrasquillo
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Nilufer Ertekin-Taner
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Val J Lowe
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Keith A Josephs
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
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17
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Roelofs A. A neurocognitive computational account of word production, comprehension, and repetition in primary progressive aphasia. BRAIN AND LANGUAGE 2022; 227:105094. [PMID: 35202892 DOI: 10.1016/j.bandl.2022.105094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/15/2021] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
Computational models have elucidated word production, comprehension, and repetition in poststroke aphasia syndromes, but simulations are lacking for primary progressive aphasia (PPA) resulting from neurodegenerative disease. Here, the WEAVER++/ARC model, which has previously been applied to poststroke aphasia, is extended to the three major PPA variants: nonfluent/agrammatic, semantic, and logopenic. Following a seminal suggestion by Pick (1892/1977) and modern empirical insights, the model assumes that PPA arises from a progressive loss of activation capacity in portions of the language network with neurocognitive epicenters specific to each PPA variant. Computer simulations revealed that the model succeeds reasonably well in capturing the patterns of impaired and spared naming, comprehension, and repetition performance, at both group and individual patient levels. Moreover, it captures the worsening of performance with progression of the disease. The model explains about 90% of the variance, lending computational support to Pick's suggestion and modern insights.
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Affiliation(s)
- Ardi Roelofs
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands.
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18
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Illán-Gala I, Montal V, Borrego-Écija S, Mandelli ML, Falgàs N, Welch AE, Pegueroles J, Santos-Santos M, Bejanin A, Alcolea D, Dols-Icardo O, Belbin O, Sánchez-Saudinós MB, Bargalló N, González-Ortiz S, Lladó A, Blesa R, Dickerson BC, Rosen HJ, Miller BL, Lleó A, Gorno-Tempini ML, Sánchez-Valle R, Fortea J. Cortical microstructure in primary progressive aphasia: a multicenter study. Alzheimers Res Ther 2022; 14:27. [PMID: 35139897 PMCID: PMC8830043 DOI: 10.1186/s13195-022-00974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cortical mean diffusivity is a novel imaging metric sensitive to early changes in neurodegenerative syndromes. Higher cortical mean diffusivity values reflect microstructural disorganization and have been proposed as a sensitive biomarker that might antedate macroscopic cortical changes. We aimed to test the hypothesis that cortical mean diffusivity is more sensitive than cortical thickness to detect cortical changes in primary progressive aphasia (PPA). METHODS In this multicenter, case-control study, we recruited 120 patients with PPA (52 non-fluent, 31 semantic, and 32 logopenic variants; and 5 GRN-related PPA) as well as 89 controls from three centers. The 3-Tesla MRI protocol included structural and diffusion-weighted sequences. Disease severity was assessed with the Clinical Dementia Rating scale. Cortical thickness and cortical mean diffusivity were computed using a surface-based approach. RESULTS The comparison between each PPA variant and controls revealed cortical mean diffusivity increases and cortical thinning in overlapping regions, reflecting the canonical loci of neurodegeneration of each variant. Importantly, cortical mean diffusivity increases also expanded to other PPA-related areas and correlated with disease severity in all PPA groups. Cortical mean diffusivity was also increased in patients with very mild PPA when only minimal cortical thinning was observed and showed a good correlation with measures of disease severity. CONCLUSIONS Cortical mean diffusivity shows promise as a sensitive biomarker for the study of the neurodegeneration-related microstructural changes in PPA.
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Affiliation(s)
- Ignacio Illán-Gala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Atlantic Fellow for Equity in Brain Health at the University of California San Francisco, San Francisco, CA, 94115, USA.
| | - Victor Montal
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Sergi Borrego-Écija
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Neus Falgàs
- Atlantic Fellow for Equity in Brain Health at the University of California San Francisco, San Francisco, CA, 94115, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Jordi Pegueroles
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Miguel Santos-Santos
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Alexandre Bejanin
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Oriol Dols-Icardo
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Olivia Belbin
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Mª Belén Sánchez-Saudinós
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Nuria Bargalló
- Radiology Department, Hospital Clinic Barcelona and Magnetic Resonance Image Core facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Albert Lladó
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Raquel Sánchez-Valle
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Barcelona Down Medical Center. Fundació Catalana de Síndrome de Down, Barcelona, Spain.
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19
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de la Sablonnière J, Tastevin M, Lavoie M, Laforce R. Longitudinal Changes in Cognition, Behaviours, and Functional Abilities in the Three Main Variants of Primary Progressive Aphasia: A Literature Review. Brain Sci 2021; 11:1209. [PMID: 34573229 PMCID: PMC8466869 DOI: 10.3390/brainsci11091209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
Primary progressive aphasias (PPAs) are a group of neurodegenerative diseases presenting with insidious and relentless language impairment. Three main PPA variants have been described: the non-fluent/agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA). At the time of diagnosis, patients and their families' main question pertains to prognosis and evolution, but very few data exist to support clinicians' claims. The objective of this study was to review the current literature on the longitudinal changes in cognition, behaviours, and functional abilities in the three main PPA variants. A comprehensive review was undertaken via a search on PUBMED and EMBASE. Two authors independently reviewed a total of 65 full-text records for eligibility. A total of 14 group studies and one meta-analysis were included. Among these, eight studies included all three PPA variants. Eight studies were prospective, and the follow-up duration was between one and five years. Overall, svPPA patients showed more behavioural disturbances both at baseline and over the course of the disease. Patients with lvPPA showed a worse cognitive decline, especially in episodic memory, and faster progression to dementia. Finally, patients with nfvPPA showed the most significant losses in language production and functional abilities. Data regarding the prodromal and last stages of PPA are still missing and studies with a longer follow-up observation period are needed.
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Affiliation(s)
| | | | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques du CHU de Québec, Faculté de Médecine, Université Laval, Quebec City, QC G1J 1Z4, Canada; (J.d.l.S.); (M.T.); (M.L.)
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20
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Peet BT, Spina S, Mundada N, La Joie R. Neuroimaging in Frontotemporal Dementia: Heterogeneity and Relationships with Underlying Neuropathology. Neurotherapeutics 2021; 18:728-752. [PMID: 34389969 PMCID: PMC8423978 DOI: 10.1007/s13311-021-01101-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
Frontotemporal dementia encompasses a group of clinical syndromes defined pathologically by degeneration of the frontal and temporal lobes. Historically, these syndromes have been challenging to diagnose, with an average of about three years between the time of symptom onset and the initial evaluation and diagnosis. Research in the field of neuroimaging has revealed numerous biomarkers of the various frontotemporal dementia syndromes, which has provided clinicians with a method of narrowing the differential diagnosis and improving diagnostic accuracy. As such, neuroimaging is considered a core investigative tool in the evaluation of neurodegenerative disorders. Furthermore, patterns of neurodegeneration correlate with the underlying neuropathological substrates of the frontotemporal dementia syndromes, which can aid clinicians in determining the underlying etiology and improve prognostication. This review explores the advancements in neuroimaging and discusses the phenotypic and pathologic features of behavioral variant frontotemporal dementia, semantic variant primary progressive aphasia, and nonfluent variant primary progressive aphasia, as seen on structural magnetic resonance imaging and positron emission tomography.
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Affiliation(s)
- Bradley T Peet
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nidhi Mundada
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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21
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Evaluating the distinction between semantic knowledge and semantic access: Evidence from semantic dementia and comprehension-impaired stroke aphasia. Psychon Bull Rev 2021; 27:607-639. [PMID: 31993976 DOI: 10.3758/s13423-019-01706-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Theories of semantic memory based on neuropsychological findings have posited a distinction between stored semantic representations and the mechanisms used to access and manipulate them (e.g., Lambon Ralph, Jefferies, Patterson, & Rogers, 2017; Warrington & Cipolotti, 1996). The most recent instantiation of this view, the controlled semantic cognition theory (Lambon Ralph et al., 2017), is supported by findings suggesting that multimodal (i.e., both verbal and nonverbal) semantic deficits may result from qualitatively different impairments: on the one hand, damage to a semantic access mechanism related to executive control, which is observed in semantic aphasia (SA), and on the other, damage to semantic representations, which is observed in semantic dementia (SD) (Jefferies & Lambon Ralph, 2006). In this study we compared SA and SD patients on several phenomena previously used to support these distinctions. Contrary to the prior results, we found that (1) overall, cross-task consistency was equivalent for the two groups; (2) neither patient group showed consistency driven by item identity across different semantic tasks; (3) correlations among task performance were not obviously driven by the semantic control demands of different tasks; (4) both groups showed executive function deficits; and (5) both groups showed strong effects of distractor interference in a synonym judgment task. Furthermore, we investigated the components of executive ability that could underlie semantic control deficits by correlating performance on updating, shifting, and inhibition tasks with performance on tasks testing semantic abilities. We found that updating was related to semantic processing generally, whereas shifting and inhibition were not. These results also suggest that complex executive function tasks relate to semantic tasks through their shared relationship with language abilities. Overall, evidence from SA and SD patients does not differentiate representations and access mechanisms in the semantic system, as has previously been suggested. Implications for the storage-access distinction are discussed.
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22
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Dev SI, Dickerson BC, Touroutoglou A. Neuroimaging in Frontotemporal Lobar Degeneration: Research and Clinical Utility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:93-112. [PMID: 33433871 PMCID: PMC8787866 DOI: 10.1007/978-3-030-51140-1_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Frontotemporal lobar dementia (FTLD) is a clinically and pathologically complex disease. Advances in neuroimaging techniques have provided a specialized set of tools to investigate underlying pathophysiology and identify clinical biomarkers that aid in diagnosis, prognostication, monitoring, and identification of appropriate endpoints in clinical trials. In this chapter, we review data discussing the utility of neuroimaging biomarkers in sporadic FTLD, with an emphasis on current and future clinical applications. Among those modalities readily utilized in clinical settings, T1-weighted structural magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are best supported in differential diagnosis and as targets for clinical trial endpoints. However, a number of nonclinical neuroimaging modalities, including diffusion tensor imaging and resting-state functional connectivity MRI, show promise as biomarkers to predict progression and as clinical trial endpoints. Other neuroimaging modalities, including amyloid PET, Tau PET, and arterial spin labeling MRI, are also discussed, though more work is required to establish their utility in FTLD in clinical settings.
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Affiliation(s)
- Sheena I Dev
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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23
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Sintini I, Graff-Radford J, Senjem ML, Schwarz CG, Machulda MM, Martin PR, Jones DT, Boeve BF, Knopman DS, Kantarci K, Petersen RC, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Longitudinal neuroimaging biomarkers differ across Alzheimer's disease phenotypes. Brain 2020; 143:2281-2294. [PMID: 32572464 DOI: 10.1093/brain/awaa155] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/12/2022] Open
Abstract
Alzheimer's disease can present clinically with either the typical amnestic phenotype or with atypical phenotypes, such as logopenic progressive aphasia and posterior cortical atrophy. We have recently described longitudinal patterns of flortaucipir PET uptake and grey matter atrophy in the atypical phenotypes, demonstrating a longitudinal regional disconnect between flortaucipir accumulation and brain atrophy. However, it is unclear how these longitudinal patterns differ from typical Alzheimer's disease, to what degree flortaucipir and atrophy mirror clinical phenotype in Alzheimer's disease, and whether optimal longitudinal neuroimaging biomarkers would also differ across phenotypes. We aimed to address these unknowns using a cohort of 57 participants diagnosed with Alzheimer's disease (18 with typical amnestic Alzheimer's disease, 17 with posterior cortical atrophy and 22 with logopenic progressive aphasia) that had undergone baseline and 1-year follow-up MRI and flortaucipir PET. Typical Alzheimer's disease participants were selected to be over 65 years old at baseline scan, while no age criterion was used for atypical Alzheimer's disease participants. Region and voxel-level rates of tau accumulation and atrophy were assessed relative to 49 cognitively unimpaired individuals and among phenotypes. Principal component analysis was implemented to describe variability in baseline tau uptake and rates of accumulation and baseline grey matter volumes and rates of atrophy across phenotypes. The capability of the principal components to discriminate between phenotypes was assessed with logistic regression. The topography of longitudinal tau accumulation and atrophy differed across phenotypes, with key regions of tau accumulation in the frontal and temporal lobes for all phenotypes and key regions of atrophy in the occipitotemporal regions for posterior cortical atrophy, left temporal lobe for logopenic progressive aphasia and medial and lateral temporal lobe for typical Alzheimer's disease. Principal component analysis identified patterns of variation in baseline and longitudinal measures of tau uptake and volume that were significantly different across phenotypes. Baseline tau uptake mapped better onto clinical phenotype than longitudinal tau and MRI measures. Our study suggests that optimal longitudinal neuroimaging biomarkers for future clinical treatment trials in Alzheimer's disease are different for MRI and tau-PET and may differ across phenotypes, particularly for MRI. Baseline tau tracer retention showed the highest fidelity to clinical phenotype, supporting the important causal role of tau as a driver of clinical dysfunction in Alzheimer's disease.
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Affiliation(s)
- Irene Sintini
- 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
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester MN, USA
| | - Peter R Martin
- Department of Health Science Research, Mayo Clinic, Rochester MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Akhmadullina DR, Konovalov RN, Shpilyukova Y, Grishina DA, Berdnikovich ES, Fomenko SS, Fedotova EY, Illarioshkin SN. Brain atrophy patterns in patients with frontotemporal dementia: voxel-based morphometry. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by language and behaviour deficits, which is considered the second most common cause of early-onset dementia. Detection of brain atrophy patterns is important for FTD diagnosis. However, the visual assessment of magnetic resonance imaging data may not be sensitive enough requiring the use of objective gray matter (GM) volume determination method. The study was aimed to assess the GM atrophy pattern in patients with FTD compared to control group patients using voxel-based morphometry (VBM). The study included 16 patients with FTD (12 patients with nonfluent agrammatic variant primary progressive aphasia (nfvPPA), three patients with behavioral variant of FTD, and one patient with logopenic variant PPA) and 10 healthy volunteers. VBM of patients with FTD and healthy controls revealed three significant (pFWE-corr < 0.05) atrophy areas in the left inferior frontal, left fusiform, and left supramarginal gyri. Taking into account the predominance of patients with nfvPPA in the group of FTD patients, the additional VBM of this group and control group was carried out, which revealed a distinct atrophy pattern: the reduced GM volume was detected in the left inferior frontal and left middle frontal gyri (pFWE-corr < 0.05). The results obtained indicate that regardless of the clinical variant, there is a certain atrophy pattern characteristic of FTD, which involves both frontotemporal areas and parietal lobe. The example of nfvPPA shows that each variant of the disease is associated with distinct localization of atrophy.
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Affiliation(s)
| | | | | | - DA Grishina
- I. M. Sechenov First Moscow State Medical University, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - SS Fomenko
- Research Center of Neurology, Moscow, Russia
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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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Ramanan S, Roquet D, Goldberg ZL, Hodges JR, Piguet O, Irish M, Lambon Ralph MA. Establishing two principal dimensions of cognitive variation in logopenic progressive aphasia. Brain Commun 2020; 2:fcaa125. [PMID: 33376980 PMCID: PMC7750924 DOI: 10.1093/braincomms/fcaa125] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
Logopenic progressive aphasia is a neurodegenerative syndrome characterized by sentence repetition and naming difficulties arising from left-lateralized temporoparietal atrophy. Clinical descriptions of logopenic progressive aphasia largely concentrate on profiling language deficits, however, accumulating evidence points to the presence of cognitive deficits even on tasks with minimal language demands. Although non-linguistic cognitive deficits in logopenic progressive aphasia are thought to scale with disease severity, patients at discrete stages of language dysfunction display overlapping cognitive profiles, suggesting individual-level variation in cognitive performance, independent of primary language dysfunction. To address this issue, we used principal component analysis to decompose the individual-level variation in cognitive performance in 43 well-characterized logopenic progressive aphasia patients who underwent multi-domain neuropsychological assessments and structural neuroimaging. The principal component analysis solution revealed the presence of two, statistically independent factors, providing stable and clinically intuitive explanations for the majority of variance in cognitive performance in the syndrome. Factor 1 reflected 'speech production and verbal memory' deficits which typify logopenic progressive aphasia. Systematic variations were also confirmed on a second, orthogonal factor mainly comprising visuospatial and executive processes. Adopting a case-comparison approach, we further demonstrate that pairs of patients with comparable Factor 1 scores, regardless of their severity, diverge considerably on visuo-executive test performance, underscoring the inter-individual variability in cognitive profiles in comparably 'logopenic' patients. Whole-brain voxel-based morphometry analyses revealed that speech production and verbal memory factor scores correlated with left middle frontal gyrus, while visuospatial and executive factor scores were associated with grey matter intensity of right-lateralized temporoparietal, middle frontal regions and their underlying white matter connectivity. Importantly, logopenic progressive aphasia patients with poorer visuospatial and executive factor scores demonstrated greater right-lateralized temporoparietal and frontal atrophy. Our findings demonstrate the inherent variation in cognitive performance at an individual- and group-level in logopenic progressive aphasia, suggesting the presence of a genuine co-occurring cognitive impairment that is statistically independent of language function and disease severity.
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Affiliation(s)
- Siddharth Ramanan
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Zoë-Lee Goldberg
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
- The University of Sydney, School of Medical Sciences, Sydney, NSW, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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27
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Bejanin A, Tammewar G, Marx G, Cobigo Y, Iaccarino L, Kornak J, Staffaroni AM, Dickerson BC, Boeve BF, Knopman DS, Gorno-Tempini M, Miller BL, Jagust WJ, Boxer AL, Rosen HJ, Rabinovici GD. Longitudinal structural and metabolic changes in frontotemporal dementia. Neurology 2020; 95:e140-e154. [PMID: 32591470 PMCID: PMC7455324 DOI: 10.1212/wnl.0000000000009760] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/13/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the sensitivity of structural MRI and 18F-fludeoxyglucose PET (18FDG-PET) to detect longitudinal changes in frontotemporal dementia (FTD). METHODS Thirty patients with behavioral variant FTD (bvFTD), 7 with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA), 16 with semantic variant primary progressive aphasia (svPPA), and 43 cognitively normal controls underwent 2-4 MRI and 18FDG-PET scans (total scans/visit = 270) as part of the Frontotemporal Lobar Degeneration Neuroimaging Initiative study. Linear mixed-effects models were carried out voxel-wise and in regions of interest to identify areas showing decreased volume or metabolism over time in patients as compared to controls. RESULTS At baseline, patients with bvFTD showed bilateral temporal, dorsolateral, and medial prefrontal atrophy/hypometabolism that extended with time into adjacent structures and parietal lobe. In nfvPPA, baseline atrophy/hypometabolism in supplementary motor cortex extended with time into left greater than right precentral, dorsolateral, and dorsomedial prefrontal cortex. In svPPA, baseline atrophy/hypometabolism encompassed the anterior temporal and medial prefrontal cortex and longitudinal changes were found in temporal, orbitofrontal, and lateral parietal cortex. Across syndromes, there was substantial overlap in the brain regions showing volume and metabolism loss. Even though the pattern of metabolic decline was more extensive, metabolic changes were also more variable and sample size estimates were similar or higher for 18FDG-PET compared to MRI. CONCLUSION Our findings demonstrated the sensitivity of 18FDG-PET and structural MRI for tracking disease progression in FTD. Both modalities showed highly overlapping patterns of longitudinal change and comparable sample size estimates to detect longitudinal changes in future clinical trials.
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Affiliation(s)
- Alexandre Bejanin
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley.
| | - Gautam Tammewar
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Gabe Marx
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Yann Cobigo
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Leonardo Iaccarino
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - John Kornak
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Adam M Staffaroni
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Bradford C Dickerson
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Bradley F Boeve
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - David S Knopman
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Marilu Gorno-Tempini
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Bruce L Miller
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - William J Jagust
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Adam L Boxer
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Howard J Rosen
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
| | - Gil D Rabinovici
- From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley
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Chapleau M, Bedetti C, Devenyi GA, Sheldon S, Rosen HJ, Miller BL, Gorno-Tempini ML, Chakravarty MM, Brambati SM. Deformation-based shape analysis of the hippocampus in the semantic variant of primary progressive aphasia and Alzheimer's disease. Neuroimage Clin 2020; 27:102305. [PMID: 32544853 PMCID: PMC7298722 DOI: 10.1016/j.nicl.2020.102305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Increasing evidence shows that the semantic variant of primary progressive aphasia (svPPA) is characterized by hippocampal atrophy. However, less is known about disease-related morphological hippocampal changes. The goal of the present study is to conduct a detailed characterization of the impact of svPPA on global hippocampus volume and morphology compared with control subjects and patients with Alzheimer's disease (AD). METHODS We measured hippocampal volume and deformation-based shape differences in 22 patients with svPPA compared with 99 patients with AD and 92 controls. Multiple Automatically Generated Templates Brain Segmentation Algorithm (MAGeT-Brain) was used on MRI images obtained at the diagnostic visit. RESULTS Comparable left and right hippocampal atrophy were observed in svPPA and AD. Deformation-based shape analysis showed a common pattern of morphological deformation in svPPA and AD compared with controls. More specifically, both svPPA and AD showed inward deformations in the dorsal surface of the hippocampus, from head to tail on the left side, and more limited to the anterior portion of the body in the right hemisphere. These results also pointed out that both diseases are characterized by a lateral displacement of the central part (body) of the hippocampus. DISCUSSION Our study provides critical new evidence of hippocampal morphological changes in svPPA, similar to those found in AD. These findings highlight the importance of considering morphological hippocampal changes as part of the anatomical profile of patients with svPPA.
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Affiliation(s)
- Marianne Chapleau
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Christophe Bedetti
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Gabriel A Devenyi
- Computational Brain Anatomy Lab, Cerebral Imaging Center, Douglas Mental Health University Institute, Quebec, Canada; Department of Psychiatry, McGill University, Quebec, Canada
| | - Signy Sheldon
- Department of Psychology, McGill University, Quebec, Canada
| | - Howie J Rosen
- Memory and Aging Center, University of California in San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California in San Francisco, CA, USA
| | | | - Mallar M Chakravarty
- Computational Brain Anatomy Lab, Cerebral Imaging Center, Douglas Mental Health University Institute, Quebec, Canada; Department of Psychiatry, McGill University, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Quebec, Canada
| | - Simona M Brambati
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.
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29
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Abstract
Frontotemporal dementia (FTD) encompasses a group of clinical syndromes, including behavioral-variant FTD, nonfluent variant primary progressive aphasia, semantic variant primary progressive aphasia, FTD motor neuron disease, progressive supranuclear palsy syndrome, and corticobasal syndrome. Early on in its course, FTD is commonly seen in psychiatric clinics. We review the clinical features and diagnostic criteria in FTD spectrum disorders.
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Affiliation(s)
- Kyan Younes
- UCSF Memory and Aging Center, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143, USA.
| | - Bruce L Miller
- UCSF Memory and Aging Center, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143, USA. https://twitter.com/brucemillerucsf
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30
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Liu H, Liu T, Jiang J, Cheng J, Liu Y, Li D, Dong C, Niu H, Li S, Zhang J, Brodaty H, Sachdev P, Wen W. Differential longitudinal changes in structural complexity and volumetric measures in community-dwelling older individuals. Neurobiol Aging 2020; 91:26-35. [PMID: 32311608 DOI: 10.1016/j.neurobiolaging.2020.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 01/11/2020] [Accepted: 02/22/2020] [Indexed: 01/04/2023]
Abstract
Fractal geometry provides a method of analyzing natural and especially biological morphologies. To investigate the relationship between the complexity measure, which is indexed as fractal dimensionality (FD), and the traditional Euclidean metrics, such as the volume and thickness, of the brain in older age, we analyzed 483 MRI scans of 161 community-dwelling, nondemented individuals aged 70-90 years at the baseline and their 2-year and 6-year follow-ups. We quantified changes in neuroimaging metrics in cortical lobes and subcortical structures and investigated the effects of age, sex, hemisphere, and education on FD. We also analyzed the mediating effects of these metrics for further investigation. FD showed significant age-related decline in all structures, and its trajectory was best modeled quadratically in the bilateral frontal, parietal, and occipital lobes, as well as in the bilateral caudate, putamen, hippocampus, amygdala, and accumbens. FD showed specific mediating effects on aging and cognitive decline in some regions. Our findings suggest that FD is reliable yet shows a different pattern of decline compared with volumetric measures.
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Affiliation(s)
- Hao Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tao Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China.
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jian Cheng
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China
| | - Yan Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China
| | - Daqing Li
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China
| | - Chao Dong
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Haijun Niu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China
| | - Shuyu Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China
| | - Jicong Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China.
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
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A Meta-Analysis of Neuropsychological Functioning in the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants. J Int Neuropsychol Soc 2020; 26:322-330. [PMID: 31658919 DOI: 10.1017/s1355617719001115] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The logopenic variant of primary progressive aphasia (lvPPA) has disparate pathological and anatomical features when compared to the semantic (svPPA) and non-fluent (nfvPPA) variants of PPA. As such, there is increasing need for measures that improve diagnostic accuracy particularly when etiology-specific treatments become available. In the current study, we used meta-analytic methods to establish the neuropsychological profile of lvPPA and compare it to recent findings in svPPA and nfvPPA. METHODS We extracted neuropsychological data from 51 publications representing 663 lvPPA patients and 1379 controls. We calculated Hedges' g effect sizes for nine domains of neuropsychological functioning in lvPPA and assessed the influence of demographic, disease, and task characteristics on effect size magnitude. Results obtained in lvPPA were compared to findings in svPPA and nfvPPA. RESULTS In lvPPA, the magnitude of deficits in attention, math, visuospatial memory, and executive functioning were as prominent as language deficits. Within the language domain, lvPPA patients demonstrated greater naming than repetition deficits. Compared to svPPA and nfvPPA, lvPPA patients demonstrated greater neuropsychological deficits overall and greater impairment on attention, math, and visual set-shifting tests. CONCLUSIONS Tests of attention, delayed visuospatial memory, visual set-shifting, and math distinguish lvPPA from svPPA and nfvPPA likely reflecting the posterior temporoparietal atrophy observed early in the course of lvPPA. These findings support the inclusion of these measures in the clinical neuropsychological assessment of lvPPA and underscore the need for additional clinicopathological and longitudinal studies of arithmetic and visuospatial memory across the PPA variants.
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Abstract
Primary progressive aphasia (PPA) is classified into three variants, logopenic variant PPA (lvPPA), nonfluent agrammatic PPA (nfaPPA), and semantic variant PPA (svPPA), based on clinical (syndromic) characteristics with support from neuroimaging and/or underlying neuropathology. Classification of PPA variants provides information valuable to disease management. International consensus criteria are widely employed to identify PPA subtypes; however, classification is complex, and some individuals do not fit neatly into the subtyping scheme. In this review, diagnostic challenges and their implications are discussed, possible explanations for these challenges are explored, and approaches to address PPA classification are considered.
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Affiliation(s)
- Donna C. Tippett
- Departments of Neurology, Otolaryngology - Head and Neck Surgery, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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Reyes PA, Rueda ADP, Uriza F, Matallana DL. Networks Disrupted in Linguistic Variants of Frontotemporal Dementia. Front Neurol 2019; 10:903. [PMID: 31507513 PMCID: PMC6716200 DOI: 10.3389/fneur.2019.00903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) and semantic variant (svPPA) of frontotemporal dementia (FTD) are neurodegenerative diseases. Previous works have shown alterations of fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor images (DTIs). This manuscript is aimed at using DTI images to build a global tractography and to identify atrophy patterns of white matter in each variant. Twenty patients with svPPA, 20 patients with nfvPPA, 26 patients with behavioral variant of FTD (bvFTD) and, 33 controls were included. An analysis based on the connectivity of structural networks showed changes in FA and MD in svPPA and nfvPPA with respect to bvFTD. Much damage in the internal networks of the left temporal lobe was found in svPPA patients; in contrast, patients with nfvPPA showed atrophy in networks from the basal ganglia to motor and premotor areas. Those findings support the dual stream model of speech and language.
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Affiliation(s)
- Pablo Alexander Reyes
- Radiology Department, Hospital Universitario San Ignacio, Bogotá, Colombia.,Medicine School, Aging Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Felipe Uriza
- Radiology Department, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Diana L Matallana
- Medicine School, Aging Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
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Merck C, Noël A, Jamet E, Robert M, Hou C, Salmon A, Belliard S, Kalénine S. Identification of taxonomic and thematic relationships: Do the two semantic systems have the same status in semantic dementia? J Clin Exp Neuropsychol 2019; 41:946-964. [PMID: 31305211 DOI: 10.1080/13803395.2019.1641186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Disequilibrium between the taxonomic and thematic semantic systems was previously hypothesized in participants with semantic dementia (SD), without rigorously assessing their ability to identify the two types of semantic relationships. Therefore, the aim of the present study was to directly compare the ability of 10 participants with SD, 10 participants with Alzheimer's disease (AD), and 20 controls to identify thematic versus taxonomic relationships. Methods: Participants performed an explicit forced-choice picture-matching task in which they had to determine which of two pictures of choice was semantically related to the target picture. Target pictures could display natural or artifact objects. Each target was presented once with a taxonomically related picture and once with a thematically related picture. Results: Analyses of correct thematic and taxonomic matches as a function of target domain showed that the performance of the two groups of patients differed in the taxonomic conditions but not in the thematic conditions, demonstrating a relative preservation of thematic knowledge in SD. Additional correlation analyses further indicated that the particular status of thematic relationships in SD was even stronger for artifact concepts. Conclusions: Results provide evidence of the heterogeneous nature of semantic knowledge disruption in SD, and could be regarded as being consistent with the existence of two neuroanatomically and functionally distinct semantic systems. Results further stress the relevance of performing a more detailed and complete assessment of semantic performance in participants with SD, in order to capture the impaired but also preserved aspects of their knowledge.
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Affiliation(s)
- Catherine Merck
- Service de neurologie, CMRR Haute Bretagne, CHU Pontchaillou , Rennes , France.,Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine , Caen , France
| | - Audrey Noël
- Université Rennes 2, Laboratoire de Psychologie: Cognition, Comportement et Communication (EA 1285, laboratoire LP3C) , Rennes , France
| | - Eric Jamet
- Université Rennes 2, Laboratoire de Psychologie: Cognition, Comportement et Communication (EA 1285, laboratoire LP3C) , Rennes , France
| | - Maxime Robert
- Université Rennes 2, Laboratoire de Psychologie: Cognition, Comportement et Communication (EA 1285, laboratoire LP3C) , Rennes , France
| | - Camille Hou
- Service de neurologie, CMRR Haute Bretagne, CHU Pontchaillou , Rennes , France
| | - Anne Salmon
- Service de neurologie, CMRR Haute Bretagne, CHU Pontchaillou , Rennes , France
| | - Serge Belliard
- Service de neurologie, CMRR Haute Bretagne, CHU Pontchaillou , Rennes , France.,Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine , Caen , France
| | - Solène Kalénine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives , Lille , France
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Ash S, Nevler N, Phillips J, Irwin DJ, McMillan CT, Rascovsky K, Grossman M. A longitudinal study of speech production in primary progressive aphasia and behavioral variant frontotemporal dementia. BRAIN AND LANGUAGE 2019; 194:46-57. [PMID: 31075725 PMCID: PMC6656376 DOI: 10.1016/j.bandl.2019.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 02/10/2019] [Accepted: 04/22/2019] [Indexed: 05/03/2023]
Abstract
We examined longitudinal change in language expression during a semi-structured speech sample in 48 patients with primary progressive aphasia (PPA) or behavioral variant frontotemporal dementia (bvFTD) and related this to longitudinal neuroimaging of cortical thickness available in 25 of these patients. All patient groups declined significantly on measures of both speech fluency and grammar, although patients with nonfluent/agrammatic PPA (naPPA) declined to a greater extent than patients with the semantic variant, the logopenic variant, and bvFTD. These patient groups also declined on several neuropsychological measures, but there was no correlation between decline in speech expression and decline in neuropsychological performance. Longitudinal decline in grammaticality, assessed by the number of well-formed sentences produced, was associated with longitudinal progression of gray matter atrophy in left frontal operculum/insula and bilateral temporal cortex.
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Affiliation(s)
- Sharon Ash
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States.
| | - Naomi Nevler
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - David J Irwin
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
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Leyton CE, Landin-Romero R, Liang CT, Burrell JR, Kumfor F, Hodges JR, Piguet O. Correlates of anomia in non-semantic variants of primary progressive aphasia converge over time. Cortex 2019; 120:201-211. [PMID: 31325799 DOI: 10.1016/j.cortex.2019.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
To track neural correlates of naming performance with disease progression, we estimated key areas affected in nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) primary progressive aphasia variants over time and changes in naming correlates over time. Twenty-nine non-semantic PPA participants (17 nfvPPA and 12 lvPPA) were selected based upon current diagnostic criteria and PiB-PET status and conducted a confrontation-naming task and a structural MRI. Linear mixed-effect models implemented in FreeSurfer were used for tracking cortical thickness and epicenters of atrophy over time. Using averaged cortical thickness of epicenters and naming performance as variables of interest, two sets of multivariate analyses were conducted to compare atrophy progression and naming correlates across groups. While all PPA participants demonstrated naming deterioration and progressive cortical thinning in the left temporal lobe and the left inferior frontal gyrus, the lvPPA cohort showed greater naming deterioration and thinning in the left posterior inferior parietal cortex over time than it did the nfvPPA cohort. The multivariate analyses confirmed a widespread cortical thinning in lvPPA over time, but a more rapid thinning in the right superior frontal gyrus of nfvPPA participants. Impaired naming correlated with common cortical regions in both groups. These regions included the left anterior superior temporal gyrus and the posterior middle temporal gyrus, which was primarily affected in lvPPA. Non-semantic PPA variants initially present with separate epicenters of atrophy and different spatial-temporal patterns of neurodegeneration over time, but the common involvement in key cortical regions of the left temporal lobe accounts for naming deterioration in both groups.
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Affiliation(s)
- Cristian E Leyton
- The University of Sydney, Brain and Mind Centre, Faculty of Health Sciences, Sydney, NSW, Australia; Frontotemporal Disorders Unit, Department of Neurology Massachusetts, General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Ramon Landin-Romero
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Cheng Tao Liang
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - James R Burrell
- Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - Fiona Kumfor
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
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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: 17] [Impact Index Per Article: 3.4] [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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Hodges JR, Piguet O. Progress and Challenges in Frontotemporal Dementia Research: A 20-Year Review. J Alzheimers Dis 2019; 62:1467-1480. [PMID: 29504536 PMCID: PMC5870022 DOI: 10.3233/jad-171087] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The landscape of frontotemporal dementia (FTD) has evolved remarkably in recent years and is barely recognizable from two decades ago. Knowledge of the clinical phenomenology, cognition, neuroimaging, genetics, pathology of the different subtypes of FTD, and their relations to other neurodegenerative conditions, has increased rapidly, due in part, to the growing interests into these neurodegenerative brain conditions. This article reviews the major advances in the field of FTD over the past 20 years, focusing primarily on the work of Frontier, the frontotemporal dementia clinical research group, based in Sydney, Australia. Topics covered include clinical presentations (cognition, behavior, neuroimaging), pathology, genetics, and disease progression, as well as interventions and carer directed research. This review demonstrates the improvement in diagnostic accuracy and capacity to provide advice on genetic risks, prognosis, and outcome. The next major challenge will be to capitalize on these research findings to develop effective disease modifying drugs, which are currently lacking.
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Affiliation(s)
- John R Hodges
- The University of Sydney, Sydney Medical School and Brain and Mind Centre, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Olivier Piguet
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,The University of Sydney, School of Psychology, and Brain and Mind Centre, Sydney, Australia
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Montembeault M, Chapleau M, Jarret J, Boukadi M, Laforce R, Wilson MA, Rouleau I, Brambati SM. Differential language network functional connectivity alterations in Alzheimer's disease and the semantic variant of primary progressive aphasia. Cortex 2019; 117:284-298. [PMID: 31034993 DOI: 10.1016/j.cortex.2019.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 01/18/2023]
Abstract
Patients with Alzheimer's disease (AD) and semantic variant primary progressive aphasia (svPPA) can present with similar language impairments, mainly in naming. It has been hypothesized that these deficits are associated with different brain mechanisms in each disease, but no previous study has used a network approach to explore this hypothesis. The aim of this study was to compare resting-state functional magnetic resonance imaging (rs-fMRI) language network in AD, svPPA patients, and cognitively unimpaired elderly adults (CTRL). Therefore, 10 AD patients, 12 svPPA patients and 11 CTRL underwent rs-fMRI. Seed-based functional connectivity analyses were conducted using regions of interest in the left anterior temporal lobe (ATL), left posterior middle temporal gyrus (pMTG) and left inferior frontal gyrus (IFG), applying a voxelwise correction for gray matter volume. In AD patients, the left pMTG was the only key language region showing functional connectivity changes, mainly a reduced interhemispheric functional connectivity with its right-hemisphere counterpart, in comparison to CTRL. In svPPA patients, we observed a functional isolation of the left ATL, both decreases and increases in functional connectivity from the left pMTG and increased functional connectivity form the left IFG. Post-hoc analyses showed that naming impairments were overall associated with the functional disconnections observed across the language network. In conclusion, AD and svPPA patients present distinct language network functional connectivity profiles. In AD patients, functional connectivity changes were restricted to the left pMTG and were overall less severe in comparison to svPPA patients. Results in svPPA patients suggest decreased functional connectivity along the ventral language pathway and increased functional connectivity along the dorsal language pathway. Finally, the observed connectivity patterns are overall consistent with previously reported structural connectivity and language profiles in these patients.
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Affiliation(s)
- Maxime Montembeault
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Département de psychologie, Université de Montréal, Montréal, QC, Canada.
| | - Marianne Chapleau
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Département de psychologie, Université de Montréal, Montréal, QC, Canada.
| | - Julien Jarret
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Département de psychologie, Université de Montréal, Montréal, QC, Canada.
| | - Mariem Boukadi
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Département de psychologie, Université de Montréal, Montréal, QC, Canada.
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, QC, Canada; Faculté de médecine, Université Laval, Québec, QC, Canada.
| | - Maximiliano A Wilson
- Faculté de médecine, Université Laval, Québec, QC, Canada; Centre de recherche CERVO, Québec, QC, Canada.
| | - Isabelle Rouleau
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.
| | - Simona M Brambati
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Département de psychologie, Université de Montréal, Montréal, QC, Canada.
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Kim JP, Kim J, Park YH, Park SB, Lee JS, Yoo S, Kim EJ, Kim HJ, Na DL, Brown JA, Lockhart SN, Seo SW, Seong JK. Machine learning based hierarchical classification of frontotemporal dementia and Alzheimer's disease. NEUROIMAGE-CLINICAL 2019; 23:101811. [PMID: 30981204 PMCID: PMC6458431 DOI: 10.1016/j.nicl.2019.101811] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 01/18/2023]
Abstract
Background In a clinical setting, an individual subject classification model rather than a group analysis would be more informative. Specifically, the subtlety of cortical atrophy in some frontotemporal dementia (FTD) patients and overlapping patterns of atrophy among three FTD clinical syndromes including behavioral variant FTD (bvFTD), non-fluent/agrammatic variant primary progressive aphasia (nfvPPA), and semantic variant PPA (svPPA) give rise to the need for classification models at the individual level. In this study, we aimed to classify each individual subject into one of the diagnostic categories in a hierarchical manner by employing a machine learning-based classification method. Methods We recruited 143 patients with FTD, 50 patients with Alzheimer's disease (AD) dementia, and 146 cognitively normal subjects. All subjects underwent a three-dimensional volumetric brain magnetic resonance imaging (MRI) scan, and cortical thickness was measured using FreeSurfer. We applied the Laplace Beltrami operator to reduce noise in the cortical thickness data and to reduce the dimension of the feature vector. Classifiers were constructed by applying both principal component analysis and linear discriminant analysis to the cortical thickness data. For the hierarchical classification, we trained four classifiers using different pairs of groups: Step 1 - CN vs. FTD + AD, Step 2 - FTD vs. AD, Step 3 - bvFTD vs. PPA, Step 4 - svPPA vs. nfvPPA. To evaluate the classification performance for each step, we used a10-fold cross-validation approach, performed 1000 times for reliability. Results The classification accuracy of the entire hierarchical classification tree was 75.8%, which was higher than that of the non-hierarchical classifier (73.0%). The classification accuracies of steps 1–4 were 86.1%, 90.8%, 86.9%, and 92.1%, respectively. Changes in the right frontotemporal area were critical for discriminating behavioral variant FTD from PPA. The left frontal lobe discriminated nfvPPA from svPPA, while the bilateral anterior temporal regions were critical for identifying svPPA. Conclusions In the present study, our automated classifier successfully classified FTD clinical subtypes with good to excellent accuracy. Our classifier may help clinicians diagnose FTD subtypes with subtle cortical atrophy and facilitate appropriate specific interventions. We developed a machine learning-based automated classifier for differential diagnosis of FTD clinical syndromes and AD. Our classifier achieved good to excellent accuracy for each classification step. Discriminative regions are similar to previously known cortical atrophic patterns in each clinical syndrome.
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Affiliation(s)
- Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeonghun Kim
- Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea
| | - Yu Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Beom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Kyunghee University Medical Center, Seoul, Republic of Korea
| | - Sole Yoo
- Department of Cognitive Science, Yonsei University, Seoul, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology, Busan National University Hospital, Busan, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jesse A Brown
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Samuel N Lockhart
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Joon-Kyung Seong
- Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea; School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.
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Sheelakumari R, Chandran A, Varghese T, Zhang L, Yue GH, Mathuranath PS, Kesavadas C. Quantitative analysis of grey matter degeneration in FTD patients using fractal dimension analysis. Brain Imaging Behav 2019; 12:1221-1228. [PMID: 29086152 DOI: 10.1007/s11682-017-9784-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fractal dimension (FD) is a quantitative parameter that can characterizes the complexity of human brain tissue. Extensive grey matter (GM) pathology has been previously identified in Frontotemporal dementia (FTD) and its variants. The aim of the present study was to investigate the GM morphometric abnormalities in the behavioral variant FTD (bvFTD) and primary progressive aphasia (PPA) using FD analysis. Twenty-seven bvFTD, 12 PPA and 20 controls were studied. SPM8 was used to segment the brain into GM tissue. Then the FD values were estimated for the GM skeleton, surface and general structure in patients and controls using our previously published algorithm. We found that patients with bvFTD had significant reduction in FD values of skeleton and general structure when compared to controls. In PPA, more significant decrease in FD was noted in the whole brain and left hemisphere skeleton along with left hemisphere general structure. Only the right hemisphere skeleton had a significant correlation with total score of Frontal Systems Behavior Scale (FrSBe). The results showed that the variants of FTD are associated with disease specific morphometric complexity patterns. These results indicate that FD can be used as a biomarker for the structural changes associated with neurodegenerative diseases.
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Affiliation(s)
- Raghavan Sheelakumari
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Anuvitha Chandran
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Tinu Varghese
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Luduan Zhang
- Human performance Engineering Laboratory, Kessler foundation, 1199 Pleasant Valley way, West Orange, NJ, 07052, USA
| | - Guang H Yue
- Human performance Engineering Laboratory, Kessler foundation, 1199 Pleasant Valley way, West Orange, NJ, 07052, USA
| | - Pavagadha S Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences, Banglore, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India.
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Paek EJ, Murray LL, Newman SD, Kim DJ. Test-retest reliability in an fMRI study of naming in dementia. BRAIN AND LANGUAGE 2019; 191:31-45. [PMID: 30807893 DOI: 10.1016/j.bandl.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/18/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
fMRI has been used as an outcome measure in dementia treatment studies, with many previous studies comparing only single pre- and post-treatment fMRI scans to determine treatment-induced neural changes, while utilizing single subject experimental designs. The purpose of the current study was to evaluate fMRI test-retest reliability in dementia patients and typical older adults using noun and verb confrontation naming to evaluate the validity of using a single pre/post-treatment scan comparison. Seven individuals with dementia and 9 control participants were tested three times over two months using the same fMRI procedures. Differences in individual and group level activation patterns were observed that varied across time. Additionally, the extent of variability fluctuated across individuals, groups, and the grammatical category of target words. Our findings suggested that one time fMRI scanning may inadequately represent an individual's typical brain activation pattern, particularly an individual with dementia. Thus, multiple imaging baselines are recommended.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
| | - Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
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Tetzloff KA, Duffy JR, Clark HM, Strand EA, Machulda MM, Schwarz CG, Senjem ML, Reid RI, Spychalla AJ, Tosakulwong N, Lowe VJ, Jack CR, Josephs KA, Whitwell JL. Longitudinal structural and molecular neuroimaging in agrammatic primary progressive aphasia. Brain 2019; 141:302-317. [PMID: 29228180 DOI: 10.1093/brain/awx293] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/20/2017] [Indexed: 12/12/2022] Open
Abstract
The agrammatic variant of primary progressive aphasia affects normal grammatical language production, often occurs with apraxia of speech, and is associated with left frontal abnormalities on cross-sectional neuroimaging studies. We aimed to perform a detailed assessment of longitudinal change on structural and molecular neuroimaging to provide a complete picture of neurodegeneration in these patients, and to determine how patterns of progression compare to patients with isolated apraxia of speech (primary progressive apraxia of speech). We assessed longitudinal structural MRI, diffusion tensor imaging and 18F-fluorodeoxyglucose PET in 11 agrammatic aphasia subjects, 20 primary progressive apraxia of speech subjects, and 62 age and gender-matched controls with two serial assessments. Rates of change in grey matter volume and hypometabolism, and white matter fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity were assessed at the voxel-level and for numerous regions of interest. The greatest rates of grey matter atrophy in agrammatic aphasia were observed in inferior, middle, and superior frontal gyri, premotor and motor cortices, as well as medial temporal lobe, insula, basal ganglia, and brainstem compared to controls. Longitudinal decline in metabolism was observed in the same regions, with additional findings in medial and lateral parietal lobe. Diffusion tensor imaging changes were prominent bilaterally in inferior and middle frontal white matter and superior longitudinal fasciculus, as well as right inferior fronto-occipital fasciculus, superior frontal and precentral white matter. More focal patterns of degeneration of motor and premotor cortex were observed in primary progressive apraxia of speech. Agrammatic aphasia showed greater rates of grey matter atrophy, decline in metabolism, and white matter degeneration compared to primary progressive apraxia of speech in the left frontal lobe, predominantly inferior and middle frontal grey and white matter. Correlations were also assessed between rates of change on neuroimaging and rates of clinical decline. Progression of aphasia correlated with rates of degeneration in frontal and temporal regions within the language network, while progression of parkinsonism and limb apraxia correlated with degeneration of motor cortex and brainstem. These findings demonstrate that disease progression in agrammatic aphasia is associated with widespread neurodegeneration throughout regions of the language network, as well as connecting white matter tracts, but also with progression to regions outside of the language network that are responsible for the development of motor symptoms. The fact that patterns of progression differed from primary progressive apraxia of speech supports the clinical distinction of these syndromes.
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Affiliation(s)
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mary M Machulda
- Department of Psychology and Psychiatry, 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
| | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | | | - Nirubol Tosakulwong
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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De Leon J, Mandelli ML, Nolan A, Miller ZA, Mead C, Watson C, Welch AE, Henry ML, Bourakova V, La Joie R, Bajorek LP, Grinberg L, Rabinovici G, Miller BL, Gorno-Tempini ML. Atypical clinical features associated with mixed pathology in a case of non-fluent variant primary progressive aphasia. Neurocase 2019; 25:39-47. [PMID: 31033382 PMCID: PMC6759324 DOI: 10.1080/13554794.2019.1609522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 66-year-old woman presented with agrammatism and apraxia of speech, meeting criteria for non-fluent/agrammatic variant primary progressive aphasia (nfvPPA). However, three years later, she developed frontal/executive, short-term phonological memory, visuospatial, and visual memory deficits suggesting involvement of multiple brain networks. Multimodal neuroimaging showed damage of both fronto-striatal and posterior brain regions. She was found to have multiple pathological processes: corticobasal degeneration (CBD), Alzheimer's disease (AD), and TAR DNA-binding protein (TDP)-43 type A. We hypothesize that cognitive and neuroimaging findings consistent with damage to multiple brain networks, each associated with vulnerability to certain molecular disease subtypes, could indicate mixed pathology.
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Affiliation(s)
- Jessica De Leon
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Maria Luisa Mandelli
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Amber Nolan
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Zachary A Miller
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Christie Mead
- b PGSP-Stanford Psy.D. Consortium , Palo Alto University , Palo Alto , CA , USA
| | - Christa Watson
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Ariane E Welch
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Maya L Henry
- c Department of Communication Sciences and Disorders , University of Texas at Austin , Austin, TX , USA
| | - Viktoriya Bourakova
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Renaud La Joie
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Lynn P Bajorek
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Lea Grinberg
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Gil Rabinovici
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Bruce L Miller
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Maria Luisa Gorno-Tempini
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
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45
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Long Z, Irish M, Piguet O, Kiernan MC, Hodges JR, Burrell JR. Clinical and neuroimaging investigations of language disturbance in frontotemporal dementia–motor neuron disease patients. J Neurol 2019; 266:921-933. [DOI: 10.1007/s00415-019-09216-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
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46
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Risacher SL, Saykin AJ. Neuroimaging in aging and neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:191-227. [PMID: 31753134 DOI: 10.1016/b978-0-12-804766-8.00012-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroimaging biomarkers for neurologic diseases are important tools, both for understanding pathology associated with cognitive and clinical symptoms and for differential diagnosis. This chapter explores neuroimaging measures, including structural and functional measures from magnetic resonance imaging (MRI) and molecular measures primarily from positron emission tomography (PET), in healthy aging adults and in a number of neurologic diseases. The spectrum covers neuroimaging measures from normal aging to a variety of dementias: late-onset Alzheimer's disease [AD; including mild cognitive impairment (MCI)], familial and nonfamilial early-onset AD, atypical AD syndromes, posterior cortical atrophy (PCA), logopenic aphasia (lvPPA), cerebral amyloid angiopathy (CAA), vascular dementia (VaD), sporadic and familial behavioral-variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive nonfluent aphasia (PNFA), frontotemporal dementia with motor neuron disease (FTD-MND), frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), Parkinson's disease (PD) with and without dementia, and multiple systems atrophy (MSA). We also include a discussion of the appropriate use criteria (AUC) for amyloid imaging and conclude with a discussion of differential diagnosis of neurologic dementia disorders in the context of neuroimaging.
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Affiliation(s)
- Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States.
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47
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Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol 2018; 9:692. [PMID: 30186225 PMCID: PMC6110931 DOI: 10.3389/fneur.2018.00692] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
Primary progressive aphasias (PPA) are neurodegenerative diseases clinically characterized by an early and relatively isolated language impairment. Three main clinical variants, namely the nonfluent/agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA) have been described, each with specific linguistic/cognitive deficits, corresponding anatomical and most probable pathological features. Since the discovery and the development of diagnostic criteria for the PPA variants by the experts in the field, significant progress has been made in the understanding of these diseases. This review aims to provide an overview of the literature on each of the PPA variant in terms of their clinical, anatomical and pathological features, with a specific focus on recent findings. In terms of clinical advancements, recent studies have allowed a better characterization and differentiation of PPA patients based on both their linguistic and non-linguistic profiles. In terms of neuroimaging, techniques such as diffusion imaging and resting-state fMRI have allowed a deeper understanding of the impact of PPA on structural and functional connectivity alterations beyond the well-defined pattern of regional gray matter atrophy. Finally, in terms of pathology, despite significant advances, clinico-pathological correspondence in PPA remains far from absolute. Nonetheless, the improved characterization of PPA has the potential to have a positive impact on the management of patients. Improved reliability of diagnoses and the development of reliable in vivo biomarkers for underlying neuropathology will also be increasingly important in the future as trials for etiology-specific treatments become available.
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Affiliation(s)
- Maxime Montembeault
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle Épinière (ICM), FrontLab, Paris, France.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Simona M Brambati
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, United States
| | - Raffaella Migliaccio
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle Épinière (ICM), FrontLab, Paris, France.,Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Paris, France
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48
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Sebastian R, Thompson CB, Wang NY, Wright A, Meyer A, Friedman RB, Hillis AE, Tippett DC. Patterns of Decline in Naming and Semantic Knowledge in Primary Progressive Aphasia. APHASIOLOGY 2018; 32:1010-1030. [PMID: 30613121 PMCID: PMC6317736 DOI: 10.1080/02687038.2018.1490388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Individuals with primary progressive aphasia (PPA) and their caregivers want to know what to expect so that they can plan support appropriately. The ability to predict decline in naming and semantic knowledge, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically. AIMS The aims of this study were to investigate patterns of decline in naming and semantic knowledge in each of the clinical variants of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline. METHODS AND PROCEDURES A total of ninety-four participants with PPA underwent language testing, including thirty six participants with lvPPA, thirty-one participants with nfaPPA, and twenty-seven participants with svPPA. All participant groups were similar in age and education. We focused on decline on three tests: the short form of the Boston Naming Test (BNT), the Hopkins Assessment of Naming Actions (HANA), and the short form of the Pyramids and Palm Trees Test (PPTT). OUTCOME AND RESULTS Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA, followed by svPPA, then lvPPA. Female sex, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline. CONCLUSIONS PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. Further study of prognostically-relevant variables in PPA is indicated in this population.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
| | - Carol B Thompson
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E-3142, Baltimore, Maryland 21205-2179 USA; Telephone (410) 502-9142;
| | - Nae-Yuh Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E-3142, Baltimore, Maryland 21205-2179 USA; Telephone (410) 502-9142;
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205-2179 USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-500, Baltimore, Maryland 21205-2179 USA; Telephone (410) 614-3994;
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
| | - Aaron Meyer
- Cognitive Neuropsychology Lab, Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Building D, Suite 207, 4000 Reservoir Road, Washington, DC 20057 USA; Telephone (202) 687-4196; ,
| | - Rhonda B Friedman
- Cognitive Neuropsychology Lab, Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Building D, Suite 207, 4000 Reservoir Road, Washington, DC 20057 USA; Telephone (202) 687-4196; ,
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donna C Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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49
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Ohm DT, Kim G, Gefen T, Rademaker A, Weintraub S, Bigio EH, Mesulam MM, Rogalski E, Geula C. Prominent microglial activation in cortical white matter is selectively associated with cortical atrophy in primary progressive aphasia. Neuropathol Appl Neurobiol 2018; 45:216-229. [PMID: 29679378 DOI: 10.1111/nan.12494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/02/2018] [Indexed: 02/04/2023]
Abstract
AIMS Primary progressive aphasia (PPA) is a clinical syndrome characterized by selective language impairments associated with focal cortical atrophy favouring the language dominant hemisphere. PPA is associated with Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) and significant accumulation of activated microglia. Activated microglia can initiate an inflammatory cascade that may contribute to neurodegeneration, but their quantitative distribution in cortical white matter and their relationship with cortical atrophy remain unknown. We investigated white matter activated microglia and their association with grey matter atrophy in 10 PPA cases with either AD or FTLD-TDP pathology. METHODS Activated microglia were quantified with optical density measures of HLA-DR immunoreactivity in two regions with peak cortical atrophy, and one nonatrophied region within the language dominant hemisphere of each PPA case. Nonatrophied contralateral homologues of the language dominant regions were examined for hemispheric asymmetry. RESULTS Qualitatively, greater densities of activated microglia were observed in cortical white matter when compared to grey matter. Quantitative analyses revealed significantly greater densities of activated microglia in the white matter of atrophied regions compared to nonatrophied regions in the language dominant hemisphere (P < 0.05). Atrophied regions of the language dominant hemisphere also showed significantly more activated microglia compared to contralateral homologues (P < 0.05). CONCLUSIONS White matter activated microglia accumulate more in atrophied regions in the language dominant hemisphere of PPA. While microglial activation may constitute a response to neurodegenerative processes in white matter, the resultant inflammatory processes may also exacerbate disease progression and contribute to cortical atrophy.
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Affiliation(s)
- D T Ohm
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G Kim
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Gefen
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Rademaker
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E H Bigio
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M-M Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Geula
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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50
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Harris JM, Saxon JA, Jones M, Snowden JS, Thompson JC. Neuropsychological differentiation of progressive aphasic disorders. J Neuropsychol 2018; 13:214-239. [PMID: 29424041 PMCID: PMC6618014 DOI: 10.1111/jnp.12149] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/10/2017] [Indexed: 12/02/2022]
Abstract
The differentiation of subtypes of primary progressive aphasia (PPA) remains challenging. We aimed to identify optimum neuropsychological measures for characterizing PPA, to examine the relationship between behavioural change and subtypes of PPA and to determine whether characteristic profiles of language, working memory, and behavioural changes occur in PPA. Forty‐seven patients with PPA and multi‐domain Alzheimer's disease (AD) together with 19 age‐matched controls underwent a large battery of working memory and language tests. We found that simple tasks of sentence ordering, narrative production, and buccofacial praxis were particularly useful in differentiating non‐fluent/agrammatic variant PPA (nfvPPA) from other PPA subtypes, whereas a test of single word comprehension was useful in detecting semantic dementia (SD). No individual tests were discriminating for logopenic variant PPA (lvPPA) relative to nfvPPA. LvPPA and multidomain AD exhibited similar language profiles. A principal components analysis revealed that characteristic PPA profiles extended beyond the realms of language, in particular, the presence of apraxia in nfvPPA, behavioural changes in SD, and working memory deficits in lvPPA. These findings suggest that not all tests are equally discriminatory for PPA and highlight the importance of a test profile in differentiating PPA. These results also support the view that lvPPA is a focal form of AD and emphasize the difficulties classifying lvPPA.
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Affiliation(s)
- Jennifer M Harris
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jennifer A Saxon
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthew Jones
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Julie S Snowden
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jennifer C Thompson
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
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