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Seo SW, Thibodeau MP, Perry DC, Hua A, Sidhu M, Sible I, Vargas JNS, Gaus SE, Rabinovici GD, Rankin KD, Boxer AL, Kramer JH, Rosen HJ, Gorno-Tempini ML, Grinberg LT, Huang EJ, DeArmond SJ, Trojanowski JQ, Miller BL, Seeley WW. Early vs late age at onset frontotemporal dementia and frontotemporal lobar degeneration. Neurology 2018; 90:e1047-e1056. [PMID: 29453245 DOI: 10.1212/wnl.0000000000005163] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine clinicopathologic correlations in early vs late age at onset frontotemporal dementia (FTD) and frontotemporal lobar degeneration (FTLD). METHODS All patients were clinically evaluated and prospectively diagnosed at the UCSF Memory and Aging Center. Two consecutive series were included: (1) patients with a clinically diagnosed FTD syndrome who underwent autopsy (cohort 1) and (2) patients with a primary pathologic diagnosis of FTLD, regardless of the clinical syndrome (cohort 2). These series were divided by age at symptom onset (cutoff 65 years). RESULTS In cohort 1, 48 (25.3%) were 65 years or older at symptom onset. Pathologic causes of behavioral variant FTD (bvFTD) were similar in the early age at onset (EO) and late age at onset (LO) bvFTD groups. In corticobasal syndrome (CBS), however, the most common pathologic substrate differed according to age at onset: progressive supranuclear palsy (42.9%) in LO-CBS and Alzheimer disease (AD; 40.7%) in EO-CBS. In cohort 2, 57 (28.4%) were classified as LO-FTLD. Regarding FTLD major molecular classes, FTLD with transactive response DNA-binding protein of 43 kDa was most common in EO-FTLD (44.4%), whereas FTLD-tau (58.3%) was most common in LO-FTLD. Antemortem diagnosis of a non-FTD syndrome, usually AD-type dementia, was more frequent in LO-FTLD than EO-FTLD (19.3% vs 7.7%, p = 0.017). LO-FTLD was also associated with more prevalent comorbid pathologic changes. Of these, moderate to severe AD neuropathologic change and argyrophilic grain disease were overrepresented among patients who received an antemortem diagnosis of AD-type dementia. CONCLUSION Patients with FTD and FTLD often develop symptoms after age 65, and age at onset represents an important consideration when making antemortem neuropathologic predictions.
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Affiliation(s)
- Sang Won Seo
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Marie-Pierre Thibodeau
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - David C Perry
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Alice Hua
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Manu Sidhu
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Isabel Sible
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Jose Norberto S Vargas
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Stephanie E Gaus
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Gil D Rabinovici
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Katherine D Rankin
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Adam L Boxer
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Joel H Kramer
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Howard J Rosen
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Maria Luisa Gorno-Tempini
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Lea T Grinberg
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Eric J Huang
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Stephen J DeArmond
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - John Q Trojanowski
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - Bruce L Miller
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia
| | - William W Seeley
- From the Memory and Aging Center, Department of Neurology (S.W.S., D.C.P., A.H., M.S., I.S., J.N.S.V., S.E.G., G.R., K.D.R., A.L.B., J.H.K., H.J.R., M.L.G.-T., L.T.G., B.L.M., W.W.S.), and Department of Pathology (L.T.G., E.J.H., S.J.D., W.W.S.), University of California, San Francisco; Department of Neurology (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Geriatrics (M.-P.T.), Centre Hospitalier de l'Université de Montréal, University of Montreal, Canada; and Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research and Institute on Aging (J.Q.T.), University of Pennsylvania, Philadelphia.
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