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Shaw SR, Horne KS, Piguet O, Ahmed RM, Whitton AE, Irish M. Profiles of motivational impairment and their relationship to functional decline in frontotemporal dementia. J Neurol 2024:10.1007/s00415-024-12430-0. [PMID: 38758282 DOI: 10.1007/s00415-024-12430-0] [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: 01/22/2024] [Revised: 04/05/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Motivational disturbances are pervasive in frontotemporal dementia (FTD) and impact negatively on everyday functioning. Despite mounting evidence of anhedonia in FTD, it remains unclear how such changes fit within the broader motivational symptom profile of FTD, or how anhedonia relates to functional outcomes. Here we sought to comprehensively characterize motivational disturbances in FTD and their respective relationships with functional impairment. A cross-sectional study design was used including 211 participants-68 behavioral-variant FTD (bvFTD), 32 semantic dementia (SD), 43 Alzheimer's disease (AD), and 68 healthy older control participants. Anhedonia severity was measured using the Snaith-Hamilton Pleasure Scale while severity of apathy was assessed across Emotional, Executive, and Initiation dimensions using the Dimensional Apathy Scale. Functional impairment was established using the FTD Functional Rating Scale (FRS). Distinct motivational profiles emerged in each dementia syndrome: a domain-general motivational impairment in bvFTD; a predominantly anhedonic profile in SD; and more pronounced initiation and executive apathy in AD. Correlation analyses revealed differential associations between motivational symptoms and severity of functional impairment in each group. Executive apathy was associated with functional impairment in bvFTD, while anhedonia was strongly correlated with functional decline in SD. Finally, executive and emotional apathy were associated with functional decline in AD. Our study indicates distinct profiles of apathy and anhedonia in FTD syndromes, which in turn are differentially associated with functional decline. This detailed characterization of motivational phenotypes can inform patient stratification for targeted interventions to improve functional outcomes.
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Affiliation(s)
- Siobhán R Shaw
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Kristina S Horne
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Muireann Irish
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.
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Foxe D, Irish M, Carrick J, Cheung SC, Teng H, Burrell JR, Kessels RPC, Piguet O. Visuospatial working memory in behavioural variant frontotemporal dementia: a comparative analysis with Alzheimer's disease using the box task. J Neurol 2024:10.1007/s00415-024-12406-0. [PMID: 38713393 DOI: 10.1007/s00415-024-12406-0] [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: 03/25/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study investigated the visuospatial working memory profiles of behavioural variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) using a novel computerised test of visuospatial working memory: the Box Task. METHODS Twenty-eight bvFTD and 28 AD patients, as well as 32 age-matched control participants were recruited. All participants completed the Box Task and conventional neuropsychological tests of working memory, episodic memory, and visuospatial function. RESULTS Both the bvFTD and AD groups exhibited significantly more Box Task between-search errors than the control group across all set sizes. Notably, the AD group demonstrated a significantly higher error rate compared to the bvFTD group. Regression analysis revealed that whilst episodic memory impairment significantly predicted Box Task error performance in AD, this was not the case for bvFTD. Additionally, a noticeable trend was observed for attention in predicting Box Task errors in both bvFTD and AD groups. The Box Task demonstrated high utility in differentiating between bvFTD and AD, with a decision tree correctly classifying 82.1% of bvFTD patients and 75% of AD patients. CONCLUSIONS Our findings reveal significant visuospatial working memory impairments in bvFTD, albeit of lesser severity compared to disease-matched AD patients. The Box Task, a novel measure of visuospatial working memory, proved effective in differentiating between bvFTD and AD, outperforming many traditional neuropsychological measures. Overall, our findings highlight the utility of assessing visuospatial memory when differentiating between bvFTD and AD in the clinical setting.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, Australia.
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia.
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - James Carrick
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - Sau Chi Cheung
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
- Neuropsychology Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Her Teng
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
- Concord Medical School, The University of Sydney, Sydney, Australia
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
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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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Conti F, Carnemolla S, Piguet O, Irish M. Scene construction in healthy aging - Exploring the interplay between task complexity and oculomotor behaviour. Brain Cogn 2024; 177:106163. [PMID: 38685168 DOI: 10.1016/j.bandc.2024.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Mounting evidence indicates a close correspondence between episodic memory, mental imagery, and oculomotor behaviour. It remains unclear, however, how oculomotor variables support endogenously driven forms of mental imagery and how this relationship changes across the adult lifespan. In this study we investigated age-related changes in oculomotor signatures during scene construction and explored how task complexity impacts these processes. Younger and cognitively healthy older participants completed a guided scene construction paradigm where scene complexity was manipulated according to the number of elements to be sequentially integrated. We recorded participants' eye movements and collected subjective ratings regarding their phenomenological experience. Overall, older adults rated their constructions as more vivid and more spatially integrated, while also generating more fixations and saccades relative to the younger group, specifically on control trials. Analyses of participants' total scan paths revealed that, in the early stages of scene construction, oculomotor behaviour changed as a function of task complexity within each group. Following the introduction of a second stimulus, older but not younger adults showed a significant decrease in the production of eye movements. Whether this shift in oculomotor behaviour serves a compensatory function to bolster task performance represents an important question for future research.
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Affiliation(s)
- Federica Conti
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Sarah Carnemolla
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.
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Shatalina E, Whitehurst TS, Onwordi EC, Gilbert BJ, Rizzo G, Whittington A, Mansur A, Tsukada H, Marques TR, Natesan S, Rabiner EA, Wall MB, Howes OD. Mitochondrial complex I density is associated with IQ and cognition in cognitively healthy adults: an in vivo [ 18F]BCPP-EF PET study. EJNMMI Res 2024; 14:41. [PMID: 38632153 PMCID: PMC11024075 DOI: 10.1186/s13550-024-01099-1] [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: 11/07/2023] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Mitochondrial function plays a key role in regulating neurotransmission and may contribute to general intelligence. Mitochondrial complex I (MC-I) is the largest enzyme of the respiratory chain. Recently, it has become possible to measure MC-I distribution in vivo, using a novel positron emission tomography tracer [18F]BCPP-EF, thus, we set out to investigate the association between MC-I distribution and measures of cognitive function in the living healthy brain. RESULTS Analyses were performed in a voxel-wise manner and identified significant associations between [18F]BCPP-EF DVRCS-1 in the precentral gyrus and parietal lobes and WAIS-IV predicted IQ, WAIS-IV arithmetic and WAIS-IV symbol-digit substitution scores (voxel-wise Pearson's correlation coefficients transformed to Z-scores, thresholded at Z = 2.3 family-wise cluster correction at p < 0.05, n = 16). Arithmetic scores were associated with middle frontal and post-central gyri tracer uptake, symbol-digit substitution scores were associated with precentral gyrus tracer uptake. RAVLT recognition scores were associated with [18F]BCPP-EF DVRCS-1 in the middle frontal gyrus, post-central gyrus, occipital and parietal regions (n = 20). CONCLUSIONS Taken together, our findings support the theory that mitochondrial function may contribute to general intelligence and indicate that interindividual differences in MC-I should be a key consideration for research into mitochondrial dysfunction in conditions with cognitive impairment.
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Affiliation(s)
- Ekaterina Shatalina
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK.
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK.
| | - Thomas S Whitehurst
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Ellis Chika Onwordi
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | | | | | - Tiago Reis Marques
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Sridhar Natesan
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Eugenii A Rabiner
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
- Invicro, London, UK
| | - Matthew B Wall
- Faculty of Medicine, Imperial College London, London, UK
- Invicro, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Oliver D Howes
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
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Frampton K, Oppedijk L, Hadley R, Annett LE. Reduced Anxiety and Depression and Improved Mood in Older Adults Living in Care Homes After Participating in Chair Yoga. J Appl Gerontol 2024:7334648241241298. [PMID: 38522958 DOI: 10.1177/07334648241241298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Providing opportunities for older adults to engage in physical and mental activity is important to support healthy aging. The present preliminary study investigated the feasibility of accessible chair yoga for older adults in care homes. Chair yoga participants (n = 17) were assessed before and after attending twice weekly chair yoga sessions for 8 weeks, while control participants (n = 16) underwent the assessments only. Participant ages ranged from 80 to 101 years and included those living with mild to severe dementia. Anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS), and negative affect measured by the Positive and Negative Affect Schedule (PANAS), improved in the chair yoga but not the control group. Balance confidence (Modified Falls Efficacy Scale) and Health-related Quality of Life (EQ-5D-3L) were unchanged. Chair yoga is a feasible activity for older care home residents, including those living with dementia, with the potential to improve mental well-being.
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Affiliation(s)
- Keeley Frampton
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | | | - Rebecca Hadley
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Lucy E Annett
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
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7
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Wilson NA, Ahmed R, Piguet O, Irish M. Disrupted social perception in frontotemporal dementia and Alzheimer's disease - Associated cognitive processes and clinical implications. J Neurol Sci 2024; 458:122902. [PMID: 38325063 DOI: 10.1016/j.jns.2024.122902] [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: 09/28/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Social perception refers to the ability to adapt and update one's behaviour in accordance with the current context and provides the foundation for many complex social and emotional interactions. Alterations in social cognition are a hallmark of the behavioural variant of frontotemporal dementia (bvFTD), yet the capacity for social perception in this syndrome remains unclear. METHODS We examined social perception in 18 bvFTD and 13 Alzheimer's disease (AD) patients, in comparison with 17 healthy older controls, using a social perception task derived from the Dewey Story Test. Participants also completed a comprehensive neuropsychological battery and carers provided ratings of behavioural and neuropsychiatric changes. RESULTS Overall, bvFTD and AD performance diverged significantly from control ratings on the social perception task, however, no significant difference was found between patient groups. Standardised values relative to the mean control rating revealed considerable variability within the patient groups in terms of the direction of deviation, i.e., over- or under-rating the vignettes relative to healthy controls (range z-scores = -1.79 to +1.63). Greater deviation from control ratings was associated with more pronounced memory (p = .007) and behavioural (p = .009) disturbances in bvFTD; whilst social perception performance correlated exclusively with verbal fluency in AD (p = .003). CONCLUSIONS Social perception is comparably disrupted in bvFTD and AD, yet likely reflects the differential breakdown of distinct cognitive processes in each dementia syndrome. Our findings have important clinical implications for the development of targeted interventions to manage disease-specific changes in social perception in dementia.
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Affiliation(s)
- Nikki-Anne Wilson
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia; The University of New South Wales, School of Psychology, Sydney, NSW 2052, Australia; Neuroscience Research Australia, Sydney, NSW 2031, Australia.
| | - Rebekah Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia
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Tsiakiri A, Trypsiani I, Christidi F, Trypsianis G, Bakirtzis C, Vlotinou P, Tsiptsios D, Voskou P, Papageorgiou S, Aggelousis N, Vadikolias K, Serdari A. The testamentary capacity in acute stroke. A cross-sectional study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38447221 DOI: 10.1080/23279095.2024.2324126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Succession law, which governs the creation and validity of wills, is closely tied to testamentary capacity (TC), the cognitive competence required for a valid will. This study explores TC in acute stroke patients and its connections to demographic and clinical characteristics. The research included first-time stroke patients admitted within 24 hours of symptom onset, meeting specific criteria. Data were collected, and assessment tools like the Addenbrooke's Cognitive Examination III (ACE-III) and Testamentary Capacity Assessment Tool (TCAT) were used. The study found that TCAT scores were not significantly affected by age or gender but positively correlated with education, the Barthel Index and ACE-III scores. They were negatively associated with National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores. Specific cognitive domains, particularly memory and attention, were independent determinants of TCAT scores. This research introduces TCAT as a valuable tool for evaluating testamentary capacity in stroke patients and highlights the multifaceted nature of TC, emphasizing the need for a nuanced approach. As the population ages and complex medical conditions become more prevalent, understanding the interplay between cognitive functioning and testamentary capacity becomes increasingly crucial for both legal and medical professionals.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioanna Trypsiani
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Trypsianis
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Bakirtzis
- B' Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, Athens, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiota Voskou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis Papageorgiou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Aspasia Serdari
- Department of Child and Adolescent, Democritus University of Thrace, Alexandroupolis, Greece
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Lan F, Roquet D, Dalton MA, El-Omar H, Ahmed RM, Piguet O, Irish M. Exploring graded profiles of hippocampal atrophy along the anterior-posterior axis in semantic dementia and Alzheimer's disease. Neurobiol Aging 2024; 135:70-78. [PMID: 38232501 DOI: 10.1016/j.neurobiolaging.2024.01.004] [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: 07/13/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
Mounting evidence indicates marked hippocampal degeneration in semantic dementia (SD) however, the spatial distribution of hippocampal atrophy profiles in this syndrome remains unclear. Using a recently developed parcellation approach, we extracted hippocampal volumes from four distinct subregions running from anterior to posterior along the longitudinal axis (anterior, intermediate rostral, intermediate caudal, and posterior). Volumetric differences in hippocampal subregions were compared between 21 SD, 24 matched Alzheimer's disease (AD), and 27 healthy older Control participants. Despite comparable overall hippocampal volume loss, SD and AD groups diverged in terms of the magnitude of atrophy along the anterior-posterior axis of the hippocampus. Global hippocampal atrophy was observed in AD, with no discernible gradation or lateralisation. In contrast, SD patients displayed graded bilateral hippocampal atrophy, most pronounced on the left-hand side, and concentrated in anterior relative to posterior subregions. Finally, we found preliminary evidence that disease-specific vulnerability along the anterior-posterior axis of the hippocampus was associated with canonical clinical features of these syndromes.
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Affiliation(s)
- Fang Lan
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Marshall A Dalton
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.
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10
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de Boer SC, Riedl L, Fenoglio C, Rue I, Landin-Romero R, Matis S, Chatterton Z, Galimberti D, Halliday G, Diehl-Schmid J, Piguet O, Pijnenburg YA, Ducharme S. Rationale and Design of the "DIagnostic and Prognostic Precision Algorithm for behavioral variant Frontotemporal Dementia" (DIPPA-FTD) Study: A Study Aiming to Distinguish Early Stage Sporadic FTD from Late-Onset Primary Psychiatric Disorders. J Alzheimers Dis 2024; 97:963-973. [PMID: 38143357 PMCID: PMC10836537 DOI: 10.3233/jad-230829] [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] [Accepted: 11/06/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The behavioral variant of frontotemporal dementia (bvFTD) is very heterogeneous in pathology, genetics, and disease course. Unlike Alzheimer's disease, reliable biomarkers are lacking and sporadic bvFTD is often misdiagnosed as a primary psychiatric disorder (PPD) due to overlapping clinical features. Current efforts to characterize and improve diagnostics are centered on the minority of genetic cases. OBJECTIVE The multi-center study DIPPA-FTD aims to develop diagnostic and prognostic algorithms to help distinguish sporadic bvFTD from late-onset PPD in its earliest stages. METHODS The prospective DIPPA-FTD study recruits participants with late-life behavioral changes, suspect for bvFTD or late-onset PPD diagnosis with a negative family history for FTD and/or amyotrophic lateral sclerosis. Subjects are invited to participate after diagnostic screening at participating memory clinics or recruited by referrals from psychiatric departments. At baseline visit, participants undergo neurological and psychiatric examination, questionnaires, neuropsychological tests, and brain imaging. Blood is obtained to investigate biomarkers. Patients are informed about brain donation programs. Follow-up takes place 10-14 months after baseline visit where all examinations are repeated. Results from the DIPPA-FTD study will be integrated in a data-driven approach to develop diagnostic and prognostic models. CONCLUSIONS DIPPA-FTD will make an important contribution to early sporadic bvFTD identification. By recruiting subjects with ambiguous or prodromal diagnoses, our research strategy will allow the characterization of early disease stages that are not covered in current sporadic FTD research. Results will hopefully increase the ability to diagnose sporadic bvFTD in the early stage and predict progression rate, which is pivotal for patient stratification and trial design.
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Affiliation(s)
- Sterre C.M. de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Chiara Fenoglio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Ishana Rue
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Ramon Landin-Romero
- Faculty of Medicine and Health, School of Health Sciences & Brain and Mind Sciences, The University of Sydney, Sydney, Australia
| | - Sophie Matis
- Faculty of Medicine and Health, School of Health Sciences & Brain and Mind Sciences, The University of Sydney, Sydney, Australia
| | - Zac Chatterton
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Daniela Galimberti
- University of Milan, Milan, Italy
- Fondazione Ca’ Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Glenda Halliday
- School of Medical Sciences & Brain and Mind Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg/Inn, Germany
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Yolande A.L. Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
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11
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Cabrera-Martín MN, Nespral P, Valles-Salgado M, Bascuñana P, Delgado-Alonso C, Delgado-Álvarez A, Fernández-Romero L, López-Carbonero JI, Díez-Cirarda M, Gil-Moreno MJ, Matías-Guiu J, Matias-Guiu JA. FDG-PET-based neural correlates of Addenbrooke's cognitive examination III scores in Alzheimer's disease and frontotemporal degeneration. Front Psychol 2023; 14:1273608. [PMID: 38034292 PMCID: PMC10687370 DOI: 10.3389/fpsyg.2023.1273608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The Addenbrooke's Cognitive Examination III (ACE-III) is a brief test useful for neuropsychological assessment. Several studies have validated the test for the diagnosis of Alzheimer's disease (AD) and frontotemporal dementia (FTD). In this study, we aimed to examine the metabolic correlates associated with the performance of ACE-III in AD and behavioral variant FTD. Methods We enrolled 300 participants in a cross-sectional study, including 180 patients with AD, 60 with behavioral FTD (bvFTD), and 60 controls. An 18F-Fluorodeoxyglucose positron emission tomography study was performed in all cases. Correlation between the ACE-III and its domains (attention, memory, fluency, language, and visuospatial) with the brain metabolism was estimated. Results The ACE-III showed distinct neural correlates in bvFTD and AD, effectively capturing the most relevant regions involved in these disorders. Neural correlates differed for each domain, especially in the case of bvFTD. Lower ACE-III scores were associated with more advanced stages in both disorders. The ACE-III exhibited high discrimination between bvFTD vs. HC, and between AD vs. HC. Additionally, it was sensitive to detect hypometabolism in brain regions associated with bvFTD and AD. Conclusion Our study contributes to the knowledge of the brain regions associated with ACE-III, thereby facilitating its interpretation, and highlighting its suitability for screening and monitoring. This study provides further validation of ACE-III in the context of AD and FTD.
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Affiliation(s)
- María Nieves Cabrera-Martín
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Pedro Nespral
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Maria Valles-Salgado
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Pablo Bascuñana
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Alfonso Delgado-Álvarez
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Lucía Fernández-Romero
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Juan Ignacio López-Carbonero
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - María Díez-Cirarda
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - María José Gil-Moreno
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Jordi A. Matias-Guiu
- Department of Nuclear Medicine, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
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12
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Clarke AJ, Manser D, Fleischer R, Fulham M, Ahmed RM. Pearls & Oy-sters: Huntington Disease Presenting as Primary Progressive Aphasia: A Case of Semantics. Neurology 2023; 101:414-417. [PMID: 37202171 PMCID: PMC10501099 DOI: 10.1212/wnl.0000000000207428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
We present a case of semantic variant primary progressive aphasia as the presenting feature in a patient with Huntington disease (HD). The patient initially developed progressive language impairment including impaired naming and object knowledge and single-word comprehension and then developed chorea and behavioral changes. An MRI of the brain showed left anterior temporal lobe and hippocampal atrophy. A neurologic FDG PET/CT showed reduced metabolism in the head of the left caudate nucleus. Huntingtin gene testing revealed an expansion of 39 CAG repeats in 1 allele. This case outlines the substantial overlap between the clinical presentation of HD and frontotemporal lobar degeneration syndromes and provides commentary on the investigation of these neurodegenerative diseases.
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Affiliation(s)
- Antonia J Clarke
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia.
| | - David Manser
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Ronald Fleischer
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Michael Fulham
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Rebekah M Ahmed
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
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13
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Noad R, Newman C, Chynoweth J, Mayers J, Hall S, Murphy D. A pilot examination of the validity of stylus and finger drawing on visuomotor-mediated tests on ACEmobile. J Clin Exp Neuropsychol 2023; 45:445-451. [PMID: 37621191 DOI: 10.1080/13803395.2023.2249167] [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: 02/27/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Cognitive assessments, such as the Addenbrooke's Cognitive Examination (ACE-III) and Montreal Cognitive Assessment (MoCA), have been modified for administration using tablet computers. While this offers important advantages for practice, it may also threaten the test validity. The current study sought to test whether administering visuospatial and writing tests using a tablet (finger or stylus drawing), would demonstrate equivalence to traditional pencil and paper administration on ACEmobile. METHOD This study recruited 26 participants with Alzheimer's disease and 23 healthy older adults. Most participants had low familiarity with using a tablet computer. Participants completed ACEmobile in its entirety, after which they repeated the infinity loops, cube, and clock drawing and sentence writing tests by drawing with a stylus and their finger onto an iPad. Performance on the drawing and writing tests using a stylus, finger, and pencil were compared. RESULTS Statistically significant differences were observed between the finger and pencil administration on the ACEmobile, with participants performing worse on the finger drawing trials. Differences in scores were most apparent on the sentence writing task. In contrast, no statistical differences were observed between the pencil and stylus administration. DISCUSSION The findings of this pilot study have important implications for clinical neuropsychology and demonstrate that administering ACEmobile drawing tests with finger drawing is invalid. However, due to the small sample size, a lack of counterbalancing and the narrow range of scores of the dependent variable, we are unable to confidently interpret the validity of stylus drawing. This is an important consideration for future research.
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Affiliation(s)
- Rupert Noad
- Faculty of Health, University of Plymouth, Plymouth, UK
- Clinical Neuropsychology, University Hospitals Plymouth, UK
| | | | | | - Jacob Mayers
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Stephen Hall
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Donnchadh Murphy
- Faculty of Health, University of Plymouth, Plymouth, UK
- Clinical Neuropsychology, Livewell Southwest, UK
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14
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The influence of culture and cognitive reserve on the clinical presentation of behavioural-variant frontotemporal dementia. J Neurol 2023; 270:3192-3203. [PMID: 36914787 DOI: 10.1007/s00415-023-11638-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
Characterisation of the clinical profile of behavioural-variant frontotemporal dementia (bvFTD) has predominantly been based on Western samples. Some small studies have suggested that the clinical profile may differ in culturally and linguistically diverse populations. Additionally, there is evidence that patients from non-English speaking backgrounds may have more cognitive reserve, allowing them to tolerate more disease pathology before clinical symptoms emerge. This study aims to characterise the clinical profiles of patients with bvFTD from culturally diverse backgrounds. BvFTD patients were classified as Australian-born (Australian) or Culturally and Linguistically Diverse-English-speaking (CALD-English) and Culturally and Linguistically Diverse-Language Other Than English (CALD-LOTE). Clinical features, cognitive test performance and cognitive reserve were compared between groups. Voxel-based morphometry was used to examine the neural correlates of cognitive reserve. 107 patients with bvFTD (53 Australian, 36 CALD-English, 18 CALD-LOTE) and 51 controls were included. Analysis of neuropsychiatric features revealed more elation in Australian patients compared to CALD-English patients, with trends for CALD-LOTE patients to report more irritability. CALD-LOTE patients also had higher cognitive reserve and showed relatively greater verbal than non-verbal cognitive impairment. Neuroimaging analyses revealed that higher cognitive reserve was associated with lower integrity in the frontal-temporal regions associated with typical disease pathology in bvFTD. Our findings support the hypothesis that cognitive reserve may delay early cognitive decline in culturally and linguistically diverse patients, although these patients may still show poor verbal performance due to cultural testing biases. Clinically, these results highlight the need to consider cultural and linguistic background to inform the assessment of dementia.
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15
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Calderón C, Bekios-Calfa J, Bekios-Canales N, Véliz-García O, Beyle C, Palominos D, Ávalos-Tejeda M, Domic-Siede M. Application of machine learning techniques for dementia severity prediction from psychometric tests in the elderly population. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 36587834 DOI: 10.1080/23279095.2022.2162899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Previous research has shown the benefits of early detection and treatment of dementia. This detection is usually performed manually by one or more clinicians based on reports and psychometric testing. Machine learning algorithms provide an alternative method of prediction that may contribute, with an automated process and insights, to the diagnosis and classification of the severity level of dementia. The aim of this study is to explore the use of neuropsychological data from a reduced version of the Addenbrooke's Cognitive Examination III (ACE-III) to predict absence or different levels of dementia severity using the Global Deterioration Scale (GDS) scores through the implementation of the kNN machine learning algorithm. A sample of 1164 elderly people over sixty years old were evaluated using a reduced version of the ACE-III and the GDS. The kNN classifier provided good accuracies using 15 items from the ACE-III and adequately differentiating people with absence and mild impairment, from those with more severe levels of impairment according to the GDS rating. Our results suggest that the kNN algorithm may be used to automate aspects of clinical cognitive impairment classification in the elderly population.
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Affiliation(s)
- Carlos Calderón
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Juan Bekios-Calfa
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Escuela de Ingeniería, Universidad Católica del Norte, Coquimbo, Chile
| | - Nikolás Bekios-Canales
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Oscar Véliz-García
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Christian Beyle
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Católica de Temuco. Temuco, Chile
| | - Diego Palominos
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcelo Ávalos-Tejeda
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcos Domic-Siede
- Núcleo de Investigación en Neurociencia Cognitiva, Afectiva y Neuropsicología, Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
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16
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Georgiou E(EZ, Prapiadou S, Thomopoulos V, Skondra M, Charalampopoulou M, Pachi A, Anagnostopoulou Α, Vorvolakos T, Perneczky R, Politis A, Alexopoulos P. Naming ability assessment in neurocognitive disorders: a clinician's perspective. BMC Psychiatry 2022; 22:837. [PMID: 36585667 PMCID: PMC9801565 DOI: 10.1186/s12888-022-04486-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared. METHODS Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content. RESULTS Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language. CONCLUSIONS Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.
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Affiliation(s)
- Eliza ( Eleni-Zacharoula) Georgiou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Savvina Prapiadou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vasileios Thomopoulos
- grid.11047.330000 0004 0576 5395Large-Scale Machine Learning & Cloud Data Engineering Laboratory (ML@Cloud-Lab), Faculty of Computer Engineering & Informatics, School of Engineering, University of Patras, Patras, Greece
| | - Maria Skondra
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Asimina Pachi
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Αlexandra Anagnostopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece ,General Hospital of Zakynthos “Saint Dionysios”, Zakynthos, Greece
| | - Theofanis Vorvolakos
- grid.12284.3d0000 0001 2170 8022Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert Perneczky
- grid.5252.00000 0004 1936 973XDivision of Mental Health in Older Adults and Alzheimer Therapy and Research Center, Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany ,grid.7445.20000 0001 2113 8111Ageing Epidemiology (AGE) Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neurosciences (SITraN), University of Sheffield, Sheffield, UK
| | - Antonios Politis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.21107.350000 0001 2171 9311Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, USA
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece. .,Global Brain Health Institute, Medical School, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany. .,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled - FRODIZO, Patras, Greece.
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17
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Kowalczyk M, Panasiuk-Kowalczyk A, Stadnik A, Guz M, Cybulski M, Jeleniewicz W, Stepulak A, Kwiatosz-Muc M. Dexmedetomidine Increases MMP-12 and MBP Concentrations after Coronary Artery Bypass Graft Surgery with Extracorporeal Circulation Anaesthesia without Impacting Cognitive Function: A Randomised Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16512. [PMID: 36554397 PMCID: PMC9778911 DOI: 10.3390/ijerph192416512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Postoperative neurological deficits remain a concern for patients undergoing cardiac surgeries. Even minor injuries can lead to neurocognitive decline (i.e., postoperative cognitive dysfunction). Dexmedetomidine may be beneficial given its reported neuroprotective effect. We aimed to investigate the effects of dexmedetomidine on brain injury during cardiac surgery anaesthesia. This prospective observational study analysed data for 46 patients who underwent coronary artery bypass graft surgery with extracorporeal circulation between August 2018 and March 2019. The patients were divided into two groups: control (CON) with typical anaesthesia and dexmedetomidine (DEX) with dexmedetomidine infusion. Concentrations of the biomarkers matrix metalloproteinase-12 (MMP-12) and myelin basic protein (MBP) were measured preoperatively and at 24 and 72 h postoperatively. Cognitive evaluations were performed preoperatively, at discharge, and 3 months after discharge using Addenbrooke's Cognitive Examination version III (ACE-III). The primary endpoint was the ACE-III score at discharge. Increased MMP-12 and MBP concentrations were observed in the DEX group 24 and 72 h postoperatively. No significant differences in ACE-III scores were observed between the groups at discharge; however, the values were increased when compared with initial values after 3 months (p = 0.000). The current results indicate that the administration of dexmedetomidine as an adjuvant to anaesthesia can increase MMP-12 and MBP levels without effects on neurocognitive outcomes at discharge and 3 months postoperatively.
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Affiliation(s)
- Michał Kowalczyk
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Anna Panasiuk-Kowalczyk
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Adam Stadnik
- Department of Cardiac Surgery, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Małgorzata Guz
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
| | - Marek Cybulski
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
| | - Witold Jeleniewicz
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
| | - Andrzej Stepulak
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
| | - Magdalena Kwiatosz-Muc
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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18
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Coemans S, Keulen S, Savieri P, Tsapkini K, Engelborghs S, Chrispeels N, Vandenborre D, Paquier P, Wilssens I, Declerck M, Struys E. Executive functions in primary progressive aphasia: A meta-analysis. Cortex 2022; 157:304-322. [PMID: 36395634 PMCID: PMC11161026 DOI: 10.1016/j.cortex.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022]
Abstract
Executive functions (EFs) refer to a set of cognitive processes, specifically shifting, inhibition, updating of working memory, and are involved in the cognitive control of behavior. Conflicting results have been reported regarding impairments of EFs in Primary Progressive Aphasia (PPA). We performed a multi-level meta-analysis to confirm whether deficits of EFs exist in this population, focusing on a common EFs composite, and the components shifting, inhibition and updating separately. We included 141 studies that report on 294 EFs tasks. The overall mean weighted effect size was large (d = -1,28), indicating poorer EFs in PPA as compared to age-matched cognitively healthy controls. Differences between effect sizes of the EFs components were not significant, indicating all components are affected similarly. Overall, moderator analysis revealed that PPA variant and disease duration were significant moderators of performance, while task modality and years of education were not. The non-fluent/agrammatic PPA and the logopenic PPA variants were similarly affected, but the semantic variant was affected to a lesser extent. We discuss implications for clinical and research settings, and future research.
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Affiliation(s)
- Silke Coemans
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Stefanie Keulen
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Perseverence Savieri
- Interfaculty Center for Data Processing and Statistics (ICDS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Biostatistics and Medical Informatics (BISI) Research Group, Department of Public Health, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Sebastiaan Engelborghs
- Neuroprotection & Neuromodulation, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Department of Biomedical Sciences, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Nini Chrispeels
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Philippe Paquier
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Mathieu Declerck
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Esli Struys
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Hocking DR, Loesch DZ, Stimpson P, Tassone F, Atkinson A, Storey E. Relationships of Motor Changes with Cognitive and Neuropsychiatric Features in FMR1 Male Carriers Affected with Fragile X-Associated Tremor/Ataxia Syndrome. Brain Sci 2022; 12:brainsci12111549. [PMID: 36421873 PMCID: PMC9688438 DOI: 10.3390/brainsci12111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The premutation expansion of the Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene on the X chromosome has been linked to a range of clinical and subclinical features. Nearly half of men with FMR1 premutation develop a neurodegenerative disorder; Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). In this syndrome, cognitive executive decline and psychiatric changes may co-occur with major motor features, and in this study, we explored the interrelationships between these three domains in a sample of adult males affected with FXTAS. A sample of 23 adult males aged between 48 and 80 years (mean = 62.3; SD = 8.8), carrying premutation expansions between 45 and 118 CGG repeats, and affected with FXTAS, were included in this study. We employed a battery of cognitive assessments, two standard motor rating scales, and two self-reported measures of psychiatric symptoms. When controlling for age and/or educational level, where appropriate, there were highly significant correlations between motor rating score for ICARS gait domain, and the scores representing global cognitive decline (ACE-III), processing speed (SDMT), immediate memory (Digit Span), and depression and anxiety scores derived from both SCL90 and DASS instruments. Remarkably, close relationships of UPDRS scores, representing the contribution of Parkinsonism to FXTAS phenotypes, were exclusive to psychiatric scores. Highly significant relationships between CGG repeat size and most scores for three phenotypic domains suggest a close tracking with genetic liability. These findings of relationships between a constellation of phenotypic domains in male PM carriers with FXTAS are reminiscent of other conditions associated with disruption to cerebro-cerebellar circuits.
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Affiliation(s)
- Darren R. Hocking
- Developmental Neuromotor & Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Danuta Z. Loesch
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Paige Stimpson
- Psychology Department, Monash Health, Clayton, VIC 3068, Australia
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, M.I.N.D. Institute, School of Medicine, University of California Davis Medical Center, University of California, Davis, Davis, CA 95616, USA
| | - Anna Atkinson
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Alfred Hospital Campus, Monash University, Melbourne, VIC 3068, Australia
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20
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Foxe D, Irish M, Ramanan S, Stark S, Cordato NJ, Burrell JR, Piguet O. Longitudinal changes in behaviour, mood and functional capacity in the primary progressive aphasia variants. Eur J Neurosci 2022; 56:5601-5614. [PMID: 34888957 DOI: 10.1111/ejn.15557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterised by a progressive decline in speech and language functions. Deficits in behaviour, mood and functional capacity are reported in PPA but are less well understood. This study examined the PPA variants' profiles on these domains at initial presentation and over time and evaluated their relations to overall cognitive ability. Behaviour, mood and functional capacity were measured annually (over ~6 years) in 145 individuals diagnosed with PPA (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA] and 60 semantic variants [sv-PPA]) using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Overall cognition was assessed annually with the Addenbrooke's Cognitive Examination-III. Distinct profiles were observed across PPA syndromes. Notably, sv-PPA carers reported greater behavioural, eating and motivational disturbances than the other PPA variants throughout the disease course. Reported memory problems were also greater in sv-PPA and lv-PPA than in nfv-PPA across all time points. These disturbances occurred in the context of the sv-PPA group demonstrating a slower rate of cognitive decline than the lv-PPA group and a parallel rate to that found in the nfv-PPA group. Associations between overall cognition and the CBI-R domains were trivial at baseline assessment; however, distinct profiles emerged when mapping each syndrome's overall cognitive decline with their behavioural, mood and functional trajectories. Our findings demonstrate that the evolving behaviour, mood and functional capacity profiles of the PPA variants are distinct and extend beyond the primary disorder of language. These findings have important implications for clinical management and caregiver education in PPA.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Siddharth Ramanan
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,MRC Cognition and Brain Sciences Unit, The University of Cambridge, Cambridge, UK
| | - Samuel Stark
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas J Cordato
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,The Department of Aged Care, St George Hospital, Sydney, New South Wales, Australia.,Calvary Community Health, Calvary Health Care Kogarah, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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21
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Design and Verbal Fluency in Alzheimer's Disease and Frontotemporal Dementia: Clinical and Metabolic Correlates. J Int Neuropsychol Soc 2022; 28:947-962. [PMID: 34569460 DOI: 10.1017/s1355617721001144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cognitive processes underlying verbal and design fluency, and their neural correlates in patients with Alzheimer's disease (AD) and behavioural variant Frontotemporal Dementia (bvFTD) remain unclear. We hypothesised that verbal and design fluency may be associated with distinct neuropsychological processes in AD and FTD, showing different patterns of impairment and neural basis. METHODS We enrolled 142 participants including patients with AD (n = 80, mean age = 74.71), bvFTD (n = 34, mean age = 68.18), and healthy controls (HCs) (n = 28, mean age = 71.14), that underwent cognitive assessment and 18F-fluorodeoxyglucose positron emission tomography imaging. RESULTS Semantic and phonemic fluency showed the largest effect sizes between groups, showing lower scores in bvFTD than AD and HCs, and lower scores in AD than HC. Both AD and bvFTD showed a lower number of unique designs in design fluency in comparison to HC. Semantic fluency was correlated with left frontotemporal lobe in AD, and with left frontal, caudate, and thalamus in bvFTD. Percentage of unique designs in design fluency was associated with the metabolism of the bilateral fronto-temporo-parietal cortex in AD, and the bilateral frontal cortex with right predominance in bvFTD. Repetitions in AD were correlated with bilateral frontal, temporal, and parietal lobes, and with left prefrontal cortex in bvFTD. CONCLUSIONS Our findings demonstrate differential underlying cognitive processes in verbal and design fluency in AD and bvFTD. While memory and executive functioning associated with fronto-temporo-parietal regions were key in AD, attention and executive functions correlated with the frontal cortex and played a more significant role in bvFTD during fluency tasks.
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22
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Zarrella GV, Kay CD, Gettens K, Sherman JC, Colvin MK. Addenbrooke's Cognitive Examination-Third Edition Predicts Neuropsychological Test Performance. J Neuropsychiatry Clin Neurosci 2022; 35:178-183. [PMID: 35989574 DOI: 10.1176/appi.neuropsych.21080196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effective screening tools can help providers with treatment decisions, including when to refer patients for neuropsychological evaluations, which are the gold standard for cognitive assessment of neurodegenerative disease. The authors examined whether performance on the Addenbrooke's Cognitive Examination-Third Edition (ACE-III), a readily available cognitive screening tool for older adults, predicted performance on subsequent neuropsychological evaluations. METHODS In total, 217 patients referred for neurocognitive concerns completed a neuropsychological evaluation, including the ACE-III. Patients were diagnosed as having normal cognition (NC, N=67), mild neurocognitive disorder (mild NCD, N=105), or major NCD (N=45). Regression analyses were used to determine whether ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. Logistic regression was used to assess whether ACE-III total score and overall neuropsychological test performance predicted diagnosis. Separate analyses compared those with higher and lower educational attainments. ACE-III subscales and total scores were compared by diagnostic group. RESULTS Across all groups, ACE-III subscale scores predicted within-construct neuropsychological performances with moderate to strong effects (p<0.001) but were less predictive for those with lower educational attainment. ACE-III total score was less sensitive than overall neuropsychological test performance in predicting neurocognitive disorders. ACE-III subscale and total scores distinguished diagnostic groups (NC>mild NCD>major NCD, p<0.001). CONCLUSIONS ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. However, overall performance on neuropsychological testing was more sensitive than ACE-III total score in predicting neurocognitive disorder diagnosis. Total ACE-III score differed by level of cognitive impairment. Comprehensive neuropsychological testing is recommended for patients who have lower educational status or complex symptom presentations or are younger.
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Affiliation(s)
- Giuliana V Zarrella
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (all authors); Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston (Gettens)
| | - Christina D Kay
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (all authors); Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston (Gettens)
| | - Katelyn Gettens
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (all authors); Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston (Gettens)
| | - Janet C Sherman
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (all authors); Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston (Gettens)
| | - Mary K Colvin
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (all authors); Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston (Gettens)
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23
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Carnemolla S, Kumfor F, Liang CT, Foxe D, Ahmed R, Piguet O. Olfactory Bulb Integrity in Frontotemporal Dementia and Alzheimer’s Disease. J Alzheimers Dis 2022; 89:51-66. [DOI: 10.3233/jad-220080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Olfactory dysfunction is highly prevalent in dementia syndromes, including Alzheimer’s disease (AD) and frontotemporal dementia (FTD). The structural integrity of the olfactory bulb (OB) is thought to play a critical role in odor detection and identification, but no MRI study has measured OB volume in FTD, or measured OB volume longitudinally in AD. Objective: To measure OB volume in FTD and AD patients longitudinally using MRI. Methods: This study measured OB volumes using MRI in patients diagnosed with behavioral-variant FTD (n = 55), semantic dementia (n = 34), progressive non-fluent aphasia (n = 30), AD (n = 50), and healthy age-matched controls (n = 55) at their first visit to a dementia research clinic (‘baseline’). Imaging data in patients 12-months later were analyzed where available (n = 84) for longitudinal assessment. Volumes of subcortical and cortical olfactory regions (‘olfactory network’) were obtained via surface-based morphometry. Results: Results revealed that in AD and FTD at baseline, OB volumes were similar to controls, whereas volumes of olfactory network regions were significantly reduced in all patient groups except in progressive non-fluent aphasia. Longitudinal data revealed that OB volume became significantly reduced (10–25% volume reduction) in all dementia groups with disease progression. Conclusion: Olfactory dysfunction is common in patients diagnosed with AD or FTD, but our results indicate that there is no detectable volume loss to the OBs upon first presentation to the clinic. Our findings indicate that the OBs become detectably atrophied later in the disease process. OB atrophy indicates the potential usefulness for OBs to be targeted in interventions to improve olfactory function.
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Affiliation(s)
- Sarah Carnemolla
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
| | - Fiona Kumfor
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
| | - Cheng Tao Liang
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
| | - David Foxe
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
| | - Rebekah Ahmed
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Central Sydney Medical School, Sydney, New South Wales, Australia
| | - Olivier Piguet
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
- University of Sydney, Brain & Mind Centre, Sydney, New South Wales, Australia
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24
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Foxe D, Hu A, Cheung SC, Ahmed RM, Cordato NJ, Devenney E, Hwang YT, Halliday GM, Mueller N, Leyton CE, Hodges JR, Burrell JR, Irish M, Piguet O. Utility of the Addenbrooke’s Cognitive Examination III online calculator to differentiate the primary progressive aphasia variants. Brain Commun 2022; 4:fcac161. [PMID: 35912134 PMCID: PMC9336588 DOI: 10.1093/braincomms/fcac161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/22/2022] Open
Abstract
The Addenbrooke’s Cognitive Examination III is a brief cognitive screening tool that is widely used for the detection and monitoring of dementia. Recent findings suggest that the three variants of primary progressive aphasia can be distinguished based on their distinct profiles on the five subdomain scores of this test. Here, we investigated the utility of the Addenbrooke’s Cognitive Examination III to differentiate the primary progressive aphasia variants based on their item-by-item performance profiles on this test. From these results, we created an interactive primary progressive aphasia Addenbrooke’s Cognitive Examination III calculator which predicts the variant based on a patient’s unique item-by-item profile. Twenty-eight logopenic variant, 25 non-fluent variant and 37 semantic variant primary progressive aphasia patients and 104 healthy controls completed the Addenbrooke’s Cognitive Examination III at first clinical presentation. Multinomial regression analyses were conducted to establish performance profiles among groups, and R Shiny from RStudio was used to create the interactive Addenbrooke’s Cognitive Examination III diagnostic calculator. To verify its accuracy, probability values of the regression model were derived based on a 5-fold cross-validation of cases. The calculator’s accuracy was then verified in an independent sample of 17 logopenic, 19 non-fluent and 13 semantic variant primary progressive aphasia patients and 68 Alzheimer’s disease patients who had completed the Addenbrooke’s Cognitive Examination III (or an older version of this test: Revised) and had in vivo amyloid-PET imaging and/or brain autopsy pathological confirmation. Cross-validation of cases in the calculator model revealed different rates of sensitivity in classifying variants: semantic = 100%, non-fluent = 80.6% and logopenic = 79.9%; healthy controls were distinguished from primary progressive aphasia patients with 100% sensitivity. Verification of in vivo amyloid and/or autopsy-confirmed patients showed that the calculator correctly classified 10/13 (77%) semantic variant, 3/19 (16%) non-fluent variant and 4/17 (24%) logopenic variant patients. Importantly, for patients who were not classified, diagnostic probability values mostly pointed toward the correct clinical diagnosis. Furthermore, misclassified diagnoses of the primary progressive aphasia cohort were rare (1/49; 2%). Although 22 of the 68 Alzheimer’s disease patients (32%) were misclassified with primary progressive aphasia, 19/22 were misclassified with the logopenic variant (i.e. falling within the same neuropathological entity). The Addenbrooke’s Cognitive Examination III primary progressive aphasia diagnostic calculator demonstrates sound accuracy in differentiating the variants based on an item-by-item Addenbrooke’s Cognitive Examination III profile. This calculator represents a new frontier in using data-driven approaches to differentiate the primary progressive aphasia variants.
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Affiliation(s)
- D Foxe
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - A Hu
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- School of Mathematics and Statistics, The University of Sydney , Sydney, NSW 2006 , Australia
| | - S C Cheung
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - R M Ahmed
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N J Cordato
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- St George Clinical School, University of New South Wales , Sydney, NSW 2217 , Australia
- The Department of Aged Care, St George Hospital , Sydney, NSW 2217 , Australia
- Calvary Health Care Kogarah, Calvary Community Health , Sydney, NSW 2217 , Australia
| | - E Devenney
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - Y T Hwang
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - G M Halliday
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N Mueller
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - C E Leyton
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Hodges
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Burrell
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Concord Clinical School, Sydney Medical School, The University of Sydney , Sydney, NSW 2139 , Australia
| | - M Irish
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - O Piguet
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
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25
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Kumfor F, Liang CT, Hazelton JL, Leyton CE, Kaizik C, Devenney E, Connaughton E, Langdon R, Mioshi E, Kwok JB, Dobson‐Stone C, Halliday GM, Piguet O, Hodges JR, Landin‐Romero R. Examining the presence and nature of delusions in Alzheimer's disease and frontotemporal dementia syndromes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5692. [PMID: 35178786 PMCID: PMC9546395 DOI: 10.1002/gps.5692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Abnormal beliefs and delusions have been reported in some people with dementia, however, the prevalence of delusions, and their neurocognitive basis has been underexplored. This study aimed to examine the presence, severity, content and neural correlates of delusions in a large, well-characterised cohort of dementia patients using a transdiagnostic, cross-sectional approach. METHODS Four-hundred and eighty-seven people with dementia were recruited: 102 Alzheimer's disease, 136 behavioural-variant frontotemporal dementia, 154 primary progressive aphasia, 29 motor neurone disease, 46 corticobasal syndrome, 20 progressive supranuclear palsy. All patients underwent neuropsychological assessment and brain magnetic resonance imaging, and the Neuropsychiatric Inventory was conducted with an informant, by an experienced clinician. RESULTS In our cohort, 48/487 patients (10.8%) had delusions. A diagnosis of behavioural-variant frontotemporal dementia (18.4%) and Alzheimer's disease (11.8%) were associated with increased risk of delusions. A positive gene mutation was observed in 11/27 people with delusions. Individuals with frequent delusions performed worse on the Addenbrooke's Cognitive Examination (p = 0.035), particularly on the orientation/attention (p = 0.022) and memory (p = 0.013) subtests. Voxel-based morphometry analyses found that increased delusional psychopathology was associated with reduced integrity of the right middle frontal gyrus, right planum temporale and left anterior temporal pole. CONCLUSION Our results demonstrate that delusions are relatively common in dementia and uncover a unique cognitive and neural profile associated with the manifestation of delusions. Clinically, delusions may lead to delayed or misdiagnosis. Our results shed light on how to identify individuals at risk of neuropsychiatric features of dementia, a crucial first step to enable targeted symptom management.
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Affiliation(s)
- Fiona Kumfor
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Cheng Tao Liang
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Jessica L. Hazelton
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Cristian E. Leyton
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Cassandra Kaizik
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Memory and Cognition ClinicRPA HospitalSydneyLocal Health District, New South WalesAustralia
| | - Emma Devenney
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Emily Connaughton
- Department of Cognitive SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Robyn Langdon
- Department of Cognitive SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - John B. Kwok
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Carol Dobson‐Stone
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Glenda M. Halliday
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Olivier Piguet
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - John R. Hodges
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Ramon Landin‐Romero
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
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26
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Chen Y, Landin-Romero R, Kumfor F, Irish M, Dobson-Stone C, Kwok JB, Halliday GM, Hodges JR, Piguet O. Cerebellar integrity and contributions to cognition in C9orf72-mediated frontotemporal dementia. Cortex 2022; 149:73-84. [DOI: 10.1016/j.cortex.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
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27
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Wilson NA, Ahmed RM, Piguet O, Irish M. Putting the Pieces Together: Mental Construction of Semantically Congruent and Incongruent Scenes in Dementia. Brain Sci 2021; 12:brainsci12010020. [PMID: 35053763 PMCID: PMC8773466 DOI: 10.3390/brainsci12010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Scene construction refers to the process by which humans generate richly detailed and spatially cohesive scenes in the mind’s eye. The cognitive processes that underwrite this capacity remain unclear, particularly when the envisaged scene calls for the integration of various types of contextual information. Here, we explored social and non-social forms of scene construction in Alzheimer’s disease (AD; n = 11) and the behavioural variant of frontotemporal dementia (bvFTD; n = 15) relative to healthy older control participants (n = 16) using a novel adaptation of the scene construction task. Participants mentally constructed detailed scenes in response to scene–object cues that varied in terms of their sociality (social; non-social) and congruence (congruent; incongruent). A significant group × sociality × congruence interaction was found whereby performance on the incongruent social scene condition was significantly disrupted in both patient groups relative to controls. Moreover, bvFTD patients produced significantly less contextual detail in social relative to non-social incongruent scenes. Construction of social and non-social incongruent scenes in the patient groups combined was significantly associated with independent measures of semantic processing and visuospatial memory. Our findings demonstrate the influence of schema-incongruency on scene construction performance and reinforce the importance of episodic–semantic interactions during novel event construction.
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Affiliation(s)
- Nikki-Anne Wilson
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; (N.-A.W.); (R.M.A.); (O.P.)
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
- School of Psychology, The University of New South Wales, Sydney, NSW 2052, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Rebekah M. Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; (N.-A.W.); (R.M.A.); (O.P.)
- Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; (N.-A.W.); (R.M.A.); (O.P.)
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Muireann Irish
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; (N.-A.W.); (R.M.A.); (O.P.)
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
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28
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Cognitive and Neural Mechanisms of Social Communication Dysfunction in Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11121600. [PMID: 34942902 PMCID: PMC8699060 DOI: 10.3390/brainsci11121600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Mounting evidence suggests that, in parallel with well-defined changes in language, primary progressive aphasia (PPA) syndromes display co-occurring social cognitive impairments. Here, we explored multidimensional profiles of carer-rated social communication using the La Trobe Communication Questionnaire (LCQ) in 11 semantic dementia (SD), 12 logopenic progressive aphasia (LPA) and 9 progressive non-fluent aphasia (PNFA) cases and contrasted their performance with 19 Alzheimer’s disease (AD) cases, 26 behavioural variant frontotemporal dementia (bvFTD) cases and 31 healthy older controls. Relative to the controls, the majority of patient groups displayed significant overall social communication difficulties, with common and unique profiles of impairment evident on the LCQ subscales. Correlation analyses revealed a differential impact of social communication disturbances on functional outcomes in patient and carer well-being, most pronounced for SD and bvFTD. Finally, voxel-based morphometry analyses based on a structural brain MRI pointed to the degradation of a distributed brain network in mediating social communication dysfunction in dementia. Our findings suggest that social communication difficulties are an important feature of PPA, with significant implications for patient function and carer well-being. The origins of these changes are likely to be multifactorial, reflecting the breakdown of fronto-thalamic brain circuits specialised in the integration of complex information.
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Hutchings R, Palermo R, Hazelton JL, Piguet O, Kumfor F. Considering Hemispheric Specialization in Emotional Face Processing: An Eye Tracking Study in Left- and Right-Lateralised Semantic Dementia. Brain Sci 2021; 11:brainsci11091195. [PMID: 34573215 PMCID: PMC8472320 DOI: 10.3390/brainsci11091195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 01/27/2023] Open
Abstract
Face processing relies on a network of occipito-temporal and frontal brain regions. Temporal regions are heavily involved in looking at and processing emotional faces; however, the contribution of each hemisphere to this process remains under debate. Semantic dementia (SD) is a rare neurodegenerative brain condition characterized by anterior temporal lobe atrophy, which is either predominantly left- (left-SD) or right-lateralised (right-SD). This syndrome therefore provides a unique lesion model to understand the role of laterality in emotional face processing. Here, we investigated facial scanning patterns in 10 left-SD and 6 right-SD patients, compared to 22 healthy controls. Eye tracking was recorded via a remote EyeLink 1000 system, while participants passively viewed fearful, happy, and neutral faces over 72 trials. Analyses revealed that right-SD patients had more fixations to the eyes than controls in the Fear (p = 0.04) condition only. Right-SD patients also showed more fixations to the eyes than left-SD patients in all conditions: Fear (p = 0.01), Happy (p = 0.008), and Neutral (p = 0.04). In contrast, no differences between controls and left-SD patients were observed for any emotion. No group differences were observed for fixations to the mouth, or the whole face. This study is the first to examine patterns of facial scanning in left- versus right- SD, demonstrating more of a focus on the eyes in right-SD. Neuroimaging analyses showed that degradation of the right superior temporal sulcus was associated with increased fixations to the eyes. Together these results suggest that right lateralised brain regions of the face processing network are involved in the ability to efficiently utilise changeable cues from the face.
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Affiliation(s)
- Rosalind Hutchings
- Brain & Mind Centre, School of Psychology, The University of Sydney, Sydney, NSW 2050, Australia; (R.H.); (J.L.H.); (O.P.)
| | - Romina Palermo
- School of Psychological Science, The University of Western Australia, Perth, WA 6009, Australia;
| | - Jessica L. Hazelton
- Brain & Mind Centre, School of Psychology, The University of Sydney, Sydney, NSW 2050, Australia; (R.H.); (J.L.H.); (O.P.)
| | - Olivier Piguet
- Brain & Mind Centre, School of Psychology, The University of Sydney, Sydney, NSW 2050, Australia; (R.H.); (J.L.H.); (O.P.)
| | - Fiona Kumfor
- Brain & Mind Centre, School of Psychology, The University of Sydney, Sydney, NSW 2050, Australia; (R.H.); (J.L.H.); (O.P.)
- Correspondence: ; Tel.: +61-2-9114-4181
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Landin-Romero R, Liang CT, Monroe PA, Higashiyama Y, Leyton CE, Hodges JR, Piguet O, Ballard KJ. Brain changes underlying progression of speech motor programming impairment. Brain Commun 2021; 3:fcab205. [PMID: 34541532 PMCID: PMC8445394 DOI: 10.1093/braincomms/fcab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Aquired apraxia of speech is a disorder that impairs speech production, despite intact peripheral neuromotor function. Its pathomechanism remains to be established. Neurodegenerative lesion models provide an unequalled opportunity to explore the neural correlates of apraxia of speech, which is present in a subset of patients diagnosed with non-semantic variants of primary progressive aphasia. The normalized pairwise variability index, an acoustic measure of speech motor programming, has shown high sensitivity and specificity for apraxia of speech in cross-sectional studies. Here, we aimed to examine the strength of the pairwise variability index and overall word duration (i.e. articulation rate) as markers of progressive motor programming deficits in primary progressive aphasia with apraxia of speech. Seventy-nine individuals diagnosed with primary progressive aphasia (39 with non-fluent variant and 40 with logopenic variant) and 40 matched healthy controls participated. Patients were followed-up annually (range 1-6 years, median number of visits = 2). All participants completed a speech assessment task and a high-resolution MRI. Our analyses investigated trajectories of speech production (e.g. pairwise variablity index and word duration) and associations with cortical atrophy in the patients. At first presentation, word duration differentiated the nonfluent and logopenic cases statistically, but the range of scores overlapped substantially across groups. Longitudinally, we observed progressive deterioration in pairwise variability index and word duration specific to the non-fluent group only. The pairwise variability index showed particularly strong associations with progressive atrophy in speech motor programming brain regions. Of novelty, our results uncovered a key role of the right frontal gyrus in underpinning speech motor programming changes in non-fluent cases, highlighting the importance of right-brain regions in responding to progressive neurological changes in the speech motor network. Taken together, our findings validate the use of a new metric, the pairwise variability index, as a robust marker of apraxia of speech in contrast to more generic measures of speaking rate. Sensitive/specific neuroimaging biomarkers of the emergence and progression of speech impairments will be useful to inform theories of the pathomechanisms underpinning impaired speech motor control. Our findings justify developing more sensitive measures of rhythmic temporal control of speech that may enable confident detection of emerging speech disturbances and more sensitive tracking of intervention-related changes for pharmacological, neuromodulatory and behavioural interventions. A more reliable detection of speech disturbances has relevance for patient care, with predominance of progressive apraxia of speech a high-risk factor for later diagnosis of progressive supranuclear palsy or corticobasal degeneration.
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Affiliation(s)
- Ramon Landin-Romero
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Cheng T Liang
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Penelope A Monroe
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yuichi Higashiyama
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Cristian E Leyton
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John R Hodges
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kirrie J Ballard
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Verbal Short-Term Memory Disturbance in the Primary Progressive Aphasias: Challenges and Distinctions in a Clinical Setting. Brain Sci 2021; 11:brainsci11081060. [PMID: 34439679 PMCID: PMC8391512 DOI: 10.3390/brainsci11081060] [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: 07/07/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Impaired verbal ‘phonological’ short-term memory is considered a cardinal feature of the logopenic variant of primary progressive aphasia (lv-PPA) and is assumed to underpin most of the language deficits in this syndrome. Clinically, examination of verbal short-term memory in individuals presenting with PPA is common practice and serves two objectives: (i) to help understand the possible mechanisms underlying the patient’s language profile and (ii) to help differentiate lv-PPA from other PPA variants or from other dementia syndromes. Distinction between lv-PPA and the non-fluent variant of PPA (nfv-PPA), however, can be especially challenging due to overlapping language profiles and comparable psychometric performances on verbal short-term memory tests. Here, we present case vignettes of the three PPA variants (lv-PPA, nfv-PPA, and the semantic variant (sv-PPA)) and typical Alzheimer’s disease (AD). These vignettes provide a detailed description of the short-term and working memory profiles typically found in these patients and highlight how speech output and language comprehension deficits across the PPA variants differentially interfere with verbal memory performance. We demonstrate that a combination of verbal short-term and working memory measures provides crucial information regarding the cognitive mechanisms underlying language disturbances in PPA. In addition, we propose that analogous visuospatial span tasks are essential for the assessment of PPA as they measure memory capacity without language contamination.
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Anhedonia in Semantic Dementia-Exploring Right Hemispheric Contributions to the Loss of Pleasure. Brain Sci 2021; 11:brainsci11080998. [PMID: 34439617 PMCID: PMC8392684 DOI: 10.3390/brainsci11080998] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Semantic dementia (SD) is a younger-onset neurodegenerative disease characterised by progressive deterioration of the semantic knowledge base in the context of predominantly left-lateralised anterior temporal lobe (ATL) atrophy. Mounting evidence indicates the emergence of florid socioemotional changes in SD as atrophy encroaches into right temporal regions. How lateralisation of temporal lobe pathology impacts the hedonic experience in SD remains largely unknown yet has important implications for understanding socioemotional and functional impairments in this syndrome. Here, we explored how lateralisation of temporal lobe atrophy impacts anhedonia severity on the Snaith–Hamilton Pleasure Scale in 28 SD patients presenting with variable right- (SD-R) and left-predominant (SD-L) profiles of temporal lobe atrophy compared to that of 30 participants with Alzheimer’s disease and 30 healthy older Control participants. Relative to Controls, SD-R but not SD-L or Alzheimer’s patients showed clinically significant anhedonia, representing a clear departure from premorbid levels. Overall, anhedonia was more strongly associated with functional impairment on the Frontotemporal Dementia Functional Rating Scale and motivational changes on the Cambridge Behavioural Inventory in SD than in Alzheimer’s disease patients. Voxel-based morphometry analyses revealed that anhedonia severity correlated with reduced grey matter intensity in a restricted set of regions centred on right orbitofrontal and temporopolar cortices, bilateral posterior temporal cortices, as well as the anterior cingulate gyrus and parahippocampal gyrus, bilaterally. Finally, regression and mediation analysis indicated a unique role for right temporal lobe structures in modulating anhedonia in SD. Our findings suggest that degeneration of predominantly right-hemisphere structures deleteriously impacts the capacity to experience pleasure in SD. These findings offer important insights into hemispheric lateralisation of motivational disturbances in dementia and suggest that anhedonia may emerge at different timescales in the SD disease trajectory depending on the integrity of the right hemisphere.
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Foxe D, Irish M, D'Mello M, Barhon L, Burrell JR, Kessels RPC, Piguet O. The Box Task: A novel tool to differentiate the primary progressive aphasias. Eur J Neurol 2021; 28:3945-3954. [PMID: 34310820 DOI: 10.1111/ene.15035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Differentiating the primary progressive aphasia (PPA) variants in clinical settings remains complex and challenging, especially for the logopenic (lv-PPA) and non-fluent variants (nfv-PPA). Recent studies suggest that visuospatial memory is more compromised in lv-PPA than in nfv-PPA and is relatively spared in the semantic variant (sv-PPA). Accordingly, assessment of visuospatial memory performance may assist in the differential diagnosis of PPA variants. Here, we investigated the utility of a novel computerised visuospatial working memory test-the Box Task-to differentiate the three PPA variants and typical Alzheimer's disease (AD). METHODS Eighteen lv-PPA, 14 nfv-PPA, 23 sv-PPA, 33 AD patients, and 32 healthy controls matched for age and education were recruited. All participants completed the computerised Box Task and WMS-III Spatial Span as measures of visuospatial working memory. RESULTS The lv-PPA group made significantly more Box Task between-search errors than nfv-PPA, sv-PPA and control groups. The AD group, however, displayed the greatest impairments on this measure relative to the PPA variants. Logistic regression analyses in lv-PPA and nfv-PPA demonstrated that the combination of Box Task between-search error variables (i.e., 4- and 6-box levels) could correctly classify 72% of lv-PPA patients and nearly 79% of nfv-PPA patients. Area under the receiver operator characteristics curve (AUC) analyses revealed the Box Task was more sensitive than Spatial Span at differentiating lv-PPA from nfv-PPA. CONCLUSIONS Our findings suggest that a simple, computerised measure of visuospatial working memory-the Box Task-shows potential diagnostic utility in differentiating lv-PPA from the other PPA variants.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mirelle D'Mello
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucienne Barhon
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Murty DV, Manikandan K, Kumar WS, Ramesh RG, Purokayastha S, Nagendra B, Ml A, Balakrishnan A, Javali M, Rao NP, Ray S. Stimulus-induced gamma rhythms are weaker in human elderly with mild cognitive impairment and Alzheimer's disease. eLife 2021; 10:61666. [PMID: 34099103 PMCID: PMC8238507 DOI: 10.7554/elife.61666] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/23/2021] [Indexed: 12/16/2022] Open
Abstract
Alzheimer’s disease (AD) in elderly adds substantially to socioeconomic burden necessitating early diagnosis. While recent studies in rodent models of AD have suggested diagnostic and therapeutic value for gamma rhythms in brain, the same has not been rigorously tested in humans. In this case-control study, we recruited a large population (N = 244; 106 females) of elderly (>49 years) subjects from the community, who viewed large gratings that induced strong gamma oscillations in their electroencephalogram (EEG). These subjects were classified as healthy (N = 227), mild cognitively impaired (MCI; N = 12), or AD (N = 5) based on clinical history and Clinical Dementia Rating scores. Surprisingly, stimulus-induced gamma rhythms, but not alpha or steady-state visually evoked responses, were significantly lower in MCI/AD subjects compared to their age- and gender-matched controls. This reduction was not due to differences in eye movements or baseline power. Our results suggest that gamma could be used as a potential screening tool for MCI/AD in humans. Alzheimer’s disease is one of the most common forms of dementia, characterised by declining memory and thinking skills, and behavioural changes that worsen over time. It affects millions of people worldwide, mostly in older age, and yet early indicators of the disease are lacking. Most cases are only diagnosed once a person’s brain function becomes noticeably impaired, even though known biological changes underpin the disease. Detecting Alzheimer’s disease early could aid diagnosis and enable early intervention, while also improving the chances of finding treatments to halt or reverse the disease. Currently, brain function is measured by performing cognitive tests, such as remembering a set of words, imaging the brain with MRIs or CT scans, and blood or spinal fluid tests. Many of these tests can be invasive and expensive, so researchers are exploring whether measuring oscillations in the brain’s electrical activity can be a non-invasive and chepaer way of testing brain function. Gamma oscillations are rhythmic signals, thought to be involved in attention and working memory. Animals used to study Alzheimer’s disease have shown some abnormalities in gamma oscillations, and studies of healthy humans have also observed a decline in the strength and frequency of these oscillations with age. These findings have spurred an interest in understanding the link between gamma oscillations and AD in humans. To investigate this link, Murty et al. measured patterns of brain activity in elderly people chosen from the community using electrodes placed on their scalps (a technique called electroencephalography). These participants watched certain images previously shown to elicit gamma oscillations. Participants who were later diagnosed with early Alzheimer’s disease had weaker gamma oscillations than their cognitively healthy peers in the part of the brain that processes visual images. These results build upon previous findings from animal research suggesting that gamma oscillations may be disrupted in early Alzheimer’s disease. The work by Murty et al. could lead the way to new ways of diagnosing Alzheimer’s disease, where early indicators are urgently needed.
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Affiliation(s)
| | | | | | | | | | - Bhargavi Nagendra
- Centre for Neuroscience, Indian Institute of Science, Bengaluru, India
| | - Abhishek Ml
- Centre for Neuroscience, Indian Institute of Science, Bengaluru, India
| | | | - Mahendra Javali
- MS Ramaiah Medical College & Memorial Hospital, Bengaluru, India
| | | | - Supratim Ray
- Centre for Neuroscience, Indian Institute of Science, Bengaluru, India
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Ahmed RM, Tse NY, Chen Y, Henning E, Hodges JR, Kiernan MC, Irish M, Farooqi IS, Piguet O. Neural correlates of fat preference in frontotemporal dementia: translating insights from the obesity literature. Ann Clin Transl Neurol 2021; 8:1318-1329. [PMID: 33973740 PMCID: PMC8164857 DOI: 10.1002/acn3.51369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/28/2021] [Accepted: 04/11/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Alterations in eating behaviour are one of the diagnostic features of behavioural variant frontotemporal dementia (bvFTD). It is hypothesised that underlying brain network disturbances and atrophy to key structures may affect macronutrient preference in bvFTD. We aimed to establish whether a preference for dietary fat exists in bvFTD, its association with cognitive symptoms and the underlying neural mechanisms driving these changes. METHODS Using a test meal paradigm, adapted from the obesity literature, with variable fat content (low 20%, medium 40% and high 60%), preference for fat in 20 bvFTD was compared to 16 Alzheimer's disease (AD) and 13 control participants. MRI brain scans were analysed to determine the neural correlates of fat preference. RESULTS Behavioural variant FTD patients preferred the high-fat meal compared to both AD (U = 61.5; p = 0.001) and controls (U = 41.5; p = 0.001), with 85% of bvFTD participants consistently rating the high-fat content meal as their preferred option. This increased preference for the high-fat meal was associated with total behavioural change (Cambridge Behavioural Inventory: rs = 0.462; p = 0.001), as well as overall functional decline (Frontotemporal Dementia Rating Scale: rs = -0.420; p = 0.03). A preference for high-fat content in bvFTD was associated with atrophy in an extended brain network including frontopolar, anterior cingulate, insular cortices, putamen and amygdala extending into lateral temporal, posteromedial parietal and occipital cortices. CONCLUSIONS Increased preference for fat content is associated with many of the canonical features of bvFTD. These findings offer new insights into markers of disease progression and pathogenesis, providing potential treatment targets.
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Affiliation(s)
- Rebekah M Ahmed
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Nga Yan Tse
- Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Yu Chen
- Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elana Henning
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, the NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - John R Hodges
- Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence of Cognition and its Disorders, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Muireann Irish
- ARC Centre of Excellence of Cognition and its Disorders, Sydney, NSW, Australia.,School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - I Sadaf Farooqi
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, the NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olivier Piguet
- ARC Centre of Excellence of Cognition and its Disorders, Sydney, NSW, Australia.,School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
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Calderón C, Beyle C, Véliz-García O, Bekios-Calfa J. Psychometric properties of Addenbrooke's Cognitive Examination III (ACE-III): An item response theory approach. PLoS One 2021; 16:e0251137. [PMID: 33956900 PMCID: PMC8101956 DOI: 10.1371/journal.pone.0251137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
The Addenbrooke's Cognitive Examination III is one of the most widely used tests to assess cognitive impairment. Although previous studies have shown adequate levels of diagnostic utility to detect severe impairment, it has not shown sensitivity to detect mild decline. The aim of this study was to evaluate the psychometric properties of Addenbrooke's Cognitive Examination III in a large sample of elderly people through Item Response Theory, due to the lack of studies using this approach. A cross-sectional study was conducted with 1164 people from the age of 60 upwards, of which 63 had a prior diagnosis of Alzheimer dementia. The results showed that, globally, the Addenbrooke's Cognitive Examination III possesses adequate psychometrics properties. Furthermore, the information function test shows that the subscales have different sensitivity to different levels of impairment. These results can contribute to determining patterns of cognitive deterioration for the adequate detection of different levels of dementia. An optimized version is suggested which may be an economic alternative in the applied field.
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Affiliation(s)
- Carlos Calderón
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
- * E-mail:
| | - Christian Beyle
- Departamento de Psicología, Universidad Católica de Temuco, Temuco, Chile
| | - Oscar Véliz-García
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Juan Bekios-Calfa
- Departamento de Ingeniería en Sistemas y Ciencias de la Computación, Universidad Católica del Norte, Antofagasta, Chile
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Beales A, Whitworth A, Cartwright J, Panegyres PK, Kane RT. Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:697-712. [PMID: 33751904 DOI: 10.1044/2020_ajslp-20-00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.
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Affiliation(s)
- Ashleigh Beales
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Anne Whitworth
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jade Cartwright
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Peter K Panegyres
- Neurodegenerative Disorders Research, West Perth, Western Australia, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Nguyen C, Caga J, Mahoney CJ, Kiernan MC, Huynh W. Behavioural changes predict poorer survival in amyotrophic lateral sclerosis. Brain Cogn 2021; 150:105710. [PMID: 33725515 DOI: 10.1016/j.bandc.2021.105710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The Motor Neuron Disease Behavioural Scale (MiND-B) is a clinically validated tool that was developed to detect behavioural dysfunction in patients with amyotrophic lateral sclerosis (ALS). The current study aimed to evaluate behavioural impairment using MiND-B, as well as cognitive dysfunction in ALS patients, and to determine their prognostic implications. METHOD Patients with a clinical diagnosis of ALS were prospectively recruited from a specialised multidisciplinary ALS clinic. Patients underwent behavioural assessment with the Motor Neuron Disease Behavioural Scale (MiND-B) and cognitive evaluation using the Addenbrooke's Cognitive Examination (ACE). Primary outcome measure was selected as survival time, defined by time from assessment to time of death or censor date. Univariate assessment of survival effect was carried out using Kaplan-Meier survival analysis followed by cox regression analysis to assess the effect of MiND-B and ACE scores on survival time. RESULTS A total of 134 patients were included in the study. MiND-B testing determined that 59% were classified as having behavioural dysfunction, with deficits associated with a significantly shorter survival time (HR 2.53, p = 0.003, 95% CI 1.3-4.6). Furthermore, regression analysis demonstrated that for every 1-point reduction in the MiND-B score, risk of death increased by 3%. ACE testing established that 33% of the cohort had evidence of cognitive dysfunction. Patients with cognitive dysfunction on ACE testing had a significantly shorter survival time than patients without cognitive impairment (HR 2.0, p = 0.042, 95% CI 1.04-3.3). CONCLUSION The presence of behavioural and cognitive impairments in ALS patients was associated with poor survival. The MiND-B and ACE inventories are simple and efficient clinical tools that can be administered in the multidisciplinary ALS clinic, that aid in the prognostication of this patient population.
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Affiliation(s)
- Chilan Nguyen
- School of Medicine, University of Notre Dame, NSW, Australia
| | - Jashelle Caga
- Brain and Mind Centre, University of Sydney, NSW, Australia
| | | | | | - William Huynh
- Brain and Mind Centre, University of Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, NSW, Australia.
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Huynh K, Piguet O, Kwok J, Dobson-Stone C, Halliday GM, Hodges JR, Landin-Romero R. Clinical and Biological Correlates of White Matter Hyperintensities in Patients With Behavioral-Variant Frontotemporal Dementia and Alzheimer Disease. Neurology 2021; 96:e1743-e1754. [PMID: 33597290 DOI: 10.1212/wnl.0000000000011638] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/18/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To test the hypothesis that white matter hyperintensities (WMH) in behavioral-variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD) are associated with disease variables such as disease severity, cortical atrophy, and cognition, we conducted a cross-sectional brain MRI study with volumetric and voxel-wise analyses. METHODS A total of 129 patients (64 bvFTD, 65 AD) and 66 controls underwent high-resolution brain MRI and clinical and neuropsychological examination. Genetic screening was conducted in 124 cases (54 bvFTD, 44 AD, 26 controls) and postmortem pathology was available in 18 cases (13 bvFTD, 5 AD). WMH were extracted using an automated segmentation algorithm and analyses of total volumes and spatial distribution were conducted. Group differences in total WMH volume and associations with vascular risk and disease severity were examined. Syndrome-specific voxel-wise associations between WMH, cortical atrophy, and performance across different cognitive domains were assessed. RESULTS Total WMH volumes were larger in patients with bvFTD than patients with AD and controls. In bvFTD, WMH volumes were associated with disease severity but not vascular risk. Patients with bvFTD and patients with AD showed distinct spatial patterns of WMH that mirrored characteristic patterns of cortical atrophy. Regional WMH load correlated with worse cognitive performance in discrete cognitive domains. WMH-related cognitive impairments were shared between syndromes, with additional associations found in bvFTD. CONCLUSION Increased WMH are common in patients with bvFTD and patients with AD. Our findings suggest that WMH are partly independent of vascular pathology and associated with the neurodegenerative process. WMH occur in processes independent of and related to cortical atrophy. Furthermore, increased WMH in different regions contributes to cognitive deficits.
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Affiliation(s)
- Katharine Huynh
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - John Kwok
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Carol Dobson-Stone
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Glenda M Halliday
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - John R Hodges
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Ramón Landin-Romero
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia.
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Caga J, Zoing MC, Foxe D, Ramsey E, D'Mello M, Mioshi E, Ahmed RM, Kiernan MC, Piguet O. Problem-focused coping underlying lower caregiver burden in ALS-FTD: implications for caregiver intervention. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:434-441. [PMID: 33438449 DOI: 10.1080/21678421.2020.1867180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder which includes cognitive and behavioral symptoms akin to frontotemporal dementia (FTD). Despite the necessity of caregiver intervention to assist with the management of cognitive and behavioral symptoms, there has been a lack of research on the topic. A focus on caregiver coping may offer a promising foundation to guide the development of interventions as part of ALS care. Accordingly, the aim of the present study was to examine the relationships between caregiver coping, psychological morbidity and burden of care in the context of ALS cognitive and behavioral symptoms. Methods: Fifty-five patient-caregiver dyads were recruited from specialized ALS and FTD clinics. Specific coping strategies were examined using the COPE Inventory/Brief COPE and psychological morbidity and burden were assessed using the Depression, Anxiety, and Stress Scale-21 and Zarit Burden Interview. The relationship between coping, psychological morbidity and burden of care were analyzed using univariate and multivariate methods. Results: High-burden caregivers were more likely to be caring for patients with a diagnosis of ALS-FTD (p =.0001). Caregivers used problem-focused strategies (particularly planning) more frequently (M = 71.4, SD = 15.3) compared to emotion-focused (M = 60.8, SD = 12.3) and dysfunctional coping strategies (M = 42.2, SD = 8.6). A diagnosis of ALS-FTD (p=.0001) and problem-focused strategies (p=.024) emerged as significant predictors of caregiver burden. Caregiver anxiety, depression and stress were not predictive of caregiver burden (p=.151). Conclusions: Timely provision of caregiver support optimizing problem-focused coping strategies as part of multidisciplinary ALS care, particularly for caregivers of ALS-FTD patients may mitigate caregiver burden.
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Affiliation(s)
- Jashelle Caga
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Margaret C Zoing
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - David Foxe
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eleanor Ramsey
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Mirelle D'Mello
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eneida Mioshi
- School of Health Sciences, The University of East Anglia, Norwich, UK
| | - Rebekah M Ahmed
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Olivier Piguet
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
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Longitudinal cognitive and functional changes in primary progressive aphasia. J Neurol 2021; 268:1951-1961. [PMID: 33417000 DOI: 10.1007/s00415-020-10382-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The variants of primary progressive aphasia (PPA) are predominantly diagnosed on the basis of specific profiles of language impairments. Deficits in other cognitive domains and their evolution over time are less well documented. This study examined the cognitive profiles of the PPA variants over time and determined the contribution of cognition on functional capacity. METHODS Longitudinal performance on the Addenbrooke's Cognitive Examination-III (ACE-III) total and cognitive subdomains were investigated in 147 PPA individuals (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA], and 62 semantic variants [sv-PPA]). The relative contribution of ACE-III subdomain scores to overall functional capacity over time was identified using mixed and hierarchical regression modelling. RESULTS The annual rate of global ACE-III decline was twice that in lv-PPA than in nfv-PPA and sv-PPA, despite lv-PPA performing intermediate to the other variants at baseline assessment. Notably, attention and visuospatial subdomains declined faster in lv-PPA than in nfv-PPA and sv-PPA; and memory impairment was more severe in lv-PPA than in nfv-PPA at all time points. Functional decline was comparable across PPA variants; however, the contribution of cognition on functional capacity varied across variants and over time. CONCLUSION The cognitive profiles of the PPA variants are distinct at baseline and over time. Crucially, cognitive decline in lv-PPA was more widespread and pervasive than in nfv-PPA and sv-PPA. Our findings also demonstrate the complex interplay between cognition and functional capacity. This study underscores the importance of routinely assessing cognition and functional capacity in PPA to improve diagnostic accuracy and provide targeted support services.
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Tse NY, Chen Y, Irish M, Cordato NJ, Landin-Romero R, Hodges JR, Piguet O, Ahmed RM. Cerebellar contributions to cognition in corticobasal syndrome and progressive supranuclear palsy. Brain Commun 2021; 2:fcaa194. [PMID: 33381758 PMCID: PMC7753056 DOI: 10.1093/braincomms/fcaa194] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023] Open
Abstract
Mounting evidence suggests an association between cerebellar atrophy and cognitive impairment in the main frontotemporal dementia syndromes. In contrast, whether cerebellar atrophy is present in the motor syndromes associated with frontotemporal lobar degeneration (corticobasal syndrome and progressive supranuclear palsy) and the extent of its contribution to their cognitive profile remain poorly understood. The current study aimed to comprehensively chart profiles of cognitive impairment in relation to cerebellar atrophy in 49 dementia patients (corticobasal syndrome = 33; progressive supranuclear palsy = 16) compared to 33 age-, sex- and education-matched healthy controls. Relative to controls, corticobasal syndrome and progressive supranuclear palsy patients demonstrated characteristic cognitive impairment, spanning the majority of cognitive domains including attention and processing speed, language, working memory, and executive function with relative preservation of verbal and nonverbal memory. Voxel-based morphometry analysis revealed largely overlapping patterns of cerebellar atrophy in corticobasal syndrome and progressive supranuclear palsy relative to controls, primarily involving bilateral Crus II extending into adjacent lobules VIIb and VIIIa. After controlling for overall cerebral atrophy and disease duration, exploratory voxel-wise general linear model analysis revealed distinct cerebellar subregions differentially implicated across cognitive domains in each patient group. In corticobasal syndrome, reduction in grey matter intensity in the left Crus I was significantly correlated with executive dysfunction. In progressive supranuclear palsy, integrity of the vermis and adjacent right lobules I-IV was significantly associated with language performance. These results are consistent with the well-established role of Crus I in executive functions and provide further supporting evidence for vermal involvement in cognitive processing. The current study presents the first detailed exploration of the role of cerebellar atrophy in cognitive deficits in corticobasal syndrome and progressive supranuclear palsy, offering insights into the cerebellum's contribution to cognitive processing even in neurodegenerative syndromes characterized by motor impairment.
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Affiliation(s)
- Nga Yan Tse
- Central Sydney Medical School and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Yu Chen
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Muireann Irish
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas J Cordato
- Faculty of Medicine, The University of New South Wales, Sydney, Australia.,The Department of Aged Care, St George Hospital, Kogarah, Australia.,Calvary Health Care Sydney, Kogarah, Australia
| | - Ramon Landin-Romero
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - John R Hodges
- Central Sydney Medical School and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Rebekah M Ahmed
- Central Sydney Medical School and Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE Commonly used measures of instrumental activities of daily living (IADL) do not capture activities for a technologically advancing society. This study aimed to adapt the proxy/informant-based Amsterdam IADL Questionnaire (A-IADL-Q) for use in the UK and develop a self-report version. DESIGN An iterative mixed method cross-cultural adaptation of the A-IADL-Q and the development of a self-report version involving a three-step design: (1) interviews and focus groups with lay and professional stakeholders to assess face and content validity; (2) a questionnaire to measure item relevance to older adults in the U.K.; (3) a pilot of the adapted questionnaire in people with cognitive impairment. SETTING Community settings in the UK. PARTICIPANTS One hundred and forty-eight participants took part across the three steps: (1) 14 dementia professionals; 8 people with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia due to Alzheimer's disease; and 6 relatives of people with MCI or dementia; (2) 92 older adults without cognitive impairment; and (3) 28 people with SCD or MCI. MEASUREMENTS The cultural relevance and applicability of the A-IADL-Q scale items were assessed using a 6-point Likert scale. Cognitive and functional performance was measured using a battery of cognitive and functional measures. RESULTS Iterative modifications to the scale resulted in a 55-item adapted version appropriate for UK use (A-IADL-Q-UK). Pilot data revealed that the new and revised items performed well. Four new items correlated with the weighted average score (Kendall's Tau -.388, -.445, -.497, -.569). An exploratory analysis of convergent validity found correlations in the expected direction with cognitive and functional measures. CONCLUSION The A-IADL-Q-UK provides a measurement of functional decline for use in the UK that captures culturally relevant activities. A new self-report version has been developed and is ready for testing. Further evaluation of the A-IADL-Q-UK for construct validity is now needed.
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Liu L, Roquet D, Ahmed RM, Hodges JR, Piguet O, Irish M. Examining prefrontal contributions to past- and future-oriented memory disturbances in daily life in dementia. Cortex 2020; 134:307-319. [PMID: 33333361 DOI: 10.1016/j.cortex.2020.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/24/2020] [Accepted: 11/10/2020] [Indexed: 01/17/2023]
Abstract
Deficits in episodic memory are commonplace in dementia, yet mounting evidence indicates pervasive impairments in future-oriented thinking in these syndromes. How such impairments manifest in the daily lives of people with dementia remain unclear, as do their neural bases. This study aimed to determine the neurocognitive mechanisms of past- and future-oriented memory performance across a large sample of dementia syndromes, each of which is characterised by distinct clinical and cognitive profiles. Carer-rated memory changes in everyday life in Alzheimer's disease, behavioural-variant frontotemporal dementia, semantic dementia, progressive non-fluent aphasia, and logopenic progressive aphasia were assessed using the Prospective and Retrospective Memory Questionnaire (PRM-Q). Participants underwent neuropsychological testing and whole-brain structural MRI. Relative to Controls, past- and future-oriented memory were compromised exclusively in AD and bvFTD, with no impairments reported for the other groups. For AD, atrophy in a distributed network of prefrontal, lateral and medial temporal regions including the hippocampus, correlated with past- and future-oriented memory impairments. In contrast, lateral and medial prefrontal regions correlated with past- and future-oriented memory difficulties in bvFTD. Notably, the orbitofrontal cortex emerged as a common neural substrate implicated in memory disturbances across the AD and bvFTD groups. This study confirms the presence of episodic amnesia in bvFTD across a host of everyday activities, mirroring the profile typically observed in AD. Of note, the orbitofrontal cortex emerged as a common region implicated in past- and future-oriented memory deficits in both patient groups, underscoring a critical role for prefrontal regions in supporting complex aspects of memory function in everyday life.
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Affiliation(s)
- Lulu Liu
- The University of Sydney, School of Psychology, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Daniel Roquet
- The University of Sydney, School of Psychology, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Olivier Piguet
- The University of Sydney, School of Psychology, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Muireann Irish
- The University of Sydney, School of Psychology, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia.
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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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Paulin T, Roquet D, Kenett YN, Savage G, Irish M. The effect of semantic memory degeneration on creative thinking: A voxel-based morphometry analysis. Neuroimage 2020; 220:117073. [DOI: 10.1016/j.neuroimage.2020.117073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
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Visuospatial short-term and working memory disturbance in the primary progressive aphasias: Neuroanatomical and clinical implications. Cortex 2020; 132:223-237. [PMID: 32998062 DOI: 10.1016/j.cortex.2020.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) comprises three main variants: logopenic (lv-PPA), non-fluent (nfv-PPA) and semantic variant (sv-PPA). Differentiating the language profiles of the PPA variants remains challenging, especially for lv-PPA and nfv-PPA. As such, diagnostic tools that do not rely on speech and language may offer some utility. Here, we investigated the short-term and working memory profiles of the PPA variants and typical Alzheimer's disease (AD), with a particular interest in the visuospatial system. We hypothesised visuospatial short-term and working memory would be more compromised in lv-PPA and AD than in the other PPA variants, and that this would relate to degeneration of posterior temporoparietal brain regions. METHOD Thirty-three lv-PPA, 26 nfv-PPA, 31 sv-PPA and 58 AD patients, and 45 matched healthy controls were recruited. All participants completed the WMS-III Spatial and Digit Span tasks and underwent a structural brain MRI for voxel-based morphometry analyses. RESULTS Relative to Controls, Spatial Span Forward (SSF) performance was impaired in lv-PPA and AD but not in nfv-PPA or sv-PPA. In contrast, Digit Span Forward (DSF) performance was impaired in lv-PPA and nfv-PPA (to a similar level), and AD, but was relatively intact in sv-PPA. As expected, most backward span scores across both modalities were lower than forward span scores. Neuroimaging analyses revealed that SSF and SSB performance in all patients combined correlated with grey matter intensity decrease in several clusters located in temporo-parieto-occipital brain regions. Post-hoc group comparisons of these regions showed that grey matter loss was more extensive in the lv-PPA and AD groups than in the nfv-PPA and sv-PPA groups. CONCLUSIONS The findings suggest that the visuospatial short-term and working memory profiles of the PPA variants are separable and likely reflect their distinct patterns of temporo-parieto-occipital brain atrophy.
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Wilson NA, Ahmed RM, Hodges JR, Piguet O, Irish M. Constructing the social world: Impaired capacity for social simulation in dementia. Cognition 2020; 202:104321. [DOI: 10.1016/j.cognition.2020.104321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
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Manuel AL, Roquet D, Landin-Romero R, Kumfor F, Ahmed RM, Hodges JR, Piguet O. Interactions between decision-making and emotion in behavioral-variant frontotemporal dementia and Alzheimer's disease. Soc Cogn Affect Neurosci 2020; 15:681-694. [PMID: 32613246 PMCID: PMC7393308 DOI: 10.1093/scan/nsaa085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/16/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Negative and positive emotions are known to shape decision-making toward more or less impulsive responses, respectively. Decision-making and emotion processing are underpinned by shared brain regions including the ventromedial prefrontal cortex (vmPFC) and the amygdala. How these processes interact at the behavioral and brain levels is still unclear. We used a lesion model to address this question. Study participants included individuals diagnosed with behavioral-variant frontotemporal dementia (bvFTD, n = 18), who typically present deficits in decision-making/emotion processing and atrophy of the vmPFC, individuals with Alzheimer’s disease (AD, n = 12) who present with atrophy in limbic structures and age-matched healthy controls (CTRL, n = 15). Prior to each choice on the delay discounting task participants were cued with a positive, negative or neutral picture and asked to vividly imagine witnessing the event. As hypothesized, our findings showed that bvFTD patients were more impulsive than AD patients and CTRL and did not show any emotion-related modulation of delay discounting rate. In contrast, AD patients showed increased impulsivity when primed by negative emotion. This increased impulsivity was associated with reduced integrity of bilateral amygdala in AD but not in bvFTD. Altogether, our results indicate that decision-making and emotion interact at the level of the amygdala supporting findings from animal studies.
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Affiliation(s)
- Aurélie L Manuel
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia.,Laboratory for Research in Neuroimaging LREN, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Roquet
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia
| | - Ramon Landin-Romero
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia
| | - Rebekah M Ahmed
- Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia.,Clinical Medical School, The University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia.,Clinical Medical School, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain & Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition & its Disorders, Sydney, Australia
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