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Holland N, Savulich G, Jones PS, Whiteside DJ, Street D, Swann P, Naessens M, Malpetti M, Hong YT, Fryer TD, Rittman T, Mulroy E, Aigbirhio FI, Bhatia KP, O'Brien JT, Rowe JB. Differential Synaptic Loss in β-Amyloid Positive Versus β-Amyloid Negative Corticobasal Syndrome. Mov Disord 2024; 39:1166-1178. [PMID: 38671545 DOI: 10.1002/mds.29814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND/OBJECTIVE The corticobasal syndrome (CBS) is a complex asymmetric movement disorder, with cognitive impairment. Although commonly associated with the primary 4-repeat-tauopathy of corticobasal degeneration, clinicopathological correlation is poor, and a significant proportion is due to Alzheimer's disease (AD). Synaptic loss is a pathological feature of many clinical and preclinical tauopathies. We therefore measured the degree of synaptic loss in patients with CBS and tested whether synaptic loss differed according to β-amyloid status. METHODS Twenty-five people with CBS, and 32 age-/sex-/education-matched healthy controls participated. Regional synaptic density was estimated by [11C]UCB-J non-displaceable binding potential (BPND), AD-tau pathology by [18F]AV-1451 BPND, and gray matter volume by T1-weighted magnetic resonance imaging. Participants with CBS had β-amyloid imaging with 11C-labeled Pittsburgh Compound-B ([11C]PiB) positron emission tomography. Symptom severity was assessed with the progressive supranuclear palsy-rating-scale, the cortical basal ganglia functional scale, and the revised Addenbrooke's Cognitive Examination. Regional differences in BPND and gray matter volume between groups were assessed by ANOVA. RESULTS Compared to controls, patients with CBS had higher [18F]AV-1451 uptake, gray matter volume loss, and reduced synaptic density. Synaptic loss was more severe and widespread in the β-amyloid negative group. Asymmetry of synaptic loss was in line with the clinically most affected side. DISCUSSION Distinct patterns of [11C]UCB-J and [18F]AV-1451 binding and gray matter volume loss, indicate differences in the pathogenic mechanisms of CBS according to whether it is associated with the presence of Alzheimer's disease or not. This highlights the potential for different therapeutic strategies in CBSs. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - David J Whiteside
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Duncan Street
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Peter Swann
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Michelle Naessens
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Buccellato FR, D'Anca M, Tartaglia GM, Del Fabbro M, Galimberti D. Frontotemporal dementia: from genetics to therapeutic approaches. Expert Opin Investig Drugs 2024; 33:561-573. [PMID: 38687620 DOI: 10.1080/13543784.2024.2349286] [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: 12/30/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) includes a group of neurodegenerative diseases characterized clinically by behavioral disturbances and by neurodegeneration of brain anterior temporal and frontal lobes, leading to atrophy. Apart from symptomatic treatments, there is, at present, no disease-modifying cure for FTD. AREAS COVERED Three main mutations are known as causes of familial FTD, and large consortia have studied carriers of mutations, also in preclinical Phases. As genetic cases are the only ones in which the pathology can be predicted in life, compounds developed so far are directed toward specific proteins or mutations. Herein, recently approved clinical trials will be summarized, including molecules, mechanisms of action and pharmacological testing. EXPERT OPINION These studies are paving the way for the future. They will clarify whether single mutations should be addressed rather than common proteins depositing in the brain to move from genetic to sporadic FTD.
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Affiliation(s)
- Francesca R Buccellato
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marianna D'Anca
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Chen M, Burke S, Olm CA, Irwin DJ, Massimo L, Lee EB, Trojanowski JQ, Gee JC, Grossman M. Antemortem network analysis of spreading pathology in autopsy-confirmed frontotemporal degeneration. Brain Commun 2023; 5:fcad147. [PMID: 37223129 PMCID: PMC10202556 DOI: 10.1093/braincomms/fcad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Despite well-articulated hypotheses of spreading pathology in animal models of neurodegenerative disease, the basis for spreading neurodegenerative pathology in humans has been difficult to ascertain. In this study, we used graph theoretic analyses of structural networks in antemortem, multimodal MRI from autopsy-confirmed cases to examine spreading pathology in sporadic frontotemporal lobar degeneration. We defined phases of progressive cortical atrophy on T1-weighted MRI using a published algorithm in autopsied frontotemporal lobar degeneration with tau inclusions or with transactional DNA binding protein of ∼43 kDa inclusions. We studied global and local indices of structural networks in each of these phases, focusing on the integrity of grey matter hubs and white matter edges projecting between hubs. We found that global network measures are compromised to an equal degree in patients with frontotemporal lobar degeneration with tau inclusions and frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions compared to healthy controls. While measures of local network integrity were compromised in both frontotemporal lobar degeneration with tau inclusions and frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions, we discovered several important characteristics that distinguished between these groups. Hubs identified in controls were degraded in both patient groups, but degraded hubs were associated with the earliest phase of cortical atrophy (i.e. epicentres) only in frontotemporal lobar degeneration with tau inclusions. Degraded edges were significantly more plentiful in frontotemporal lobar degeneration with tau inclusions than in frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions, suggesting that the spread of tau pathology involves more significant white matter degeneration. Weakened edges were associated with degraded hubs in frontotemporal lobar degeneration with tau inclusions more than in frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions, particularly in the earlier phases of the disease, and phase-to-phase transitions in frontotemporal lobar degeneration with tau inclusions were characterized by weakened edges in earlier phases projecting to diseased hubs in subsequent phases of the disease. When we examined the spread of pathology from a region diseased in an earlier phase to physically adjacent regions in subsequent phases, we found greater evidence of disease spreading to adjacent regions in frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions than in frontotemporal lobar degeneration with tau inclusions. We associated evidence of degraded grey matter hubs and weakened white matter edges with quantitative measures of digitized pathology from direct observations of patients' brain samples. We conclude from these observations that the spread of pathology from diseased regions to distant regions via weakened long-range edges may contribute to spreading disease in frontotemporal dementia-tau, while spread of pathology to physically adjacent regions via local neuronal connectivity may play a more prominent role in spreading disease in frontotemporal lobar degeneration-transactional DNA binding protein of ∼43 kDa inclusions.
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Affiliation(s)
- Min Chen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sarah Burke
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christopher A Olm
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David J Irwin
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lauren Massimo
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James C Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Murray Grossman
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
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Risacher SL, Apostolova LG. Neuroimaging in Dementia. Continuum (Minneap Minn) 2023; 29:219-254. [PMID: 36795879 DOI: 10.1212/con.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Neurodegenerative diseases are significant health concerns with regard to morbidity and social and economic hardship around the world. This review describes the state of the field of neuroimaging measures as biomarkers for detection and diagnosis of both slowly progressing and rapidly progressing neurodegenerative diseases, specifically Alzheimer disease, vascular cognitive impairment, dementia with Lewy bodies or Parkinson disease dementia, frontotemporal lobar degeneration spectrum disorders, and prion-related diseases. It briefly discusses findings in these diseases in studies using MRI and metabolic and molecular-based imaging (eg, positron emission tomography [PET] and single-photon emission computerized tomography [SPECT]). LATEST DEVELOPMENTS Neuroimaging studies with MRI and PET have demonstrated differential patterns of brain atrophy and hypometabolism in different neurodegenerative disorders, which can be useful in differential diagnoses. Advanced MRI sequences, such as diffusion-based imaging, and functional MRI (fMRI) provide important information about underlying biological changes in dementia and new directions for development of novel measures for future clinical use. Finally, advancements in molecular imaging allow clinicians and researchers to visualize dementia-related proteinopathies and neurotransmitter levels. ESSENTIAL POINTS Diagnosis of neurodegenerative diseases is primarily based on symptomatology, although the development of in vivo neuroimaging and fluid biomarkers is changing the scope of clinical diagnosis, as well as the research into these devastating diseases. This article will help inform the reader about the current state of neuroimaging in neurodegenerative diseases, as well as how these tools might be used for differential diagnoses.
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Affiliation(s)
- Shannon L Risacher
- Address correspondence to Dr Shannon L. Risacher, 355 W 16th St, Indianapolis, IN 46202,
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5
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Lukic S, Licata AE, Weis E, Bogley R, Ratnasiri B, Welch AE, Hinkley LBN, Miller Z, Garcia AM, Houde JF, Nagarajan SS, Gorno-Tempini ML, Borghesani V. Auditory Verb Generation Performance Patterns Dissociate Variants of Primary Progressive Aphasia. Front Psychol 2022; 13:887591. [PMID: 35814055 PMCID: PMC9267767 DOI: 10.3389/fpsyg.2022.887591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Primary progressive aphasia (PPA) is a clinical syndrome in which patients progressively lose speech and language abilities. Three variants are recognized: logopenic (lvPPA), associated with phonology and/or short-term verbal memory deficits accompanied by left temporo-parietal atrophy; semantic (svPPA), associated with semantic deficits and anterior temporal lobe (ATL) atrophy; non-fluent (nfvPPA) associated with grammar and/or speech-motor deficits and inferior frontal gyrus (IFG) atrophy. Here, we set out to investigate whether the three variants of PPA can be dissociated based on error patterns in a single language task. We recruited 21 lvPPA, 28 svPPA, and 24 nfvPPA patients, together with 31 healthy controls, and analyzed their performance on an auditory noun-to-verb generation task, which requires auditory analysis of the input, access to and selection of relevant lexical and semantic knowledge, as well as preparation and execution of speech. Task accuracy differed across the three variants and controls, with lvPPA and nfvPPA having the lowest and highest accuracy, respectively. Critically, machine learning analysis of the different error types yielded above-chance classification of patients into their corresponding group. An analysis of the error types revealed clear variant-specific effects: lvPPA patients produced the highest percentage of "not-a-verb" responses and the highest number of semantically related nouns (production of baseball instead of throw to noun ball); in contrast, svPPA patients produced the highest percentage of "unrelated verb" responses and the highest number of light verbs (production of take instead of throw to noun ball). Taken together, our findings indicate that error patterns in an auditory verb generation task are associated with the breakdown of different neurocognitive mechanisms across PPA variants. Specifically, they corroborate the link between temporo-parietal regions with lexical processing, as well as ATL with semantic processes. These findings illustrate how the analysis of pattern of responses can help PPA phenotyping and heighten diagnostic sensitivity, while providing insights on the neural correlates of different components of language.
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Affiliation(s)
- Sladjana Lukic
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY, United States
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Abigail E. Licata
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth Weis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Rian Bogley
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Buddhika Ratnasiri
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Ariane E. Welch
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Leighton B. N. Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Z. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Adolfo M. Garcia
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - John F. Houde
- Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Valentina Borghesani
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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Burke SE, Phillips JS, Olm CA, Peterson CS, Cook PA, Gee JC, Lee EB, Trojanowski JQ, Massimo L, Irwin DJ, Grossman M. Phases of volume loss in patients with known frontotemporal lobar degeneration spectrum pathology. Neurobiol Aging 2022; 113:95-107. [PMID: 35325815 PMCID: PMC9241163 DOI: 10.1016/j.neurobiolaging.2022.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) includes clinically similar FTLD-tau or FTLD-TDP proteinopathies which lack in vivo markers for accurate antemortem diagnosis. To identify early distinguishing sites of cortical atrophy between groups, we retrospectively analyzed in vivo volumetric MRI from 42 FTLD-Tau and 21 FTLD-TDP patients and validated these findings with postmortem measures of pathological burden. Our frequency-based staging model revealed distinct loci of maximal early cortical atrophy in each group, including dorsolateral and medial frontal regions in FTLD-Tau and ventral frontal and anterior temporal regions in FTLD-TDP. Sørenson-Dice calculations between proteinopathy groups showed little overlap of phases. Conversely, within-group subtypes showed good overlap between 3R- and 4R-tauopathies, and between TDP-43 Types A and C for early regions with subtle divergence between subtypes in subsequent phases of atrophy. Postmortem validation found an association of imaging phases with pathologic burden within FTLD-tau (F(4, 238) = 17.44, p < 0.001) and FTLD-TDP (F(4,245) = 42.32, p < 0.001). These results suggest that relatively early, distinct markers of atrophy may distinguish FTLD proteinopathies during life.
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Affiliation(s)
- Sarah E Burke
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA..
| | - Jeffrey S Phillips
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA
| | - Christopher A Olm
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA.; Department of Radiology, Penn Image Computing & Science Lab (PICSL), Philadelphia, PA, USA
| | - Claire S Peterson
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA.; Digital Pathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip A Cook
- Department of Radiology, Penn Image Computing & Science Lab (PICSL), Philadelphia, PA, USA
| | - James C Gee
- Department of Radiology, Penn Image Computing & Science Lab (PICSL), Philadelphia, PA, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Center of Neurodegenerative Disease Research, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center of Neurodegenerative Disease Research, Philadelphia, PA, USA
| | - Lauren Massimo
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA.; Digital Pathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA
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7
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Tisdall MD, Ohm DT, Lobrovich R, Das SR, Mizsei G, Prabhakaran K, Ittyerah R, Lim S, McMillan CT, Wolk DA, Gee J, Trojanowski JQ, Lee EB, Detre JA, Yushkevich P, Grossman M, Irwin DJ. Ex vivo MRI and histopathology detect novel iron-rich cortical inflammation in frontotemporal lobar degeneration with tau versus TDP-43 pathology. Neuroimage Clin 2022; 33:102913. [PMID: 34952351 PMCID: PMC8715243 DOI: 10.1016/j.nicl.2021.102913] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/28/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023]
Abstract
Comparative study of whole-hemisphere ex vivo T2*-weighted MRI and histopathology. Sample of FTLD-Tau and FTLD-TDP subtypes with reference to healthy and AD brain. Novel focal upper cortical-layer iron-rich pathology distinguishes FTLD-TDP from clinically-similar FTLD-Tau and AD. Distinct novel iron-rich FTLD-Tau pathology in mid-to-deep cortical-layers and WM. T2*-weighted MRI signatures offer in vivo biomarker targets for FTLD proteinopathy.
Frontotemporal lobar degeneration (FTLD) is a heterogeneous spectrum of age-associated neurodegenerative diseases that include two main pathologic categories of tau (FTLD-Tau) and TDP-43 (FTLD-TDP) proteinopathies. These distinct proteinopathies are often clinically indistinguishable during life, posing a major obstacle for diagnosis and emerging therapeutic trials tailored to disease-specific mechanisms. Moreover, MRI-derived measures have had limited success to date discriminating between FTLD-Tau or FTLD-TDP. T2*-weighted (T2*w) ex vivo MRI has previously been shown to be sensitive to non-heme iron in healthy intracortical lamination and myelin, and to pathological iron deposits in amyloid-beta plaques and activated microglia in Alzheimer’s disease neuropathologic change (ADNC). However, an integrated, ex vivo MRI and histopathology approach is understudied in FTLD. We apply joint, whole-hemisphere ex vivo MRI at 7 T and histopathology to the study autopsy-confirmed FTLD-Tau (n = 4) and FTLD-TDP (n = 3), relative to ADNC disease-control brains with antemortem clinical symptoms of frontotemporal dementia (n = 2), and an age-matched healthy control. We detect distinct laminar patterns of novel iron-laden glial pathology in both FTLD-Tau and FTLD-TDP brains. We find iron-positive ameboid and hypertrophic microglia and astrocytes largely in deeper GM and adjacent WM in FTLD-Tau. In contrast, FTLD-TDP presents prominent superficial cortical layer iron reactivity in astrocytic processes enveloping small blood vessels with limited involvement of adjacent WM, as well as more diffuse distribution of punctate iron-rich dystrophic microglial processes across all GM lamina. This integrated MRI/histopathology approach reveals ex vivo MRI features that are consistent with these pathological observations distinguishing FTLD-Tau and FTLD-TDP subtypes, including prominent irregular hypointense signal in deeper cortex in FTLD-Tau whereas FTLD-TDP showed upper cortical layer hypointense bands and diffuse cortical speckling. Moreover, differences in adjacent WM degeneration and iron-rich gliosis on histology between FTLD-Tau and FTLD-TDP were also readily apparent on MRI as hyperintense signal and irregular areas of hypointensity, respectively that were more prominent in FTLD-Tau compared to FTLD-TDP. These unique histopathological and radiographic features were distinct from healthy control and ADNC brains, suggesting that iron-sensitive T2*w MRI, adapted to in vivo application at sufficient resolution, may eventually offer an opportunity to improve antemortem diagnosis of FTLD proteinopathies using tissue-validated methods.
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Affiliation(s)
- M Dylan Tisdall
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States.
| | - Daniel T Ohm
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Rebecca Lobrovich
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sandhitsu R Das
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Gabor Mizsei
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Karthik Prabhakaran
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Ranjit Ittyerah
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sydney Lim
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Corey T McMillan
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - David A Wolk
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - James Gee
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Q Trojanowski
- Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Edward B Lee
- Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - John A Detre
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States; Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Yushkevich
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Murray Grossman
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - David J Irwin
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States; Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States.
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8
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Spinelli EG, Ghirelli A, Basaia S, Cividini C, Riva N, Canu E, Castelnovo V, Domi T, Magnani G, Caso F, Caroppo P, Prioni S, Rossi G, Tremolizzo L, Appollonio I, Silani V, Carrera P, Filippi M, Agosta F. Structural MRI Signatures in Genetic Presentations of the Frontotemporal Dementia/Motor Neuron Disease Spectrum. Neurology 2021; 97:e1594-e1607. [PMID: 34544819 PMCID: PMC8548958 DOI: 10.1212/wnl.0000000000012702] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess cortical, subcortical, and cerebellar gray matter (GM) atrophy using MRI in patients with disorders of the frontotemporal lobar degeneration (FTLD) spectrum with known genetic mutations. METHODS Sixty-six patients carrying FTLD-related mutations were enrolled, including 44 with pure motor neuron disease (MND) and 22 with frontotemporal dementia (FTD). Sixty-one patients with sporadic FTLD (sFTLD) matched for age, sex, and disease severity with genetic FTLD (gFTLD) were also included, as well as 52 healthy controls. A whole-brain voxel-based morphometry (VBM) analysis was performed. GM volumes of subcortical and cerebellar structures were obtained. RESULTS Compared with controls, GM atrophy on VBM was greater and more diffuse in genetic FTD, followed by sporadic FTD and genetic MND cases, whereas patients with sporadic MND (sMND) showed focal motor cortical atrophy. Patients carrying C9orf72 and GRN mutations showed the most widespread cortical volume loss, in contrast with GM sparing in SOD1 and TARDBP. Globally, patients with gFTLD showed greater atrophy of parietal cortices and thalami compared with sFTLD. In volumetric analysis, patients with gFTLD showed volume loss compared with sFTLD in the caudate nuclei and thalami, in particular comparing C9-MND with sMND cases. In the cerebellum, patients with gFTLD showed greater atrophy of the right lobule VIIb than sFTLD. Thalamic volumes of patients with gFTLD with a C9orf72 mutation showed an inverse correlation with Frontal Behavioral Inventory scores. DISCUSSION Measures of deep GM and cerebellar structural involvement may be useful markers of gFTLD, particularly C9orf72-related disorders, regardless of the clinical presentation within the FTLD spectrum.
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Affiliation(s)
- Edoardo Gioele Spinelli
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Alma Ghirelli
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Silvia Basaia
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Camilla Cividini
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Nilo Riva
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Elisa Canu
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Veronica Castelnovo
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Teuta Domi
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Magnani
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Francesca Caso
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Paola Caroppo
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Sara Prioni
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Giacomina Rossi
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Lucio Tremolizzo
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Ildebrando Appollonio
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Paola Carrera
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy
| | - Federica Agosta
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., C.C., E.C., V.C., M.F., F.A.) and Experimental Neuropathology Unit (N.R., T.D.), Division of Neuroscience, Neurorehabilitation Unit (N.R., M.F.), Neurology Unit (E.G.S., G.M., F.C., M.F., F.A.), Laboratory of Clinical Molecular Biology (P. Carrera), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., C.C., V.C., M.F., F.A.); Unit of Neurology 5-Neuropathology (P. Caroppo, S.P., G.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Neurology Unit (L.T., I.A.), "San Gerardo" Hospital and University of Milano-Bicocca, Monza; Department of Neurology and Laboratory of Neuroscience (V.S.), IRCCS Istituto Auxologico Italiano; and "Dino Ferrari" Center, Department of Pathophysiology and Transplantation (V.S.), Università degli Studi di Milano, Milan, Italy.
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Murley AG, Rouse MA, Coyle-Gilchrist ITS, Jones PS, Li W, Wiggins J, Lansdall C, Vázquez Rodríguez P, Wilcox A, Patterson K, Rowe JB. Predicting loss of independence and mortality in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:737-744. [PMID: 33563798 PMCID: PMC8223632 DOI: 10.1136/jnnp-2020-324903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that in syndromes associated with frontotemporal lobar degeneration, behavioural impairment predicts loss of functional independence and motor clinical features predict mortality, irrespective of diagnostic group. METHODS We used a transdiagnostic approach to survival in an epidemiological cohort in the UK, testing the association between clinical features, independence and survival in patients with clinical diagnoses of behavioural variant frontotemporal dementia (bvFTD n=64), non-fluent variant primary progressive aphasia (nfvPPA n=36), semantic variant primary progressive aphasia (svPPA n=25), progressive supranuclear palsy (PSP n=101) and corticobasal syndrome (CBS n=68). A principal components analysis identified six dimensions of clinical features. Using Cox proportional hazards and logistic regression, we identified the association between each of these dimensions and both functionally independent survival (time from clinical assessment to care home admission) and absolute survival (time to death). Analyses adjusted for the covariates of age, gender and diagnostic group. Secondary analysis excluded specific diagnostic groups. RESULTS Behavioural disturbance, including impulsivity and apathy, was associated with reduced functionally independent survival (OR 2.46, p<0.001), even if patients with bvFTD were removed from the analysis. Motor impairments were associated with reduced absolute survival, even if patients with PSP and CBS were removed from the analysis. CONCLUSION Our results can assist individualised prognostication and planning of disease-modifying trials, and they support a transdiagnostic approach to symptomatic treatment trials in patients with clinical syndromes associated with frontotemporal lobar degeneration.
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Affiliation(s)
- Alexander G Murley
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew A Rouse
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ian T S Coyle-Gilchrist
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P Simon Jones
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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10
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Ho WY, Agrawal I, Tyan SH, Sanford E, Chang WT, Lim K, Ong J, Tan BSY, Moe AAK, Yu R, Wong P, Tucker-Kellogg G, Koo E, Chuang KH, Ling SC. Dysfunction in nonsense-mediated decay, protein homeostasis, mitochondrial function, and brain connectivity in ALS-FUS mice with cognitive deficits. Acta Neuropathol Commun 2021; 9:9. [PMID: 33407930 PMCID: PMC7789430 DOI: 10.1186/s40478-020-01111-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) represent two ends of the same disease spectrum of adult-onset neurodegenerative diseases that affect the motor and cognitive functions, respectively. Multiple common genetic loci such as fused in sarcoma (FUS) have been identified to play a role in ALS and FTD etiology. Current studies indicate that FUS mutations incur gain-of-toxic functions to drive ALS pathogenesis. However, how the disease-linked mutations of FUS affect cognition remains elusive. Using a mouse model expressing an ALS-linked human FUS mutation (R514G-FUS) that mimics endogenous expression patterns, we found that FUS proteins showed an age-dependent accumulation of FUS proteins despite the downregulation of mouse FUS mRNA by the R514G-FUS protein during aging. Furthermore, these mice developed cognitive deficits accompanied by a reduction in spine density and long-term potentiation (LTP) within the hippocampus. At the physiological expression level, mutant FUS is distributed in the nucleus and cytosol without apparent FUS aggregates or nuclear envelope defects. Unbiased transcriptomic analysis revealed a deregulation of genes that cluster in pathways involved in nonsense-mediated decay, protein homeostasis, and mitochondrial functions. Furthermore, the use of in vivo functional imaging demonstrated widespread reduction in cortical volumes but enhanced functional connectivity between hippocampus, basal ganglia and neocortex in R514G-FUS mice. Hence, our findings suggest that disease-linked mutation in FUS may lead to changes in proteostasis and mitochondrial dysfunction that in turn affect brain structure and connectivity resulting in cognitive deficits.
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Affiliation(s)
- Wan Yun Ho
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
| | - Ira Agrawal
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
| | - Sheue-Houy Tyan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emma Sanford
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
| | - Wei-Tang Chang
- Agency for Science, Technology and Research, Singapore Bioimaging Consortium, Singapore, Singapore
- Present Address: University of North Carolina, Chapel Hill, NC USA
| | - Kenneth Lim
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
- Computational Biology Programme, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jolynn Ong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
| | - Bernice Siu Yan Tan
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
| | - Aung Aung Kywe Moe
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Regina Yu
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Peiyan Wong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Program in Neuroscience and Behavior Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Greg Tucker-Kellogg
- Computational Biology Programme, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Edward Koo
- Agency for Science, Technology and Research, Singapore Bioimaging Consortium, Singapore, Singapore
- Department of Neurosciences, University of California at San Diego, La Jolla, USA
| | - Kai-Hsiang Chuang
- Agency for Science, Technology and Research, Singapore Bioimaging Consortium, Singapore, Singapore
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Shuo-Chien Ling
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117549 Singapore
- Program in Neuroscience and Behavior Disorders, Duke-NUS Medical School, Singapore, Singapore
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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12
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Chen Q, Boeve BF, Schwarz CG, Reid R, Tosakulwong N, Lesnick TG, Bove J, Brannelly P, Brushaber D, Coppola G, Dheel C, Dickerson BC, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova RH, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford NR, Grossman M, Haley D, Heuer HW, Hsiung GYR, Huey E, Irwin DJ, Jack CR, Jones DT, Jones L, Karydas AM, Knopman DS, Kornak J, Kramer J, Kremers W, Kukull WA, Lapid M, Lucente D, Lungu C, Mackenzie IRA, Manoochehri M, McGinnis S, Miller BL, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Rascovsky K, Sengdy P, Shaw L, Syrjanen J, Tatton N, Taylor J, Toga AW, Trojanowski J, Weintraub S, Wong B, Boxer AL, Rosen H, Wszolek Z, Kantarci K. Tracking white matter degeneration in asymptomatic and symptomatic MAPT mutation carriers. Neurobiol Aging 2019; 83:54-62. [PMID: 31585367 PMCID: PMC6858933 DOI: 10.1016/j.neurobiolaging.2019.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 02/05/2023]
Abstract
Our aim was to investigate the patterns and trajectories of white matter (WM) diffusion abnormalities in microtubule-associated protein tau (MAPT) mutations carriers. We studied 22 MAPT mutation carriers (12 asymptomatic, 10 symptomatic) and 20 noncarriers from 8 families, who underwent diffusion tensor imaging (DTI) and a subset (10 asymptomatic, 6 symptomatic MAPT mutation carriers, and 10 noncarriers) were followed annually (median = 4 years). Cross-sectional and longitudinal changes in mean diffusivity (MD) and fractional anisotropy were analyzed. Asymptomatic MAPT mutation carriers had higher MD in entorhinal WM, which propagated to the limbic tracts and frontotemporal projections in the symptomatic stage compared with noncarriers. Reduced fractional anisotropy and increased MD in the entorhinal WM were associated with the proximity to estimated and actual age of symptom onset. The annualized change of entorhinal MD on serial DTI was accelerated in MAPT mutation carriers compared with noncarriers. Entorhinal WM diffusion abnormalities precede the symptom onset and track with disease progression in MAPT mutation carriers. Our cross-sectional and longitudinal data showed a potential clinical utility for DTI to track neurodegenerative disease progression for MAPT mutation carriers in clinical trials.
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Affiliation(s)
- Qin Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica Bove
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, TX, USA
| | | | - Giovanni Coppola
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Bradford C Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Julie Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jamie Fong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Debra Gearhart
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Nupur Ghoshal
- Departments of Neurology and Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill Goldman
- Department of Neurology, Columbia University, New York, NY, USA
| | | | | | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Haley
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ging-Yuek R Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Department of Neurology, Columbia University, New York, NY, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Lynne Jones
- Department of Radiology, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Anna M Karydas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter A Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | - Maria Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Diane Lucente
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Ian R A Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Scott McGinnis
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Rosa Rademakers
- Department of Neurosciences, Mayo Clinic, Jacksonville, FL, USA
| | - Eliana M Ramos
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pheth Sengdy
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy Syrjanen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Joanne Taylor
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Arthur W Toga
- Departments of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, Laboratory of Neuroimaging (LONI), USC, Los Angeles, CA, USA
| | - John Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Weintraub
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Wong
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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13
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Forrest SL, Kril JJ, Halliday GM. Cellular and regional vulnerability in frontotemporal tauopathies. Acta Neuropathol 2019; 138:705-727. [PMID: 31203391 DOI: 10.1007/s00401-019-02035-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
The frontotemporal tauopathies all deposit abnormal tau protein aggregates, but often of only certain isoforms and in distinguishing pathologies of five main types (neuronal Pick bodies, neurofibrillary tangles, astrocytic plaques, tufted astrocytes, globular glial inclusions and argyrophilic grains). In those with isoform specific tau aggregates glial pathologies are substantial, even though there is limited evidence that these cells normally produce tau protein. This review will assess the differentiating features and clinicopathological correlations of the frontotemporal tauopathies, the genetic predisposition for these different pathologies, their neuroanatomical selectivity, current observations on how they spread through the brain, and any potential contributing cellular and molecular changes. The findings show that diverse clinical phenotypes relate most to the brain region degenerating rather than the type of pathology involved, that different regions on the MAPT gene and novel risk genes are associated with specific tau pathologies, that the 4-repeat glial tauopathies do not follow individual patterns of spreading as identified for neuronal pathologies, and that genetic and pathological data indicate that neuroinflammatory mechanisms are involved. Each pathological frontotemporal tauopathy subtype with their distinct pathological features differ substantially in the cell type affected, morphology, biochemical and anatomical distribution of inclusions, a fundamental concept central to future success in understanding the disease mechanisms required for developing therapeutic interventions. Tau directed therapies targeting genetic mechanisms, tau aggregation and pathological spread are being trialled, although biomarkers that differentiate these diseases are required. Suggested areas of future research to address the regional and cellular vulnerabilities in frontotemporal tauopathies are discussed.
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14
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Whitwell JL. FTD spectrum: Neuroimaging across the FTD spectrum. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:187-223. [PMID: 31481163 DOI: 10.1016/bs.pmbts.2019.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia is a complex and heterogeneous neurodegenerative disease that encompasses many clinical syndromes, pathological diseases, and genetic mutations. Neuroimaging has played a critical role in our understanding of the underlying pathophysiology of frontotemporal dementia and provided biomarkers to aid diagnosis. Early studies defined patterns of neurodegeneration and hypometabolism associated with the clinical, pathological and genetic aspects of frontotemporal dementia, with more recent studies highlighting how the breakdown of structural and functional brain networks define frontotemporal dementia. Molecular positron emission tomography ligands allowing the in vivo imaging of tau proteins have also provided important insights, although more work is needed to understand the biology of the currently available ligands.
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15
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Pineault J, Jolicœur P, Grimault S, Lacombe J, Brambati SM, Bier N, Chayer C, Joubert S. A MEG study of the neural substrates of semantic processing in semantic variant primary progressive aphasia. Neurocase 2019; 25:118-129. [PMID: 31256711 DOI: 10.1080/13554794.2019.1631853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite a well-documented pattern of semantic impairment, the patterns of brain activation during semantic processing in semantic variant primary progressive aphasia (svPPA) still remain poorly understood. In the current study, one svPPA patient (EC) and six elderly controls carried out a general-level semantic categorization task while their brain activity was recorded using magnetoencephalography (MEG). Despite similar behavioral performance, EC showed hyperactivation of the left inferior temporal gyrus (ITG) and right anterior temporal lobe (ATL) relative to controls. This suggests that periatrophic regions within the ATL region may support preserved semantic abilities in svPPA.
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Affiliation(s)
- Jessica Pineault
- a Département de psychologie , Université de Montréal , Montréal , Canada.,b Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Université de Montréal , Montréal , Canada
| | - Pierre Jolicœur
- a Département de psychologie , Université de Montréal , Montréal , Canada.,c Centre de Recherche en Neuropsychologie et Cognition , Université de Montréal , Montréal , Canada
| | - Stephan Grimault
- a Département de psychologie , Université de Montréal , Montréal , Canada.,c Centre de Recherche en Neuropsychologie et Cognition , Université de Montréal , Montréal , Canada
| | - Jacinthe Lacombe
- a Département de psychologie , Université de Montréal , Montréal , Canada.,b Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Université de Montréal , Montréal , Canada
| | - Simona Maria Brambati
- a Département de psychologie , Université de Montréal , Montréal , Canada.,b Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Université de Montréal , Montréal , Canada
| | - Nathalie Bier
- b Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Université de Montréal , Montréal , Canada.,d Faculté de médecine , Université de Montréal , Montréal , Canada
| | - Céline Chayer
- d Faculté de médecine , Université de Montréal , Montréal , Canada.,e Service de neurologie , Hôpital Maisonneuve-Rosemont , Montréal , Canada
| | - Sven Joubert
- a Département de psychologie , Université de Montréal , Montréal , Canada.,b Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Université de Montréal , Montréal , Canada
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16
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Risacher SL, Saykin AJ. Neuroimaging in aging and neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:191-227. [PMID: 31753134 DOI: 10.1016/b978-0-12-804766-8.00012-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroimaging biomarkers for neurologic diseases are important tools, both for understanding pathology associated with cognitive and clinical symptoms and for differential diagnosis. This chapter explores neuroimaging measures, including structural and functional measures from magnetic resonance imaging (MRI) and molecular measures primarily from positron emission tomography (PET), in healthy aging adults and in a number of neurologic diseases. The spectrum covers neuroimaging measures from normal aging to a variety of dementias: late-onset Alzheimer's disease [AD; including mild cognitive impairment (MCI)], familial and nonfamilial early-onset AD, atypical AD syndromes, posterior cortical atrophy (PCA), logopenic aphasia (lvPPA), cerebral amyloid angiopathy (CAA), vascular dementia (VaD), sporadic and familial behavioral-variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive nonfluent aphasia (PNFA), frontotemporal dementia with motor neuron disease (FTD-MND), frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), Parkinson's disease (PD) with and without dementia, and multiple systems atrophy (MSA). We also include a discussion of the appropriate use criteria (AUC) for amyloid imaging and conclude with a discussion of differential diagnosis of neurologic dementia disorders in the context of neuroimaging.
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Affiliation(s)
- Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States.
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17
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Abstract
PURPOSE OF REVIEW Tauopathies represent a spectrum of incurable and progressive age-associated neurodegenerative diseases that currently are diagnosed definitively only at autopsy. Few clinical diagnoses, such as classic Richardson's syndrome of progressive supranuclear palsy, are specific for underlying tauopathy and no clinical syndrome is fully sensitive to reliably identify all forms of clinically manifest tauopathy. Thus, a major unmet need for the development and implementation of tau-targeted therapies is precise antemortem diagnosis. This article reviews new and emerging diagnostic therapies for tauopathies including novel imaging techniques and biomarkers and also reviews recent tau therapeutics. RECENT FINDINGS Building evidence from animal and cell models suggests that prion-like misfolding and propagation of pathogenic tau proteins between brain cells are central to the neurodegenerative process. These rapidly growing developments build rationale and motivation for the development of therapeutics targeting this mechanism through altering phosphorylation and other post-translational modifications of the tau protein, blocking aggregation and spread using small molecular compounds or immunotherapy and reducing or silencing expression of the MAPT tau gene. New clinical criteria, CSF, MRI, and PET biomarkers will aid in identifying tauopathies earlier and more accurately which will aid in selection for new clinical trials which focus on a variety of agents including immunotherapy and gene silencing.
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Affiliation(s)
- David Coughlin
- Frontotemporal Dementia Center (FTDC), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Frontotemporal Dementia Center (FTDC), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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18
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Sieben A, Van Mossevelde S, Wauters E, Engelborghs S, van der Zee J, Van Langenhove T, Santens P, Praet M, Boon P, Miatton M, Van Hoecke S, Vandenbulcke M, Vandenberghe R, Cras P, Cruts M, De Deyn PP, Van Broeckhoven C, Martin JJ. Extended FTLD pedigree segregating a Belgian GRN-null mutation: neuropathological heterogeneity in one family. ALZHEIMERS RESEARCH & THERAPY 2018; 10:7. [PMID: 29370838 PMCID: PMC6389176 DOI: 10.1186/s13195-017-0334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this paper, we describe the clinical and neuropathological findings of nine members of the Belgian progranulin gene (GRN) founder family. In this family, the loss-of-function mutation IVS1 + 5G > C was identified in 2006. In 2007, a clinical description of the mutation carriers was published that revealed the clinical heterogeneity among IVS1 + 5G > C carriers. We report our comparison of our data with the published clinical and neuropathological characteristics of other GRN mutations as well as other frontotemporal lobar degeneration (FTLD) syndromes, and we present a review of the literature. METHODS For each case, standardized sampling and staining were performed to identify proteinopathies, cerebrovascular disease, and hippocampal sclerosis. RESULTS The neuropathological substrate in the studied family was compatible in all cases with transactive response DNA-binding protein (TDP) proteinopathy type A, as expected. Additionally, most of the cases presented also with primary age-related tauopathy (PART) or mild Alzheimer's disease (AD) neuropathological changes, and one case had extensive Lewy body pathology. An additional finding was the presence of cerebral small vessel changes in every patient in this family. CONCLUSIONS Our data show not only that the IVS1 + 5G > C mutation has an exclusive association with FTLD-TDP type A proteinopathy but also that other proteinopathies can occur and should be looked for. Because the penetrance rate of the clinical phenotype of carriers of GRN mutations is age-dependent, further research is required to investigate the role of co-occurring age-related pathologies such as AD, PART, and cerebral small vessel disease.
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Affiliation(s)
- Anne Sieben
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, B-2160, Antwerp, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium
| | - Sara Van Mossevelde
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium.,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Netwerk Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.,Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Eline Wauters
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium.,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, B-2160, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Netwerk Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Julie van der Zee
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium.,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Tim Van Langenhove
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium.,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Marleen Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Marijke Miatton
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Van Hoecke
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Old Age Psychiatry and Memory Clinic, University Hospitals Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Cras
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, B-2160, Antwerp, Belgium.,Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Marc Cruts
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium.,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Peter Paul De Deyn
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, B-2160, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Netwerk Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.,Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB , Universiteitsplein 1, B-2610, Antwerp, Belgium. .,Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| | - Jean-Jacques Martin
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, B-2160, Antwerp, Belgium.
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Biomarkers for Alzheimer’s Disease and Frontotemporal Lobar Degeneration: Imaging. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Kim BJ, Irwin DJ, Song D, Daniel E, Leveque JD, Raquib AR, Pan W, Ying GS, Aleman TS, Dunaief JL, Grossman M. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology 2017; 89:1604-1611. [PMID: 28887373 DOI: 10.1212/wnl.0000000000004500] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Whereas Alzheimer disease (AD) is associated with inner retina thinning visualized by spectral-domain optical coherence tomography (SD-OCT), we sought to determine if the retina has a distinguishing biomarker for frontotemporal degeneration (FTD). METHODS Using a cross-sectional design, we examined retinal structure in 38 consecutively enrolled patients with FTD and 44 controls using a standard SD-OCT protocol. Retinal layers were segmented with the Iowa Reference Algorithm. Subgroups of highly predictive molecular pathology (tauopathy, TAR DNA-binding protein 43, unknown) were determined by clinical criteria, genetic markers, and a CSF biomarker (total tau: β-amyloid) to exclude presumed AD. We excluded eyes with poor image quality or confounding diseases. SD-OCT measures of patients (n = 46 eyes) and controls (n = 69 eyes) were compared using a generalized linear model accounting for intereye correlation, and correlations between retinal layer thicknesses and Mini-Mental State Examination (MMSE) were evaluated. RESULTS Adjusting for age, sex, and race, patients with FTD had a thinner outer retina than controls (132 vs 142 μm, p = 0.004). Patients with FTD also had a thinner outer nuclear layer (ONL) (88.5 vs 97.9 μm, p = 0.003) and ellipsoid zone (EZ) (14.5 vs 15.1 μm, p = 0.009) than controls, but had similar thicknesses for inner retinal layers. The outer retina thickness of patients correlated with MMSE (Spearman r = 0.44, p = 0.03). The highly predictive tauopathy subgroup (n = 31 eyes) also had a thinner ONL (88.7 vs 97.4 μm, p = 0.01) and EZ (14.4 vs 15.1 μm, p = 0.01) than controls. CONCLUSIONS FTD is associated with outer retina thinning, and this thinning correlates with disease severity.
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Affiliation(s)
- Benjamin J Kim
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - David J Irwin
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Delu Song
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer D Leveque
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aaishah R Raquib
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wei Pan
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tomas S Aleman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joshua L Dunaief
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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21
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Yousef A, Robinson JL, Irwin DJ, Byrne MD, Kwong LK, Lee EB, Xu Y, Xie SX, Rennert L, Suh E, Van Deerlin VM, Grossman M, Lee VMY, Trojanowski JQ. Neuron loss and degeneration in the progression of TDP-43 in frontotemporal lobar degeneration. Acta Neuropathol Commun 2017; 5:68. [PMID: 28877758 PMCID: PMC5586052 DOI: 10.1186/s40478-017-0471-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 12/11/2022] Open
Abstract
Frontotemporal lobar degeneration with TDP-43 inclusions (FTLD-TDP) is associated with the accumulation of pathological neuronal and glial intracytoplasmic inclusions as well as accompanying neuron loss. We explored if cortical neurons detected by NeuN decreased with increasing TDP-43 inclusion pathology in the postmortem brains of 63 patients with sporadic and familial FTLD-TDP. Semi-automated quantitative algorithms to quantify histology in tissue sections stained with antibodies specific for pathological or phosphorylated TDP-43 (pTDP-43) and NeuN were developed and validated in affected (cerebral cortex) and minimally affected (cerebellar cortex) brain regions of FTLD-TDP cases. Immunohistochemistry (IHC) for NeuN and other neuronal markers found numerous neurons lacking reactivity, suggesting NeuN may reflect neuron health rather than neuron loss in FTLD. We found three patterns of NeuN and pTDP-43 reactivity in our sample of cortical tissue representing three intracortical region-specific stages of FTLD-TDP progression: Group 1 showed low levels of pathological pTDP-43 and high levels NeuN, while Group 2 showed increased levels of pTDP-43, and Group 3 tissues were characterized by reduced staining for both pTDP-43 and NeuN. Comparison of non-C9orf72/GRN FTLD-TDP with cases linked to both GRN mutations and C9orf72 expansions showed a significantly increased frequency of Group 3 histopathology in the latter cases, suggesting more advanced cortical disease. Hence, we propose that IHC profiles of pTDP-43 and NeuN reflect the burden of pTDP-43 and its deleterious effects on neuron health.
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22
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Meeter LH, Kaat LD, Rohrer JD, van Swieten JC. Imaging and fluid biomarkers in frontotemporal dementia. Nat Rev Neurol 2017. [PMID: 28621768 DOI: 10.1038/nrneurol.2017.75] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia (FTD), the second most common type of presenile dementia, is a heterogeneous neurodegenerative disease characterized by progressive behavioural and/or language problems, and includes a range of clinical, genetic and pathological subtypes. The diagnostic process is hampered by this heterogeneity, and correct diagnosis is becoming increasingly important to enable future clinical trials of disease-modifying treatments. Reliable biomarkers will enable us to better discriminate between FTD and other forms of dementia and to predict disease progression in the clinical setting. Given that different underlying pathologies probably require specific pharmacological interventions, robust biomarkers are essential for the selection of patients with specific FTD subtypes. This Review emphasizes the increasing availability and potential applications of structural and functional imaging biomarkers, and cerebrospinal fluid and blood fluid biomarkers in sporadic and genetic FTD. The relevance of new MRI modalities - such as voxel-based morphometry, diffusion tensor imaging and arterial spin labelling - in the early stages of FTD is discussed, together with the ability of these modalities to classify FTD subtypes. We highlight promising new fluid biomarkers for staging and monitoring of FTD, and underline the importance of large, multicentre studies of individuals with presymptomatic FTD. Harmonization in the collection and analysis of data across different centres is crucial for the implementation of new biomarkers in clinical practice, and will become a great challenge in the next few years.
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Affiliation(s)
- Lieke H Meeter
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Laura Donker Kaat
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative diseases, Institute of Neurology, Queen Square, University College London, London WC1N 3BG, UK
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.,Department of Clinical Genetics, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, Netherlands
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23
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Golden HL, Clark CN, Nicholas JM, Cohen MH, Slattery CF, Paterson RW, Foulkes AJM, Schott JM, Mummery CJ, Crutch SJ, Warren JD. Music Perception in Dementia. J Alzheimers Dis 2017; 55:933-949. [PMID: 27802226 PMCID: PMC5260961 DOI: 10.3233/jad-160359] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite much recent interest in music and dementia, music perception has not been widely studied across dementia syndromes using an information processing approach. Here we addressed this issue in a cohort of 30 patients representing major dementia syndromes of typical Alzheimer's disease (AD, n = 16), logopenic aphasia (LPA, an Alzheimer variant syndrome; n = 5), and progressive nonfluent aphasia (PNFA; n = 9) in relation to 19 healthy age-matched individuals. We designed a novel neuropsychological battery to assess perception of musical patterns in the dimensions of pitch and temporal information (requiring detection of notes that deviated from the established pattern based on local or global sequence features) and musical scene analysis (requiring detection of a familiar tune within polyphonic harmony). Performance on these tests was referenced to generic auditory (timbral) deviance detection and recognition of familiar tunes and adjusted for general auditory working memory performance. Relative to healthy controls, patients with AD and LPA had group-level deficits of global pitch (melody contour) processing while patients with PNFA as a group had deficits of local (interval) as well as global pitch processing. There was substantial individual variation within syndromic groups. Taking working memory performance into account, no specific deficits of musical temporal processing, timbre processing, musical scene analysis, or tune recognition were identified. The findings suggest that particular aspects of music perception such as pitch pattern analysis may open a window on the processing of information streams in major dementia syndromes. The potential selectivity of musical deficits for particular dementia syndromes and particular dimensions of processing warrants further systematic investigation.
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Affiliation(s)
- Hannah L Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Camilla N Clark
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Miriam H Cohen
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Catherine F Slattery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Ross W Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Alexander J M Foulkes
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Catherine J Mummery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
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24
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Mapping brain morphological and functional conversion patterns in predementia late-onset bvFTD. Eur J Nucl Med Mol Imaging 2016; 43:1337-47. [DOI: 10.1007/s00259-016-3335-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/08/2016] [Indexed: 02/01/2023]
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25
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Pathophysiology of the behavioral variant of frontotemporal lobar degeneration: A study combining MRI and FDG-PET. Brain Imaging Behav 2016; 11:240-252. [DOI: 10.1007/s11682-016-9521-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Li YQ, Tan MS, Yu JT, Tan L. Frontotemporal Lobar Degeneration: Mechanisms and Therapeutic Strategies. Mol Neurobiol 2015; 53:6091-6105. [PMID: 26537902 DOI: 10.1007/s12035-015-9507-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) is characterized by progressive deterioration of frontal and anterior temporal lobes of the brain and often exhibits frontotemporal dementia (FTD) on clinic, in <65-year-old patients at the time of diagnosis. Interdisciplinary approaches combining genetics, molecular and cell biology, and laboratory animal science have revealed some of its potential molecular mechanisms. Although there is still no effective treatment to delay, prevent, and reverse the progression of FTD, emergence of agents targeting molecular mechanisms has been beginning to promote potential pharmaceutical development. Our review summarizes the latest new findings of FTLD and challenges in FTLD therapy.
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Affiliation(s)
- Ya-Qing Li
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Meng-Shan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China. .,Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.
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27
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Cognitive and Brain Profiles Associated with Current Neuroimaging Biomarkers of Preclinical Alzheimer's Disease. J Neurosci 2015. [PMID: 26203136 DOI: 10.1523/jneurosci.0150-15.2015] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neuroimaging biomarkers, namely hippocampal volume loss, temporoparietal hypometabolism, and neocortical β-amyloid (Aβ) deposition, are included in the recent research criteria for preclinical Alzheimer's disease (AD). However, how to use these biomarkers is still being debated, especially regarding their sequence. Our aim was to characterize the cognitive and brain profiles of elders classified as positive or negative for each biomarker to further our understanding of their use in the preclinical diagnosis of AD. Fifty-four cognitively normal individuals (age = 65.8 ± 8.3 years) underwent neuropsychological tests (structural MRI, FDG-PET, and Florbetapir-PET) and were dichotomized into positive or negative independently for each neuroimaging biomarker. Demographic, neuropsychological, and neuroimaging data were compared between positive and negative subgroups. The MRI-positive subgroup had lower executive performances and mixed patterns of lower volume and metabolism in AD-characteristic regions and in the prefrontal cortex. The FDG-positive subgroup showed only hypometabolism, predominantly in AD-sensitive areas extending to the whole neocortex, compared with the FDG-negative subgroup. The amyloid-positive subgroup was older and included more APOE ε4 carriers compared with the amyloid-negative subgroup. When considering MRI and/or FDG biomarkers together (i.e., the neurodegeneration-positive), there was a trend for an inverse relationship with Aβ deposition such that those with neurodegeneration tended to show less Aβ deposition and the reverse was true as well. Our findings suggest that: (1) MRI and FDG biomarkers provide complementary rather than redundant information and (2) relatively young cognitively normal elders tend to have either neurodegeneration or Aβ deposition, but not both, suggesting additive rather than sequential/causative links between AD neuroimaging biomarkers at this age. Significance statement: Neuroimaging biomarkers are included in the recent research criteria for preclinical Alzheimer's disease (AD). However, how to use these biomarkers is still being debated, especially regarding their sequence. Our findings suggest that MRI and FDG-PET biomarkers should be used in combination, offering an additive contribution instead of reflecting the same process of neurodegeneration. Moreover, the present study also challenges the hierarchical use of the neuroimaging biomarkers in preclinical AD because it suggests that the neurodegeneration observed in this population is not due to β-amyloid deposition. Rather, our results suggest that β-amyloid- and tau-related pathological processes may interact but not necessarily appear in a systematic sequence.
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28
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Allaïli N, Valabrègue R, Auerbach EJ, Guillemot V, Yahia-Cherif L, Bardinet E, Jabourian M, Fossati P, Lehéricy S, Marjańska M. Single-voxel (1)H spectroscopy in the human hippocampus at 3 T using the LASER sequence: characterization of neurochemical profile and reproducibility. NMR IN BIOMEDICINE 2015; 28:1209-17. [PMID: 26282328 PMCID: PMC4573920 DOI: 10.1002/nbm.3364] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 05/22/2023]
Abstract
The hippocampus is crucial for long-term episodic memory and learning. It undergoes structural change in aging and is sensitive to neurodegenerative and psychiatric diseases. MRS studies have seldom been performed in the hippocampus due to technical challenges. The reproducibility of MRS in the hippocampus has not been evaluated at 3 T. The purpose of the present study was to quantify the concentration of metabolites in a small voxel placed in the hippocampus and evaluate the reproducibility of the quantification. Spectra were measured in a 2.4 mL voxel placed in the left hippocampus covering the body and most of the tail of the structure in 10 healthy subjects across three different sessions and quantified using LCModel. High-quality spectra were obtained, which allowed a reliable quantification of 10 metabolites including glutamate and glutamine. Reproducibility of MRS was evaluated with coefficient of variation, standard errors of measurement, and intraclass correlation coefficients. All of these measures showed improvement with increased number of averages. Changes of less than 5% in concentration of N-acetylaspartate, choline-containing compounds, and total creatine and of less than 10% in concentration of myo-inositol and the sum of glutamate and glutamine can be confidently detected between two measurements in a group of 20 subjects. A reliable and reproducible neurochemical profile of the human hippocampus was obtained using MRS at 3 T in a small hippocampal volume.
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Affiliation(s)
- Najib Allaïli
- Institut du cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, F-75013, France
- APHP – Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis – Lariboisière – Fernand-Widal, Paris, France
| | - Romain Valabrègue
- Institut du cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
| | - Edward J. Auerbach
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, USA
| | - Vincent Guillemot
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
- ICM, Plate-forme de Bio-informatique/Biostatistique, F-75013, Paris, France
| | - Lydia Yahia-Cherif
- Institut du cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
| | - Eric Bardinet
- Institut du cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
| | | | - Philippe Fossati
- Department of Psychiatry, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Institut du cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, USA
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29
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Downey LE, Mahoney CJ, Buckley AH, Golden HL, Henley SM, Schmitz N, Schott JM, Simpson IJ, Ourselin S, Fox NC, Crutch SJ, Warren JD. White matter tract signatures of impaired social cognition in frontotemporal lobar degeneration. NEUROIMAGE-CLINICAL 2015; 8:640-51. [PMID: 26236629 PMCID: PMC4513187 DOI: 10.1016/j.nicl.2015.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/03/2015] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Abstract
Impairments of social cognition are often leading features in frontotemporal lobar degeneration (FTLD) and likely to reflect large-scale brain network disintegration. However, the neuroanatomical basis of impaired social cognition in FTLD and the role of white matter connections have not been defined. Here we assessed social cognition in a cohort of patients representing two core syndromes of FTLD, behavioural variant frontotemporal dementia (bvFTD; n = 29) and semantic variant primary progressive aphasia (svPPA; n = 15), relative to healthy older individuals (n = 37) using two components of the Awareness of Social Inference Test, canonical emotion identification and sarcasm identification. Diffusion tensor imaging (DTI) was used to derive white matter tract correlates of social cognition performance and compared with the distribution of grey matter atrophy on voxel-based morphometry. The bvFTD and svPPA groups showed comparably severe deficits for identification of canonical emotions and sarcasm, and these deficits were correlated with distributed and overlapping white matter tract alterations particularly affecting frontotemporal connections in the right cerebral hemisphere. The most robust DTI associations were identified in white matter tracts linking cognitive and evaluative processing with emotional responses: anterior thalamic radiation, fornix (emotion identification) and uncinate fasciculus (sarcasm identification). DTI associations of impaired social cognition were more consistent than corresponding grey matter associations. These findings delineate a brain network substrate for the social impairment that characterises FTLD syndromes. The findings further suggest that DTI can generate sensitive and functionally relevant indexes of white matter damage in FTLD, with potential to transcend conventional syndrome boundaries. Social cognition deficits define frontotemporal dementias but are poorly understood. We studied brain network correlates of sarcasm processing in these dementias with DTI. Sarcasm deficits were particularly linked to right frontotemporal tract changes. DTI generates functionally relevant metrics of white matter damage in these dementias.
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Affiliation(s)
- Laura E Downey
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Colin J Mahoney
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Aisling H Buckley
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Hannah L Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Susie M Henley
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Nicole Schmitz
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ivor J Simpson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK ; Centre for Medical Image Computing, University College London, London, UK
| | - Sebastien Ourselin
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK ; Centre for Medical Image Computing, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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Right temporal lobe variant of frontotemporal dementia. J Clin Neurosci 2015; 22:1139-43. [PMID: 25981552 DOI: 10.1016/j.jocn.2014.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/03/2014] [Accepted: 12/07/2014] [Indexed: 11/22/2022]
Abstract
We present two women with the right temporal lobe variant (RTLV) of frontotemporal dementia (FTD) and analyse the clinical features that are determined by the anatomical distribution of atrophy. Each of our patients displayed different clinical and radiological profiles which were in line with findings reported by other authors. One of two patients carries a novel mutation in the granulin gene. FTD is heterogeneous with regard to clinical manifestation, genetics, distribution of cortical atrophy and underlying disease. Its clinical manifestations are related to the distribution of the cortical atrophy. The RTLV of FTD is an uncommon entity. There is no consensus about its name despite the fact that its clinical and radiological features are well-defined and distinguish it from other types of FTD including semantic dementia.
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Irwin DJ, Cairns NJ, Grossman M, McMillan CT, Lee EB, Van Deerlin VM, Lee VMY, Trojanowski JQ. Frontotemporal lobar degeneration: defining phenotypic diversity through personalized medicine. Acta Neuropathol 2015; 129:469-91. [PMID: 25549971 PMCID: PMC4369168 DOI: 10.1007/s00401-014-1380-1] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/18/2014] [Accepted: 12/20/2014] [Indexed: 12/11/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) comprises two main classes of neurodegenerative diseases characterized by neuronal/glial proteinaceous inclusions (i.e., proteinopathies) including tauopathies (i.e., FTLD-Tau) and TDP-43 proteinopathies (i.e., FTLD-TDP) while other very rare forms of FTLD are known such as FTLD with FUS pathology (FTLD-FUS). This review focuses mainly on FTLD-Tau and FLTD-TDP, which may present as several clinical syndromes: a behavioral/dysexecutive syndrome (behavioral variant frontotemporal dementia); language disorders (primary progressive aphasia variants); and motor disorders (amyotrophic lateral sclerosis, corticobasal syndrome, progressive supranuclear palsy syndrome). There is considerable heterogeneity in clinical presentations of underlying neuropathology and current clinical criteria do not reliably predict underlying proteinopathies ante-mortem. In contrast, molecular etiologies of hereditary FTLD are consistently associated with specific proteinopathies. These include MAPT mutations with FTLD-Tau and GRN, C9orf72, VCP and TARDBP with FTLD-TDP. The last decade has seen a rapid expansion in our knowledge of the molecular pathologies associated with this clinically and neuropathologically heterogeneous group of FTLD diseases. Moreover, in view of current limitations to reliably diagnose specific FTLD neuropathologies prior to autopsy, we summarize the current state of the science in FTLD biomarker research including neuroimaging, biofluid and genetic analyses. We propose that combining several of these biomarker modalities will improve diagnostic specificity in FTLD through a personalized medicine approach. The goals of these efforts are to enhance power for clinical trials focused on slowing or preventing progression of spread of tau, TDP-43 and other FTLD-associated pathologies and work toward the goal of defining clinical endophenotypes of FTD.
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Affiliation(s)
- David J Irwin
- Center for Neurodegenerative Disease Research Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nigel J. Cairns
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward B. Lee
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vivianna M. Van Deerlin
- Center for Neurodegenerative Disease Research Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Virginia M.-Y. Lee
- Center for Neurodegenerative Disease Research Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Q. Trojanowski
- Center for Neurodegenerative Disease Research Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Mattsson N, Insel PS, Aisen PS, Jagust W, Mackin S, Weiner M. Brain structure and function as mediators of the effects of amyloid on memory. Neurology 2015; 84:1136-44. [PMID: 25681451 DOI: 10.1212/wnl.0000000000001375] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to test whether effects of β-amyloid (Aβ) pathology on episodic memory were mediated by metabolism and gray matter volume in the early stages of Alzheimer disease. METHODS This was a prospective cohort study. We measured baseline Aβ (using florbetapir-PET), brain function (using fluorodeoxyglucose-PET), and brain structure (using MRI). A mediation analysis was performed to test whether statistical effects of Aβ positivity on cross-sectional and longitudinal episodic memory were mediated by hypometabolism or regional gray matter volume in cognitively healthy controls (CN, n = 280) and mild cognitive impairment (MCI, n = 463). RESULTS Lower memory scores were associated with Aβ positivity (CN, mildly; MCI, strongly), smaller gray matter volumes (CN, few regions, including hippocampus; MCI, widespread), and hypometabolism. Smaller volumes and hypometabolism mediated effects of Aβ in MCI but not in CN. The strongest individual regions mediated up to approximately 25%. A combination of brain structure and function mediated up to approximately 40%. In several regions, gray matter atrophy and hypometabolism predicted episodic memory without being associated (at p < 0.05) with Aβ positivity. CONCLUSIONS Changes in brain structure and function appear to be, in part, downstream events from Aβ pathology, ultimately resulting in episodic memory deficits. However, Aβ pathology is also strongly related to memory deficits through mechanisms that are not quantified by these imaging measurements, and episodic memory decline is partly caused by Alzheimer disease-like brain changes independently of Aβ pathology.
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Affiliation(s)
- Niklas Mattsson
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco.
| | - Philip S Insel
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco
| | - Paul S Aisen
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco
| | - William Jagust
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco
| | - Scott Mackin
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco
| | - Michael Weiner
- From the Department of Veterans Affairs Medical Center (N.M., P.S.I., S.M., M.W.), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA; Clinical Neurochemistry Laboratory (N.M.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Radiology and Biomedical Imaging (N.M., P.S.I., M.W.), University of California, San Francisco; Alzheimer's Disease Cooperative Study (P.S.A.), Department of Neurosciences, University of California, San Diego, La Jolla; Helen Wills Neuroscience Institute and School of Public Health (W.J.), University of California, Berkeley; and Department of Psychiatry (S.M.), University of California, San Francisco
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Mahoney CJ, Ridgway GR, Malone IB, Downey LE, Beck J, Kinnunen KM, Schmitz N, Golden HL, Rohrer JD, Schott JM, Rossor MN, Ourselin S, Mead S, Fox NC, Warren JD. Profiles of white matter tract pathology in frontotemporal dementia. Hum Brain Mapp 2014; 35:4163-79. [PMID: 24510641 PMCID: PMC4312919 DOI: 10.1002/hbm.22468] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/13/2013] [Accepted: 01/07/2014] [Indexed: 12/11/2022] Open
Abstract
Despite considerable interest in improving clinical and neurobiological characterisation of frontotemporal dementia and in defining the role of brain network disintegration in its pathogenesis, information about white matter pathway alterations in frontotemporal dementia remains limited. Here we investigated white matter tract damage using an unbiased, template-based diffusion tensor imaging (DTI) protocol in a cohort of 27 patients with the behavioral variant of frontotemporal dementia (bvFTD) representing both major genetic and sporadic forms, in relation both to healthy individuals and to patients with Alzheimer's disease. Widespread white matter tract pathology was identified in the bvFTD group compared with both healthy controls and Alzheimer's disease group, with prominent involvement of uncinate fasciculus, cingulum bundle and corpus callosum. Relatively discrete and distinctive white matter profiles were associated with genetic subgroups of bvFTD associated with MAPT and C9ORF72 mutations. Comparing diffusivity metrics, optimal overall separation of the bvFTD group from the healthy control group was signalled using radial diffusivity, whereas optimal overall separation of the bvFTD group from the Alzheimer's disease group was signalled using fractional anisotropy. Comparing white matter changes with regional grey matter atrophy (delineated using voxel based morphometry) in the bvFTD cohort revealed co-localisation between modalities particularly in the anterior temporal lobe, however white matter changes extended widely beyond the zones of grey matter atrophy. Our findings demonstrate a distributed signature of white matter alterations that is likely to be core to the pathophysiology of bvFTD and further suggest that this signature is modulated by underlying molecular pathologies.
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Affiliation(s)
- Colin J Mahoney
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
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Harper L, Barkhof F, Scheltens P, Schott JM, Fox NC. An algorithmic approach to structural imaging in dementia. J Neurol Neurosurg Psychiatry 2014; 85:692-8. [PMID: 24133287 PMCID: PMC4033032 DOI: 10.1136/jnnp-2013-306285] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Accurate and timely diagnosis of dementia is important to guide management and provide appropriate information and support to patients and families. Currently, with the exception of individuals with genetic mutations, postmortem examination of brain tissue remains the only definitive means of establishing diagnosis in most cases, however, structural neuroimaging, in combination with clinical assessment, has value in improving diagnostic accuracy during life. Beyond the exclusion of surgical pathology, signal change and cerebral atrophy visible on structural MRI can be used to identify diagnostically relevant imaging features, which provide support for clinical diagnosis of neurodegenerative dementias. While no structural imaging feature has perfect sensitivity and specificity for a given diagnosis, there are a number of imaging characteristics which provide positive predictive value and help to narrow the differential diagnosis. While neuroradiological expertise is invaluable in accurate scan interpretation, there is much that a non-radiologist can gain from a focused and structured approach to scan analysis. In this article we describe the characteristic MRI findings of the various dementias and provide a structured algorithm with the aim of providing clinicians with a practical guide to assessing scans.
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Affiliation(s)
- Lorna Harper
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, , London, UK
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Abstract
25% of all people aged 55 years and older have a family history of dementia. For most, the family history is due to genetically complex disease, where many genetic variations of small effect interact to increase risk of dementia. The lifetime risk of dementia for these families is about 20%, compared with 10% in the general population. A small proportion of families have an autosomal dominant family history of early-onset dementia, which is often due to mendelian disease, caused by a mutation in one of the dementia genes. Each family member has a 50% chance of inheriting the mutation, which confers a lifetime dementia risk of over 95%. In this Review, we focus on the evidence for, and the approach to, genetic testing in Alzheimer's disease (APP, PSEN1, and PSEN2 genes), frontotemporal dementia (MAPT, GRN, C9ORF72, and other genes), and other familial dementias. We conclude by discussing the practical aspects of genetic counselling.
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Affiliation(s)
- Clement T Loy
- School of Public Health, University of Sydney, Sydney, NSW, Australia; Neuroscience Research Australia, Randwick, NSW, Australia; Huntington Disease Service, Westmead Hospital, Westmead, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Kensington, NSW, Australia
| | - Anne M Turner
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - John B J Kwok
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Kensington, NSW, Australia.
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Tartaglia MC, Hazrati LN, Davis KD, Green REA, Wennberg R, Mikulis D, Ezerins LJ, Keightley M, Tator C. Chronic traumatic encephalopathy and other neurodegenerative proteinopathies. Front Hum Neurosci 2014; 8:30. [PMID: 24550810 PMCID: PMC3907709 DOI: 10.3389/fnhum.2014.00030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 01/14/2014] [Indexed: 12/14/2022] Open
Abstract
"Chronic traumatic encephalopathy" (CTE) is described as a slowly progressive neurodegenerative disease believed to result from multiple concussions. Traditionally, concussions were considered benign events and although most people recover fully, about 10% develop a post-concussive syndrome with persisting neurological, cognitive and neuropsychiatric symptoms. CTE was once thought to be unique to boxers, but it has now been observed in many different athletes having suffered multiple concussions as well as in military personal after repeated blast injuries. Much remains unknown about the development of CTE but its pathological substrate is usually tau, similar to that seen in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). The aim of this "perspective" is to compare and contrast clinical and pathological CTE with the other neurodegenerative proteinopathies and highlight that there is an urgent need for understanding the relationship between concussion and the development of CTE as it may provide a window into the development of a proteinopathy and thus new avenues for treatment.
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Affiliation(s)
- Maria Carmela Tartaglia
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - Lili-Naz Hazrati
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada ; Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, ON, Canada
| | - Karen D Davis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, University Health Network, University of Toronto Toronto, ON, Canada ; Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada ; Department of Surgery, University of Toronto Toronto, ON, Canada ; Institute of Medical Science, University of Toronto Toronto, ON, Canada
| | - Robin E A Green
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - David Mikulis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, The University of Toronto Toronto, ON, Canada
| | - Leo J Ezerins
- Canadian Sports Concussion Project Toronto, ON, Canada ; Executive Director, Canadian Football League Alumni Association Toronto, ON, Canada
| | - Michelle Keightley
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada ; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Occupational Science and Occupational Therapy, University of Toronto Toronto, ON, Canada ; Graduate Department of Rehabilitation Science, University of Toronto Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Charles Tator
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto Toronto, ON, Canada
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Murray ME, Kouri N, Lin WL, Jack CR, Dickson DW, Vemuri P. Clinicopathologic assessment and imaging of tauopathies in neurodegenerative dementias. ALZHEIMERS RESEARCH & THERAPY 2014; 6:1. [PMID: 24382028 PMCID: PMC3978456 DOI: 10.1186/alzrt231] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microtubule-associated protein tau encoded by the MAPT gene binds to microtubules and is important for maintaining neuronal morphology and function. Alternative splicing of MAPT pre-mRNA generates six major tau isoforms in the adult central nervous system resulting in tau proteins with three or four microtubule-binding repeat domains. In a group of neurodegenerative disorders called tauopathies, tau becomes aberrantly hyperphosphorylated and dissociates from microtubules, resulting in a progressive accumulation of intracellular tau aggregates. The spectrum of sporadic frontotemporal lobar degeneration associated with tau pathology includes progressive supranuclear palsy, corticobasal degeneration, and Pick’s disease. Alzheimer’s disease is considered the most prevalent tauopathy. This review is divided into two broad sections. In the first section we discuss the molecular classification of sporadic tauopathies, with a focus on describing clinicopathologic relationships. In the second section we discuss the neuroimaging methodologies that are available for measuring tau pathology (directly using tau positron emission tomography ligands) and tau-mediated neuronal injury (magnetic resonance imaging and fluorodeoxyglucose positron emission tomography). Both sections have detailed descriptions of the following neurodegenerative dementias – Alzheimer’s disease, progressive supranuclear palsy, corticobasal degeneration and Pick’s disease.
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Affiliation(s)
- Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Wen-Lang Lin
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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Léger GC, Banks SJ. Neuropsychiatric symptom profile differs based on pathology in patients with clinically diagnosed behavioral variant frontotemporal dementia. Dement Geriatr Cogn Disord 2014; 37:104-12. [PMID: 24135712 PMCID: PMC4041327 DOI: 10.1159/000354368] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) is pathologically heterogeneous. With emerging therapeutics, determining underlying pathology during life is increasingly important. Neuropsychiatric symptoms are prevalent and diagnostic in bvFTD. METHODS We assessed the neuropsychiatric profile of patients with clinically diagnosed bvFTD as a function of pathology at autopsy. Patients with a clinical diagnosis of bvFTD at the initial visit were selected from the National Alzheimer's Coordinating Center (NACC) database. Neuropsychiatric symptoms endorsed on the Neuropsychiatric Inventory Questionnaire (NPI-Q) were analyzed. RESULTS Of 149 patients with clinically diagnosed bvFTD, pathology was primarily Alzheimer's disease (AD) in 20.5%. These patients differed from those with underlying frontotemporal lobar degeneration: patients with AD pathology (plaques and tangles) were more likely to have hallucinations, delusions, or agitation. Patients were further differentiated into tau-positive (30% of cases, including Pick's disease, FTD and parkinsonism with tau-positive or argyrophilic inclusions, and other tauopathies) or tau-negative cases (70% of cases, including bvFTD tau-negative ubiquitin-positive inclusions). These patients also differed in some of the neuropsychiatric symptoms seen. Tau-negative cases were more likely to demonstrate depression, delusions, and changes in appetite and eating. CONCLUSIONS These preliminary findings contribute to our increasing ability to predict, using simple clinical tools, the neuropathological underpinnings of bvFTD during life.
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Affiliation(s)
- Gabriel C Léger
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
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Bozzali M, Serra L. Biomarkers for Alzheimer’s Disease and Frontotemporal Lobar Degeneration: Imaging. NEURODEGENER DIS 2014. [DOI: 10.1007/978-1-4471-6380-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jacova C, Hsiung GYR, Tawankanjanachot I, Dinelle K, McCormick S, Gonzalez M, Lee H, Sengdy P, Bouchard-Kerr P, Baker M, Rademakers R, Sossi V, Stoessl AJ, Feldman HH, Mackenzie IR. Anterior brain glucose hypometabolism predates dementia in progranulin mutation carriers. Neurology 2013; 81:1322-31. [PMID: 24005336 DOI: 10.1212/wnl.0b013e3182a8237e] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In this prospective cohort study, we investigated cerebral glucose metabolism reductions on [(18)F]-fluorodeoxyglucose (FDG)-PET in progranulin (GRN) mutation carriers prior to frontotemporal dementia (FTD) onset. METHODS Nine mutation carriers (age 51.5 ± 13.5 years) and 11 noncarriers (age 52.7 ± 9.5 years) from 5 families with FTD due to GRN mutations underwent brain scanning with FDG-PET and MRI and clinical evaluation. Normalized FDG uptake values were calculated with reference to the pons. PET images were analyzed with regions of interest (ROI) and statistical parametric mapping (SPM) approaches. RESULTS Compared with noncarriers, GRN mutation carriers had a lowered anterior-to-posterior (AP) ratio of FDG uptake (0.86 ± 0.09 vs 0.92 ± 0.05) and less left-right asymmetry, consistent with an overall pattern of right anterior cerebral hypometabolism. This pattern was observed regardless of whether they were deemed clinically symptomatic no dementia or asymptomatic. Individual ROIs with lowered FDG uptake included right anterior cingulate, insula, and gyrus rectus. SPM analysis supported and extended these findings, demonstrating abnormalities in the right and left medial frontal regions, right insular cortex, right precentral and middle frontal gyri, and right cerebellum. Right AP ratio was correlated with cognitive and clinical scores (modified Mini-Mental State Examination r = 0.74; Functional Rating Scale r = -0.73) but not age and years to estimated onset in mutation carriers. CONCLUSION The frontotemporal lobar degenerative process associated with GRN mutations appears to begin many years prior to the average age at FTD onset (late 50s-early 60s). Right medial and ventral frontal cortex and insula may be affected in this process but the specific regional patterns associated with specific clinical variants remain to be elucidated.
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Affiliation(s)
- Claudia Jacova
- From the Division of Neurology, Department of Medicine (C.J., G.-Y.R.H., I.T., H.L., P.S., P.B.-K., A.J.S., H.H.F.), Department of Physics and Astronomy (K.D., S.M., M.G., V.S.), and Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; and Department of Neuroscience (M.B., R.R.), Mayo Clinic, Jacksonville, FL
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Abstract
Neurodegenerative disorders leading to dementia are common diseases that affect many older and some young adults. Neuroimaging methods are important tools for assessing and monitoring pathological brain changes associated with progressive neurodegenerative conditions. In this review, the authors describe key findings from neuroimaging studies (magnetic resonance imaging and radionucleotide imaging) in neurodegenerative disorders, including Alzheimer's disease (AD) and prodromal stages, familial and atypical AD syndromes, frontotemporal dementia, amyotrophic lateral sclerosis with and without dementia, Parkinson's disease with and without dementia, dementia with Lewy bodies, Huntington's disease, multiple sclerosis, HIV-associated neurocognitive disorder, and prion protein associated diseases (i.e., Creutzfeldt-Jakob disease). The authors focus on neuroimaging findings of in vivo pathology in these disorders, as well as the potential for neuroimaging to provide useful information for differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
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Warren JD, Rohrer JD, Schott JM, Fox NC, Hardy J, Rossor MN. Molecular nexopathies: a new paradigm of neurodegenerative disease. Trends Neurosci 2013; 36:561-9. [PMID: 23876425 PMCID: PMC3794159 DOI: 10.1016/j.tins.2013.06.007] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 12/12/2022]
Abstract
Neural networks provide candidate substrates for the spread of proteinopathies causing neurodegeneration, and emerging data suggest that macroscopic signatures of network disintegration differentiate diseases. However, how do protein abnormalities produce network signatures? The answer may lie with 'molecular nexopathies': specific, coherent conjunctions of pathogenic protein and intrinsic network characteristics that define network signatures of neurodegenerative pathologies. Key features of the paradigm that we propose here include differential intrinsic network vulnerability to propagating protein abnormalities, in part reflecting developmental structural and functional factors; differential vulnerability of neural connection types (e.g., clustered versus distributed connections) to particular pathogenic proteins; and differential impact of molecular effects (e.g., toxic-gain-of-function versus loss-of-function) on gradients of network damage. The paradigm has implications for understanding and predicting neurodegenerative disease biology.
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Affiliation(s)
- Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK.
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Mahoney CJ, Malone IB, Ridgway GR, Buckley AH, Downey LE, Golden HL, Ryan NS, Ourselin S, Schott JM, Rossor MN, Fox NC, Warren JD. White matter tract signatures of the progressive aphasias. Neurobiol Aging 2013; 34:1687-99. [PMID: 23312804 PMCID: PMC3601331 DOI: 10.1016/j.neurobiolaging.2012.12.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/30/2012] [Accepted: 12/03/2012] [Indexed: 11/29/2022]
Abstract
The primary progressive aphasias (PPA) are a heterogeneous group of language-led neurodegenerative diseases resulting from large-scale brain network degeneration. White matter (WM) pathways bind networks together, and might therefore hold information about PPA pathogenesis. Here we used diffusion tensor imaging and tract-based spatial statistics to compare WM tract changes between PPA syndromes and with respect to Alzheimer's disease and healthy controls in 33 patients with PPA (13 nonfluent/agrammatic PPA); 10 logopenic variant PPA; and 10 semantic variant PPA. Nonfluent/agrammatic PPA was associated with predominantly left-sided and anterior tract alterations including uncinate fasciculus (UF) and subcortical projections; semantic variant PPA with bilateral alterations in inferior longitudinal fasciculus and UF; and logopenic variant PPA with bilateral but predominantly left-sided alterations in inferior longitudinal fasciculus, UF, superior longitudinal fasciculus, and subcortical projections. Tract alterations were more extensive than gray matter alterations, and the extent of alteration across tracts and PPA syndromes varied between diffusivity metrics. These WM signatures of PPA syndromes illustrate the selective vulnerability of brain language networks in these diseases and might have some pathologic specificity.
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Affiliation(s)
- Colin J Mahoney
- Dementia Research Centre, UCL Institute of Neurology, London, UK.
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Premi E, Grassi M, Gazzina S, Paghera B, Pepe D, Archetti S, Padovani A, Borroni B. The neuroimaging signature of frontotemporal lobar degeneration associated with Granulin mutations: an effective connectivity study. J Nucl Med 2013; 54:1066-71. [PMID: 23687363 DOI: 10.2967/jnumed.112.111773] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED It has been suggested that monogenic frontotemporal lobar degeneration (FTLD) due to Granulin (GRN) mutations might present a specific pattern of atrophy, as compared with FTLD GRN-negative disease. Recent literature has suggested that the study of functional neural networks, rather than regional structural damage, might better elucidate the pathogenic mechanisms, showing complex relationships among structural alterations observed with conventional neuroimaging. The aim of this study was to evaluate effective brain connectivity in FTLD patients carrying GRN mutations (GRN+), compared with FTLD patients without pathogenetic GRN mutations (GRN-) and healthy controls (HCs). METHODS Twenty-six FTLD patients (13 GRN+ and 13 GRN- matched for age, sex, and phenotype) and 13 age- and sex-matched HCs underwent brain perfusion SPECT. Brain regions involved in FTLD (dorsolateral, anterior cingulate, orbitofrontal, posterior temporal, temporal pole, and parietal) were used as regions of interest to identify functionally interconnected areas. An effective connectivity (path) analysis was defined with a PC algorithm (named after its inventors Peter Spirtes and Clark Glymour) search procedure and structural equation fitting. Statistically significant differences among the 3 groups were determined. RESULTS The best-fitting model was obtained by the data-driven approach, and brain connectivity pathways resembling state-of-the-art anatomic knowledge were obtained. When GRN+ and GRN- groups were considered, the former presented a selective bilateral parietotemporal disconnection, compared with GRN- patients. Furthermore, in FTLD GRN+ patients an increased compensative connectivity of the temporal regions (temporal pole and posterior temporal cortices) was observed. CONCLUSION The present work suggests that impairment of effective functional connectivity of the parietotemporal regions is the hallmark of GRN-related FTLD. However, compensative mechanisms--which should be further investigated-may occur.
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Affiliation(s)
- Enrico Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Italy
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Whitwell JL, Josephs KA. Recent advances in the imaging of frontotemporal dementia. Curr Neurol Neurosci Rep 2013; 12:715-23. [PMID: 23015371 DOI: 10.1007/s11910-012-0317-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuroimaging has played an important role in the characterization of the frontotemporal dementia (FTD) syndromes, demonstrating neurodegenerative signatures that can aid in the differentiation of FTD from other neurodegenerative disorders. Recent advances have been driven largely by the refinement of the clinical syndromes that underlie FTD, and by the discovery of new genetic and pathological features associated with FTD. Many new imaging techniques and modalities are also now available that allow the assessment of other aspects of brain structure and function, such as diffusion tensor imaging and resting-state functional MRI. Studies have used these recent techniques, as well as traditional volumetric MRI, to provide further insight into disease progression across the many clinical, genetic, and pathological variants of FTD. Importantly, neuroimaging signatures have been identified that will improve the clinician's ability to predict underlying genetic and pathological features, and hence ultimately improve patient diagnosis.
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Affiliation(s)
- Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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Zhang Y, Tartaglia MC, Schuff N, Chiang GC, Ching C, Rosen HJ, Gorno-Tempini ML, Miller BL, Weiner MW. MRI signatures of brain macrostructural atrophy and microstructural degradation in frontotemporal lobar degeneration subtypes. J Alzheimers Dis 2013; 33:431-44. [PMID: 22976075 PMCID: PMC3738303 DOI: 10.3233/jad-2012-121156] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Brain magnetic resonance imaging (MRI) studies have demonstrated regional patterns of brain macrostructural atrophy and white matter microstructural alterations separately in the three major subtypes of frontotemporal lobar degeneration (FTLD), which includes behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SD), and progressive nonfluent aphasia (PNFA). This study was to investigate to what extent the pattern of white matter microstructural alterations in FTLD subtypes mirrors the pattern of brain atrophy, and to compare the ability of various diffusion tensor imaging (DTI) indices in characterizing FTLD patients, as well as to determine whether DTI measures provide greater classification power for FTLD than measuring brain atrophy. Twenty-five patients with FTLD (13 with bvFTD, 6 with SD, and 6 with PNFA) and 19 healthy age-matched control subjects underwent both structural MRI and DTI scans. Measurements of regional brain atrophy were based on T1-weighted MRI data and voxel-based morphometry. Measurements of regional white matter degradation were based on voxelwise as well as regions-of-interest tests of DTI variations, expressed as fractional anisotropy, axial diffusivity, and radial diffusivity. Compared to controls, bvFTD, SD, and PNFA patients each exhibited characteristic regional patterns of brain atrophy and white matter damage. DTI overall provided significantly greater accuracy for FTLD classification than brain atrophy. Moreover, radial diffusivity was more sensitive in assessing white matter damage in FTLD than other DTI indices. The findings suggest that DTI in general and radial diffusivity in particular are more powerful measures for the classification of FTLD patients from controls than brain atrophy.
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Affiliation(s)
- Yu Zhang
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA 94121, USA.
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