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Hadad R, Mandelli ML, Rankin KP, Toohey C, Sturm VE, Javandel S, Milicic A, Knudtson M, Allen IE, Hoffmann N, Friedberg A, Possin K, Valcour V, Miller BL. Itching Frequency and Neuroanatomic Correlates in Frontotemporal Lobar Degeneration. JAMA Neurol 2024:2821069. [PMID: 39037825 PMCID: PMC11264090 DOI: 10.1001/jamaneurol.2024.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/24/2024] [Indexed: 07/24/2024]
Abstract
Importance Itching is common in geriatric populations and is frequently linked to dermatological or systemic conditions. Itching engages specific brain regions that are implicated in the pathogenesis of frontotemporal lobar degeneration spectrum disorders (FTLD-SD). Thus, itching of undetermined origin (IUO) may indicate the presence of a neurodegenerative process. Objective To compare the frequency of itching in FTLD-SD and Alzheimer disease (AD) and to determine the neuroanatomical underpinnings of IUO. Design, Setting, and Participants This case-control study evaluated data and brain magnetic resonance images (MRIs) for participants with FTLD-SD or AD. Participants of a research study on FTLD-SD at the University of California, San Francisco, Memory and Aging Center were evaluated from May 1, 2002, to December 31, 2021. The exposure group underwent structural brain MRI within 6 months of initial diagnosis. Research visit summaries were reviewed to validate qualitative details and accurately identify itching with undetermined origin (IUO). Exposures Symptoms suggestive of FTLD-SD or AD. Main Outcomes and Measures Frequency of itching in FTLD-SD and AD and neuroanatomic correlates. Results A total of 2091 research visit summaries were reviewed for 1112 patients exhibiting symptoms indicative of FTLD-SD or AD. From 795 records where itching or a related phrase was endorsed, 137 had IUO. A total of 454 participants were included in the study: 137 in the itching group (mean [SD] age, 62.7 [9.9] years; 74 [54%] females and 63 males [46%]) and 317 in the nonitching group (mean [SD] age, 60.7 [10.8] years; 154 [49%] females and 163 males [51%]). Groups were similar in age, sex, and disease severity. More frequent itching was found in FTLD-SD (95/248 patients [38%], of which 44 [46%] had behavioral variant frontotemporal dementia [bvFTD]) compared with the AD group (14/77 patients [18%]; P = .001). The odds of itching were 2.4 (95% CI, 1.48-3.97) times higher for FTLD-SD compared with all other cases of dementia. Compared with healthy controls, the group with IUO exhibited greater gray matter atrophy bilaterally in the amygdala, insula, precentral gyrus, and cingulum, as well as in the right frontal superior gyrus and thalamus. Among patients with bvFTD and itching vs bvFTD without itching, itching was associated with right-lateralized gray matter atrophy affecting the insula, thalamus, superior frontal gyrus, and cingulum. Conclusions and Relevance Among individuals with IUO, FTLD-SD was disproportionately represented compared with AD. In FTLD-SD, dysfunction in the right anterior insula and its connected regions, including the right precentral gyrus, cingulum, and bilateral amygdala, contribute to dysregulation of the itching-scratching networks, resulting in uncontrollable itching or skin picking. Awareness among physicians about the relationship between neurodegeneration and itching may help in the management of itch in older individuals. Further studies are needed to determine the best treatments for these symptoms in patients with neurodegenerative disorders.
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Affiliation(s)
- Rafi Hadad
- Stroke and Cognition Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
| | - Maria Luisa Mandelli
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Katherine P. Rankin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Charlie Toohey
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Virginia E. Sturm
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco
| | - Shireen Javandel
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Andjelika Milicic
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Marguerite Knudtson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Isabel Elaine Allen
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nathalia Hoffmann
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Adit Friedberg
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Katherine Possin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Victor Valcour
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Bruce L. Miller
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Zhang L, Zhang H, Cao X, Wang L, Gan C, Sun H, Shan A, Yuan Y, Zhang K. Association between the functional connectivity of ventral tegmental area-prefrontal network and pure apathy in Parkinson's disease: a cross-sectional study. Quant Imaging Med Surg 2024; 14:4735-4748. [PMID: 39022244 PMCID: PMC11250350 DOI: 10.21037/qims-23-1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/14/2024] [Indexed: 07/20/2024]
Abstract
Background Apathy, characterized by diminished goal-directed behaviors, frequently occurs in patients with Parkinson's disease (PD). The dopamine-releasing neurons of the ventral tegmental area (VTA) have been closely related to this behavioral disruption and project widely to the corticolimbic areas, yet their functional and structural connectivity in regard to other brain regions remain unknown in patients with PD and pure apathy (PD-PA). This study thus aimed to characterize the alterations of functional connectivity (FC) of the VTA and white matter structural connectivity in PD-PA. Methods In this study, 29 patients with PD-PA, 37 with PD but not pure apathy (PD-NPA), and 28 matched healthy controls (HCs) underwent T1-weighted, resting state functional magnetic resonance imaging, and diffusion tensor imaging scans. Patients of this cross-sectional retrospective study were consecutively recruited from The First Affiliated Hospital of Nanjing Medical University between April 2017 and October 2021. Meanwhile, HCs were consecutively recruited from the local community and the Health Examination Center of our hospital. An analysis of covariance and a general linear model were respectively conducted to investigate the functional and structural connectivity among three groups. The tract-based spatial statistics (TBSS) approach was used to investigate the white matter structural connectivity. Results Patients with PD-PA showed reduced FC of the VTA with the left medial superior frontal gyrus (SFGmed) when compared to the patients with PD-NPA [t=-3.67; voxel-level P<0.001; cluster-level family-wise error-corrected P (PFWE)<0.05]. Relative to the HCs, patients with PD-PA demonstrated reduced FC of the VTA with the left SFGmed (t=-4.98; voxel-level P<0.001; cluster-level PFWE<0.05), right orbital superior frontal gyrus (SFGorb) (t=-5.08; voxel-level P<0.001; cluster-level PFWE<0.05), and right middle frontal gyrus (MFG) (t=-5.08; voxel-level P<0.001; cluster-level PFWE<0.05). Moreover, the reductions in VTA FC with the left SFGmed were associated with severe apathy symptoms in patients with PD-PA (r=-0.600; P=0.003). However, a TBSS approach did not reveal any significant differences in fiber tracts between the three groups. Conclusions This study identified reduced FC within the mesocortical network (VTA-SFGmed) of patients with PD-PA. These findings may provide valuable information for administering neuromodulation therapies in the alleviation of apathy symptoms in those with PD.
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Affiliation(s)
- Li Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kang B, Ma J, Shen J, Zhao C, Hua X, Qiu G, A X, Xu H, Xu J, Xiao L. Hemisphere lateralization of graph theoretical network in end-stage knee osteoarthritis patients. Brain Res Bull 2024; 213:110976. [PMID: 38750971 DOI: 10.1016/j.brainresbull.2024.110976] [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: 01/03/2024] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Hemisphere functional lateralization is a prominent feature of the human brain. However, it is not known whether hemispheric lateralization features are altered in end-stage knee osteoarthritis (esKOA). In this study, we performed resting-state functional magnetic imaging on 46 esKOA patients and 31 healthy controls (HCs) and compared with the global and inter-hemisphere network to clarify the hemispheric functional network lateralization characteristics of patients. A correlation analysis was performed to explore the relationship between the inter-hemispheric network parameters and clinical features of patients. The node attributes were analyzed to explore the factors changing in the hemisphere network function lateralization in patients. We found that patients and HCs exhibited "small-world" brain network topology. Clustering coefficient increased in patients compared with that in HCs. The hemisphere difference in inter-hemispheric parameters including assortativity, global efficiency, local efficiency, clustering coefficients, small-worldness, and shortest path length. The pain course and intensity of esKOA were positively correlated with the right hemispheric lateralization in local efficiency, clustering coefficients, and the small-worldness, respectively. The significant alterations of several nodal properties were demonstrated within group in pain-cognition, pain-emotion, and pain regulation circuits. The abnormal lateralization inter-hemisphere network may be caused by the destruction of regional network properties.
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Affiliation(s)
- Bingxin Kang
- Rehabilitation Treatment Centre, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jie Ma
- Center of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
| | - Jun Shen
- Shanghai Guanghua Hospital of Integrative Chinese and Western Medicine, Shanghai, China
| | - Chi Zhao
- Acupuncture Tuina Institute, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuyun Hua
- Center of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
| | - Guowei Qiu
- Shanghai Guanghua Hospital of Integrative Chinese and Western Medicine, Shanghai, China
| | - Xinyu A
- Shanghai Guanghua Hospital of Integrative Chinese and Western Medicine, Shanghai, China
| | - Hui Xu
- Acupuncture Tuina Institute, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jianguang Xu
- Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Lianbo Xiao
- Shanghai Guanghua Hospital of Integrative Chinese and Western Medicine, No. 540 Xinhua Road, Shanghai 200052, China.
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Smith DM, Aggarwal G, Niehoff ML, Jones SA, Banerjee S, Farr SA, Nguyen AD. Biochemical, Biomarker, and Behavioral Characterization of the Grn R493X Mouse Model of Frontotemporal Dementia. Mol Neurobiol 2024:10.1007/s12035-024-04190-9. [PMID: 38696065 DOI: 10.1007/s12035-024-04190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
Heterozygous loss-of-function mutations in the progranulin gene (GRN) are a major cause of frontotemporal dementia due to progranulin haploinsufficiency; complete deficiency of progranulin causes neuronal ceroid lipofuscinosis. Several progranulin-deficient mouse models have been generated, including both knockout mice and knockin mice harboring a common patient mutation (R493X). However, the GrnR493X mouse model has not been characterized completely. Additionally, while homozygous GrnR493X and Grn knockout mice have been extensively studied, data from heterozygous mice is still limited. Here, we performed more in-depth characterization of heterozygous and homozygous GrnR493X knockin mice, which includes biochemical assessments, behavioral studies, and analysis of fluid biomarkers. In the brains of homozygous GrnR493X mice, we found increased phosphorylated TDP-43 along with increased expression of lysosomal genes, markers of microgliosis and astrogliosis, pro-inflammatory cytokines, and complement factors. Heterozygous GrnR493X mice did not have increased TDP-43 phosphorylation but did exhibit limited increases in lysosomal and inflammatory gene expression. Behavioral studies found social and emotional deficits in GrnR493X mice that mirror those observed in Grn knockout mouse models, as well as impairment in memory and executive function. Overall, the GrnR493X knockin mouse model closely phenocopies Grn knockout models. Lastly, in contrast to homozygous knockin mice, heterozygous GrnR493X mice do not have elevated levels of fluid biomarkers previously identified in humans, including neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in both plasma and CSF. These results may help to inform pre-clinical studies that use this Grn knockin mouse model and other Grn knockout models.
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Affiliation(s)
- Denise M Smith
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA
| | - Geetika Aggarwal
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA
| | - Michael L Niehoff
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Veterans Affairs Medical Center, St. Louis, USA
| | - Spencer A Jones
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA
| | - Subhashis Banerjee
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA
| | - Susan A Farr
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA
- Veterans Affairs Medical Center, St. Louis, USA
| | - Andrew D Nguyen
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA.
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, USA.
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, USA.
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Isella V, Licciardo D, Ferri F, Crivellaro C, Morzenti S, Appollonio IM, Ferrarese C. Left and right corticobasal syndrome: comparison of cognitive profiles between metabolic imaging - matched groups. Neurol Sci 2024; 45:1499-1506. [PMID: 37889380 PMCID: PMC10942890 DOI: 10.1007/s10072-023-07148-2] [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: 06/23/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Corticobasal syndrome (CBS) is typically asymmetric. Case reports suggest that left-hemisphere CBS (lhCBS) is associated with major language impairment, and right-hemisphere CBS (rhCBS) is associated with major visuospatial deficits, but no group study has ever verified these observations. In our study, we enrolled 49 patients with CBS, classified them as lhCBS or rhCBS based on asymmetry of hypometabolism on brain FDG-PET and compared their cognitive and behavioural profiles. METHODS We defined asymmetry of hypometabolism upon visual inspection of qualitative PET images and confirmed it through paired comparison of left- and right-hemisphere FDG uptake values. The two groups were also matched for severity of hypometabolism within the more affected and more preserved hemispheres, to unravel differences in the cognitive profiles ascribable specifically to each hemisphere's functional specializations. All patients were assessed for memory, language, executive and visuospatial deficits, apraxia, neglect, dyscalculia, agraphia and behavioural disturbances. RESULTS LhCBS (n. 26) and rhCBS (n. 23) patients did not differ for demographics, disease duration and severity of global cognitive impairment. The two cognitive profiles were largely overlapping, with two exceptions: Digit span forward was poorer in lhCBS, and visual neglect was more frequent in rhCBS. CONCLUSIONS After balancing out patients for hemispheric hypometabolism, we did not confirm worse language or visuospatial deficits in, respectively, lhCBS and rhCBS. However, verbal short-term memory was more impaired in lhCBS, and spatial attention was more impaired in rhCBS. Both of these functions reflect the functional specialization of the left and right fronto-parietal pathways, i.e. of the main loci of neurodegeneration in CBS.
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Affiliation(s)
- Valeria Isella
- School of Medicine and Surgery (Neurology), University of Milano-Bicocca, Via Cadore 48, 20900, Monza(MB), Italy.
| | - Daniele Licciardo
- School of Medicine and Surgery (Neurology), University of Milano-Bicocca, Via Cadore 48, 20900, Monza(MB), Italy
- Fondazione IRCCS San Gerardo Dei Tintori (Neurology), Monza, Italy
| | - Francesca Ferri
- Fondazione IRCCS San Gerardo Dei Tintori (Neurology), Monza, Italy
| | - Cinzia Crivellaro
- Fondazione IRCCS San Gerardo Dei Tintori (Nuclear Medicine), Monza, Italy
| | - Sabrina Morzenti
- Fondazione IRCCS San Gerardo Dei Tintori (Medical Physics), Monza, Italy
| | - Ildebrando Marco Appollonio
- School of Medicine and Surgery (Neurology), University of Milano-Bicocca, Via Cadore 48, 20900, Monza(MB), Italy
- Fondazione IRCCS San Gerardo Dei Tintori (Neurology), Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery (Neurology), University of Milano-Bicocca, Via Cadore 48, 20900, Monza(MB), Italy
- Fondazione IRCCS San Gerardo Dei Tintori (Neurology), Monza, Italy
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Smith DM, Aggarwal G, Niehoff ML, Jones SA, Banerjee S, Farr SA, Nguyen AD. Biochemical, biomarker, and behavioral characterization of the GrnR493X mouse model of frontotemporal dementia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.05.27.542495. [PMID: 37398305 PMCID: PMC10312473 DOI: 10.1101/2023.05.27.542495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Heterozygous loss-of-function mutations in the progranulin gene (GRN) are a major cause of frontotemporal dementia due to progranulin haploinsufficiency; complete deficiency of progranulin causes neuronal ceroid lipofuscinosis. Several progranulin-deficient mouse models have been generated, including both knockout mice and knockin mice harboring a common patient mutation (R493X). However, the GrnR493X mouse model has not been characterized completely. Additionally, while homozygous GrnR493X and Grn knockout mice have been extensively studied, data from heterozygous mice is still limited. Here, we performed more in-depth characterization of heterozygous and homozygous GrnR493X knockin mice, which includes biochemical assessments, behavioral studies, and analysis of fluid biomarkers. In the brains of homozygous GrnR493X mice, we found increased phosphorylated TDP-43 along with increased expression of lysosomal genes, markers of microgliosis and astrogliosis, pro-inflammatory cytokines, and complement factors. Heterozygous GrnR493X mice did not have increased TDP-43 phosphorylation but did exhibit limited increases in lysosomal and inflammatory gene expression. Behavioral studies found social and emotional deficits in GrnR493X mice that mirror those observed in Grn knockout mouse models, as well as impairment in memory and executive function. Overall, the GrnR493X knockin mouse model closely phenocopies Grn knockout models. Lastly, in contrast to homozygous knockin mice, heterozygous GrnR493X mice do not have elevated levels of fluid biomarkers previously identified in humans, including neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in both plasma and CSF. These results may help to inform pre-clinical studies that use this Grn knockin mouse model and other Grn knockout models.
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Affiliation(s)
- Denise M. Smith
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
| | - Geetika Aggarwal
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
| | - Michael L. Niehoff
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Veterans Affairs Medical Center, United States of America
| | - Spencer A. Jones
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
| | - Subhashis Banerjee
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
| | - Susan A. Farr
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
- Veterans Affairs Medical Center, United States of America
| | - Andrew D. Nguyen
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, United States of America
- Saint Louis University School of Medicine, Department of Pharmacology and Physiology, United States of America
- Saint Louis University, Institute for Translational Neuroscience, United States of America
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El Haffaf LM, Ronat L, Cannizzaro A, Hanganu A. Associations Between Hyperactive Neuropsychiatric Symptoms and Brain Morphology in Mild Cognitive Impairment and Alzheimer's Disease. J Alzheimers Dis 2024; 97:841-853. [PMID: 38143342 DOI: 10.3233/jad-220857] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Hyperactive neuropsychiatric symptoms (NPS) (i.e., agitation, disinhibition, and irritability) are among the most challenging symptoms to manage in Alzheimer's disease (AD). However, their underlying brain correlates have been poorly studied. OBJECTIVE We aimed to investigate the associations between the total score of hyperactive NPS and brain structures in participants with AD, mild cognitive impairment (MCI), and cognitively normal older adults (CN). METHODS Neuropsychiatric and 3T MRI data from 216 AD, 564 MCI, and 660 CN participants were extracted from the Alzheimer's Disease Neuroimaging Initiative database. To define NPS and brain structures' associations, we fitted a general linear model (GLM) in two ways: 1) an overall GLM including all three groups (AD, MCI, CN) and 2) three pair-wise GLMs (AD versus MCI, MCI versus CN, AD versus CN). The cortical changes as a function of NPS total score were investigated using multiple regression analyses. RESULTS Results from the overall GLM include associations between 1) agitation and the right parietal supramarginal surface area in the MCI-CN contrast, 2) disinhibition and the cortical thickness of the right frontal pars opercularis and temporal inferior in the AD-MCI contrast, and 3) irritability and the right frontal pars opercularis, frontal superior, and temporal superior volumes in the MCI-CN contrast. CONCLUSIONS Our study shows that each hyperactive NPS is associated with distinct brain regions in AD, MCI, and CN (groups with different levels of cognitive performance). This suggests that each NPS is associated with a unique signature of brain morphology, including variations in volume, thickness, or area.
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Affiliation(s)
- Lyna Mariam El Haffaf
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montréal, QC, Canada
- Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Montréal, QC, Canada
| | - Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montréal, QC, Canada
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Adriana Cannizzaro
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montréal, QC, Canada
- Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Montréal, QC, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montréal, QC, Canada
- Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Montréal, QC, Canada
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Khalaila R, Dasgupta J, Sturm V. The neuroscience of respect: insights from cross-cultural perspectives. Front Psychol 2023; 14:1259474. [PMID: 38179496 PMCID: PMC10766356 DOI: 10.3389/fpsyg.2023.1259474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Cultural values such as respect influence cognition, emotion, and behavior by modulating brain functioning. This mini-review discusses the cultural differences of respect as an essential human value, and the neural underpinnings accompanying them. Although neuroscientific studies are limited, we outline potential brain structures and networks that contribute to respect and use clinical examples to illustrate how behavior changes when these neural systems fail. A better understanding of the neuroanatomical basis of respect and its neural manifestations across cultures will help to advance current conceptualizations of the biology of human values.
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Affiliation(s)
- Rabia Khalaila
- Memory and Aging Center, Global Brain Health Institute, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California at San Francisco, San Francisco, CA, United States
- Nursing Department, Zefat Academic College, Zefat, Israel
| | - Jayashree Dasgupta
- Memory and Aging Center, Global Brain Health Institute, San Francisco, CA, United States
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Samvedna Care, Gurugram, India
| | - Virginia Sturm
- Memory and Aging Center, Global Brain Health Institute, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California at San Francisco, San Francisco, CA, United States
- John Douglas French Alzheimer's Foundation Endowed, Los Angeles, CA, United States
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Sokołowski A, Roy ARK, Goh SM, Hardy EG, Datta S, Cobigo Y, Brown JA, Spina S, Grinberg L, Kramer J, Rankin KP, Seeley WW, Sturm VE, Rosen HJ, Miller BL, Perry DC. Neuropsychiatric symptoms and imbalance of atrophy in behavioral variant frontotemporal dementia. Hum Brain Mapp 2023; 44:5013-5029. [PMID: 37471695 PMCID: PMC10502637 DOI: 10.1002/hbm.26428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
Behavioral variant frontotemporal dementia is characterized by heterogeneous frontal, insular, and anterior temporal atrophy patterns that vary along left-right and dorso-ventral axes. Little is known about how these structural imbalances impact clinical symptomatology. The goal of this study was to assess the frequency of frontotemporal asymmetry (right- or left-lateralization) and dorsality (ventral or dorsal predominance of atrophy) and to investigate their clinical correlates. Neuropsychiatric symptoms and structural images were analyzed for 250 patients with behavioral variant frontotemporal dementia. Frontotemporal atrophy was most often symmetric while left-lateralized (9%) and right-lateralized (17%) atrophy were present in a minority of patients. Atrophy was more often ventral (32%) than dorsal (3%) predominant. Patients with right-lateralized atrophy were characterized by higher severity of abnormal eating behavior and hallucinations compared to those with left-lateralized atrophy. Subsequent analyses clarified that eating behavior was associated with right atrophy to a greater extent than a lack of left atrophy, and hallucinations were driven mainly by right atrophy. Dorsality analyses showed that anxiety, euphoria, and disinhibition correlated with ventral-predominant atrophy. Agitation, irritability, and depression showed greater severity with a lack of regional atrophy, including in dorsal regions. Aberrant motor behavior and apathy were not explained by asymmetry or dorsality. This study provides additional insight into how anatomical heterogeneity influences the clinical presentation of patients with behavioral variant frontotemporal dementia. Behavioral symptoms can be associated not only with the presence or absence of focal atrophy, but also with right/left or dorsal/ventral imbalance of gray matter volume.
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Affiliation(s)
- Andrzej Sokołowski
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ashlin R. K. Roy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sheng‐Yang M. Goh
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Emily G. Hardy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Samir Datta
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jesse A. Brown
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lea Grinberg
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Virginia E. Sturm
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - David C. Perry
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Horne KS, Ceslis A, Mosley P, Adam R, Robinson GA. The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration. Cogn Behav Neurol 2023; 36:178-193. [PMID: 37378480 DOI: 10.1097/wnn.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. OBJECTIVE To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). METHOD We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. RESULTS The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. CONCLUSION Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.
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Affiliation(s)
- Kristina S Horne
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Queensland, Australia
| | - Philip Mosley
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Biomedical Informatics Group, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia
| | - Robert Adam
- University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- School of Psychology, The University of Queensland, Queensland, Australia
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11
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Wright LM, Donaghy PC, Burn DJ, Taylor JP, O'Brien JT, Yarnall AJ, Matthews FE, Firbank MJ, Thomas AJ, Lawson RA. Predicting cognitive decline using neuropsychiatric symptoms in prodromal Lewy body dementia: A longitudinal study. Parkinsonism Relat Disord 2023; 113:105762. [PMID: 37441886 DOI: 10.1016/j.parkreldis.2023.105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) in Lewy body dementias (LBD) occur frequently and early in disease progression. Such symptoms are associated with worse quality of life, caregiver burden and functional limitations. Limited evidence exists, however, outlining the longitudinal relationship between NPS and cognitive decline in prodromal LBD. METHODS 123 participants were derived from three cohort studies. Patients with mild cognitive impairment (MCI) relating to probable dementia with Lewy bodies (MCI-LB, n = 67) and Parkinson's disease (PD-MCI, n = 56) completed comprehensive cognitive and neuropsychiatric assessment and were followed up longitudinally. Linear regression and mixed effects models assessed the relationship between baseline NPS and cognition at baseline and over time. RESULTS In MCI-LB, overall NPS burden was associated with declines over time in executive function (p = 0.026) and processing speed (p = 0.028) and baseline aberrant motor behaviour was associated with declines in attention (p < 0.025). Anxiety was significantly associated with poorer visuospatial functioning (p = 0.016) at baseline and poorer attention both at baseline (p = 0.017) and across time points (p = 0.024). In PD-MCI, psychosis was associated with poorer executive functioning at baseline (p = 0.008) and across time points (p = 0.002) but had no association with changes longitudinally. CONCLUSIONS Core neuropsychiatric components of LBD are not strongly associated with cognition in prodromal disease. This may suggest that neuropathological mechanisms underlying NPS may not be the same as those underlying cognitive impairment. Non-core NPS, however, may be more directly associated with cognitive change. Future studies utilising neuroimaging techniques are needed to explore the neuropathological basis of NPS in prodromal LBD.
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Affiliation(s)
- Laura M Wright
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - David J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
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12
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Ozzoude M, Varriano B, Beaton D, Ramirez J, Adamo S, Holmes MF, Scott CJM, Gao F, Sunderland KM, McLaughlin P, Goubran M, Kwan D, Roberts A, Bartha R, Symons S, Tan B, Swartz RH, Abrahao A, Saposnik G, Masellis M, Lang AE, Marras C, Zinman L, Shoesmith C, Borrie M, Fischer CE, Frank A, Freedman M, Montero-Odasso M, Kumar S, Pasternak S, Strother SC, Pollock BG, Rajji TK, Seitz D, Tang-Wai DF, Turnbull J, Dowlatshahi D, Hassan A, Casaubon L, Mandzia J, Sahlas D, Breen DP, Grimes D, Jog M, Steeves TDL, Arnott SR, Black SE, Finger E, Rabin J, Tartaglia MC. White matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases. Alzheimers Res Ther 2023; 15:114. [PMID: 37340319 PMCID: PMC10280981 DOI: 10.1186/s13195-023-01257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. METHODS Five hundred thirteen participants with one of these conditions, i.e. Alzheimer's Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson's Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory - Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. RESULTS Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson's disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. CONCLUSIONS In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.
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Affiliation(s)
- Miracle Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Derek Beaton
- Data Science & Advanced Analytic, St. Michael's Hospital, Toronto, ON, Canada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sabrina Adamo
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Melissa F Holmes
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher J M Scott
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Maged Goubran
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert Bartha
- Robarts Research Institute, Western University, London, ON, Canada
| | - Sean Symons
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario Masellis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lorne Zinman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Michael Borrie
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Corinne E Fischer
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew Frank
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Manuel Montero-Odasso
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Lawsone Health Research Institute, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, London, ON, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen Pasternak
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen C Strother
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Dallas Seitz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - John Turnbull
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Leanne Casaubon
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Healthcare Centre, London, ON, Canada
| | - Demetrios Sahlas
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Rabin
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada.
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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13
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Yan H, Wu H, Cai Z, Du S, Li L, Xu B, Chang C, Wang N. The neural correlates of apathy in the context of aging and brain disorders: a meta-analysis of neuroimaging studies. Front Aging Neurosci 2023; 15:1181558. [PMID: 37396666 PMCID: PMC10311641 DOI: 10.3389/fnagi.2023.1181558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Apathy is a prevalent mood disturbance that occurs in a wide range of populations, including those with normal cognitive aging, mental disorders, neurodegenerative disorders and traumatic brain injuries. Recently, neuroimaging technologies have been employed to elucidate the neural substrates underlying brain disorders accompanying apathy. However, the consistent neural correlates of apathy across normal aging and brain disorders are still unclear. Methods This paper first provides a brief review of the neural mechanism of apathy in healthy elderly individuals, those with mental disorders, neurodegenerative disorders, and traumatic brain injuries. Further, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, the structural and functional neuroimaging meta-analysis using activation likelihood estimation method is performed on the apathy group with brain disorders and the healthy elderly, aiming at exploring the neural correlates of apathy. Results The structural neuroimaging meta-analysis showed that gray matter atrophy is associated with apathy in the bilateral precentral gyrus (BA 13/6), bilateral insula (BA 47), bilateral medial frontal gyrus (BA 11), bilateral inferior frontal gyrus, left caudate (putamen) and right anterior cingulate, while the functional neuroimaging meta-analysis suggested that the functional connectivity in putamen and lateral globus pallidus is correlated with apathy. Discussion Through the neuroimaging meta-analysis, this study has identified the potential neural locations of apathy in terms of brain structure and function, which may offer valuable pathophysiological insights for developing more effective therapeutic interventions for affected patients.
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Affiliation(s)
- Hongjie Yan
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Huijun Wu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zenglin Cai
- Department of Neurology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
- Department of Neurology, Gusu School, Suzhou Science and Technology Town Hospital, Nanjing Medical University, Suzhou, China
| | - Shouyun Du
- Department of Neurology, Guanyun People’s Hospital, Guanyun, China
| | - Lejun Li
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Bingchao Xu
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Chunqi Chang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Pengcheng Laboratory, Shenzhen, China
| | - Nizhuan Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
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Cannizzaro A, Ronat L, El Haffaf LM, Hanganu A. Associations between neuropsychiatric symptoms of affective and vegetative domains and brain morphology in aging people with mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2023; 38:e5952. [PMID: 37351584 DOI: 10.1002/gps.5952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPS) are common in mild cognitive impairment (MCI) and even more in Alzheimer's disease (AD). The symptom-based cluster including nighttime disturbances, depression, appetite changes, anxiety, and apathy (affective and vegetative symptoms) was associated with an increased risk of dementia in MCI and has common neuroanatomical associations. Our objective was to investigate the differences in brain morphology associations with affective and vegetative symptoms between three groups: cognitively normal older adults (CN), MCI and AD. MATERIAL AND METHODS Alzheimer's Disease Neuroimaging Initiative data of 223 CN, 367 MCI and 175 AD, including cortical volumes, surface areas and thicknesses and severity scores of the five NPS were analyzed. A whole-brain vertex-wise general linear model was performed to test for intergroup differences (CN-MCI, CN-AD, AD-MCI) in brain morphology associations with five NPS. Multiple regressions were conducted to investigate cortical change as a function of NPS severity in the AD-MCI contrast. RESULTS We found (1) signature differences in nighttime disturbances associations with prefrontal regions in AD-MCI, (2) signature differences in NPS associations with temporal regions in AD-MCI for depression and in CN-AD for anxiety, (3) decreased temporal metrics in MCI as nighttime disturbances and depression severity increased, (4) decreased pars triangularis metrics in AD as nighttime disturbances and apathy severity increased. CONCLUSION Each NPS seems to have a signature on brain morphology. Affective and vegetative NPS were primarily associated with prefrontal and temporal regions. These signatures open the possibility of potential future assessments of links between brain morphology and NPS on an individual level.
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Affiliation(s)
- Adriana Cannizzaro
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté de Médecine, Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Lyna Mariam El Haffaf
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
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15
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Silveira CRA, Mitchell E, Restrepo-Martinez M, Coleman K, Ruiz-Garcia R, Finger E. Changes in motor activity level in individuals with frontotemporal dementia. J Neurol 2023:10.1007/s00415-023-11713-2. [PMID: 37062017 DOI: 10.1007/s00415-023-11713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
Changes in motor activity are common in individuals with Frontotemporal dementia (FTD). Yet, it remains unclear why some individuals become motorically hyperactive, while others hypoactive even in early stages of the disease. This study aimed to examine the relationship between motor activity level and (1) FTD clinical subtype, and (2) cortical thickness and subcortical volumes. Eighty-two charts were retrospectively reviewed from patients meeting consensus criteria for one of the three main clinical subtypes of FTD: probable bvFTD, semantic variant Primary Progressive Aphasia (PPA), or non-fluent variant PPA. Participants were assigned to one of three groups: (1) hyperactive, (2) hypoactive, or (3) no record of change. Hyperactivity was prevalent among bvFTD (58.5%) and semantic PPA (68.8%) subtypes while hypoactivity was less common in both subtypes (29.3% and 18.8%, respectively). The majority of patients with non-fluent PPA showed no record of change in motor activity (66.7%). The analysis of cortical thickness and subcortical volumes did not identify significant associations with motor activity levels. In conclusion, increased motor activity is highly prevalent among individuals with FTD, especially bvFTD and svPPA subtypes. These findings may inform prognosis and prediction of changes in motor activity, and allow planning for appropriate environmental and behavioural interventions. Future studies with prospective, standardized longitudinal collection of information regarding the type and level of change in motor activity, including wearable measures of actigraphy, may help to further delineate the onset and progression of abnormal motor behaviours and determine neuroanatomic associations in FTD.
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Affiliation(s)
- C R A Silveira
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
| | - E Mitchell
- Schulich School of Medicine and Dentistry, Department of Clinical Neurological Science, Western University, London, ON, Canada
| | - M Restrepo-Martinez
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, Department of Clinical Neurological Science, Western University, London, ON, Canada
| | - K Coleman
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - R Ruiz-Garcia
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, Department of Clinical Neurological Science, Western University, London, ON, Canada
| | - E Finger
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, Department of Clinical Neurological Science, Western University, London, ON, Canada
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16
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Rhodes E, Mechanic-Hamilton D, Phillips JS, McMillan C, Bahena A, Vitali N, Hlava Q, Cook P, Gee J, Grossman M, Massimo L. Discrepancies in patient and caregiver ratings of personality change in Alzheimer's disease and related dementias. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.09.23287003. [PMID: 36993170 PMCID: PMC10055470 DOI: 10.1101/2023.03.09.23287003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Assessment of personality change in Alzheimer's disease and related dementias (ADRD) is clinically meaningful but complicated by patient (i.e., reduced insight) and informant (i.e., caregiver burden) factors that confound accurate reporting of personality traits. This study assessed the impact of caregiver burden on informant report of Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness) and investigated regional cortical volumes associated with larger discrepancies in patient and informant report of Big Five personality traits. Methods Sixty-four ADRD participants with heterogeneous neurodegenerative clinical phenotypes and their informants completed the Big Five Inventory (BFI). Caregiver burden was measured using the Zarit Burden Interview (ZBI). Discrepancy scores were computed as the absolute value of the difference between patient and informant ratings for all BFI trait scores and summed to create a global score. Regional grey matter volumes from T1-weighted 3T MRI were normalized to intracranial volume and related to global Big Five discrepancy scores using linear regression. Results Higher levels of caregiver burden were associated with higher informant ratings of patient Neuroticism (ß =0.27, p =.016) and lower informant ratings of patient Agreeableness (ß =-0.32, p =.002), Conscientiousness (ß =-0.3, p =.002), and Openness (ß =-0.34, p =.003) independent of disease severity. Patients with greater Big Five discrepancy scores showed smaller cortical volumes in right medial PFC (β = -0.00015, p = .002), right superior temporal gyrus (β = -0.00028, p = .025), and left inferior frontal gyrus (β = -0.00006 p = .013). Conclusions Informant ratings of personality traits in ADRD can be confounded by caregiver burden, highlighting the need for more objective measures of personality and behavior in dementia samples. Discrepancies between informant and patient ratings of personality may additionally reflect loss of insight secondary to cortical atrophy in frontal and temporal structures.
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17
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Columbres RCA, Chin Y, Pratti S, Quinn C, Gonzalez-Cuyar LF, Weiss M, Quintero-Rivera F, Kimonis V. Novel Variants in the VCP Gene Causing Multisystem Proteinopathy 1. Genes (Basel) 2023; 14:genes14030676. [PMID: 36980948 PMCID: PMC10048343 DOI: 10.3390/genes14030676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Valosin-containing protein (VCP) gene mutations have been associated with a rare autosomal dominant, adult-onset progressive disease known as multisystem proteinopathy 1 (MSP1), or inclusion body myopathy (IBM), Paget's disease of bone (PDB), frontotemporal dementia (FTD), (IBMPFD), and amyotrophic lateral sclerosis (ALS). We report the clinical and genetic analysis findings in five patients, three from the same family, with novel VCP gene variants: NM_007126.5 c.1106T>C (p.I369T), c.478G>A (p.A160T), and c.760A>T (p.I254F), associated with cardinal MSP1 manifestations including myopathy, PDB, and FTD. Our report adds to the spectrum of heterozygous pathogenic variants found in the VCP gene and the high degree of clinical heterogeneity. This case series prompts increased awareness and early consideration of MSP1 in the differential diagnosis of myopathies and/or PDB, dementia, or ALS to improve the diagnosis and early management of clinical symptoms.
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Affiliation(s)
- Rod Carlo Agram Columbres
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA 92697, USA
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Yue Chin
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Sanjana Pratti
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Colin Quinn
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luis F Gonzalez-Cuyar
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104, USA
| | - Michael Weiss
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Fabiola Quintero-Rivera
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA 92697, USA
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA 92697, USA
- Department of Neurology, University of California, Irvine, CA 92697, USA
- Department of Pathology, University of California, Irvine, CA 92697, USA
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18
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Mendez MF. A Functional and Neuroanatomical Model of Dehumanization. Cogn Behav Neurol 2023; 36:42-47. [PMID: 36149395 PMCID: PMC9991937 DOI: 10.1097/wnn.0000000000000316] [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: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
The dehumanization of others is a major scourge of mankind; however, despite its significance, physicians have little understanding of the neurobiological mechanisms for this behavior. We can learn much about dehumanization from its brain-behavior localization and its manifestations in people with brain disorders. Dehumanization as an act of denying to others human qualities includes two major forms. Animalistic dehumanization (also called infrahumanization) results from increased inhibition of prepotent tendencies for emotional feelings and empathy for others. The mechanism may be increased activity in the inferior frontal gyrus. In contrast, mechanistic dehumanization results from a loss of perception of basic human nature and decreased mind-attribution. The mechanism may be hypofunction of a mentalization network centered in the ventromedial prefrontal cortex and adjacent subgenual anterior cingulate cortex. Whereas developmental factors may promote animalistic dehumanization, brain disorders, such as frontotemporal dementia, primarily promote mechanistic dehumanization. The consideration of these two processes as distinct, with different neurobiological origins, could help guide efforts to mitigate expression of this behavior.
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Affiliation(s)
- Mario F. Mendez
- Department of Neurology, University of California Los Angeles, Los Angeles, California
- Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, California
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19
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An exploratory study of functional brain activation underlying response inhibition in major depressive disorder and borderline personality disorder. PLoS One 2023; 18:e0280215. [PMID: 36608051 PMCID: PMC9821521 DOI: 10.1371/journal.pone.0280215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
Cognitive control is associated with impulsive and harmful behaviours, such as substance abuse and suicidal behaviours, as well as major depressive disorder (MDD) and borderline personality disorder (BPD). The association between MDD and BPD is partially explained by shared pathological personality traits, which may be underpinned by aspects of cognitive control, such as response inhibition. The neural basis of response inhibition in MDD and BPD is not fully understood and could illuminate factors that differentiate between the disorders and that underlie individual differences in cross-cutting pathological traits. In this study, we sought to explore the neural correlates of response inhibition in MDD and BPD, as well as the pathological personality trait domains contained in the ICD-11 personality disorder model. We measured functional brain activity underlying response inhibition on a Go/No-Go task using functional magnetic resonance imaging in 55 female participants recruited into three groups: MDD without comorbid BPD (n = 16), MDD and comorbid BPD (n = 18), and controls with neither disorder (n = 21). Whereas response-inhibition-related activation was observed bilaterally in frontoparietal cognitive control regions across groups, there were no group differences in activation or significant associations between activation in regions-of-interest and pathological personality traits. The findings highlight potential shared neurobiological substrates across diagnoses and suggest that the associations between individual differences in neural activation and pathological personality traits may be small in magnitude. Sufficiently powered studies are needed to elucidate the associations between the functional neural correlates of response inhibition and pathological personality trait domains.
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20
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Bui TA, Jickling GC, Winship IR. Neutrophil dynamics and inflammaging in acute ischemic stroke: A transcriptomic review. Front Aging Neurosci 2022; 14:1041333. [PMID: 36620775 PMCID: PMC9813499 DOI: 10.3389/fnagi.2022.1041333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Stroke is among the leading causes of death and disability worldwide. Restoring blood flow through recanalization is currently the only acute treatment for cerebral ischemia. Unfortunately, many patients that achieve a complete recanalization fail to regain functional independence. Recent studies indicate that activation of peripheral immune cells, particularly neutrophils, may contribute to microcirculatory failure and futile recanalization. Stroke primarily affects the elderly population, and mortality after endovascular therapies is associated with advanced age. Previous analyses of differential gene expression across injury status and age identify ischemic stroke as a complex age-related disease. It also suggests robust interactions between stroke injury, aging, and inflammation on a cellular and molecular level. Understanding such interactions is crucial in developing effective protective treatments. The global stroke burden will continue to increase with a rapidly aging human population. Unfortunately, the mechanisms of age-dependent vulnerability are poorly defined. In this review, we will discuss how neutrophil-specific gene expression patterns may contribute to poor treatment responses in stroke patients. We will also discuss age-related transcriptional changes that may contribute to poor clinical outcomes and greater susceptibility to cerebrovascular diseases.
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Affiliation(s)
- Truong An Bui
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Glen C. Jickling
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ian R. Winship
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,*Correspondence: Ian R. Winship,
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Abstract
OBJECTIVE Behavioral variant frontotemporal dementia (bvFTD) is associated with social and criminal transgressions; studies from countries around the world have documented such behavior in persons with this condition. An overview and analysis of social and criminal transgressions in bvFTD and their potential neurobiological mechanisms can provide a window for understanding the relationship of antisocial behavior and the brain. METHODS This review evaluated the literature on the frequency of social and criminal transgressions in bvFTD and the neurobiological disturbances that underlie them. RESULTS There is a high frequency of transgressions among patients with bvFTD due to impairments in neurocognition, such as social perception, behavioral regulation, and theory of mind, and impairments in social emotions, such as self-conscious emotions and empathy. Additionally, there is significant evidence for a specific impairment in an innate sense of morality. Alterations in these neurobiological processes result from predominantly right-hemisphere pathology in frontal (ventromedial, orbitofrontal, inferolateral frontal), anterior temporal (amygdala, temporal pole), limbic (anterior cingulate, amygdala), and insular regions. CONCLUSIONS Overlapping disturbances in neurocognition, social emotions, and moral reasoning result from disease in the mostly mesial and right-sided frontotemporal network necessary for responding emotionally to others and for behavioral control. With increased sophistication in neurobiological interventions, future goals may be the routine evaluation of these processes among individuals with bvFTD who engage in social and criminal transgressions and the targeting of these neurobiological mechanisms with behavioral, pharmacological, and other interventions.
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Affiliation(s)
- Mario F Mendez
- Departments of Neurology and Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; and Neurology Service, Neurobehavior Unit, VA Greater Los Angeles Healthcare System
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22
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Tsentidou G, Moraitou D, Tsolaki M. Emotion Recognition in a Health Continuum: Comparison of Healthy Adults of Advancing Age, Community Dwelling Adults Bearing Vascular Risk Factors and People Diagnosed with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13366. [PMID: 36293946 PMCID: PMC9602834 DOI: 10.3390/ijerph192013366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
The identification of basic emotions plays an important role in social relationships and behaviors linked to survival. In neurodegenerative conditions such as Alzheimer's disease (AD), the ability to recognize emotions may already be impaired at early stages of the disease, such as the stage of Mild Cognitive Impairment (MCI). However, as regards vascular pathologies related to cognitive impairment, very little is known about emotion recognition in people bearing vascular risk factors (VRF). Therefore, the aim of the present study was to examine emotion recognition ability in the health continuum "healthy advancing age-advancing age with VRF-MCI". The sample consisted of 106 adults divided in three diagnostic groups; 43 adults with MCI, 41 adults bearing one or more VRF, and 22 healthy controls of advancing age (HC). Since HC were more educated and younger than the other two groups, the age-group and level of educational were taken into account in the statistical analyses. A dynamic visual test was administered to examine recognition of basic emotions and emotionally neutral conditions. The results showed only a significant diagnostic group x educational level interaction as regards total emotion recognition ability, F (4, 28.910) = 4.117 p = 0.004 η2 = 0.166. High educational level seems to contribute to a high-level-emotion-recognition-performance both in healthy adults of advancing age and in adults bearing vascular risk factors. Medium educational level appears to play the same role only in healthy adults. Neither educational level can help MCI people to enhance their significantly lower emotion recognition ability.
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Affiliation(s)
- Glykeria Tsentidou
- Laboratory of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Magdalini Tsolaki
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
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23
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Miao D, Zhou X, Wu X, Chen C, Tian L. Hippocampal morphological atrophy and distinct patterns of structural covariance network in Alzheimer's disease and mild cognitive impairment. Front Psychol 2022; 13:980954. [PMID: 36160522 PMCID: PMC9505506 DOI: 10.3389/fpsyg.2022.980954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Elucidating distinct morphological atrophy patterns of Alzheimer's disease (AD) and its prodromal stage, namely, mild cognitive impairment (MCI) helps to improve early diagnosis and medical intervention of AD. On that account, we aimed to obtain distinct patterns of voxel-wise morphological atrophy and its further perturbation on structural covariance network in AD and MCI compared with healthy controls (HCs). T1-weighted anatomical images of matched AD, MCI, and HCs were included in this study. Gray matter volume was obtained using voxel-based morphometry and compared among three groups. In addition, structural covariance network of identified brain regions exhibiting morphological difference was constructed and compared between pairs of three groups. Thus, patients with AD have a reduced hippocampal volume and an increased rate of atrophy compared with MCI and HCs. MCI exhibited a decreased trend in bilateral hippocampal volume compared with HCs and the accelerated right hippocampal atrophy rate than HCs. In AD, the hippocampus further exhibited increased structural covariance connected to reward related brain regions, including the anterior cingulate cortex, the putamen, the caudate, and the insula compared with HCs. In addition, the patients with AD exhibited increased structural covariance of left hippocampus with the bilateral insula, the inferior frontal gyrus, the superior temporal gyrus, and the cerebellum than MCI. These results reveal distinct patterns of morphological atrophy in AD and MCI, providing new insights into pathology of AD.
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Affiliation(s)
- Dawei Miao
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaoguang Zhou
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaoyuan Wu
- School of Economics and Management, Minjiang University, Fuzhou, China
| | - Chengdong Chen
- School of Economics and Management, Minjiang University, Fuzhou, China
| | - Le Tian
- School of Electrical and Information Engineering, Beijing University of Civil Engineering and Architecture, Beijing, China
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24
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Vuic B, Konjevod M, Tudor L, Milos T, Nikolac Perkovic M, Nedic Erjavec G, Pivac N, Uzun S, Mimica N, Svob Strac D. Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia. Expert Rev Neurother 2022; 22:707-720. [PMID: 35950234 DOI: 10.1080/14737175.2022.2112668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy. AREAS COVERED This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD. EXPERT OPINION Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.
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Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
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25
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Cobigo Y, Goh MS, Wolf A, Staffaroni AM, Kornak J, Miller BL, Rabinovici GD, Seeley WW, Spina S, Boxer AL, Boeve BF, Wang L, Allegri R, Farlow M, Mori H, Perrin RJ, Kramer J, Rosen HJ. Detection of emerging neurodegeneration using Bayesian linear mixed-effect modeling. Neuroimage Clin 2022; 36:103144. [PMID: 36030718 PMCID: PMC9428846 DOI: 10.1016/j.nicl.2022.103144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 01/18/2023]
Abstract
Early detection of neurodegeneration, and prediction of when neurodegenerative diseases will lead to symptoms, are critical for developing and initiating disease modifying treatments for these disorders. While each neurodegenerative disease has a typical pattern of early changes in the brain, these disorders are heterogeneous, and early manifestations can vary greatly across people. Methods for detecting emerging neurodegeneration in any part of the brain are therefore needed. Prior publications have described the use of Bayesian linear mixed-effects (BLME) modeling for characterizing the trajectory of change across the brain in healthy controls and patients with neurodegenerative disease. Here, we use an extension of such a model to detect emerging neurodegeneration in cognitively healthy individuals at risk for dementia. We use BLME to quantify individualized rates of volume loss across the cerebral cortex from the first two MRIs in each person and then extend the BLME model to predict future values for each voxel. We then compare observed values at subsequent time points with the values that were expected from the initial rates of change and identify voxels that are lower than the expected values, indicating accelerated volume loss and neurodegeneration. We apply the model to longitudinal imaging data from cognitively normal participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), some of whom subsequently developed dementia, and two cognitively normal cases who developed pathology-proven frontotemporal lobar degeneration (FTLD). These analyses identified regions of accelerated volume loss prior to or accompanying the earliest symptoms, and expanding across the brain over time, in all cases. The changes were detected in regions that are typical for the likely diseases affecting each patient, including medial temporal regions in patients at risk for Alzheimer's disease, and insular, frontal, and/or anterior/inferior temporal regions in patients with likely or proven FTLD. In the cases where detailed histories were available, the first regions identified were consistent with early symptoms. Furthermore, survival analysis in the ADNI cases demonstrated that the rate of spread of accelerated volume loss across the brain was a statistically significant predictor of time to conversion to dementia. This method for detection of neurodegeneration is a potentially promising approach for identifying early changes due to a variety of diseases, without prior assumptions about what regions are most likely to be affected first in an individual.
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Affiliation(s)
- Yann Cobigo
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States.
| | - Matthew S. Goh
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Amy Wolf
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Adam M. Staffaroni
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - John Kornak
- University of California, San Francisco, Department of Epidemiology and Biostatistics, United States
| | - Bruce L. Miller
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Gil D. Rabinovici
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - William W. Seeley
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Salvatore Spina
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Adam L. Boxer
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | | | - Lei Wang
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences and Department Radiology, United States
| | - Ricardo Allegri
- FLENI Institute of Neurological Research (Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia), Argentina
| | | | - Hiroshi Mori
- Osaka City University Medical School, Department of Neurosciences, Japan
| | | | - Joel Kramer
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
| | - Howard J. Rosen
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, United States
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Toller G, Cobigo Y, Ljubenkov PA, Appleby BS, Dickerson BC, Domoto-Reilly K, Fong JC, Forsberg LK, Gavrilova RH, Ghoshal N, Heuer HW, Knopman DS, Kornak J, Lapid MI, Litvan I, Lucente DE, Mackenzie IR, McGinnis SM, Miller BL, Pedraza O, Rojas JC, Staffaroni AM, Wong B, Wszolek ZK, Boeve BF, Boxer AL, Rosen HJ, Rankin KP. Sensitivity of the Social Behavior Observer Checklist to Early Symptoms of Patients With Frontotemporal Dementia. Neurology 2022; 99:e488-e499. [PMID: 35584922 PMCID: PMC9421596 DOI: 10.1212/wnl.0000000000200582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/08/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Changes in social behavior are common symptoms of frontotemporal lobar degeneration (FTLD) and Alzheimer disease syndromes. For early identification of individual patients and differential diagnosis, sensitive clinical measures are required that are able to assess patterns of behaviors and detect syndromic differences in both asymptomatic and symptomatic stages. We investigated whether the examiner-based Social Behavior Observer Checklist (SBOCL) is sensitive to early behavior changes and reflects disease severity within and between neurodegenerative syndromes. METHODS Asymptomatic individuals and patients with neurodegenerative disease were selected from the multisite ALLFTD cohort study. In a sample of participants with at least 1 time point of SBOCL data, we investigated whether the Disorganized, Reactive, and Insensitive subscales of the SBOCL change as a function of disease stage within and between these syndromes. In a longitudinal subsample with both SBOCL and neuroimaging data, we examined whether change over time on each subscale corresponds to progressive gray matter atrophy. RESULTS A total of 1,082 FTLD pathogenic variant carriers and noncarriers were enrolled (282 asymptomatic, 341 behavioral variant frontotemporal dementia, 114 semantic and 95 nonfluent variant primary progressive aphasia, 137 progressive supranuclear palsy, and 113 Alzheimer disease syndrome). The Disorganized score increased between asymptomatic to very mild (p = 0.016, estimate = -1.10, 95% CI = -1.99 to -0.22), very mild to mild (p = 0.013, estimate = -1.17, 95% CI = -2.08 to -0.26), and mild to moderate/severe (p < 0.001, estimate = -2.00, 95% CI = -2.55 to -1.45) disease stages in behavioral variant frontotemporal dementia regardless of pathogenic variant status. Asymptomatic GRN pathogenic gene variant carriers showed more reactive behaviors (preoccupation with time: p = 0.001, estimate = 1.11, 95% CI = 1.06 to 1.16; self-consciousness: p = 0.003, estimate = 1.77, 95% CI = 1.52 to 2.01) than asymptomatic noncarriers (estimate = 1.01, 95% CI = 0.98 to 1.03; estimate = 1.31, 95% CI = 1.20 to 1.41). The Insensitive score increased to a clinically abnormal level in advanced stages of behavioral variant frontotemporal dementia (p = 0.003, estimate = -0.73, 95% CI = -1.18 to -0.29). Higher scores on each subscale corresponded with higher caregiver burden (p < 0.001). Greater change over time corresponded to greater fronto-subcortical atrophy in the semantic-appraisal and fronto-parietal intrinsically connected networks. DISCUSSION The SBOCL is sensitive to early symptoms and reflects disease severity, with some evidence for progression across asymptomatic and symptomatic stages of FTLD syndromes; thus, it may hold promise for early measurement and monitoring of behavioral symptoms in clinical practice and treatment trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the SBOCL is sensitive to early behavioral changes in FTLD pathogenic variants and early symptomatic individuals in a highly educated patient cohort.
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Affiliation(s)
- Gianina Toller
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL.
| | - Yann Cobigo
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Peter A Ljubenkov
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Brian S Appleby
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bradford C Dickerson
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Kimiko Domoto-Reilly
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Jamie C Fong
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Leah K Forsberg
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Ralitza H Gavrilova
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Nupur Ghoshal
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Hilary W Heuer
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - John Kornak
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Maria I Lapid
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Irene Litvan
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Diane E Lucente
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Ian R Mackenzie
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Scott M McGinnis
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bruce L Miller
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Otto Pedraza
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Julio C Rojas
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Adam M Staffaroni
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bonnie Wong
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Zbigniew K Wszolek
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Brad F Boeve
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Adam L Boxer
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Howard J Rosen
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Katherine P Rankin
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
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Tanguy D, Batrancourt B, Estudillo-Romero A, Baxter JSH, Le Ber I, Bouzigues A, Godefroy V, Funkiewiez A, Chamayou C, Volle E, Saracino D, Rametti-Lacroux A, Morandi X, Jannin P, Levy R, Migliaccio R. An ecological approach to identify distinct neural correlates of disinhibition in frontotemporal dementia. Neuroimage Clin 2022; 35:103079. [PMID: 35700600 PMCID: PMC9194654 DOI: 10.1016/j.nicl.2022.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
Disinhibition is a core symptom of many neurodegenerative diseases, particularly frontotemporal dementia, and is a major cause of stress for caregivers. While a distinction between behavioural and cognitive disinhibition is common, an operational definition of behavioural disinhibition is still missing. Furthermore, conventional assessment of behavioural disinhibition, based on questionnaires completed by the caregivers, often lacks ecological validity. Therefore, their neuroanatomical correlates are non-univocal. In the present work, we used an original behavioural approach in a semi-ecological situation to assess two specific dimensions of behavioural disinhibition: compulsivity and social disinhibition. First, we investigated disinhibition profile in patients compared to controls. Then, to validate our approach, compulsivity and social disinhibition scores were correlated with classic cognitive tests measuring disinhibition (Hayling Test) and social cognition (mini-Social cognition & Emotional Assessment). Finally, we disentangled the anatomical networks underlying these two subtypes of behavioural disinhibition, taking in account the grey (voxel-based morphometry) and white matter (diffusion tensor imaging tractography). We included 17 behavioural variant frontotemporal dementia patients and 18 healthy controls. We identified patients as more compulsive and socially disinhibited than controls. We found that behavioural metrics in the semi-ecological task were related to cognitive performance: compulsivity correlated with the Hayling test and both compulsivity and social disinhibition were associated with the emotion recognition test. Based on voxel-based morphometry and tractography, compulsivity correlated with atrophy in the bilateral orbitofrontal cortex, the right temporal region and subcortical structures, as well as with alterations of the bilateral cingulum and uncinate fasciculus, the right inferior longitudinal fasciculus and the right arcuate fasciculus. Thus, the network of regions related to compulsivity matched the "semantic appraisal" network. Social disinhibition was associated with bilateral frontal atrophy and impairments in the forceps minor, the bilateral cingulum and the left uncinate fasciculus, regions corresponding to the frontal component of the "salience" network. Summarizing, this study validates our semi-ecological approach, through the identification of two subtypes of behavioural disinhibition, and highlights different neural networks underlying compulsivity and social disinhibition. Taken together, these findings are promising for clinical practice by providing a better characterisation of inhibition disorders, promoting their detection and consequently a more adapted management of patients.
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Affiliation(s)
- Delphine Tanguy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - John S H Baxter
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Isabelle Le Ber
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Arabella Bouzigues
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Valérie Godefroy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Aurélie Funkiewiez
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Céline Chamayou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Emmanuelle Volle
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Dario Saracino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Armelle Rametti-Lacroux
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Xavier Morandi
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Pierre Jannin
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Richard Levy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Raffaella Migliaccio
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France.
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28
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Mendez MF. THE IMPLICATIONS OF FRONTOTEMPORAL DEMENTIA FOR BRAIN DYSFUNCTION IN PSYCHOPATHY. Biol Psychol 2022; 171:108342. [PMID: 35487297 DOI: 10.1016/j.biopsycho.2022.108342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Understanding how psychopathy compares with brain disease can help clarify its underlying mechanisms. This literature review is a broad overview of the neurobiology of psychopathic traits in comparison to behavioral variant frontotemporal dementia (bvFTD), a disorder uniquely associated with criminal behavior. In addition to violation of social norms, both psychopathy and bvFTD result in impaired socioemotional perception and empathy, impulsivity, and altered moral judgment. Despite wide areas of decreased function in psychopathy, structural changes are primarily evident in amygdala and, to a lesser extent, anterior insula, whereas in bvFTD neuropathology involves a wider paralimbic region. In psychopathy, relatively intact medial prefrontal and anterior cingulate cortices facilitate theory of mind and psychopathic traits such as deceitfulness and manipulation, bold fearlessness, and risk-taking behavior. In conclusion, many frontotemporal areas are hypoactive in psychopathy and bvFTD, but differences in dysfunctional connectivity in psychopathy vs. direct involvement in bvFTD potentially explain similarities and differences between these two conditions.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology and Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA); Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System.
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29
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Jenkins LM, Wang L, Rosen H, Weintraub S. A transdiagnostic review of neuroimaging studies of apathy and disinhibition in dementia. Brain 2022; 145:1886-1905. [PMID: 35388419 PMCID: PMC9630876 DOI: 10.1093/brain/awac133] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/18/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022] Open
Abstract
Apathy and disinhibition are common and highly distressing neuropsychiatric symptoms associated with negative outcomes in persons with dementia. This paper is a critical review of functional and structural neuroimaging studies of these symptoms transdiagnostically in dementia of the Alzheimer type, which is characterized by prominent amnesia early in the disease course, and behavioural variant frontotemporal dementia, characterized by early social-comportmental deficits. We describe the prevalence and clinical correlates of these symptoms and describe methodological issues, including difficulties with symptom definition and different measurement instruments. We highlight the heterogeneity of findings, noting however, a striking similarity of the set of brain regions implicated across clinical diagnoses and symptoms. These regions involve several key nodes of the salience network, and we describe the functions and anatomical connectivity of these brain areas, as well as present a new theoretical account of disinhibition in dementia. Future avenues for research are discussed, including the importance of transdiagnostic studies, measuring subdomains of apathy and disinhibition, and examining different units of analysis for deepening our understanding of the networks and mechanisms underlying these extremely distressing symptoms.
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Affiliation(s)
- Lisanne M Jenkins
- Correspondence to: Lisanne Jenkins 710 N Lakeshore Drive, Suite 1315 Chicago, IL 60611, USA E-mail:
| | - Lei Wang
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - Howie Rosen
- Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, CA, USA 94158
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA,Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA 60611
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30
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Pillai JA, Bena J, Rothenberg K, Boron B, Leverenz JB. Association of Variation in Behavioral Symptoms With Initial Cognitive Phenotype in Adults With Dementia Confirmed by Neuropathology. JAMA Netw Open 2022; 5:e220729. [PMID: 35238936 PMCID: PMC8895258 DOI: 10.1001/jamanetworkopen.2022.0729] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/29/2021] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Behavioral and psychological symptoms of dementia (BPSDs) in association with amnestic and nonamnestic cognitive phenotypes have not been evaluated across diagnoses of Alzheimer disease pathology (ADP), Lewy body-related pathology (LRP), and mixed pathology (ADP-LRP). OBJECTIVES To determine the clinical phenotypes at the initial visit that are associated with the nature and severity of BPSDs in patients with ADP, LRP, and ADP-LRP. DESIGN, SETTING, AND PARTICIPANTS This retrospective longitudinal cohort study included 2422 participants with neuropathologically confirmed ADP, LRP, or mixed ADP-LRP in the National Alzheimer Coordinating Center database from June 20, 2005, to September 4, 2019. Participants had a mean (SD) interval of 5.5 (2.8) years from initial visit to autopsy. MAIN OUTCOMES AND MEASURES Clinician-determined diagnosis of change across 10 BPSDs (agitation, apathy, depression, delusions, disinhibition, auditory hallucinations, visual hallucinations, irritability, personality change, and rapid eye movement [REM] sleep behavior) and the highest severity score for behavioral change on the Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS A total of 2422 participants (1187 with ADP, 904 with ADP-LRP, and 331 with LRP) were included in the analysis (1446 men [59.7%]; mean [SD] age, 74.4 [10.1] years). Compared with initial amnestic symptoms, executive symptoms were associated with a higher risk for 7 of the 10 BPSDs (hazard ratio [HR] range, 1.28-2.45), and visuospatial symptoms were associated with a higher risk for 2 of the 10 BPSDs (HR range, 1.91-2.51), but neither were associated with a low risk for any BPSD. Language symptoms were associated with a low risk of onset for 3 of 10 BPSDs (HR range, 0.43-0.79) and a high risk for 1 BPSD (personality change) (HR, 1.42 [95% CI, 1.10-1.83]). Participants with LRP had a lower risk for agitation (HR, 0.74 [95% CI, 0.60-0.92]), disinhibition (HR, 0.78 [95% CI, 0.62-0.99]), and irritability (HR, 0.81 [95% CI, 0.68-0.96]) and a higher risk for apathy (HR, 1.19 [95% CI, 1.02-1.38]), depression (HR, 1.32 [95% CI, 1.12-1.55]), auditory (HR, 2.00 [95% CI, 1.37-2.93]) and visual (HR, 2.78 [95% CI, 2.21-3.49]) hallucinations, and REM sleep behavior changes (HR, 4.77 [95% CI, 3.61-6.31]) compared with the ADP group. The ADP-LRP group had a higher risk for delusions (HR, 1.27 [95% CI, 1.08-1.48]), auditory (HR, 1.62 [95% CI, 1.21-2.15]) and visual (HR, 1.57 [95% CI, 1.30-1.89]) hallucinations, and REM sleep behavior changes (HR, 2.10 [95% CI, 1.63-2.70]) than the ADP group and a lower risk for visual hallucinations (HR, 0.56 [95% CI, 0.45-0.71]) and REM sleep behavior changes (HR, 0.44 [95% CI, 0.34-0.57) than the LRP group. Overall, women showed a lower risk of agitation (HR, 0.86 [95% CI, 0.75-0.98]), apathy (HR, 0.79 [95% CI, 0.71-0.87]), visual hallucinations (HR, 0.76 [95% CI, 0.64-0.90]), irritability (HR, 0.77 [95% CI, 0.69-0.86]), and REM sleep behavior change (HR, 0.45 [95% CI, 0.35-0.58]) and a higher risk of depression (HR, 1.26 [95% CI, 1.13-1.41]). Older age was associated with a lower risk of most BPSDs (HR range, 0.98-0.99) except delusions (HR, 1.00 [95% CI, 1.00-1.01]) and auditory hallucinations (HR, 0.99 [95% CI, 0.97-1.00]) and a low NPI-Q composite score (β = -0.07 [95% CI, -0.08 to -0.05]; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that the risks of BPSDs differ with respect to the initial cognitive phenotype, underlying neuropathology, age, and sex. Awareness of these associations could be helpful in dementia management.
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Affiliation(s)
- Jagan A. Pillai
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Kasia Rothenberg
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Psychiatry, Cleveland Clinic, Cleveland, Ohio
| | - Bryce Boron
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
| | - James B. Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio
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31
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Toller G, Zitser J, Sukhanov P, Grant H, Miller BL, Kramer JH, Rosen HJ, Rankin KP, Grinberg LT. Clinical, neuroimaging, and neuropathological characterization of a patient with Alzheimer's disease syndrome due to Pick's pathology. Neurocase 2022; 28:19-28. [PMID: 34402746 PMCID: PMC9472769 DOI: 10.1080/13554794.2021.1936072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The most common neurodegenerative syndrome associated with Pick's disease pathology (PiD) is behavioral variant frontotemporal dementia (bvFTD), which features profound social behavioral changes. Rarely, PiD can manifest as an Alzheimer's disease (AD)-type dementia with early memory impairment. We describe a patient with AD-type dementia and pure PiD pathology who showed slowly progressive memory impairment, early social changes, and paucity of motor symptoms. Atrophy and PiD were found mainly in frontotemporal regions underlying social behavior. This report may help predict the pathology of patients with atypical AD, which will ultimately be critical for enrolling suitable subjects into disease-modifying clinical trials.
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Affiliation(s)
- Gianina Toller
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Zitser
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA.,Movement Disorders Unit, Department of Neurology, Tel Aviv Sourazky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Paul Sukhanov
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Harli Grant
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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Basavaraju R, Feng X, France J, Huey ED, Provenzano FA. Depression Is Associated With Preserved Cortical Thickness Relative to Apathy in Frontotemporal Dementia. J Geriatr Psychiatry Neurol 2022; 35:78-88. [PMID: 33030106 PMCID: PMC8026775 DOI: 10.1177/0891988720964258] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To understand the differential neuroanatomical substrates underlying apathy and depression in Frontotemporal dementia (FTD). METHODS T1-MRIs and clinical data of patients with behavioral and aphasic variants of FTD were obtained from an open database. Cortical thickness was derived, its association with apathy severity and difference between the depressed and not depressed were examined with appropriate covariates. RESULTS Apathy severity was significantly associated with cortical thinning of the lateral parts of the right sided frontal, temporal and parietal lobes. The right sided orbitofrontal, parsorbitalis and rostral anterior cingulate cortex were thicker in depressed compared to patients not depressed. CONCLUSIONS Greater thickness of right sided ventromedial and inferior frontal cortex in depression compared to patients without depression suggests a possible requisite of gray matter in this particular area for the manifestation of depression in FTD. This study demonstrates a method for deriving neuroanatomical patterns across non-harmonized neuroimaging data in a neurodegenerative disease.
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Neurology, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Centre, New York, NY, USA
| | - Xinyang Feng
- Department of Biomedical Engineering, Columbia University Medical Centre, New York, NY, USA
| | - Jeanelle France
- Department of Neurology, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Centre, New York, NY, USA
| | - Edward D. Huey
- Division of Geriatric Psychiatry, Department of Psychiatry, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, and the Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Division of Aging and Dementia, Department of Neurology, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, and the Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. Feng is now with Research Scientist at Facebook Inc., Menlo Park, CA, USA
| | - Frank A. Provenzano
- Department of Neurology, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Centre, New York, NY, USA
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33
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Le C, Finger E. Pharmacotherapy for Neuropsychiatric Symptoms in Frontotemporal Dementia. CNS Drugs 2021; 35:1081-1096. [PMID: 34426949 DOI: 10.1007/s40263-021-00854-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Despite significant progress in the understanding of the frontotemporal dementias (FTDs), there remains no disease-modifying treatment for these conditions, and limited effective symptomatic treatment. Behavioural variant frontotemporal dementia (bvFTD) is the most common FTD syndrome, and is characterized by severe impairments in behaviour, personality and cognition. Neuropsychiatric symptoms are common features of bvFTD but are present in the other FTD syndromes. Current treatment strategies therefore focus on ameliorating the neuropsychiatric features. Here we review the rationale for current treatments related to each of the main neuropsychiatric symptoms forming the diagnostic criteria for bvFTD relevant to all FTD subtypes, and two additional symptoms not currently part of the diagnostic criteria: lack of insight and psychosis. Given the paucity of effective treatments for these symptoms, we highlight how contributing mechanisms delineated in cognitive neuroscience may inform future approaches to clinical trials and more precise symptomatic treatments for FTDs.
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Affiliation(s)
- Christine Le
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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34
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Silverman HE, Gazes Y, Barker MS, Manoochehri M, Goldman JS, Wassermann EM, Tierney MC, Cosentino S, Grafman J, Huey ED. Frontal Pole Hypometabolism Linked to Reduced Prosocial Sexual Behaviors in Frontotemporal Dementia and Corticobasal Syndrome. J Alzheimers Dis 2021; 77:821-830. [PMID: 32741826 DOI: 10.3233/jad-200346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Changes in sexual behaviors in frontotemporal dementia (FTD) are common and multifaceted, but not well characterized. OBJECTIVE To characterize changes in sexual behaviors and intimacy in FTD compared to corticobasal syndrome (CBS) and normal controls (NC), and to evaluate the neuroanatomical associations of these changes. METHODS Spouses of 30 FTD patients, 20 CBS patients, and 35 NC completed the Sexual Symptoms in Neurological Illness and Injury Questionnaire (SNIQ), which captures changes in sexual interest, inappropriate sexual behaviors, and prosocial sexual behaviors. 25 patients with FTD and 14 patients with CBS also received 18-flouorodeoxyglucose positron-emission topography (18FDG-PET) scans to determine the metabolic changes associated with these symptoms. RESULTS FTD patients showed a greater increase in inappropriate sexual behaviors than CBS patients [p = 0.009] and NC [p < 0.001] and a greater decrease in prosocial sexual behaviors than CBS patients [p = 0.026] and NC [p < 0.001]. Groups did not differ in change in sexual interest. Among both patient groups, the most common change was decreased prosocial sexual behaviors p < 0.01. Hypometabolism in Brodmann's Area 10 (BA10), within the right frontal pole, correlated with decreased prosocial sexual behaviors [p(FWE-corr) <0.05, k = 44]. No anatomical associations were found with other sexual changes. CONCLUSION Decreased prosocial sexual behavior was associated with hypometabolism in BA 10, an area tied to social knowledge and theory of mind, supporting the idea that changes reflect social-cognitive deficits due to frontal dysfunction.
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Affiliation(s)
- Hannah E Silverman
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yunglin Gazes
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan S Barker
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Masood Manoochehri
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jill S Goldman
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Michael C Tierney
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie Cosentino
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan Grafman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Brain Injury Research Program, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Edward D Huey
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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35
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Bocchetta M, Malpetti M, Todd EG, Rowe JB, Rohrer JD. Looking beneath the surface: the importance of subcortical structures in frontotemporal dementia. Brain Commun 2021; 3:fcab158. [PMID: 34458729 PMCID: PMC8390477 DOI: 10.1093/braincomms/fcab158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/15/2022] Open
Abstract
Whilst initial anatomical studies of frontotemporal dementia focussed on cortical involvement, the relevance of subcortical structures to the pathophysiology of frontotemporal dementia has been increasingly recognized over recent years. Key structures affected include the caudate, putamen, nucleus accumbens, and globus pallidus within the basal ganglia, the hippocampus and amygdala within the medial temporal lobe, the basal forebrain, and the diencephalon structures of the thalamus, hypothalamus and habenula. At the most posterior aspect of the brain, focal involvement of brainstem and cerebellum has recently also been shown in certain subtypes of frontotemporal dementia. Many of the neuroimaging studies on subcortical structures in frontotemporal dementia have been performed in clinically defined sporadic cases. However, investigations of genetically- and pathologically-confirmed forms of frontotemporal dementia are increasingly common and provide molecular specificity to the changes observed. Furthermore, detailed analyses of sub-nuclei and subregions within each subcortical structure are being added to the literature, allowing refinement of the patterns of subcortical involvement. This review focuses on the existing literature on structural imaging and neuropathological studies of subcortical anatomy across the spectrum of frontotemporal dementia, along with investigations of brain–behaviour correlates that examine the cognitive sequelae of specific subcortical involvement: it aims to ‘look beneath the surface’ and summarize the patterns of subcortical involvement have been described in frontotemporal dementia.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Emily G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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36
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Zhang L, Cao G, Liu Z, Bai Y, Li D, Liu J, Yin H. The gray matter volume of bilateral inferior temporal gyrus in mediating the association between psychological stress and sleep quality among Chinese college students. Brain Imaging Behav 2021; 16:557-564. [PMID: 34417968 DOI: 10.1007/s11682-021-00524-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
The role of brain regions in the relationship between psychological stress and sleep quality is unclear. This study investigates the neuroanatomical basis of the association between psychological stress and sleep quality. Data were collected using the Pittsburgh Sleep Quality Index, the Psychosomatic Tension Relaxation Inventory, and voxel-based morphometry among 318 healthy students. The results showed that psychological stress was negatively correlated with sleep quality. According to the mediation analysis results, the correlation between psychological stress and sleep quality was partially mediated by the region of the bilateral inferior temporal gyrus. These findings suggest that there is a strong link between sleep quality and psychological stress, highlighting the gray matter volume of the bilateral inferior temporal gyrus related to emotional processing, which plays an essential role in improving sleep quality.
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Affiliation(s)
- Li Zhang
- School of Education Science, Hunan Normal University, Changsha, 410081, China.,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China
| | - Gege Cao
- School of Education Science, Hunan Normal University, Changsha, 410081, China.,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China
| | - Zhenghua Liu
- Changsha Institute of Educational Sciences, Changsha, 410081, China
| | - Youling Bai
- School of Education Science, Hunan Normal University, Changsha, 410081, China.,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China
| | - Dan Li
- School of Education Science, Hunan Normal University, Changsha, 410081, China. .,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China.
| | - Jinping Liu
- Hunan Provincial Key Laboratory of Intelligent Computing and Language Information Processing, Hunan Normal University, Changsha, 410081, Hunan, China
| | - Huazhan Yin
- School of Education Science, Hunan Normal University, Changsha, 410081, China. .,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China.
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37
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Magrath Guimet N, Miller BL, Allegri RF, Rankin KP. What Do We Mean by Behavioral Disinhibition in Frontotemporal Dementia? Front Neurol 2021; 12:707799. [PMID: 34305805 PMCID: PMC8292604 DOI: 10.3389/fneur.2021.707799] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Behavioral variant frontotemporal dementia, unlike other forms of dementia, is primarily characterized by changes in behavior, personality, and language, with disinhibition being one of its core symptoms. However, because there is no single definition that captures the totality of behavioral symptoms observed in these patients, disinhibition is an umbrella term used to encompass socially disruptive or morally unacceptable behaviors that may arise from distinct neural etiologies. This paper aims to review the current knowledge about behavioral disinhibition in this syndrome, considering the cultural factors related to our perception of behavior, the importance of phenomenological interpretation, neuroanatomy, the brain networks involved and, finally, a new neuroscientific theory that offers a conceptual framework for understanding the diverse components of behavioral disinhibition in this neurodegenerative disorder.
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Affiliation(s)
- Nahuel Magrath Guimet
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Cognitive Neurology, Neuropsychiatry and Neuropsychology, Instituto Neurológico Fleni, Buenos Aires, Argentina
| | - Bruce L Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ricardo F Allegri
- Department of Cognitive Neurology, Neuropsychiatry and Neuropsychology, Instituto Neurológico Fleni, Buenos Aires, Argentina.,Department of Neurosciences, Universidad de la Costa (CUC), Barranquilla, Colombia
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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38
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Atee M, Morris T, Macfarlane S, Cunningham C. Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors. J Pain Symptom Manage 2021; 61:1215-1226. [PMID: 33068708 DOI: 10.1016/j.jpainsymman.2020.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Pain is linked to behaviors and psychological symptoms of dementia (BPSD); however, it often remains underrecognized in this population. OBJECTIVES We aimed to investigate the prevalence and intensity of pain in people living in aged care homes with BPSD and by dementia subtypes and the association between pain intensity and BPSD. METHODS A 1-year retrospective cross-sectional analysis was conducted on BPSD and the presence of pain in referrals to a national BPSD support service using the Neuropsychiatric Inventory and PainChek®, respectively. Referrals were categorized into two groups: pain group and no pain group. RESULTS Of the 479 referrals (81.9 ± 8.3 years old) included in the analysis, two-thirds (65.6%) had pain identified, with almost half (48.4%) of these categorized as experiencing moderate-severe pain. Pain was highly prevalent (range: 54.6-78.6%) in all subtypes of dementia, particularly in mixed dementia and dementia with Lewy bodies. Compared with the no pain group, the pain group had 25.3% more neuropsychiatric behaviors, 33.6% higher total severity of these behaviors, and 31.4% higher total distress caused to caregivers. For all results, effect sizes were small to medium (η²p = 0.04-0.06). Despite a high prevalence of aggressive or agitated behaviors across the entire group, the pain group was 3.8 times more likely to experience these behaviors than referrals not in pain. CONCLUSION There is a strong need to consider the possibility of pain as a contributor to behavioral changes in aged care residents living with dementia.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia; Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia.
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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39
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Fahed M, Steffens DC. Apathy: Neurobiology, Assessment and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:181-189. [PMID: 33888648 PMCID: PMC8077060 DOI: 10.9758/cpn.2021.19.2.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Apathy is a highly prevalent, disabling and treatment resistant syndrome. It is defined as a quantitative reduction of goal- directed activity in comparison to the patient’s previous level of in multiple dimensions including behavior/cognition, emotion and social interaction. It has been described in major depressive disorder, Alzheimer’s disease, frontotemporal dementia, Parkinson’s Disease, cerebrovascular disease, and vascular dementia, among others. This review will address the neuropsychology and associated neurobiological underpinnings of apathy in the above conditions, identify specific methods to assess apathy clinically, and review the literature on managing apathy across these various disorders.
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Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
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40
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Nakamura Y, Koike S. Association of Disinhibited Eating and Trait of Impulsivity With Insula and Amygdala Responses to Palatable Liquid Consumption. Front Syst Neurosci 2021; 15:647143. [PMID: 34012386 PMCID: PMC8128107 DOI: 10.3389/fnsys.2021.647143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/09/2021] [Indexed: 12/31/2022] Open
Abstract
Eating behavior is not only influenced by the current energy balance, but also by the behavioral characteristics of eating. One of the recognized eating behavior constructs is ‘disinhibited eating,’ which refers to the tendency to overeat in response to negative emotional states or the presence of highly palatable foods. Food-related disinhibition is involved in binge eating, weight gain, and obesity and is also associated with the trait of impulsivity, which in turn, is linked to weight gain or maladaptive eating. However, the relationships among food-related disinhibition, the trait of impulsivity, and the neural substrates of eating behaviors in adolescence remain unclear. Therefore, we designed a functional magnetic resonance imaging (fMRI) study to examine the associations between brain responses to palatable liquid consumption and disinhibited eating behavior or impulsivity in healthy adolescents. Thirty-four adolescents (mean age ± standard deviation = 17.12 ± 1.91 years, age range = 14–19 years, boys = 15, girls = 19) participated in this study. Disinhibited eating was assessed with the disinhibition subscale of the Three-Factor Eating Questionnaire, while impulsivity was assessed using the Barratt impulsiveness scale. Participants received two fMRI sessions−a palatable liquid consumption fMRI and a resting-state fMRI. The fMRI experiment showed that increased disinhibited eating was positively associated with a greater insular response to palatable liquid consumption, while increased impulsivity was positively correlated with a greater amygdala response. The resting-state fMRI experiment showed that increased disinhibited eating was positively correlated with strengthened intrinsic functional connectivity between the insula and the amygdala, adjusting for sex (estimates of the beta coefficients = 0.146, standard error = 0.068, p = 0.040). Given that the amygdala and insular cortex are structurally and functionally connected and involved in trait impulsivity and ingestive behavior, our findings suggest that increased disinhibited eating would be associated with impulsivity via strengthened intrinsic functional connectivity between the insula and amygdala and linked to maladaptive eating.
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Affiliation(s)
- Yuko Nakamura
- UTokyo Center for Integrative Science of Human Behavior, The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- UTokyo Center for Integrative Science of Human Behavior, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence, The University of Tokyo Institutes for Advanced Study, Tokyo, Japan.,UTokyo Institute for Diversity and Adaptation of Human Mind, The University of Tokyo, Tokyo, Japan.,Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
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41
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Singleton E, Hansson O, Pijnenburg YAL, La Joie R, Mantyh WG, Tideman P, Stomrud E, Leuzy A, Johansson M, Strandberg O, Smith R, Berendrecht E, Miller BL, Iaccarino L, Edwards L, Strom A, Wolters EE, Coomans E, Visser D, Golla SSV, Tuncel H, Bouwman F, Van Swieten JC, Papma JM, van Berckel B, Scheltens P, Dijkstra AA, Rabinovici GD, Ossenkoppele R. Heterogeneous distribution of tau pathology in the behavioural variant of Alzheimer's disease. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325497. [PMID: 33850001 PMCID: PMC8292599 DOI: 10.1136/jnnp-2020-325497] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/16/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The clinical phenotype of the rare behavioural variant of Alzheimer's disease (bvAD) is insufficiently understood. Given the strong clinico-anatomical correlations of tau pathology in AD, we investigated the distribution of tau deposits in bvAD, in-vivo and ex-vivo, using positron emission tomography (PET) and postmortem examination. METHODS For the tau PET study, seven amyloid-β positive bvAD patients underwent [18F]flortaucipir or [18F]RO948 PET. We converted tau PET uptake values into standardised (W-)scores, adjusting for age, sex and mini mental state examination in a 'typical' memory-predominant AD (n=205) group. W-scores were computed within entorhinal, temporoparietal, medial and lateral prefrontal, insular and whole-brain regions-of-interest, frontal-to-entorhinal and frontal-to-parietal ratios and within intrinsic functional connectivity network templates. For the postmortem study, the percentage of AT8 (tau)-positive area in hippocampus CA1, temporal, parietal, frontal and insular cortices were compared between autopsy-confirmed patients with bvAD (n=8) and typical AD (tAD;n=7). RESULTS Individual regional W-scores ≥1.96 (corresponding to p<0.05) were observed in three cases, that is, case #5: medial prefrontal cortex (W=2.13) and anterior default mode network (W=3.79), case #2: lateral prefrontal cortex (W=2.79) and salience network (W=2.77), and case #7: frontal-to-entorhinal ratio (W=2.04). The remaining four cases fell within the normal distributions of the tAD group. Postmortem AT8 staining indicated no group-level regional differences in phosphorylated tau levels between bvAD and tAD (all p>0.05). CONCLUSIONS Both in-vivo and ex-vivo, patients with bvAD showed heterogeneous distributions of tau pathology. Since key regions involved in behavioural regulation were not consistently disproportionally affected by tau pathology, other factors are more likely driving the clinical phenotype in bvAD.
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Affiliation(s)
- Ellen Singleton
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - William G Mantyh
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Pontus Tideman
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital Lund, Lund, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital Lund, Lund, Sweden
| | - Antoine Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ruben Smith
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Evi Berendrecht
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Amelia Strom
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Emma E Wolters
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Emma Coomans
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Denise Visser
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sandeep S V Golla
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hayel Tuncel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Femke Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Janne M Papma
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anke A Dijkstra
- Department of Pathology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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42
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Sheelakumari R, Bineesh C, Varghese T, Kesavadas C, Verghese J, Mathuranath PS. Neuroanatomical correlates of apathy and disinhibition in behavioural variant frontotemporal dementia. Brain Imaging Behav 2021; 14:2004-2011. [PMID: 31273672 DOI: 10.1007/s11682-019-00150-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroanatomical correlates of apathy and disinhibition, behavioral abnormalities in behavioral variant Frontotemporal dementia (bvFTD) remain unclear. In this study 45 participants (25 bvFTD patients and 20 controls) provided data on clinical, neuropsychological, behavioral (on Frontal Systems Behavior (FrSBe) Scale), cortical volume (on voxel-based morphometry (VBM)) and tract based spatial fractional anisotropy ((FA) on magnetic resonance imaging (MRI), allowing examination of the neural correlates of apathy and disinhibition. The patients with bvFTD had predominant grey matter loss and corresponding white matter fractional anisotropy reduction in the frontal and temporal lobe compared to the controls. Grey matter loss in frontal, temporal and limbic structures correlated with apathy and degeneration in temporal limbic brain areas correlated with disinhibition. FA changes in inferior fronto-occipital fasciculus and forceps minor correlated with apathy and fibre integrity changes in the superior longitudinal fasciculus correlated with disinhibition. The current study suggests that apathy and disinhibition arises due to changes in the frontal, temporal and limbic brain areas in bvFTD.
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Affiliation(s)
- Raghavan Sheelakumari
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Tinu Varghese
- Department of Electronics and Instrumentation, Noorul Islam University, Kumaracoil, Thuckalay, Tamilnadu, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Joe Verghese
- Integrated Divisions of Cognitive and Motor Aging (Neurology) and Geriatrics (Medicine), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pavagada S Mathuranath
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Banglore, Karnataka, 560029, India.
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Shaw SR, El-Omar H, Roquet D, Hodges JR, Piguet O, Ahmed RM, Whitton AE, Irish M. Uncovering the prevalence and neural substrates of anhedonia in frontotemporal dementia. Brain 2021; 144:1551-1564. [PMID: 33843983 DOI: 10.1093/brain/awab032] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Much of human behaviour is motivated by the drive to experience pleasure. The capacity to envisage pleasurable outcomes and to engage in goal-directed behaviour to secure these outcomes depends upon the integrity of frontostriatal circuits in the brain. Anhedonia refers to the diminished ability to experience, and to pursue, pleasurable outcomes, and represents a prominent motivational disturbance in neuropsychiatric disorders. Despite increasing evidence of motivational disturbances in frontotemporal dementia (FTD), no study to date has explored the hedonic experience in these syndromes. Here, we present the first study to document the prevalence and neural correlates of anhedonia in FTD in comparison with Alzheimer's disease, and its potential overlap with related motivational symptoms including apathy and depression. A total of 172 participants were recruited, including 87 FTD, 34 Alzheimer's disease, and 51 healthy older control participants. Within the FTD group, 55 cases were diagnosed with clinically probable behavioural variant FTD, 24 presented with semantic dementia, and eight cases had progressive non-fluent aphasia (PNFA). Premorbid and current anhedonia was measured using the Snaith-Hamilton Pleasure Scale, while apathy was assessed using the Dimensional Apathy Scale, and depression was indexed via the Depression, Anxiety and Stress Scale. Whole-brain voxel-based morphometry analysis was used to examine associations between grey matter atrophy and levels of anhedonia, apathy, and depression in patients. Relative to controls, behavioural variant FTD and semantic dementia, but not PNFA or Alzheimer's disease, patients showed clinically significant anhedonia, representing a clear departure from pre-morbid levels. Voxel-based morphometry analyses revealed that anhedonia was associated with atrophy in an extended frontostriatal network including orbitofrontal and medial prefrontal, paracingulate and insular cortices, as well as the putamen. Although correlated on the behavioural level, the neural correlates of anhedonia were largely dissociable from that of apathy, with only a small region of overlap detected in the right orbitofrontal cortices whilst no overlapping regions were found between anhedonia and depression. This is the first study, to our knowledge, to demonstrate profound anhedonia in FTD syndromes, reflecting atrophy of predominantly frontostriatal brain regions specialized for hedonic tone. Our findings point to the importance of considering anhedonia as a primary presenting feature of behavioural variant FTD and semantic dementia, with distinct neural drivers to that of apathy or depression. Future studies will be essential to address the impact of anhedonia on everyday activities, and to inform the development of targeted interventions to improve quality of life in patients and their families.
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Affiliation(s)
- Siobhán R Shaw
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.,The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia.,Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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44
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Khoury R, Liu Y, Sheheryar Q, Grossberg GT. Pharmacotherapy for Frontotemporal Dementia. CNS Drugs 2021; 35:425-438. [PMID: 33840052 DOI: 10.1007/s40263-021-00813-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia is a heterogeneous spectrum of neurodegenerative disorders. The neuropathological inclusions are tau proteins, TAR DNA binding protein 43 kDa-TDP-43, or fused in sarcoma-ubiquitinated inclusions. Genetically, several autosomal mutations account for the heritability of the disorder. Phenotypically, frontotemporal dementia can present with a behavioral variant or a language variant called primary progressive aphasia. To date, there are no approved symptomatic or disease-modifying treatments for frontotemporal dementia. Currently used therapies are supported by low-level of evidence (mostly uncontrolled) studies. The off-label use of drugs is also limited by their side-effect profile including an increased risk of confusion, parkinsonian symptoms, and risk of mortality. Emerging disease-modifying treatments currently target the progranulin and the expansion on chromosome 9 open reading frame 72 genes as well as tau deposits. Advancing our understanding of the pathophysiology of the disease and improving the design of future clinical trials are much needed to optimize the chances to obtain positive outcomes.
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Affiliation(s)
- Rita Khoury
- Department of Psychiatry and Clinical Psychology, Saint Georges Hospital University Medical Center, Youssef Sursock Street, PO Box 166378, Beirut, Lebanon. .,Faculty of Medicine, University of Balamand, Beirut, Lebanon. .,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | - Yu Liu
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Quratulanne Sheheryar
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
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45
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Tissot C, Therriault J, Pascoal TA, Chamoun M, Lussier FZ, Savard M, Mathotaarachchi SS, L. Benedet A, Thomas EM, Parsons M, Nasreddine Z, Rosa‐Neto P, Gauthier S. Association between regional tau pathology and neuropsychiatric symptoms in aging and dementia due to Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12154. [PMID: 33816761 PMCID: PMC8012244 DOI: 10.1002/trc2.12154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are frequent in aging and Alzheimer's disease (AD). Here we study the relationship between NPS and AD pathologies in vivo. METHOD Two hundred and twenty-one individuals from the TRIAD cohort (143 cognitively unimpaired, 52 mild cognitive impairment, and 26 AD) underwent [18F]MK6240-tau-positron emission tomography (PET), [18F]AZD4694-amyloid-PET, magnetic resonance imaging, and neuropsychological evaluations. Spearman correlations and voxel-based regression models evaluated the relationship between Neuropsychiatric Inventory Questionnaire (NPI-Q) scores, and tau-PET, amyloid-PET, and voxel-based morphometry. RESULTS Fifty percent of individuals presented NPS; these correlated with tau, not amyloid beta or neurodegeneration. Associations between NPI-Q score and tau-PET were stronger in the parietal association area, superior frontal, temporal, and medial occipital lobes. NPI-Q domains associated with distinct patterns of tau uptake. CONCLUSIONS NPS are predominantly related to tau in aging and dementia. Regions affected are part of the behavioral circuits, and vulnerable to early AD pathology. Domain-specific analyses showed NPS are related to the AD pathophysiological processes in a symptom-specific manner.
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Affiliation(s)
- Cécile Tissot
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Joseph Therriault
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Tharick A. Pascoal
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Mira Chamoun
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Firoza Z. Lussier
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Melissa Savard
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Sulantha S. Mathotaarachchi
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Andréa L. Benedet
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Emilie M. Thomas
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Marlee Parsons
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Ziad Nasreddine
- MoCA Clinic and InstituteNeuro‐Rive‐SudGreenfield ParkQuebecCanada
| | - Pedro Rosa‐Neto
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- Translational Neuroimaging Laboratory‐McGill UniversityVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
| | - Serge Gauthier
- McGill University Research Centre for Studies in AgingVerdunQuebecCanada
- McGill UniversityMontrealQuebecCanada
- Douglas Hospital Research CentreVerdunQuebecCanada
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46
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Curet Burleson AX, Pham NTT, Buciuc M, Botha H, Duffy JR, Clark HM, Utianski RL, Machulda MM, Baker MC, Rademakers R, Lowe VJ, Whitwell JL, Josephs KA. Neurobehavioral Characteristics of FDG-PET Defined Right-Dominant Semantic Dementia: A Longitudinal Study. Dement Geriatr Cogn Disord 2021; 50:17-28. [PMID: 33756466 PMCID: PMC8243786 DOI: 10.1159/000513979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Semantic dementia (SD) is characterized by fluent speech, anomia, and loss of word and object knowledge with varying degrees of right and left anterior-medial temporal lobe hypometabolism on [18F] fluorodeoxyglucose (FDG)-PET. We assessed neurobehavioral features in SD patients across 3 FDG-PET-defined metabolic patterns and investigated progression over time. METHODS Thirty-four patients with SD who completed FDG-PET were classified into a left- and right-dominant group based on the degree of hypometabolism in each temporal lobe. The left-dominant group was further subdivided depending on whether hypometabolism in the right temporal lobe was more or less than 2 standard deviations from controls (left+ group). Neurobehavioral characteristics determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) were compared across groups. Progression of NPI-Q scores and FDG-PET hypometabolism was assessed in 14 patients with longitudinal follow-up. RESULTS The right-dominant group performed worse on the NPI-Q and had a greater frequency of abnormal behaviors and more severe disinhibition compared to the left-dominant group. Performance on the NPI-Q and severity of disinhibition correlated with right medial and lateral, but not left, temporal lobe hypometabolism. Severity of abnormal behaviors worsened over time in most left-dominant and left+ patients but appeared to improve in the 2 right-dominant patients with longitudinal follow-up. All groups showed progressive worsening of metabolism in both temporal lobes over time, with hypometabolism spreading from anteromedial to posterior temporal regions. However, the degree of temporal lobe asymmetry remained relatively constant over time. CONCLUSION In SD, neurobehavioral features, especially disinhibition, are associated with right medial and lateral temporal lobe hypometabolism and commonly develop over time even in patients that present with left-dominant patterns of hypometabolism.
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Affiliation(s)
- Alexis X Curet Burleson
- Medical School of Puerto Rico, Rio Piedras Campus, Rio Piedras, Puerto Rico
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA,
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47
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Fathy YY, Hoogers SE, Berendse HW, van der Werf YD, Visser PJ, de Jong FJ, van de Berg WDJ. Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis. Brain Imaging Behav 2021; 14:2799-2816. [PMID: 31011951 PMCID: PMC7648006 DOI: 10.1007/s11682-019-00099-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The insular cortex is proposed to function as a central brain hub characterized by wide-spread connections and diverse functional roles. As a result, its centrality in the brain confers high metabolic demands predisposing it to dysfunction in disease. However, the functional profile and vulnerability to degeneration varies across the insular sub-regions. The aim of this systematic review and meta-analysis is to summarize and quantitatively analyze the relationship between insular cortex sub-regional atrophy, studied by voxel based morphometry, with cognitive and neuropsychiatric deficits in frontotemporal dementia (FTD), Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB). We systematically searched through Pubmed and Embase and identified 519 studies that fit our criteria. A total of 41 studies (n = 2261 subjects) fulfilled the inclusion criteria for the meta-analysis. The peak insular coordinates were pooled and analyzed using Anatomic Likelihood Estimation. Our results showed greater left anterior insular cortex atrophy in FTD whereas the right anterior dorsal insular cortex showed larger clusters of atrophy in AD and PD/DLB. Yet contrast analyses did not reveal significant differences between disease groups. Functional analysis showed that left anterior insular cortex atrophy is associated with speech, emotion, and affective-cognitive deficits, and right dorsal atrophy with perception and cognitive deficits. In conclusion, insular sub-regional atrophy, particularly the anterior dorsal region, may contribute to cognitive and neuropsychiatric deficits in neurodegeneration. Our results support anterior insular cortex vulnerability and convey the differential involvement of the insular sub-regions in functional deficits in neurodegenerative diseases.
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Affiliation(s)
- Yasmine Y Fathy
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, Netherlands.
| | - Susanne E Hoogers
- Department of Neurology, Erasmus Medical Center, Postbus, 2040 3000, Rotterdam, CA, Netherlands
| | - Henk W Berendse
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy and Neurosciences, Section Neuropsychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Pieter J Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Frank J de Jong
- Department of Neurology, Erasmus Medical Center, Postbus, 2040 3000, Rotterdam, CA, Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, Netherlands
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48
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Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Eating Disorders in Frontotemporal Dementia and Alzheimer's Disease: Evaluation of Brain Perfusion Correlates Using 99mTc-HMPAO SPECT with Brodmann Areas Analysis. J Alzheimers Dis 2021; 80:1657-1667. [PMID: 33720894 DOI: 10.3233/jad-201434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Eating disorders (ED) in dementia represent a significant impairment affecting patients' and caregivers' lives. In frontotemporal dementia (FTD), ED include overeating, sweet food preference, stereotypical eating, and hyperorality, while in Alzheimer's disease (AD), anorexia and appetite loss are the most common ED. OBJECTIVE The aim of our study was to highlight Brodmann areas (BAs) implicated specifically in the appearance of ED in FTD and AD. METHODS We studied 141 patients, 75 with FTD and 66 with AD. We used the NeuroGamTM software on the reconstructed single photon emission computed tomography-SPECT data for the automated comparison of BAs perfusion on the left (L) and right (R) hemisphere with perfusion in corresponding BAs of a normal database. RESULTS The FTD group included 27 men and 48 women, age (mean±SD) 65.8±8.5 years, duration of disease 3.4±3.3 years, Mini-Mental State Examination (MMSE) 17.9±8.6, ED score on Neuropsychiatric Inventory (NPI) 4.7±8.5. ED in FTD were correlated with hypoperfusion in right anterior and dorsolateral prefrontal cortices (BAs 10R, 46R), left orbitofrontal cortex (BA 12L), orbital part of the right inferior frontal gyrus (BA 47R), and left parahippocampal gyrus (BA 36L). The AD group included 21 men and 45 women, age (mean±SD) 70.2±8.0 years, duration of disease 3.3±2.4 years, MMSE 20.2±6, ED-NPI score 2.7±3.9. ED in AD were correlated with hypoperfusion in left inferior temporal cortex (BA 20L). CONCLUSION SPECT imaging with automated mapping of brain cortex could contribute to the understanding of the neural networks involved in the manifestation of ED in dementia.
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Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Nikolaos Sifakis
- Nuclear Medicine Department, "Alexandra" General Hospital, Athens, Greece
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, Athens, Greece
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, Athens, Greece
| | | | - Dimitra Sali
- Neurology Department, Evrokliniki, Athens, Greece
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Ioannis Tsougos
- Medical Physics Department, Medical School, University of Thessaly, Greece
| | | | | | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, Athens, Greece.,Memory Disorders Clinic, Medical Center, Athens, Greece
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49
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Petitet P, Scholl J, Attaallah B, Drew D, Manohar S, Husain M. The relationship between apathy and impulsivity in large population samples. Sci Rep 2021; 11:4830. [PMID: 33649399 PMCID: PMC7921138 DOI: 10.1038/s41598-021-84364-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Apathy and impulsivity are debilitating conditions associated with many neuropsychiatric conditions, and expressed to variable degrees in healthy people. While some theories suggest that they lie at different ends of a continuum, others suggest their possible co-existence. Surprisingly little is known, however, about their empirical association in the general population. Here, gathering data from six large studies (\documentclass[12pt]{minimal}
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\begin{document}$$n = 3755$$\end{document}n=3755), we investigated the relationship between measures of apathy and impulsivity in young adults. The questionnaires included commonly used self-assessment tools—Apathy Evaluation Scale, Barratt Impulsiveness Scale (BIS-11) and UPPS-P Scale—as well as a more recent addition, the Apathy Motivation Index (AMI). Remarkably, across datasets and assessment tools, global measures of apathy and impulsivity correlated positively. However, analysis of sub-scale scores revealed a more complex relationship. Although most dimensions correlated positively with one another, there were two important exceptions revealed using the AMI scale. Social apathy was mostly negatively correlated with impulsive behaviour, and emotional apathy was orthogonal to all other sub-domains. These results suggest that at a global level, apathy and impulsivity do not exist at distinct ends of a continuum. Instead, paradoxically, they most often co-exist in young adults. Processes underlying social and emotional apathy, however, appear to be different and dissociable from behavioural apathy and impulsivity.
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Affiliation(s)
- Pierre Petitet
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.
| | - Jacqueline Scholl
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK
| | - Bahaaeddin Attaallah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Daniel Drew
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
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50
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Regional prefrontal cortical atrophy predicts specific cognitive-behavioral symptoms in ALS-FTD. Brain Imaging Behav 2021; 15:2540-2551. [PMID: 33587281 DOI: 10.1007/s11682-021-00456-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 01/01/2023]
Abstract
Amyotrophic Lateral Sclerosis-Frontotemporal Dementia (ALS-FTD) may present typical behavioral variant FTD symptoms. This study aims to determine whether profile and severity of cognitive-behavioral symptoms in ALS/ALS-FTD are predicted by regional cortical atrophy. The hypothesis is that executive dysfunction can be predicted by dorsolateral prefrontal cortical (dlPFC) atrophy, apathy by dorsomedial PFC (dmPFC) and anterior cingulate cortical (ACC) atrophy, disinhibition by orbitofrontal cortical (OFC) atrophy. 3.0 Tesla MRI scans were acquired from 22 people with ALS or ALS-FTD. Quantitative cortical thickness analysis was performed with FreeSurfer. A priori-defined regions of interest (ROI) were used to measure cortical thickness in each participant and calculate magnitude of atrophy in comparison to 115 healthy controls. Spearman correlations were used to evaluate associations between frontal ROI cortical thickness and cognitive-behavioral symptoms, measured by Neuropsychiatric Inventory Questionnaire (NPI-Q) and Clinical Dementia Rating (CDR) scale. ALS-FTD participants exhibited variable degrees of apathy (NPI-Q/apathy: 1.6 ± 1.2), disinhibition (NPI-Q/disinhibition: 1.2 ± 1.2), executive dysfunction (CDR/judgment-problem solving: 1.7 ± 0.8). Within the ALS-FTD group, executive dysfunction correlated with dlPFC atrophy (ρ:-0.65;p < 0.05); similar trends were seen for apathy with ACC (ρ:-0.53;p < 0.10) and dmPFC (ρ:-0.47;p < 0.10) atrophy, for disinhibition with OFC atrophy (ρ:-0.51;p < 0.10). Compared to people with ALS, those with ALS-FTD showed more diffuse atrophy involving precentral gyrus, prefrontal, temporal regions. Profile and severity of cognitive-behavioral symptoms in ALS-FTD are predicted by regional prefrontal atrophy. These findings are consistent with established brain-behavior models and support the role of quantitative MRI in diagnosis, management, counseling, monitoring and prognostication for a neurodegenerative disorder with diverse phenotypes.
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