1
|
Cárdenas-Belaunzarán J, Cerrillo-Avila KA. Visual Agnosia Mimicking Memory Impairment: A Case Report of Posterior Cortical Atrophy. Neuroophthalmology 2023; 48:30-36. [PMID: 38357623 PMCID: PMC10863342 DOI: 10.1080/01658107.2023.2257311] [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: 03/23/2023] [Accepted: 09/01/2023] [Indexed: 02/16/2024] Open
Abstract
Vision specialists will benefit from increased awareness of posterior cortical atrophy (PCA) syndrome. Failure to adequately identify the chief complaint as a visual symptom may lead to incorrect diagnosis or diagnostic delay. A previously healthy, 59-year-old woman presented with a 5-year history of 'losing her stuff'. Upon psychiatric and neuro-ophthalmological evaluation, this symptom was better recognised as a feature of visual agnosia and simultanagnosia. She also presented with multiple previously unrecognised symptoms indicative of higher visual processing dysfunction, such as alexia without agraphia, ocular motor apraxia, optic ataxia, prosopagnosia, akinetopsia and topographagnosia, so further assessment to investigate for PCA was carried out. After a work-up including cognitive assessment, brain structural/functional imaging, and laboratory tests she was diagnosed with visual-variant Alzheimer's disease. Patients with PCA merit a detailed review of their symptoms, as well as the use of office tests such as cognitive evaluation tools, different types of perimetry, colour vision tests, and non-delayed psychiatric consultation for correct management and assessment. This report will emphasise five key aspects to be considered when evaluating patients with PCA.
Collapse
Affiliation(s)
- Jorge Cárdenas-Belaunzarán
- Neuro-Ophthalmology Department, Asociación para Evitar la Ceguera en México, I.A.P., Mexico City, Mexico
| | | |
Collapse
|
2
|
Pelak VS, Mahmood A, Abe-Ridgway K. Perspectives and a Systematic Scoping Review on Longitudinal Profiles of Posterior Cortical Atrophy Syndrome. Curr Neurol Neurosci Rep 2022; 22:803-812. [PMID: 36242715 DOI: 10.1007/s11910-022-01238-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] [Accepted: 09/16/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To provide perspectives on the importance of understanding longitudinal profiles of posterior cortical atrophy (PCA) and report results of a scoping review to identify data and knowledge gaps related to PCA survival and longitudinal clinical and biomarker outcomes. RECENT FINDINGS Thirteen longitudinal studies were identified; all but two had fewer than 30 participants with PCA. Relatively few longitudinal data exist, particularly for survival. In PCA, posterior cortical dysfunction and atrophy progress at faster rates compared to non-posterior regions, potentially up to a decade after symptom onset. Unlike typical AD, PCA phenotype-defined cognitive dysfunction and atrophy remain relatively more severe compared to other regions throughout the PCA course. Select cognitive tests hold promise as PCA outcome measures and for staging. Further longitudinal investigations are critically needed to enable PCA inclusion in treatment trials and to provide appropriate care to patients and enhance our understanding of the pathophysiology of dementing diseases.
Collapse
Affiliation(s)
- Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA. .,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Asher Mahmood
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Abe-Ridgway
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
3
|
Whitwell JL, Martin PR, Graff-Radford J, Machulda MM, Sintini I, Buciuc M, Senjem ML, Schwarz CG, Botha H, Carrasquillo MM, Ertekin-Taner N, Lowe VJ, Jack CR, Josephs KA. Investigating Heterogeneity and Neuroanatomic Correlates of Longitudinal Clinical Decline in Atypical Alzheimer Disease. Neurology 2022; 98:e2436-e2445. [PMID: 35483899 PMCID: PMC9231842 DOI: 10.1212/wnl.0000000000200336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aims of this work were to compare rates of longitudinal change in neurologic and neuropsychological test performance between the logopenic progressive aphasia (LPA) and posterior cortical atrophy (PCA) variants of atypical Alzheimer disease (AD) and to use unbiased principal component analysis to assess heterogeneity in patterns of change and relationships to demographics and concurrent brain atrophy. METHODS Patients with PCA or LPA who were positive for amyloid and tau AD biomarkers and had undergone serial neurologic and neuropsychological assessments and structural MRI were identified. Rates of change in 13 clinical measures were compared between groups in a case-control design, and principal component analysis was used to assess patterns of clinical change unbiased by clinical phenotype. Components were correlated with rates of regional brain atrophy with tensor-based morphometry. RESULTS Twenty-eight patients with PCA and 27 patients with LPA were identified. Those with LPA showed worse baseline performance and faster rates of decline in naming, repetition, and working memory, as well as faster rates of decline in verbal episodic memory, compared to those with PCA. Conversely, patients with PCA showed worse baseline performance in tests of visuospatial and perceptual function and on the Clinical Dementia Rating Scale and faster rates of decline in visuoperceptual function compared to those with LPA. Principal component analysis showed that patterns of clinical decline were highly heterogeneous across the cohort, with 10 principal components required to explain >90% of the variance. The first principal component reflected overall severity, with higher scores in LPA than PCA reflecting faster decline in LPA, and was related to left temporoparietal atrophy. The second and third principal components were not related to clinical phenotype but showed some relationship to regional atrophy. No relationships were identified between the principal components and age, sex, disease duration, amyloid PET findings, or apolipoprotein genotype. DISCUSSION Longitudinal patterns of clinical decline differ between LPA and PCA but are heterogeneous and related to different patterns of topographic spread. PCA is associated with a more slowly progressive course than LPA.
Collapse
Affiliation(s)
- Jennifer L Whitwell
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL.
| | - Peter R Martin
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Irene Sintini
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Marina Buciuc
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Matthew L Senjem
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Christopher G Schwarz
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Minerva M Carrasquillo
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Nilufer Ertekin-Taner
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Val J Lowe
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Keith A Josephs
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| |
Collapse
|
4
|
Clinical Screening for Posterior Cortical Atrophy. Cogn Behav Neurol 2022; 35:104-109. [PMID: 35639011 DOI: 10.1097/wnn.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) is a progressive neurologic syndrome that presents with complex visual deficits. Although PCA is most commonly a form of Alzheimer disease (AD), its early diagnosis is usually delayed due to a lack of understanding for how best to clinically screen for the syndrome. OBJECTIVE To identify neurobehavioral screening tasks for PCA-beyond simple visual constructions-that can be administered in clinic or at bedside. METHOD We compared the performance of 12 individuals who met neuroimaging-supported consensus criteria for PCA with that of 12 matched individuals with typical AD (tAD) and 24 healthy controls (HC) on clinic/bedside tasks measuring (a) complex figure copying, (b) Balint syndrome, (c) visual object agnosia, (d) color identification, (e) figure-ground discrimination, (f) global-local processing, (g) dressing apraxia, (h) ideomotor apraxia, and (i) Gerstmann syndrome. RESULTS All of the individuals with PCA were impaired on the figure-ground discrimination task compared with half of the tAD group and no HC. Approximately half of the PCA group had Balint syndrome, dressing apraxia, and ideomotor apraxia compared with none in the tAD group. Difficulty copying a complex figure, global-local processing impairment, and Gerstmann syndrome did not distinguish between the two dementia groups. CONCLUSION The figure-ground discrimination task can be used successfully as an overall screening measure for PCA, followed by specific tasks for Balint syndrome and dressing and limb apraxia. Findings reinforce PCA as a predominant occipitoparietal disorder with dorsal visual stream involvement and parietal signs with spatiomotor impairments.
Collapse
|
5
|
Mendez MF, Khattab YI, Yerstein O. Impaired visual search in posterior cortical atrophy vs. typical Alzheimer's disease. J Neurol Sci 2021; 428:117574. [PMID: 34271285 DOI: 10.1016/j.jns.2021.117574] [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: 06/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) is a neurocognitive disorder characterized by difficulty localizing in space. Recognizing PCA is important because it is usually missed early in its course and may result from a number of neurological disorders other than Alzheimer's disease (AD). OBJECTIVE This study aimed to clarify whether impaired visual search tasks of spatial localization distinguished patients with PCA from those with other more typical dementias as well as from healthy control (HC) subjects. METHODS Twelve patients meeting neuroimaging-supported Consensus Criteria for PCA, 12 comparably advanced patients with amnestic-predominant typical AD (tAD), and 24 HC participants were compared on tests of untimed and timed visual search, spatial neglect, mental rotation, environmental orientation, visuospatial construction, and face recognition. RESULTS Only abnormalities in untimed and timed visual search and environmental orientation distinguished the PCA patients from both the tAD group and the HC group without also distinguishing the tAD patients from HC's. The PCA patients also had a tendency to greater difficulty scanning left hemispace compared to HC's. Visuospatial constructions, although worse in PCA, and face recognition were impaired in both dementia groups. CONCLUSIONS These findings support the concept of PCA as a disorder of spatial processing and localization, indicating that visual search tasks are particularly sensitive and specific for detecting PCA and distinguishing it from more typical dementia syndromes.
Collapse
Affiliation(s)
- Mario F Mendez
- Departments of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA; Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA; Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, USA.
| | - Youssef I Khattab
- Departments of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA
| | - Oleg Yerstein
- Department of Neurology, Lahey Hospital and Medical Center, USA.
| |
Collapse
|
6
|
Shea YF, Pan Y, Mak HKF, Bao Y, Lee SC, Chiu PKC, Chan HWF. A systematic review of atypical Alzheimer's disease including behavioural and psychological symptoms. Psychogeriatrics 2021; 21:396-406. [PMID: 33594793 DOI: 10.1111/psyg.12665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) is the commonest cause of dementia, characterized by the clinical presentation of progressive anterograde episodic memory impairment. However, atypical presentation of patients is increasingly recognized. These atypical AD include logopenic aphasia, behavioural variant AD, posterior cortical atrophy, and corticobasal syndrome. These atypical AD are more common in patients with young onset AD before the age of 65 years old. Since medical needs (including the behavioural and psychological symptoms of dementia) of atypical AD patients could be different from typical AD patients, it is important for clinicians to be aware of these atypical forms of AD. In addition, disease modifying treatment may be available in the future. This review aims at providing an update on various important subtypes of atypical AD including behavioural and psychological symptoms.
Collapse
Affiliation(s)
- Yat-Fung Shea
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yining Pan
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yiwen Bao
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Shui-Ching Lee
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Patrick Ka-Chun Chiu
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Hon-Wai Felix Chan
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| |
Collapse
|
7
|
Yerstein O, Parand L, Liang LJ, Isaac A, Mendez MF. Benson's Disease or Posterior Cortical Atrophy, Revisited. J Alzheimers Dis 2021; 82:493-502. [PMID: 34057092 PMCID: PMC8316293 DOI: 10.3233/jad-210368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND D. Frank Benson and colleagues first described the clinical and neuropathological features of posterior cortical atrophy (PCA) from patients in the UCLA Neurobehavior Program. OBJECTIVE We reviewed the Program's subsequent clinical experience with PCA, and its potential for clarifying this relatively rare syndrome in comparison to the accumulated literature on PCA. METHODS Using the original criteria derived from this clinic, 65 patients with neuroimaging-supported PCA were diagnosed between 1995 and 2020. RESULTS On presentation, most had visual localization complaints and related visuospatial symptoms, but nearly half had memory complaints followed by symptoms of depression. Neurobehavioral testing showed predominant difficulty with visuospatial constructions, Gerstmann's syndrome, and Balint's syndrome, but also impaired memory and naming. On retrospective application of the current Consensus Criteria for PCA, 59 (91%) met PCA criteria with a modification allowing for "significantly greater visuospatial over memory and naming deficits." There were 37 deaths (56.9%) with the median overall survival of 10.3 years (95% CI: 9.6-13.6 years), consistent with a slow neurodegenerative disorder in most patients. CONCLUSION Together, these findings recommend modifying the PCA criteria for "relatively spared" memory, language, and behavior to include secondary memory and naming difficulty and depression, with increased emphasis on the presence of Gerstmann's and Balint's syndromes.
Collapse
Affiliation(s)
- Oleg Yerstein
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Leila Parand
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Adrienne Isaac
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Mario F. Mendez
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| |
Collapse
|
8
|
Cortical diffusivity investigation in posterior cortical atrophy and typical Alzheimer's disease. J Neurol 2020; 268:227-239. [PMID: 32770413 PMCID: PMC7815619 DOI: 10.1007/s00415-020-10109-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/26/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
Objectives To investigate the global cortical and regional quantitative features of cortical neural architecture in the brains of patients with posterior cortical atrophy (PCA) and typical Alzheimer’s disease (tAD) compared with elderly healthy controls (HC). Methods A novel diffusion MRI method, that has been shown to correlate with minicolumnar organization changes in the cerebral cortex, was used as a surrogate of neuropathological changes in dementia. A cohort of 15 PCA patients, 23 tAD and 22 healthy elderly controls (HC) were enrolled to investigate the changes in cortical diffusivity among groups. For each subject, 3 T MRI T1-weighted images and diffusion tensor imaging (DTI) scans were analysed to extract novel cortical DTI derived measures (AngleR, PerpPD and ParlPD). Receiver operating characteristics (ROC) curve analysis and the area under the curve (AUC) were used to assess the group discrimination capability of the method. Results The results showed that the global cortical DTI derived measures were able to detect differences, in both PCA and tAD patients compared to healthy controls. The AngleR was the best measure to discriminate HC from tAD (AUC = 0.922), while PerpPD was the best measure to discriminate HC from PCA (AUC = 0.961). Finally, the best global measure to differentiate the two patient groups was ParlPD (AUC = 0.771). The comparison between PCA and tAD patients revealed a different pattern of damage within the AD spectrum and the regional comparisons identified significant differences in key regions including parietal and temporal lobe cortical areas. The best AUCs were shown by PerpPD right lingual cortex (AUC = 0.856), PerpPD right superior parietal cortex (AUC = 0.842) and ParlPD right lateral occipital cortex (AUC = 0.826). Conclusions Diagnostic group differences were found, suggesting that the new cortical DTI analysis method may be useful to investigate cortical changes in dementia, providing better characterization of neurodegeneration, and potentially aiding differential diagnosis and prognostic accuracy. Electronic supplementary material The online version of this article (10.1007/s00415-020-10109-w) contains supplementary material, which is available to authorized users.
Collapse
|
9
|
Olds JJ, Hills WL, Warner J, Falardeau J, Alasantro LH, Moster ML, Egan RA, Cornblath WT, Lee AG, Frishberg BM, Turbin RE, Katz DM, Charley JA, Pelak VS. Posterior Cortical Atrophy: Characteristics From a Clinical Data Registry. Front Neurol 2020; 11:358. [PMID: 32581988 PMCID: PMC7297208 DOI: 10.3389/fneur.2020.00358] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that presents with higher-order visual dysfunction with relative sparing of memory and other cognitive domains, and it is most commonly associated with Alzheimer's disease pathology. There is a lack of data regarding the presentation of PCA to non-cognitive specialists. Therefore, we collected clinical data from neuro-ophthalmologists regarding the presentation of PCA to their practices and compared data to published cohorts and a published survey of cognitive specialists. Methods: Members of the North American Neuro-Ophthalmology Society Listserv (NANOSnet) were invited to complete an online, retrospective, chart-review data-entry survey regarding their patients with PCA, and REDCap was used for data collection. Results: Data for 38 patients were entered by 12 neuro-ophthalmologists. Patient mean age at presentation was 67.8 years, and 74% of patients were women. Difficulty reading was reported at presentation by 91% of patients, and poor performance on color vision, stereopsis, and visual field testing (performed reliably by 36/38 patients) were common findings. Most patients who were treated were treated with donepezil and/or memantine. Conclusions: Compared to published data from cognitive specialists, patients presenting to neuro-ophthalmology with PCA were more likely to be older and female and have a reading complaint. Reliable visual field testing was the norm with homonymous defects in the majority of patients. The neuro-ophthalmologist plays an important role in diagnosing PCA in older adults with unexplained visual signs and symptoms, and future studies of PCA should involve multiple specialists in order to advance our understanding of PCA and develop effective treatments.
Collapse
Affiliation(s)
- Jennifer J Olds
- Department of Ophthalmology, Keesler Air Force Base, Biloxi, MS, United States
| | - William L Hills
- Department of Neurology & Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Judith Warner
- Department of Ophthalmology & Neurology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, United States
| | - Julie Falardeau
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Lori Haase Alasantro
- Department of Neuroscience, The Neurology Center of Southern California, University of California San Diego School of Medicine, Carlsbad, CA, United States
| | - Mark L Moster
- Department of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert A Egan
- Eye & Vascular Neurology, LLC, Carlton, OR, United States
| | - Wayne T Cornblath
- Department of Ophthalmology, Visual Sciences & Neurology, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, United States
| | - Benjamin M Frishberg
- Department of Neuroscience, The Neurology Center of Southern California, University of California San Diego School of Medicine, Carlsbad, CA, United States
| | - Roger E Turbin
- Division of Neuro-ophthalmology and Orbital Surgery, Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Sciences, Newark, NJ, United States
| | - David M Katz
- Bethesda Neurology, LLC, Department of Ophthalmology & Neurology, Howard University Hospital, Georgetown University Hospital, Washington, DC, United States
| | - John A Charley
- Retired Private Practice Ophthalmologist, Pittsburgh, PA, United States
| | - Victoria S Pelak
- Department of Neurology & Ophthalmology, UCHealth Sue Anschutz-Rodgers Eye Center and the Neurosciences Center, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
10
|
Sakae N, Josephs KA, Litvan I, Murray ME, Duara R, Uitti RJ, Wszolek ZK, van Gerpen J, Graff-Radford NR, Dickson DW. Clinicopathologic subtype of Alzheimer's disease presenting as corticobasal syndrome. Alzheimers Dement 2019; 15:1218-1228. [PMID: 31399334 DOI: 10.1016/j.jalz.2019.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The corticobasal syndrome (CBS) is associated with several neuropathologic disorders, including corticobasal degeneration and Alzheimer's disease (AD). METHOD In this report, we studied 43 AD patients with CBS (AD-CBS) and compared them with 42 AD patients with typical amnestic syndrome (AD-AS), as well as 15 cases of corticobasal degeneration and CBS pathology. RESULTS Unlike AD-AS, AD-CBS had prominent motor problems, including limb apraxia (90%), myoclonus (81%), and gait disorders (70%). Alien limb phenomenon was reported in 26% and cortical sensory loss in 14%. Language problems were also more frequent in AD-CBS, and memory impairment was less frequent. AD-CBS had more tau pathology in perirolandic cortices but less in superior temporal cortex than AD-AS. In addition, AD-CBS had greater neuronal loss in the substantia nigra. DISCUSSION AD-CBS is a clinicopathological subtype of AD with an atypical distribution of Alzheimer-type tau pathology. Greater neuronal loss in the substantia nigra may contribute to Parkinsonism which is not a feature of typical AD.
Collapse
Affiliation(s)
- Nobutaka Sakae
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Irene Litvan
- Department of Neurology, University of California San Diego, La Jolla, CA, USA
| | | | - Ranjan Duara
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jay van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | |
Collapse
|
11
|
Montembeault M, Brambati SM, Lamari F, Michon A, Samri D, Epelbaum S, Lacomblez L, Lehéricy S, Habert MO, Dubois B, Kas A, Migliaccio R. Atrophy, metabolism and cognition in the posterior cortical atrophy spectrum based on Alzheimer's disease cerebrospinal fluid biomarkers. Neuroimage Clin 2018; 20:1018-1025. [PMID: 30340200 PMCID: PMC6197495 DOI: 10.1016/j.nicl.2018.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In vivo clinical, anatomical and metabolic differences between posterior cortical atrophy (PCA) patients presenting with different Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers profiles are still unknown. METHODS Twenty-seven PCA patients underwent CSF examination and were classified as 1) PCA with a typical CSF AD profile (PCA-tAD; abnormal amyloid and T-tau/P-tau biomarkers, n = 13); 2) PCA with an atypical AD CSF profile (PCA-aAD; abnormal amyloid biomarker only, n = 9); and 3) PCA not associated with AD (PCA-nonAD; normal biomarkers, n = 5). All patients underwent clinical and cognitive assessment, structural MRI, and a subset of them underwent brain 18F-FDG PET. RESULTS All patients' groups showed a common pattern of posterior GM atrophy and hypometabolism typical of PCA, as well as equivalent demographics and clinical/cognitive profiles. PCA-tAD patients showed a group-specific pattern of hypometabolism in the left fusiform gyrus and inferior temporal gyrus. PCA-aAD did not present a group-specific atrophy pattern. Finally, group-specific gray matter atrophy in the right dorsolateral prefrontal cortex, left caudate nucleus and right medial temporal regions and hypometabolism in the right supplementary motor area and paracentral lobule were observed in PCA-nonAD patients. CONCLUSION Our findings suggest that both PCA-tAD and PCA-aAD patients are on the AD continuum, in agreement with the recently suggested A/T/N model. Furthermore, in PCA, the underlying pathology has an impact at least on the anatomo-functional presentation. Brain damage observed in PCA-tAD and PCA-aAD was mostly consistent with the well-described presentation of the disease, although it was more widespread in PCA-tAD group, especially in the left temporal lobe. Additional fronto-temporal (especially dorsolateral prefrontal) damage seems to be a clue to underlying non-AD pathology in PCA, which warrants the need for longitudinal follow-ups to investigate frontal symptoms in these patients.
Collapse
Affiliation(s)
- Maxime Montembeault
- FrontLab, Institut du Cerveau et de la Moelle épinière (ICM), 75013 Paris, France
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, UMR S1127, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière hospital, 75013 Paris, France
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, H3W 1W6 Montréal, QC, Canada
- Department of Psychology, University of Montreal, H2V 2S9 Montréal, QC, Canada
| | - Simona M. Brambati
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, H3W 1W6 Montréal, QC, Canada
- Department of Psychology, University of Montreal, H2V 2S9 Montréal, QC, Canada
| | - Foudil Lamari
- Department of Metabolic biochemistry, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Agnès Michon
- Department of Nervous system diseases, Institut de la mémoire et de la maladie d’Alzheimer (IM2A), Neurology, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Dalila Samri
- Department of Nervous system diseases, Institut de la mémoire et de la maladie d’Alzheimer (IM2A), Neurology, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Stéphane Epelbaum
- Department of Nervous system diseases, Institut de la mémoire et de la maladie d’Alzheimer (IM2A), Neurology, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Lucette Lacomblez
- LIB, Inserm U1146, Université Pierre et Marie Curie, Paris 6, 75006 Paris, France
- Department of Nervous system diseases, CIC-CET, Pitié-Salpêtrière hospital, 75013 Paris, France
- Pharmacology service, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Stéphane Lehéricy
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, UMR S1127, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière hospital, 75013 Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR) de l’Institut du Cerveau et de la Moelle Epiniere (ICM), Hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - Marie-Odile Habert
- LIB, Inserm U1146, Université Pierre et Marie Curie, Paris 6, 75006 Paris, France
- Department of Nuclear Medicine, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Bruno Dubois
- FrontLab, Institut du Cerveau et de la Moelle épinière (ICM), 75013 Paris, France
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, UMR S1127, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière hospital, 75013 Paris, France
- Department of Nervous system diseases, Institut de la mémoire et de la maladie d’Alzheimer (IM2A), Neurology, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Aurélie Kas
- LIB, Inserm U1146, Université Pierre et Marie Curie, Paris 6, 75006 Paris, France
- Department of Nuclear Medicine, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Raffaella Migliaccio
- FrontLab, Institut du Cerveau et de la Moelle épinière (ICM), 75013 Paris, France
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, UMR S1127, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière hospital, 75013 Paris, France
- Department of Nervous system diseases, Institut de la mémoire et de la maladie d’Alzheimer (IM2A), Neurology, Pitié-Salpêtrière hospital, 75013 Paris, France
| |
Collapse
|
12
|
Steeb B, García-Cordero I, Huizing MC, Collazo L, Borovinsky G, Ferrari J, Cuitiño MM, Ibáñez A, Sedeño L, García AM. Progressive Compromise of Nouns and Action Verbs in Posterior Cortical Atrophy. Front Psychol 2018; 9:1345. [PMID: 30123155 PMCID: PMC6085559 DOI: 10.3389/fpsyg.2018.01345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
Abstract
Processing of nouns and action verbs can be differentially compromised following lesions to posterior and anterior/motor brain regions, respectively. However, little is known about how these deficits progress in the course of neurodegeneration. To address this issue, we assessed productive lexical skills in a patient with posterior cortical atrophy (PCA) at two different stages of his pathology. On both occasions, he underwent a structural brain imaging protocol and completed semantic fluency tasks requiring retrieval of animals (nouns) and actions (verbs). Imaging results were compared with those of controls via voxel-based morphometry (VBM), whereas fluency performance was compared to age-matched norms through Crawford's t-tests. In the first assessment, the patient exhibited atrophy of more posterior regions supporting multimodal semantics (medial temporal and lingual gyri), together with a selective deficit in noun fluency. Then, by the second assessment, the patient's atrophy had progressed mainly toward fronto-motor regions (rolandic operculum, inferior and superior frontal gyri) and subcortical motor hubs (cerebellum, thalamus), and his fluency impairments had extended to action verbs. These results offer unprecedented evidence of the specificity of the pathways related to noun and action-verb impairments in the course of neurodegeneration, highlighting the latter's critical dependence on damage to regions supporting motor functions, as opposed to multimodal semantic processes.
Collapse
Affiliation(s)
- Brenda Steeb
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Indira García-Cordero
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Marjolein C Huizing
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Lucas Collazo
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Geraldine Borovinsky
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Jesica Ferrari
- Department of Language Speech, Institute of Cognitive Neurology, Buenos Aires, Argentina
| | - Macarena M Cuitiño
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Psychology, Favaloro University, Buenos Aires, Argentina.,Faculty of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council, Sydney, NSW, Australia
| | - Lucas Sedeño
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Education, National University of Cuyo, Mendoza, Argentina
| |
Collapse
|