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Afrashteh F, Almasi-Dooghaee M, Kamyari N, Rajabi R, Baradaran HR. Is Montreal Cognitive Assessment a valuable test for the differentiation of Alzheimer's disease, frontotemporal dementia, dementia with Lewy body, and vascular dementia? Dement Neuropsychol 2024; 18:e20230124. [PMID: 39193467 PMCID: PMC11348881 DOI: 10.1590/1980-5764-dn-2023-0124] [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: 12/23/2023] [Revised: 04/20/2024] [Accepted: 05/06/2024] [Indexed: 08/29/2024] Open
Abstract
Dementia is one of the growing diseases in the world and has different types based on its definition. The Montreal Cognitive Assessment (MoCA) test has been employed to screen patients with dementia, cognitive impairment, and disruption of daily activities. Objective This study examined the diagnostic value of the total MoCA score and its subscores in differentiating Alzheimer's disease (AD), frontotemporal dementia (FTD), dementia with Lewy body (DLB), and vascular dementia (VaD). Methods A total of 241 patients (AD=110, FTD=90, DLB=28, and VaD=13) and 59 healthy persons, who were referred to a dementia clinic with memory impairment in Firoozgar Hospital, were included in this study. MoCA tests were performed in all patients and normal persons. Results By using the receiver operating characteristic (ROC) curve and measuring the area under the curve (AUC) for the total MoCA score in each group, AUC was 0.616, 0.681, 0.6117, and 0.583 for differentiating AD, FTD, DLB, and VaD patients, respectively. Among the groups, just the VaD group showed no significant usefulness in using the total MoCA score to differentiate it. To compare MoCA subscores, AD patients had higher scores in digit span, literal fluency, and abstraction but lower delayed recall scores compared with FTD patients. Conclusion The total MoCA score and its subscores could not differentiate people with different types of dementia in the setting of screening.
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Affiliation(s)
- Fatemeh Afrashteh
- Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mostafa Almasi-Dooghaee
- Iran University of Medical Sciences, Department of Neurology, Firoozgar Clinical Research Development Center (FCRDC), Tehran, Iran
| | - Naser Kamyari
- Abadan University of Medical Sciences, Department of Biostatistics and Epidemiology, School of Health, Abadan, Iran
| | - Rayan Rajabi
- Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Hamid Reza Baradaran
- Iran University of Medical Sciences, Department of Epidemiology, School of Public Health, Tehran, Iran
- University of Aberdeen, Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, Aberdeen, UK
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2
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Snowden JS. Changing perspectives on frontotemporal dementia: A review. J Neuropsychol 2022. [DOI: 10.1111/jnp.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Julie S. Snowden
- Cerebral Function Unit, Manchester Centre for Neurosciences Salford Royal NHS Foundation Trust Salford UK
- Division of Neuroscience & Experimental Psychology School of Biological Sciences, University of Manchester Manchester UK
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3
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Kuhn T, Becerra S, Duncan J, Spivak N, Dang BH, Habelhah B, Mahdavi KD, Mamoun M, Whitney M, Pereles FS, Bystritsky A, Jordan SE. Translating state-of-the-art brain magnetic resonance imaging (MRI) techniques into clinical practice: multimodal MRI differentiates dementia subtypes in a traditional clinical setting. Quant Imaging Med Surg 2021; 11:4056-4073. [PMID: 34476189 PMCID: PMC8339641 DOI: 10.21037/qims-20-1355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study sought to validate the clinical utility of multimodal magnetic resonance imaging (MRI) techniques in the assessment of neurodegenerative disorders. We intended to demonstrate that advanced neuroimaging techniques commonly used in research can effectively be employed in clinical practice to accurately differentiate heathy aging and dementia subtypes. METHODS Twenty patients with dementia of the Alzheimer's type (DAT) and 18 patients with Parkinson's disease dementia (PDD) were identified using gold-standard techniques. Twenty-three healthy, age and sex matched control participants were also recruited. All participants underwent multimodal MRI including T1 structural, diffusion tensor imaging (DTI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). MRI modalities were evaluated by trained neuroimaging readers and were separately assessed using cross-validated, iterative discriminant function analyses with subsequent feature reduction techniques. In this way, each modality was evaluated for its ability to differentiate patients with dementia from healthy controls as well as to differentiate dementia subtypes. RESULTS Following individual and group feature reduction, each of the multimodal MRI metrics except MRS successfully differentiated healthy aging from dementia and also demonstrated distinct dementia subtypes. Using the following ten metrics, excellent separation (95.5% accuracy, 92.3% sensitivity; 100.0% specificity) was achieved between healthy aging and neurodegenerative conditions: volume of the left frontal pole, left occipital pole, right posterior superior temporal gyrus, left posterior cingulate gyrus, right planum temporale; perfusion of the left hippocampus and left occipital lobe; fractional anisotropy (FA) of the forceps major and bilateral anterior thalamic radiation. Using volume of the left frontal pole, right posterior superior temporal gyrus, left posterior cingulate gyrus, perfusion of the left hippocampus and left occipital lobe; FA of the forceps major and bilateral anterior thalamic radiation, neurodegenerative subtypes were accurately differentiated as well (87.8% accuracy, 95.2% sensitivity; 85.0% specificity). CONCLUSIONS Regional volumetrics, DTI metrics, and ASL successfully differentiated dementia patients from controls with sufficient sensitivity to differentiate dementia subtypes. Similarly, feature reduction results suggest that advanced analyses can meaningfully identify brain regions with the most positive predictive value and discriminant validity. Together, these advanced neuroimaging techniques can contribute significantly to diagnosis and treatment planning for individual patients.
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Affiliation(s)
- Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Sergio Becerra
- Neurology Management Associates, Los Angeles, California, USA
| | - John Duncan
- Neurology Management Associates, Los Angeles, California, USA
| | - Norman Spivak
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Bianca Huan Dang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | | | | | | | | | | | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Sheldon E. Jordan
- Neurology Management Associates, Los Angeles, California, USA
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
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Coraini A, Basciotta M. Frontotemporal dementia as underlying cause of newly altered mental status in a 59-year-old female: a case presentation and literature review. J Community Hosp Intern Med Perspect 2020; 10:446-451. [PMID: 33235680 PMCID: PMC7671745 DOI: 10.1080/20009666.2020.1787810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
59 y.o. female is evaluated for chronic behavioral abnormalities. We describe the diagnostic approach to cases of altered mental status. Before considering the different possible etiologies including, for example, metabolic, infectious, toxic, hypoxemic, endocrine, or iatrogenic ones, we underline the importance of assessing patient’s baseline functional status. Often, in particular in older patients’ population, dementia is the underlying culprit of mentation abnormalities. Through extensive history and with the help of neuroimaging studies, our patient was diagnosed with frontotemporal dementia.
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Affiliation(s)
- A Coraini
- Internal Medicine, North Shore Medical Center-Salem Hospital, Salem, MA, USA.,Neurology, MGH/BWH/Harvard Medical School
| | - M Basciotta
- Internal Medicine, North Shore Medical Center-Salem Hospital, Salem, MA, USA
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5
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Sonawane SK, Chinnathambi S. P301 L, an FTDP-17 Mutant, Exhibits Enhanced Glycation in vitro. J Alzheimers Dis 2020; 75:61-71. [PMID: 32250308 DOI: 10.3233/jad-191348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frontotemporal dementia and parkinsonism-linked to chromosome-17 are a group of diseases with tau mutations leading to primary tauopathies which include progressive supranuclear palsy, corticobasal syndrome, and frontotemporal lobar degeneration. Alzheimer's disease is a non-primary tauopathy, which displays tau neuropathology of excess tangle formation and accumulation. FTDP-17 mutations are responsible for early onset of AD, which can be attributed to compromised physiological functions due to the mutations. Tau is a microtubule-binding protein that secures the integrity of polymerized microtubules in neuronal cells. It malfunctions owing to various insults and stress conditions-like mutations and post-translational modifications. OBJECTIVE In this study, we modified the wild type and tau mutants by methyl glyoxal and thus studied whether glycation can enhance the aggregation of predisposed mutant tau. METHODS Tau glycation was studied by fluorescence assays, SDS-PAGE analysis, conformational evaluation, and transmission electron microscopy. RESULTS Our study suggests that FTDP-17 mutant P301 L leads to enhanced glycation-induced aggregation as well as advanced glycation end products formation. Glycation forms amorphous aggregates of tau and its mutants without altering its native conformation. CONCLUSION The metabolic anomalies and genetic predisposition have found to accelerate tau-mediated neurodegeneration and prove detrimental for the early-onset of Alzheimer's disease.
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Affiliation(s)
- Shweta Kishor Sonawane
- Neurobiology Group, Biochemical Sciences Division, CSIR-National Chemical Laboratory, Pune, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Subashchandrabose Chinnathambi
- Neurobiology Group, Biochemical Sciences Division, CSIR-National Chemical Laboratory, Pune, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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6
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Brzezicki MA, Kobetić MD, Neumann S, Pennington C. Diagnostic accuracy of frontotemporal dementia. An artificial intelligence-powered study of symptoms, imaging and clinical judgement. Adv Med Sci 2019; 64:292-302. [PMID: 30952029 DOI: 10.1016/j.advms.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/12/2019] [Accepted: 03/19/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Frontotemporal dementia (FTD) is a neurodegenerative disorder associated with a poor prognosis and a substantial reduction in quality of life. The rate of misdiagnosis of FTD is very high, with patients often waiting for years without a firm diagnosis. This study investigates the current state of the misdiagnosis of FTD using a novel artificial intelligence-based algorithm. PATIENTS & METHODS An artificial intelligence algorithm has been developed to retrospectively analyse the patient journeys of 47 individuals diagnosed with FTD (age range 52-80). The algorithm analysed the efficiency of patient pathways by utilizing a reward signal of ‒1 to +1 to assess the symptoms, imaging techniques, and clinical judgement in both behavioural and language variants of the disease. RESULTS On average, every patient was subjected to 4.93 investigations, of which 67.4% were radiological scans. From first presentation it took on average 939 days for a firm diagnosis. The mean time between appointments was 204 days, and the average patient had their diagnosis altered 7.37 times during their journey. The algorithm proposed improvements by evaluating the interventions that resulted in a decreased reward signal to both the individual and the population as a whole. CONCLUSIONS The study proves that the algorithm can efficiently guide clinical practice and improve the accuracy of the diagnosis of FTD whilst making the process of auditing faster and more economically viable.
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Krämer J, Lueg G, Schiffler P, Vrachimis A, Weckesser M, Wenning C, Pawlowski M, Johnen A, Teuber A, Wersching H, Meuth SG, Duning T. Diagnostic Value of Diffusion Tensor Imaging and Positron Emission Tomography in Early Stages of Frontotemporal Dementia. J Alzheimers Dis 2019; 63:239-253. [PMID: 29614640 DOI: 10.3233/jad-170224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Due to suboptimal sensitivity and specificity of structural and molecular neuroimaging tools, the diagnosis of behavioral variant frontotemporal dementia (bvFTD) remains challenging. OBJECTIVE Investigation of the sensitivity of diffusion tensor imaging (DTI) and fluorodeoxyglucose positron emission tomography (FDG-PET) to detect cerebral alterations in early stages of bvFTD despite inconspicuous conventional MRI. METHODS Thirty patients with early stages of bvFTD underwent a detailed neuropsychological examination, cerebral 3T MRI with DTI analysis, and FDG-PET. After 12 months of follow-up, all patients finally fulfilled the diagnosis of bvFTD. Individual FDG-PET data analyses showed that 20 patients exhibited a "typical" pattern for bvFTD with bifrontal and/or temporal hypometabolism (bvFTD/PET+), and that 10 patients showed a "non-typical"/normal pattern (bvFTD/PET-). DTI data were compared with 42 healthy controls in an individual and voxel-based group analysis. To examine the clinical relevance of the findings, associations between pathologically altered voxels of DTI or FDG-PET results and behavioral symptoms were estimated by linear regression analyses. RESULTS DTI voxel-based group analyses revealed microstructural degeneration in bifrontal and bitemporal areas in bvFTD/PET+ and bvFTD/PET- groups. However, when comparing the sensitivity of individual DTI data analysis with FDG-PET, DTI appeared to be less sensitive. Neuropsychological symptoms were considerably related to neurodegeneration within frontotemporal areas identified by DTI and FDG-PET. CONCLUSION DTI seems to be an interesting tool for detection of functionally relevant neurodegenerative alterations in early stages of bvFTD, even in bvFTD/PET- patients. However, at a single subject level, it seems to be less sensitive than FDG-PET. Thus, improvement of individual DTI analysis is necessary.
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Affiliation(s)
- Julia Krämer
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Gero Lueg
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Patrick Schiffler
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Alexis Vrachimis
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,Department of Nuclear Medicine, German Oncology Center, Limassol, Cyprus
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Christian Wenning
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | | | - Andreas Johnen
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Anja Teuber
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Heike Wersching
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Münster, Münster, Germany
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8
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Whitwell JL. FTD spectrum: Neuroimaging across the FTD spectrum. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:187-223. [PMID: 31481163 DOI: 10.1016/bs.pmbts.2019.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia is a complex and heterogeneous neurodegenerative disease that encompasses many clinical syndromes, pathological diseases, and genetic mutations. Neuroimaging has played a critical role in our understanding of the underlying pathophysiology of frontotemporal dementia and provided biomarkers to aid diagnosis. Early studies defined patterns of neurodegeneration and hypometabolism associated with the clinical, pathological and genetic aspects of frontotemporal dementia, with more recent studies highlighting how the breakdown of structural and functional brain networks define frontotemporal dementia. Molecular positron emission tomography ligands allowing the in vivo imaging of tau proteins have also provided important insights, although more work is needed to understand the biology of the currently available ligands.
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9
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Kinno R, Shiromaru A, Mori Y, Futamura A, Kuroda T, Yano S, Murakami H, Ono K. Differential Effects of the Factor Structure of the Wechsler Memory Scale-Revised on the Cortical Thickness and Complexity of Patients Aged Over 75 Years in a Memory Clinic Setting. Front Aging Neurosci 2017; 9:405. [PMID: 29270122 PMCID: PMC5725440 DOI: 10.3389/fnagi.2017.00405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022] Open
Abstract
The Wechsler Memory Scale-Revised (WMS-R) is one of the internationally well-known batteries for memory assessment in a general memory clinic setting. Several factor structures of the WMS-R for patients aged under 74 have been proposed. However, little is known about the factor structure of the WMS-R for patients aged over 75 years and its neurological significance. Thus, we conducted exploratory factor analysis to determine the factor structure of the WMS-R for patients aged over 75 years in a memory clinic setting. Regional cerebral blood flow (rCBF) was calculated from single-photon emission computed tomography data. Cortical thickness and cortical fractal dimension, as the marker of cortical complexity, were calculated from high resolution magnetic resonance imaging data. We found that the four factors appeared to be the most appropriate solution to the model, including recognition memory, paired associate memory, visual-and-working memory, and attention as factors. Patients with mild cognitive impairments showed significantly higher factor scores for paired associate memory, visual-and-working memory, and attention than patients with Alzheimer's disease. Regarding the neuroimaging data, the factor scores for paired associate memory positively correlated with rCBF in the left pericallosal and hippocampal regions. Moreover, the factor score for paired associate memory showed most robust correlations with the cortical thickness in the limbic system, whereas the factor score for attention correlated with the cortical thickness in the bilateral precuneus. Furthermore, each factor score correlated with the cortical fractal dimension in the bilateral frontotemporal regions. Interestingly, the factor scores for the visual-and-working memory and attention selectively correlated with the cortical fractal dimension in the right posterior cingulate cortex and right precuneus cortex, respectively. These findings demonstrate that recognition memory, paired associate memory, visual-and-working memory, and attention can be crucial factors for interpreting the WMS-R results of elderly patients aged over 75 years in a memory clinic setting. Considering these findings, the results of WMS-R in elderly patients aged over 75 years in a memory clinic setting should be cautiously interpreted.
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Affiliation(s)
| | | | | | | | | | | | | | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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10
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Vijverberg EGB, Dols A, Krudop WA, Peters A, Kerssens CJ, van Berckel BNM, Wattjes MP, Barkhof F, Gossink F, Prins ND, Stek ML, Scheltens P, Pijnenburg YAL. Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome. Dement Geriatr Cogn Disord 2017; 41:210-9. [PMID: 27160162 DOI: 10.1159/000444849] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We aimed to prospectively assess the diagnostic accuracy of the revised criteria for behavioural variant frontotemporal dementia (bvFTD) among subjects presenting with a frontal lobe syndrome in middle-late adulthood. METHODS Patients were included based on a predominant behavioural clinical presentation, a Frontal Behavioural Inventory (FBI) score of ≥11 and/or a Stereotypy Rating Inventory (SRI) score of ≥10. At baseline, the fulfilment of the international consensus criteria for behavioural variant FTD (FTDC) was systematically recorded. The 2-year follow-up consensus diagnosis was used as the gold standard to calculate sensitivity and specificity of the FTDC criteria for possible and probable bvFTD. RESULTS Two-year follow-up data were available for 116 patients (85%). Two-year follow-up consensus diagnoses consisted of probable/definite bvFTD (n = 27), other dementia (n = 30), psychiatric disorders (n = 46) and other neurological disorders (n = 13). Sensitivity for possible bvFTD was 85% (95% CI 70-95%) at a specificity of 27% (95% CI 19-37%). Sensitivity for probable bvFTD was 85% (95% CI 69-95%), whereas their specificity was 82% (95% CI 73-89%). CONCLUSIONS We found a good diagnostic accuracy for FTDC probable bvFTD. However, the specificity for FTDC possible bvFTD was low. Our results reflect the symptomatic overlap between bvFTD, other neurological conditions and psychiatric disorders, and the relevance of adding neuroimaging to the diagnostic process.
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Affiliation(s)
- Everard G B Vijverberg
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
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11
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Vijverberg EGB, Dols A, Krudop WA, Del Campo Milan M, Kerssens CJ, Gossink F, Prins ND, Stek ML, Scheltens P, Teunissen CE, Pijnenburg YAL. Cerebrospinal fluid biomarker examination as a tool to discriminate behavioral variant frontotemporal dementia from primary psychiatric disorders. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 7:99-106. [PMID: 28337476 PMCID: PMC5352718 DOI: 10.1016/j.dadm.2017.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To prospectively determine the diagnostic value of cerebrospinal fluid (CSF) levels total-tau (tau) to amyloid-β1-42 ratio (Aβ1-42) ratio (tau/Aβ1-42 ratio), phosphorylated-tau (p-tau) to tau ratio (p-tau/tau ratio), neurofilament light chain (NfL) and YKL40 in the late-onset frontal lobe syndrome, in particular for the differential diagnosis of behavioral variant frontotemporal dementia (bvFTD) versus primary psychiatric disorders (PSY). METHOD We included patients with a multidisciplinary 2-year-follow-up diagnosis of probable/definite bvFTD (n = 22) or PSY (n = 25), who underwent a detailed neuropsychiatric clinical examination, neuropsychological test battery, and magnetic resonance imaging at baseline. In all cases, CSF was collected through lumbar puncture at baseline. We compared CSF biomarker levels between the two groups and measured the diagnostic accuracy for probable/definite bvFTD, using the follow-up diagnosis as the reference standard. RESULTS The best discriminators between probable/definite bvFTD and PSY were the levels of CSF NfL (area under the curve [AUC] 0.93, P < .001, 95% confidence interval [CI] 0.85-1.00), p-tau/tau ratio (AUC 0.87, P < .001, 95% CI 0.77-0.97), and YKL40 (AUC 0.82, P = .001, 95% CI 0.68-0.97). The combination of these three biomarkers had a sensitivity of 91% (95% CI 66%-100%) at a specificity of 83% (95% CI 65%-95%) with an AUC of 0.94 (P < .001, 95% CI 0.87-1.00) for bvFTD. CSF tau/Aβ1-42 ratio was less accurate in differentiating between bvFTD and PSY. DISCUSSION We found a good diagnostic accuracy for higher levels of CSF NfL and YKL40 and reduced p-tau/tau ratio in distinguishing bvFTD from PSY. We advocate the use of these CSF biomarkers as potential additional tools to neuroimaging in the diagnosis of bvFTD versus PSY.
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Affiliation(s)
- Everard G B Vijverberg
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands; Department of Neurology, HagaZiekenhuis, The Hague, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Welmoed A Krudop
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marta Del Campo Milan
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Flora Gossink
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
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12
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Vijverberg EG, Wattjes MP, Dols A, Krudop WA, Möller C, Peters A, Kerssens CJ, Gossink F, Prins ND, Stek ML, Scheltens P, van Berckel BN, Barkhof F, Pijnenburg YA. Diagnostic Accuracy of MRI and Additional [18F]FDG-PET for Behavioral Variant Frontotemporal Dementia in Patients with Late Onset Behavioral Changes. J Alzheimers Dis 2016; 53:1287-97. [DOI: 10.3233/jad-160285] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Everard G.B. Vijverberg
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Neurology, Haga Ziekenhuis, The Hague, The Netherlands
| | - Mike P. Wattjes
- Department of Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Welmoed A. Krudop
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Christiane Möller
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Anne Peters
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Cora J. Kerssens
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Flora Gossink
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Niels D. Prins
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Max L. Stek
- Department of Old Age Psychiatry, GGZ InGeest, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Bart N.M. van Berckel
- Department of Nuclear Medicine & PET research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
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13
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Papageorgiou SG, Beratis IN, Horvath J, Herrmann FR, Bouras C, Kövari E. Amnesia in frontotemporal dementia: shedding light on the Geneva historical data. J Neurol 2016; 263:657-64. [PMID: 26810723 DOI: 10.1007/s00415-015-8019-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 11/30/2022]
Abstract
Recent accumulated evidence indicates that episodic memory impairments could be part of the initial clinical expression of frontotemporal dementia (FTD). An early study on this issue was carried out by Constantinidis and colleagues in 1974, but it was subsequently overlooked for a long period of time. The scope of the present research was: (a) to explore the presence of early episodic memory impairments in the entire population of neuropathologically confirmed FTD patients from the Geneva brain collection; and (b) to expand the present insight on the association between the initial symptomatology and various characteristics, namely gender, age at onset, disease duration, and presence of Pick body neuropathology. A careful review of the records of 50 FTD patients hospitalized at the Department of Psychiatry of the Bel-Air Hospital, Geneva, Switzerland, from 1929 to 1999, was conducted. Further in-depth neuropathological analysis with novel immunohistological methods was carried out in 37 of the cases. The data showed that memory impairments were the first clinical symptom in several of the patients. In addition, this specific phenotypic expression of FTD was associated with the female gender, advanced age, and positive Pick body neuropathology. The current findings give the opportunity to historically vindicate the early work of Constantinidis and colleagues. In addition, the novel observations about the association of episodic memory impairments with the female gender and positive Pick body neuropathology add to the existing knowledge about this phenotypic expression of FTD.
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Affiliation(s)
- Sokratis G Papageorgiou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Str, Haidari, 12462, Athens, Greece.
| | - Ion N Beratis
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Str, Haidari, 12462, Athens, Greece
| | - Judit Horvath
- Department of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Constantin Bouras
- Unit of Biomarkers, Department of Mental Health and Psychiatry, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Enikö Kövari
- Unit of Biomarkers, Department of Mental Health and Psychiatry, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Orasji SSS, Mulder JL, de Bruijn SFTM, Wirtz PW. Olfactory dysfunction in behavioral variant frontotemporal dementia. Clin Neurol Neurosurg 2016; 141:106-10. [PMID: 26773700 DOI: 10.1016/j.clineuro.2016.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Several neurodegenerative disorders show olfactory dysfunction. In patients with frontotemporal dementia (FTD), olfactory impairment is probably due to the involvement of the temporal and orbitofrontal lobes. We hypothesized that due to the disrupted areas in FTD, there would be an impairment in smell identification, differentiation and association. Moreover, we hypothesized that there would be a correlation between the severity of FTD and the severity of odor dysfunction. METHODS In the current study, we compared odor identification, discrimination and association of nine patients with behavioral variant FTD with eleven healthy controls using the Brief Smell Identification Test and the Odor Perception and Semantics Battery. RESULTS The results showed significant differences in the odor association test, but not in the identification or discrimination test. There was no correlation between disease severity and the performance in the odor tests. CONCLUSION We showed impairment of odor association that is most likely due to disruption of specific associative areas involved in olfactory processing. Specifically, we propose that the impairment may well be due to disrupted areas in the temporal lobe and amygdala.
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Affiliation(s)
- S S S Orasji
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - J L Mulder
- Department of Neuropsychology, Haga Teaching Hospital, The Hague, The Netherlands
| | - S F T M de Bruijn
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - P W Wirtz
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
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15
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Balasa M, Gelpi E, Martín I, Antonell A, Rey MJ, Grau-Rivera O, Molinuevo JL, Sánchez-Valle R, Lladó A. Diagnostic accuracy of behavioral variant frontotemporal dementia consortium criteria (FTDC) in a clinicopathological cohort. Neuropathol Appl Neurobiol 2015; 41:882-92. [DOI: 10.1111/nan.12194] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Mircea Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobank; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Idaira Martín
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Anna Antonell
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Ma Jesus Rey
- Neurological Tissue Bank of the Biobank; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Oriol Grau-Rivera
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Neurological Tissue Bank of the Biobank; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit; Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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16
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Barsuglia JP, Kaiser NC, Wilkins SS, Karve SJ, Barrows RJ, Paholpak P, Panchal HV, Jimenez EE, Mather MJ, Mendez MF. A scale of socioemotional dysfunction in frontotemporal dementia. Arch Clin Neuropsychol 2014; 29:793-805. [PMID: 25331776 PMCID: PMC4296158 DOI: 10.1093/arclin/acu050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/13/2022] Open
Abstract
Early social dysfunction is a hallmark symptom of behavioral variant frontotemporal dementia (bvFTD); however, validated measures for assessing social deficits in dementia are needed. The purpose of the current study was to examine the utility of a novel informant-based measure of social impairment, the Socioemotional Dysfunction Scale (SDS) in early-onset dementia. Sixteen bvFTD and 18 early-onset Alzheimer's disease (EOAD) participants received standard clinical neuropsychological measures and neuroimaging. Caregiver informants were administered the SDS. Individuals with bvFTD exhibited greater social dysfunction on the SDS compared with the EOAD group; t(32) = 6.32, p < .001. The scale demonstrated preliminary evidence for discriminating these frequently misdiagnosed groups (area under the curve = 0.920, p = <.001) and internal consistency α = 0.977. The SDS demonstrated initial evidence as an effective measure for detecting abnormal social behavior and discriminating bvFTD from EOAD. Future validation is recommended in larger and more diverse patient groups.
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Affiliation(s)
- Joseph P Barsuglia
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Natalie C Kaiser
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Stacy Schantz Wilkins
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Simantini J Karve
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robin J Barrows
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Elvira E Jimenez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michelle J Mather
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mario F Mendez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA Department of Psychiatry & Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
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17
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Kerklaan BJ, van Berckel BNM, Herholz K, Dols A, van der Flier WM, Scheltens P, Pijnenburg YAL. The added value of 18-fluorodeoxyglucose-positron emission tomography in the diagnosis of the behavioral variant of frontotemporal dementia. Am J Alzheimers Dis Other Demen 2014; 29:607-13. [PMID: 24576796 PMCID: PMC10852737 DOI: 10.1177/1533317514524811] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
UNLABELLED Characteristic frontotemporal abnormalities on structural or functional neuroimaging are mandatory for a diagnosis of probable behavioral variant of frontotemporal dementia (bvFTD) according to the new criteria. 18-Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) imaging is commonly reserved for patients with suspected bvFTD without characteristic structural neuroimaging results. We studied the diagnostic value of 18F-FDG-PET in these patients. METHODS The 18F-FDG-PET was performed in 52 patients with suspected bvFTD but lacking characteristic structural neuroimaging results. The clinical diagnosis of bvFTD in the presence of functional decline (bvFTD/fd+) after a follow-up period of 2 years was used as a golden standard. RESULTS The sensitivity of 18F-FDG-PET for bvFTD/fd+ was 47% at a specificity of 92%. The differential diagnosis comprised alternative neurodegenerative and psychiatric disorders and a benign phenocopy of bvFTD. CONCLUSIONS The 18F-FDG-PET is able to identify nearly half of the patients with bvFTD who remain undetected by magnetic resonance imaging. In our selected group, high specificity enables exclusion of psychiatric and other neurodegenerative disorders.
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Affiliation(s)
- B J Kerklaan
- Alzheimer Center VU Medical Center, Amsterdam, The Netherlands Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands Department of Neurology, Zaans Medical Center, Zaandam, The Netherlands
| | - B N M van Berckel
- Department of Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - K Herholz
- Wolfson Molecular Imaging Center, University of Manchester, Manchester, United Kingdom
| | - A Dols
- GGZ in Geest/Alzheimer Center VU Medical Center, Amsterdam, The Netherlands
| | | | - P Scheltens
- Alzheimer Center VU Medical Center, Amsterdam, The Netherlands
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Joshi A, Barsuglia J, Mather M, Jimenez E, Shapira J, Mendez MF. Evaluation of emotional blunting in behavioral variant frontotemporal dementia compared to Alzheimer's disease. Dement Geriatr Cogn Disord 2014; 38:79-88. [PMID: 24603498 PMCID: PMC4104135 DOI: 10.1159/000357838] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Emotional blunting is a major clinical feature of behavioral variant frontotemporal dementia (bvFTD). Assessing the change in emotional blunting may facilitate the differential diagnosis of this disorder and can quantify a major source of distress for the patients' caregivers and families. METHODS We evaluated investigator ratings on the Scale for Emotional Blunting (SEB) for 13 patients with bvFTD versus 18 patients with early-onset Alzheimer's disease (AD). The caregivers also performed SEB ratings for both the patients' premorbid behavior (before dementia onset) and the patients' behavior on clinical presentation (after dementia onset). RESULTS Before the onset of dementia, the caregivers reported normal SEB scores for both dementia groups. After the onset of dementia, both caregivers and investigators reported greater SEB scores for the bvFTD patients compared to the AD patients. The patients were rated to be much more emotionally blunted by the bvFTD caregivers than by the investigators. A change of ≥15 in the caregiver SEB ratings suggests bvFTD. The change in caregiver SEB ratings was positively correlated with bifrontal hypometabolism on FDG-PET scans. CONCLUSIONS Changes in the caregiver assessment of emotional blunting with dementia onset can distinguish patients with bvFTD from those with AD, and they may better reflect the impact of emotional blunting than similar assessments made by clinicians/investigators.
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Affiliation(s)
- Aditi Joshi
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph Barsuglia
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michelle Mather
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jill Shapira
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
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19
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New behavioural variant FTD criteria and clinical practice. Rev Neurol (Paris) 2013; 169:799-805. [DOI: 10.1016/j.neurol.2013.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 12/12/2022]
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20
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Costa S, Suárez-Calvet M, Antón S, Dols-Icardo O, Clarimón J, Alcolea D, Fortea J, Carmona M, Sala I, Sánchez-Saudinós MB, Blesa R, Lleó A. Comparison of 2 diagnostic criteria for the behavioral variant of frontotemporal dementia. Am J Alzheimers Dis Other Demen 2013; 28:469-76. [PMID: 23695224 PMCID: PMC10852865 DOI: 10.1177/1533317513488918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to compare the applicability of the 1998 consensus diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD) with the recently proposed diagnostic criteria of the International bvFTD Criteria Consortium (FTDC). METHODS We reviewed each individual item in the 1998 and FTDC criteria in 30 patients with bvFTD followed in a memory clinic (including 2 with the C9orf72 gene repeat expansion). RESULTS All patients fulfilled the FTDC criteria (40% possible, 60% probable bvFTD) but only 66.7% fulfilled the 1998 criteria. One of the C9orf72 expansion carriers did not fulfill the 1998 criteria. This discordance was always due to the presence of exclusion features in the 1998 criteria, the most common being spatial disorientation and early severe amnesia. CONCLUSION The new FTDC criteria are less restrictive and hence more sensitive for the diagnosis of bvFTD.
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Affiliation(s)
- Sónia Costa
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
- Neurology Department, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal
| | - Marc Suárez-Calvet
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Sofia Antón
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Oriol Dols-Icardo
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Jordi Clarimón
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Daniel Alcolea
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Juan Fortea
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - María Carmona
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Isabel Sala
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - M. Belén Sánchez-Saudinós
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Rafael Blesa
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
| | - Alberto Lleó
- Department of Neurology, Memory Disorders Unit, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat AutŒnoma de Barcelona, Barcelona, Spain
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Using the revised diagnostic criteria for frontotemporal dementia in India: evidence of an advanced and florid disease. PLoS One 2013; 8:e60999. [PMID: 23596513 PMCID: PMC3626587 DOI: 10.1371/journal.pone.0060999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The International Consortium (FTDC) that revised the diagnostic criteria for behavioural variant frontotemporal dementia (bvFTD) did not have an Asian representation. Whether the revised criteria are equally useful in the early detection of Asian bvFTD patients therefore remains largely unexplored. Earlier studies have indicated differences in clinical manifestations in Indian and other Asian bvFTD patients when compared to western groups. There is an urgent need for clarification, given the projected exponential rise in dementia in these countries and the imminent clinical trials on bvFTD. OBJECTIVE To assess how Indian bvFTD patients fulfil the FTDC criteria, hypothesizing that our patients might present differently early in the illness. METHOD In a hospital-based retrospective observational study, we assessed 48 probable bvFTD patients, diagnosed according to the FTDC criteria, for the speed with which these criteria were fulfilled, the frequency of individual symptoms and their order of appearance during the illness. RESULTS Most of our patients presented with moderate to severe dementia, in spite of having relatively short onset to diagnosis times. Patients on average took 1.4 years from onset to meet the FTDC criteria, with 90% of them presenting with four or more symptoms at diagnosis. Disinhibition was the commonest symptom and the first symptom in most patients. CONCLUSION With most patients presenting with advanced and florid disease, the FTDC criteria have little additional impact in early identification of bvFTD in India. Modifying the criteria further could allow detection of Indian patients early enough for their inclusion in future clinical trials.
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Tan YL, Ng A, Kandiah N. Frontotemporal dementia in southeast Asia: a comparative study. Dement Geriatr Cogn Dis Extra 2013; 3:1-9. [PMID: 23569453 PMCID: PMC3567878 DOI: 10.1159/000345780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The clinical profile of frontotemporal dementia (FTD) in Southeast Asia is not known. We characterized and compared the demographic and clinical characteristics of FTD patients in Southeast Asia with North Asian and Western patients. Methods The study included Southeast Asian FTD patients presenting to a tertiary neurology institute. Behavioral variant (bv-FTD) and language variant (lv-FTD) subtypes of FTD were diagnosed based on the Lund-Manchester criteria. The patients were characterized according to demographics, clinical, neuroimaging and longitudinal profiles. Results Twenty-five bv-FTD and 19 lv-FTD patients were identified, with a female predominance ratio of 2:1 and a mean age of 56 years. The mean MMSE score was 16.2, and 88.4% of patients had memory symptoms. Over 5.1 ± 2.4 years of follow-up, 60% of bv-FTD and 36.8% of lv-FTD patients developed a second FTD syndrome. bv-FTD was the predominant type of FTD among Southeast Asians. Conclusion FTD represents an important cause of young-onset dementia in Southeast Asia. Greater awareness of FTD is required to ensure early diagnosis and management.
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Affiliation(s)
- Yee-Leng Tan
- Department of Neurology, National Neuroscience Institute, Singapore
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23
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Environmental dependency behaviours in frontotemporal dementia: have we been underrating them? J Neurol 2012; 260:861-8. [PMID: 23108491 DOI: 10.1007/s00415-012-6722-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 09/24/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Environmental dependency (ED) behaviours, such as imitation behaviour (IB) and incidental utilization behaviour (UB), are considered pathognomonic of a frontal lesion and can play a unique role in diagnosing behavioural variant frontotemporal dementia (bvFTD). However, with only few focused observations of ED behaviour reported in earlier studies, their roles in the diagnosis of bvFTD have so far remained supportive. In this observational study, conducted in the cognitive clinic of a tertiary-care hospital, we explored the hypotheses that a focused and systematic search could uncover more ED behaviours in patients with bvFTD, and that the presence of ED behaviours such as incidental UB and IB should allow us to cleanly differentiate bvFTD from AD. Forty-one bvFTD patients and 75 probable AD patients, all diagnosed using accepted criteria, were seen by a neurologist and a neuropsychologist. Information regarding ED behaviour was obtained from the caregiver's history, observations for spontaneous behaviour and induction of the behaviour in the clinic. All ED behaviours were significantly more frequent in bvFTD compared with AD. UB (78 %; 66 % incidental) and IB (59 %) occurred exclusively in bvFTD. Multi-pronged and focused clinical assessment contributed to the high frequency of ED behaviours. Nearly two-thirds of bvFTD patients, but none with AD, showed three or more ED behaviours. We concluded that ED behaviours are more common in bvFTD than is currently recognized. UB, IB or three ED behaviours, if present, could clearly differentiate bvFTD from AD. A focused search should consistently uncover ED behaviours in bvFTD patients.
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Filippi M, Agosta F, Barkhof F, Dubois B, Fox NC, Frisoni GB, Jack CR, Johannsen P, Miller BL, Nestor PJ, Scheltens P, Sorbi S, Teipel S, Thompson PM, Wahlund LO. EFNS task force: the use of neuroimaging in the diagnosis of dementia. Eur J Neurol 2012; 19:e131-40, 1487-501. [DOI: 10.1111/j.1468-1331.2012.03859.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/18/2012] [Indexed: 01/18/2023]
Affiliation(s)
- M. Filippi
- Neuroimaging Research Unit; Division of Neuroscience; Institute of Experimental Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - F. Agosta
- Neuroimaging Research Unit; Division of Neuroscience; Institute of Experimental Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - F. Barkhof
- Department of Radiology; VU University Medical Center; Amsterdam The Netherlands
| | - B. Dubois
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière; Université Pierre et Marie Curie; Paris France
| | - N. C. Fox
- Dementia Research Centre; Institute of Neurology; University College London; London UK
| | - G. B. Frisoni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli di Brescia; Brescia Italy
| | - C. R. Jack
- Department of Radiology; Mayo Clinic and Foundation; Rochester MN USA
| | - P. Johannsen
- Memory Clinic; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - B. L. Miller
- Memory and Aging Center; University of California; San Francisco CA USA
| | - P. J. Nestor
- Department of Clinical Neuroscience; University of Cambridge; Cambridge UK
| | - P. Scheltens
- Department of Neurology and Alzheimer Center; VU University Medical Center; Amsterdam The Netherlands
| | - S. Sorbi
- Department of Neurological and Psychiatric Sciences; Azienda Ospedaliero-Universitaria di Careggi; Florence Italy
| | - S. Teipel
- Department of Psychiatry; University of Rostock, and German Center for Neuro-degenerative Diseases (DZNE); Rostock Germany
| | - P. M. Thompson
- Department of Neurology; David Geffen School of Medicine at the University of California Los Angeles; Los Angeles CA USA
| | - L.-O. Wahlund
- Division of Clinical Geriatrics; Department of Neurobiology; Karolinska Institute; Stockholm Sweden
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Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EGP, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 2011; 134:2456-77. [PMID: 21810890 PMCID: PMC3170532 DOI: 10.1093/brain/awr179] [Citation(s) in RCA: 3404] [Impact Index Per Article: 261.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/25/2011] [Accepted: 06/13/2011] [Indexed: 12/20/2022] Open
Abstract
Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86%) met 'possible' criteria, and 104 (76%) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53%) met previously established criteria for the syndrome (P < 0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.
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Affiliation(s)
- Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA 19104, USA.
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Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EGP, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. BRAIN : A JOURNAL OF NEUROLOGY 2011. [PMID: 21810890 DOI: 10.1093/brain/awr179.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86%) met 'possible' criteria, and 104 (76%) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53%) met previously established criteria for the syndrome (P < 0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.
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Affiliation(s)
- Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA 19104, USA.
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Jicha GA, Nelson PT. Management of frontotemporal dementia: targeting symptom management in such a heterogeneous disease requires a wide range of therapeutic options. Neurodegener Dis Manag 2011; 1:141-156. [PMID: 21927623 PMCID: PMC3172080 DOI: 10.2217/nmt.11.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
There are no US FDA-approved therapies for the management of frontotemporal dementia (FTD). Evidence-based medicine that would support a FDA indication for the treatment of FTD requires large-scale, randomized, double-blind, placebo-controlled trials that do not currently exist. Progress in obtaining approval and therapeutic indications for FTD has been severely hampered by the heterogeneity of clinical and pathological phenotypes seen in various FTD disease states. These issues are often misinterpreted by clinicians, caregivers and patients suggesting that potential treatment options are nonexistent for this devastating disease. This article discusses these issues in the context of recent studies and publications investigating therapeutic options in FTD, and further suggests a rationale for individualized therapy in FTD. Targeting the myriad of symptoms seen in FTD requires recognition of such symptoms that may play primary or secondary roles in the spectrum of deficits that lead to functional disability in FTD, and the availability of a wide range of therapeutic options that may be helpful in alleviating such symptomatology. Fortunately, agents targeting the many cognitive, behavioral, psychiatric and motor symptoms that can be seen in FTD are readily available, having been previously developed and approved for symptomatic benefit in other disease states. In contrast to the widespread belief that beneficial treatments are not available for FTD today, our therapeutic armament is stocked with pharmacological tools that may improve quality of life for those suffering from this devastating and incurable class of degenerative diseases.
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Affiliation(s)
- Gregory A Jicha
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neuropathology, University of Kentucky College of Medicine, Lexington, KY, USA
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Clionsky MI, Clionsky E. Development and validation of the Memory Orientation Screening Test (MOST™): A better screening test for dementia. Am J Alzheimers Dis Other Demen 2010; 25:650-6. [PMID: 21131671 PMCID: PMC10845489 DOI: 10.1177/1533317510386216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES Accurate, economical identification of cognitive impairment would increase dementia detection and improve care of older patients. DESIGN Analysis of archival neuropsychological data combined 3-word recall, time orientation, list memory, and clock drawing into the Memory Orientation Screening Test (MOST ™). The MOST was compared with Folstein Mini Mental State Examination (MMSE) and Mini-Cog to detect dementia presence and severity, and convergence with standardized neuropsychological tests. Internal consistency, retest reliabilities, completion likelihood, and time costs were calculated. RESULTS The MOST was significantly more sensitive than MMSE or Mini-Cog, twice as accurate as MMSE for identifying mild dementia, better correlated with standardized memory tests, more reliable over time, and minimally related to depression. CONCLUSIONS The MOST is routinely administered in less than 5 minutes by a medical assistant, more accurately identifies dementia and severity than current screening tests, and emulates longer memory testing, making it valuable for Annual Wellness Visits and many applied clinical settings.
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