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Katsumi Y, Quimby M, Hochberg D, Jones A, Brickhouse M, Eldaief MC, Dickerson BC, Touroutoglou A. Association of Regional Cortical Network Atrophy With Progression to Dementia in Patients With Primary Progressive Aphasia. Neurology 2023; 100:e286-e296. [PMID: 36192173 PMCID: PMC9869757 DOI: 10.1212/wnl.0000000000201403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with primary progressive aphasia (PPA) have gradually progressive language deficits during the initial phase of the illness. As the underlying neurodegenerative disease progresses, patients with PPA start losing independent functioning due to the development of nonlanguage cognitive or behavioral symptoms. The timeline of this progression from the mild cognitive impairment stage to the dementia stage of PPA is variable across patients. In this study, in a sample of patients with PPA, we measured the magnitude of cortical atrophy within functional networks believed to subserve diverse cognitive and affective functions. The objective of the study was to evaluate the utility of this measure as a predictor of time to subsequent progression to dementia in PPA. METHODS Patients with PPA with largely independent daily function were recruited through the Massachusetts General Hospital Frontotemporal Disorders Unit. All patients underwent an MRI scan at baseline. Cortical atrophy was then estimated relative to a group of amyloid-negative cognitively normal control participants. For each patient, we measured the time between the baseline visit and the subsequent visit at which dementia progression was documented or last observation. Simple and multivariable Cox regression models were used to examine the relationship between cortical atrophy and the likelihood of progression to dementia. RESULTS Forty-nine patients with PPA (mean age = 66.39 ± 8.36 years, 59.2% females) and 25 controls (mean age = 67.43 ± 4.84 years, 48% females) were included in the data analysis. Greater baseline atrophy in not only the left language network (hazard ratio = 1.47, 95% CI = 1.17-1.84) but also in the frontoparietal control (1.75, 1.25-2.44), salience (1.63, 1.25-2.13), default mode (1.55, 1.19-2.01), and ventral frontotemporal (1.41, 1.16-1.71) networks was associated with a higher risk of progression to dementia. A multivariable model identified contributions of the left frontoparietal control (1.94, 1.09-3.48) and ventral frontotemporal (1.61, 1.09-2.39) networks in predicting dementia progression, with no additional variance explained by the language network (0.75, 0.43-1.31). DISCUSSION These results suggest that baseline atrophy in cortical networks subserving nonlanguage cognitive and affective functions is an important predictor of progression to dementia in PPA. This measure should be included in precision medicine models of prognosis in PPA.
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Affiliation(s)
- Yuta Katsumi
- *These authors contributed equally as co-first authors.
- These authors contributed equally as co-senior authors.
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Megan Quimby
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daisy Hochberg
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Amelia Jones
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Michael Brickhouse
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mark C Eldaief
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bradford C Dickerson
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Alexandra Touroutoglou
- *These authors contributed equally as co-first authors
- These authors contributed equally as co-senior authors
- From the Frontotemporal Disorders Unit (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), the Departments of Neurology (Y.K., M.Q., D.H., A.J., M.B., M.C.E., B.C.D., A.T.), and Psychiatry (M.C.E., B.C.D., A.T.), the Massachusetts Alzheimer's Disease Research Center (M.C.E., B.C.D., A.T.), and the Athinoula A. Martinos Center for Biomedical Imaging (B.C.D.), Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Chatzidimitriou E, Ioannidis P, Moraitou D, Konstantinopoulou E, Aretouli E. The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study. Front Hum Neurosci 2023; 17:1087765. [PMID: 36923586 PMCID: PMC10009888 DOI: 10.3389/fnhum.2023.1087765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Objective: Frontotemporal dementia (FTD) impinges significantly on cognition, behavior, and everyday functioning. Goal of the present study is the detailed description of behavioral disturbances and functional limitations, as well as the investigation of associations between cognition, behavior, and functional impairment among FTD patients. Given the importance of maintaining a satisfying functional status as long as possible, this study also aims to identify the cognitive correlates of compensatory strategy use in this clinical group. Methods: A total of 13 patients diagnosed with FTD (behavioral variant FTD = 9, non-fluent variant primary progressive aphasia = 3, semantic dementia = 1) were administrated a broad range of neuropsychological tests for the assessment of different cognitive abilities. Behavioral symptomatology and performance on everyday activities were rated with informant-based measures. Descriptive statistics were used for the delineation of behavioral and functional patterns, whereas stepwise multiple regression analyses were performed to identify associations between cognition, behavior, and functional status. Results: Negative symptoms, especially apathy, were found to predominate in the behavior of FTD patients. Instrumental tasks, such as housework and leisure activities, appeared to be the most impaired functional domains. Working memory was the strongest cognitive correlate of performance across various domains of everyday functioning, whereas working memory along with short-term verbal memory accounted for a great proportion of variance in compensatory strategy use. Behavioral disturbances and especially negative symptoms were also found to contribute significantly to functional impairment in FTD. Conclusions: Executive dysfunction, as well as behavioral disturbances contribute significantly to functional disability in FTD. Early interventions tailored at these domains may have the potential to improve functional outcomes and delay the rate of functional decline among FTD patients.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Konstantinopoulou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- School of Psychology, University of Ioannina, Ioannina, Greece
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Calandri IL, Crivelli L, Morello Garcia F, Allegri RF. Utility of a Spanish version of Three Words-Three Shapes Test to detect memory impairment in primary progressive aphasia. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:20-26. [PMID: 33836135 DOI: 10.1080/23279095.2021.1907391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Three Words-Three Shapes (3W3S) is a bedside test that assesses verbal and non-verbal memory and has proven useful in staging memory decline in amnestic disorders and primary progressive aphasia. Given its simple structure, the 3W3S can be easily adapted to other languages maintaining the original shapes and only modifying the words. We aim to validate a Spanish version of the 3W3S test and establish whether memory loss patterns present in amnesic disorders associated with Alzheimer's etiology and PPA were correctly characterized. METHOD The translation and adaptation of the 3W3S were performed according to standardized guidelines and applied to a cohort of patients with Dementia of Alzheimer's type (DAT = 20), mild cognitive impairment (aMCI= 20), primary progressive aphasia (PPA = 20), and healthy controls (HC = 20). RESULTS In verbal memory performance, PPA patients' score was lower than that of MCI and HC and similar to DAT's in the effortless encoding (p < 0.001), delayed recall (p < 0.001), and recognition (p < 0.012). For non-verbal performance, PPA patients performed better than DAT and similar to HC and MCI subjects (p < 0.001). CONCLUSIONS Results show good applicability of 3W3S to determine memory function in PPA patients, independently from language ability. Visual and verbal components of memory are dissociated in PPA.
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Affiliation(s)
| | - Lucia Crivelli
- Ageing and Memory Clinic, FLENI, Buenos Aires, Argentina
| | - Florentina Morello Garcia
- Instituto de Investigaciones en Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Consejo Nacional de investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Shdo SM, Roy ARK, Datta S, Sible IJ, Lukic S, Perry DC, Rankin KP, Kramer JH, Rosen HJ, Miller BL, Seeley WW, Holley SR, Gorno-Tempini ML, Sturm VE. Enhanced positive emotional reactivity in frontotemporal dementia reflects left-lateralized atrophy in the temporal and frontal lobes. Cortex 2022; 154:405-420. [PMID: 35930892 PMCID: PMC9867572 DOI: 10.1016/j.cortex.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/03/2022] [Accepted: 02/16/2022] [Indexed: 01/26/2023]
Abstract
In frontotemporal dementia (FTD), left-lateralized atrophy patterns have been associated with elevations in certain positive emotions. Here, we investigated whether positive emotional reactivity was enhanced in semantic variant primary progressive aphasia (svPPA), an FTD syndrome that targets the left anterior temporal lobe. Sixty-one participants (16 people with svPPA, 24 people with behavioral variant FTD, and 21 healthy controls) viewed six 90-sec trials that were comprised of a series of photographs; each trial was designed to elicit a specific positive emotion, negative emotion, or no emotion. Participants rated their positive emotional experience after each trial, and their smiling behavior was coded with the Facial Action Coding System. Results indicated that positive emotional experience and smiling were elevated in svPPA in response to numerous affective and non-affective stimuli. Voxel-based morphometry analyses revealed that greater positive emotional experience and greater smiling in the patients were both associated with smaller gray matter volume in the left superior temporal gyrus (pFWE < .05), among other left-lateralized frontotemporal regions. Whereas enhanced positive emotional experience related to atrophy in middle superior temporal gyrus and structures that promote cognitive control and emotion regulation, heightened smiling related to atrophy in posterior superior temporal gyrus and structures that support motor control. Our results suggest positive emotional reactivity is elevated in svPPA and offer new evidence that atrophy in left-lateralized emotion-relevant systems relates to enhanced positive emotions in FTD.
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Affiliation(s)
- Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; University of California, Berkeley, Department of Psychology, Berkeley, CA, USA.
| | - Ashlin R K Roy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Samir Datta
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Isabel J Sible
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - David C Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Sarah R Holley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; San Francisco State University, Department of Psychology, San Francisco, CA, USA.
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Virginia E Sturm
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
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Morrow CB, Leoutsakos JMS, Onyike CU. Functional Disabilities and Psychiatric Symptoms in Primary Progressive Aphasia. Am J Geriatr Psychiatry 2022; 30:372-382. [PMID: 34412935 PMCID: PMC9103777 DOI: 10.1016/j.jagp.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study are to describe the chronology of functional disabilities in primary progressive aphasia (PPA), and to examine associations between psychiatric comorbidities and functional disabilities. METHODS We conducted a retrospective data analysis using subjects enrolled at Alzheimer's Disease Research Centers between 2005 and 2019. Data were obtained from the National Alzheimer's Coordinating Center database. We included subjects whose primary diagnosis was PPA. Functional status was coded as a binary variable for the following functions: ambulation, transaction skills, verbal communication, meal preparation, and self-care. Behavioral data derived from the Neuropsychiatric Inventory Questionnaire. Descriptive statistics and cox proportional hazard analyses were used to characterize the emergence of disabilities and their association with psychiatric comorbidities. RESULTS Data included 91 subjects with a clinical dementia rating scale of zero at baseline. At the initial visit, no individuals had impairments in self-care, while 7% had impairments in transactions, 3% in ambulation, and 2% in meal preparation. Ninety-three percent had language impairments at the onset of the study, and all by visit 4. By visit 5, 41% of patients had impairments in ambulation and in self-care, 49% were impaired in meal preparation and 70% had impairment in transactions. The presence of anxiety, depression, sleep disturbance and psychosis were all significantly associated with an increased risk for multiple functional disabilities. CONCLUSION These findings provide clinicians with guidance for forecasting disabilities and targeting interventions in PPA.
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Affiliation(s)
- Christopher B. Morrow
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD
| | - Jeannie-Marie Sheppard Leoutsakos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chiadi U. Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD
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de la Sablonnière J, Tastevin M, Lavoie M, Laforce R. Longitudinal Changes in Cognition, Behaviours, and Functional Abilities in the Three Main Variants of Primary Progressive Aphasia: A Literature Review. Brain Sci 2021; 11:1209. [PMID: 34573229 PMCID: PMC8466869 DOI: 10.3390/brainsci11091209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
Primary progressive aphasias (PPAs) are a group of neurodegenerative diseases presenting with insidious and relentless language impairment. Three main PPA variants have been described: the non-fluent/agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA). At the time of diagnosis, patients and their families' main question pertains to prognosis and evolution, but very few data exist to support clinicians' claims. The objective of this study was to review the current literature on the longitudinal changes in cognition, behaviours, and functional abilities in the three main PPA variants. A comprehensive review was undertaken via a search on PUBMED and EMBASE. Two authors independently reviewed a total of 65 full-text records for eligibility. A total of 14 group studies and one meta-analysis were included. Among these, eight studies included all three PPA variants. Eight studies were prospective, and the follow-up duration was between one and five years. Overall, svPPA patients showed more behavioural disturbances both at baseline and over the course of the disease. Patients with lvPPA showed a worse cognitive decline, especially in episodic memory, and faster progression to dementia. Finally, patients with nfvPPA showed the most significant losses in language production and functional abilities. Data regarding the prodromal and last stages of PPA are still missing and studies with a longer follow-up observation period are needed.
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Affiliation(s)
| | | | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques du CHU de Québec, Faculté de Médecine, Université Laval, Quebec City, QC G1J 1Z4, Canada; (J.d.l.S.); (M.T.); (M.L.)
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Verbal Short-Term Memory Disturbance in the Primary Progressive Aphasias: Challenges and Distinctions in a Clinical Setting. Brain Sci 2021; 11:brainsci11081060. [PMID: 34439679 PMCID: PMC8391512 DOI: 10.3390/brainsci11081060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Impaired verbal ‘phonological’ short-term memory is considered a cardinal feature of the logopenic variant of primary progressive aphasia (lv-PPA) and is assumed to underpin most of the language deficits in this syndrome. Clinically, examination of verbal short-term memory in individuals presenting with PPA is common practice and serves two objectives: (i) to help understand the possible mechanisms underlying the patient’s language profile and (ii) to help differentiate lv-PPA from other PPA variants or from other dementia syndromes. Distinction between lv-PPA and the non-fluent variant of PPA (nfv-PPA), however, can be especially challenging due to overlapping language profiles and comparable psychometric performances on verbal short-term memory tests. Here, we present case vignettes of the three PPA variants (lv-PPA, nfv-PPA, and the semantic variant (sv-PPA)) and typical Alzheimer’s disease (AD). These vignettes provide a detailed description of the short-term and working memory profiles typically found in these patients and highlight how speech output and language comprehension deficits across the PPA variants differentially interfere with verbal memory performance. We demonstrate that a combination of verbal short-term and working memory measures provides crucial information regarding the cognitive mechanisms underlying language disturbances in PPA. In addition, we propose that analogous visuospatial span tasks are essential for the assessment of PPA as they measure memory capacity without language contamination.
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Ulugut H, Stek S, Wagemans LEE, Jutten RJ, Keulen MA, Bouwman FH, Prins ND, Lemstra AW, Krudop W, Teunissen CE, van Berckel BNM, Ossenkoppele R, Barkhof F, van der Flier WM, Scheltens P, Pijnenburg YAL. The natural history of primary progressive aphasia: beyond aphasia. J Neurol 2021; 269:1375-1385. [PMID: 34216263 PMCID: PMC8857134 DOI: 10.1007/s00415-021-10689-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is divided into three prototypical subtypes that are all characterized by their single core symptom of aphasia. Although later in their course, other cognitive, behavioral, and motor domains may become involved, little is known about the progression profile of each subtype relative to the other subtypes. METHODS In this longitudinal retrospective cohort study, based on the recent biomarker-supported diagnostic criteria, 24 subjects diagnosed with semantic variant (svPPA), 22 with non-fluent variant (nfvPPA), and 18 with logopenic variant (lvPPA) were collected and followed up for 1-6 years. Symptom distribution, cognitive test and neuropsychiatric inventory scores, and progression into another syndrome were assessed. RESULTS Over time, lvPPA progressed with broader language problems (PPA-extended) and nfvPPA progressed to mutism, whereas semantic impairment remained the major problem in svPPA. Apart from linguistic problems, svPPA developed pronounced behavioral disturbances, whereas lvPPA exhibited a greater cognitive decline. By contrast, in nfvPPA motor deficits were more common. Furthermore, within 5 years (IQR = 2.5) after clinical onset, 65.6% of the patients additionally fulfilled the clinical criteria for another neurodegenerative syndrome (PPA-plus). Fourteen out of 24 (58%) svPPA patients additionally met the diagnostic criteria of behavioral variant frontotemporal dementia (5.1 years, IQR = 1.1), whereas the clinical features of 15/18 (83%) lvPPA patients were consistent with Alzheimer disease dementia (4.5 years IQR = 3.4). Furthermore, 12/22 (54%) of the subjects with the nfvPPA progressed to meet the diagnostic criteria of corticobasal syndrome, progressive supranuclear palsy, or motor neuron disease (5.1 years IQR = 3.4). DISCUSSION Despite aphasia being the initial and unique hallmark of the syndrome, our longitudinal results showed that PPA is not a language limited disorder and progression differs widely for each subtype, both with respect to the nature of symptoms and disease duration.
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Affiliation(s)
- Hulya Ulugut
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - Simone Stek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Lianne E E Wagemans
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Roos J Jutten
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Maria Antoinette Keulen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Niels D Prins
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Welmoed Krudop
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charlotte E Teunissen
- Neurological Laboratory Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- UCL Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
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9
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Moeller S, Sridhar J, Martersteck A, Coventry C, Kuang A, Zhang H, Weintraub S, Mesulam MM, Rogalski E. Functional decline in the aphasic variant of Alzheimer's disease. Alzheimers Dement 2021; 17:1641-1648. [PMID: 33829622 DOI: 10.1002/alz.12331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a clinical dementia syndrome associated with frontotemporal lobar degeneration (FTLD) or Alzheimer's disease (AD). Impairment in activities of daily living is essential for dementia diagnosis, yet less is known about the neuropathologic impact on functional decline in PPA, especially over time. METHODS Activities of Daily Living Questionnaire (ADLQ) ratings were compared by suspected underlying pathology between 17 PPAAβ+ and 11 PPAAβ- participants at 6-month intervals for 2 years using a linear mixed-effects model. A general linear model examined associations between functional decline and cortical thickness at baseline. RESULTS Groups did not differ in demographics or aphasia severity at baseline, yet overall and subdomain scores of the ADLQ were significantly worse for PPAAβ+ compared to PPAAβ- (P = .015) at each interval across 18 months. DISCUSSION Functional decline appears more pronounced and disrupts more aspects of life activities for individuals with non-semantic PPA with suspected AD versus non-AD neuropathology.
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Affiliation(s)
- Stacey Moeller
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adam Martersteck
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hui Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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10
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Beyond language impairment: Profiles of apathy in primary progressive aphasia. Cortex 2021; 139:73-85. [PMID: 33836304 DOI: 10.1016/j.cortex.2021.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/28/2020] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that apathy can be delineated into multiple dimensions: executive apathy (i.e., deficits in maintaining goals and organisation), emotional apathy (i.e., emotional blunting and indifference) and initiation apathy (i.e., reduced self-initiation). Whether the nature of apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation apathy. Voxel-based morphometry was used to identify associations between dimensions of apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional apathy than both late nfvPPA and late lvPPA groups. Executive and initiation apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional apathy was only seen in early and late svPPA. Distinct neural correlates were identified across apathy dimensions. Executive apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional apathy with the left medial prefrontal, insular and cerebellar regions; and initiation apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of apathy which emerge in PPA.
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11
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Longitudinal cognitive and functional changes in primary progressive aphasia. J Neurol 2021; 268:1951-1961. [PMID: 33417000 DOI: 10.1007/s00415-020-10382-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The variants of primary progressive aphasia (PPA) are predominantly diagnosed on the basis of specific profiles of language impairments. Deficits in other cognitive domains and their evolution over time are less well documented. This study examined the cognitive profiles of the PPA variants over time and determined the contribution of cognition on functional capacity. METHODS Longitudinal performance on the Addenbrooke's Cognitive Examination-III (ACE-III) total and cognitive subdomains were investigated in 147 PPA individuals (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA], and 62 semantic variants [sv-PPA]). The relative contribution of ACE-III subdomain scores to overall functional capacity over time was identified using mixed and hierarchical regression modelling. RESULTS The annual rate of global ACE-III decline was twice that in lv-PPA than in nfv-PPA and sv-PPA, despite lv-PPA performing intermediate to the other variants at baseline assessment. Notably, attention and visuospatial subdomains declined faster in lv-PPA than in nfv-PPA and sv-PPA; and memory impairment was more severe in lv-PPA than in nfv-PPA at all time points. Functional decline was comparable across PPA variants; however, the contribution of cognition on functional capacity varied across variants and over time. CONCLUSION The cognitive profiles of the PPA variants are distinct at baseline and over time. Crucially, cognitive decline in lv-PPA was more widespread and pervasive than in nfv-PPA and sv-PPA. Our findings also demonstrate the complex interplay between cognition and functional capacity. This study underscores the importance of routinely assessing cognition and functional capacity in PPA to improve diagnostic accuracy and provide targeted support services.
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12
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Giebel CM, Knopman D, Mioshi E, Khondoker M. Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. J Geriatr Psychiatry Neurol 2021; 34:66-75. [PMID: 32054376 PMCID: PMC7423644 DOI: 10.1177/0891988720901791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Different dementia syndromes display different patterns of everyday functioning. This article explored different patterns of functioning at baseline and trajectories of change in behavioral variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD). METHODS Data from the Uniform Data Set of the National Alzheimer's Coordinating Centre were employed. The Functional Assessment Questionnaire assessed functioning at up to 7 follow-up visits. Independent t tests assessed variations in functioning between syndromes at baseline. Linear mixed-effect modeling explored longitudinal functional trajectories between syndromes. RESULTS Data from 3351 patients (306 bvFTD and 3,045AD) were analyzed. At baseline, patients with bvFTD performed all daily activities poorer than AD dementia. Linear mixed models showed a significant effect of syndrome and time on functioning, and evidence of interaction between syndrome and time, with bvFTD showing a steeper decline for using the stove and travel. CONCLUSIONS Findings can help in the effective care planning of everyday functioning for bvFTD and AD dementia.
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Affiliation(s)
- Clarissa M. Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom,NIHR ARC NWC, Liverpool, United Kingdom
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Mizanur Khondoker, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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13
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Wong S, Irish M, Husain M, Hodges JR, Piguet O, Kumfor F. Apathy and its impact on carer burden and psychological wellbeing in primary progressive aphasia. J Neurol Sci 2020; 416:117007. [DOI: 10.1016/j.jns.2020.117007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/31/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
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14
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Kishita N, Contreras ML, West J, Mioshi E. Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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15
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Abstract
BACKGROUND/AIMS Few longitudinal studies have explored the progression of cognitive and functional impairment of patients with primary progressive aphasia (PPA). The aims of the study were to describe the clinical, neuroimaging, and genetic features of a cohort of 68 PPA patients, and to outline the natural history of the disease. MATERIALS AND METHODS A sample of 23 patients with the logopenic variant, 26 with the nonfluent/agrammatic variant, and 19 with the semantic variant was retrospectively collected and followed-up for a maximum of 6 years. Clinical-neuropsychological assessment, fluorodeoxyglucose positron emission tomographic imaging, and genetic analyses were acquired at baseline. Disease progression was evaluated in terms of language impairment, global cognitive decline, and functional dependency. RESULTS During follow-up, one third of subjects presented total language loss, and 20% severe functional dependency. Global cognitive decline after the first year (hazard ratio, 5.93; confidence interval, 1.63-21.56) and high schooling (hazard ratio, 0.07; confidence interval, 0.008-0.74) represented risk factors for functional impairment. The apolipoprotein E status was associated with the progression of cognitive decline. Positive family history for dementia was frequent and 3 genetic autosomal dominant mutations were identified. CONCLUSIONS There were no differences in the progression of PPA subtypes. Genetics plays an important role in disease onset and progression.
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16
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Faria AV, Meyer A, Friedman R, Tippett DC, Hillis AE. Baseline MRI associates with later naming status in primary progressive aphasia. BRAIN AND LANGUAGE 2020; 201:104723. [PMID: 31864209 PMCID: PMC7282486 DOI: 10.1016/j.bandl.2019.104723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
Advanced imaging studies in neurodegenerative disease have yielded new insights into subtypes of disease, progression of disease in various brain regions, and changes in structural and functional connectivity between brain regions related to symptom progression. However, few studies have revealed imaging markers at baseline that correlate with rate or degree of decline in function. Here we tested the hypothesis that imaging features at baseline correlate with outcome of naming in primary progressive aphasia. We obtained longitudinal multimodal imaging in 15 individuals with primary progressive aphasia at the same time points as assessment of naming. We found that functional connectivity between particular brain regions (measured with resting state functional connectivity magnetic resonance imaging) is strongly associated with accuracy of naming 21 months later, independently of baseline severity of naming impairment. These data indicate that functional connectivity may carry information about later performance in naming, and is potentially useful for refining prognosis.
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Affiliation(s)
- Andreia V Faria
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Aaron Meyer
- Department of Neurology, Georgetown University School of Medicine, Washington, USA
| | - Rhonda Friedman
- Department of Neurology, Georgetown University School of Medicine, Washington, USA
| | - Donna C Tippett
- Department of Otolaryngology & Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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17
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O'Connor CM, Clemson L, Brodaty H, Low LF, Jeon YH, Gitlin LN, Piguet O, Mioshi E. The tailored activity program (TAP) to address behavioral disturbances in frontotemporal dementia: a feasibility and pilot study. Disabil Rehabil 2017; 41:299-310. [PMID: 29034719 DOI: 10.1080/09638288.2017.1387614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). METHODS The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. RESULTS The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategies used by carer to engage person with dementia", "barriers to the Tailored Activity Program uptake/implementation", and "person with dementia engagement". Quantitative outcomes showed an overall reduction of behavioral symptoms (F18.34 = 8.073, p = 0.011) and maintenance of functional performance in the person with dementia (F18.03 = 0.375, p = 0.548). CONCLUSIONS This study demonstrates the potential for using an activity-based intervention such as the Tailored Activity Program in frontotemporal dementia. Service providers should recognize that while people with frontotemporal dementia present with challenging issues, tailored therapies may support their function and reduce their behavioral symptoms. Implications for rehabilitation The Tailored Activity Program is an occupational therapy based intervention that involves prescribing personalized activities for behavioral management in dementia. The Tailored Activity Program is an acceptable and feasible intervention approach to address some of the unique behavioral and functional impairments inherent in frontotemporal dementia.
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Affiliation(s)
- Claire M O'Connor
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Henry Brodaty
- c Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing (CHeBA) , University of New South Wales , Sydney , Australia
| | - Lee-Fay Low
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Yun-Hee Jeon
- d Sydney Nursing School , University of Sydney , Sydney , Australia
| | - Laura N Gitlin
- e Center for Innovative Care in Aging , Johns Hopkins University , Baltimore , MD , USA
| | - Olivier Piguet
- f Brain and Mind Centre , Sydney , Australia.,g Neuroscience Research Australia , Sydney , Australia.,h ARC Centre of Excellence in Cognition and its Disorders , University of New South Wales , Sydney , Australia
| | - Eneida Mioshi
- i School of Health Sciences , University of East Anglia , Norwich , UK
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18
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Moheb N, Mendez MF, Kremen SA, Teng E. Executive Dysfunction and Behavioral Symptoms Are Associated with Deficits in Instrumental Activities of Daily Living in Frontotemporal Dementia. Dement Geriatr Cogn Disord 2017; 43:89-99. [PMID: 28103593 PMCID: PMC5300022 DOI: 10.1159/000455119] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deficits in instrumental activities of daily living (ADLs) may be more prominent in behavioral variant frontotemporal dementia (bvFTD) than in nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) or semantic variant primary progressive aphasia (svPPA). It is uncertain whether frontotemporal dementia (FTD) subgroups exhibit different patterns and/or predictors of functional impairment. METHODS We examined data from participants diagnosed with bvFTD (n = 607), svPPA (n = 132), and nfvPPA (n = 155) who were included in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) and assessed with the Functional Activities Questionnaire (FAQ). Stepwise multiple linear regression analyses were performed to identify associations between FAQ scores and cognitive/behavioral deficits using the NACC UDS neuropsychological testing battery and the Neuropsychiatric Inventory Questionnaire. RESULTS FAQ scores were higher in bvFTD than svPPA or nfvPPA. Functional deficits across FTD subtypes differed in severity, but not pattern, and were driven by executive dysfunction and behavioral symptoms. CONCLUSION Executive dysfunction and behavioral symptoms underlie instrumental ADL deficits in FTD, which are most prominent in bvFTD.
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Affiliation(s)
- Negar Moheb
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA,Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA,Veterans Affairs Greater Los Angeles Healthcare System
| | - Sarah A. Kremen
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Edmond Teng
- Department of Neurology, David Geffen School of Medicine at UCLA,Veterans Affairs Greater Los Angeles Healthcare System
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