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Abstract
OBJECTIVE The ability to recognize others' emotions is a central aspect of socioemotional functioning. Emotion recognition impairments are well documented in Alzheimer's disease and other dementias, but it is less understood whether they are also present in mild cognitive impairment (MCI). Results on facial emotion recognition are mixed, and crucially, it remains unclear whether the potential impairments are specific to faces or extend across sensory modalities. METHOD In the current study, 32 MCI patients and 33 cognitively intact controls completed a comprehensive neuropsychological assessment and two forced-choice emotion recognition tasks, including visual and auditory stimuli. The emotion recognition tasks required participants to categorize emotions in facial expressions and in nonverbal vocalizations (e.g., laughter, crying) expressing neutrality, anger, disgust, fear, happiness, pleasure, surprise, or sadness. RESULTS MCI patients performed worse than controls for both facial expressions and vocalizations. The effect was large, similar across tasks and individual emotions, and it was not explained by sensory losses or affective symptomatology. Emotion recognition impairments were more pronounced among patients with lower global cognitive performance, but they did not correlate with the ability to perform activities of daily living. CONCLUSIONS These findings indicate that MCI is associated with emotion recognition difficulties and that such difficulties extend beyond vision, plausibly reflecting a failure at supramodal levels of emotional processing. This highlights the importance of considering emotion recognition abilities as part of standard neuropsychological testing in MCI, and as a target of interventions aimed at improving social cognition in these patients.
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Neurofilaments as Emerging Biomarkers of Neuroaxonal Damage to Differentiate Behavioral Frontotemporal Dementia from Primary Psychiatric Disorders: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11050754. [PMID: 33922390 PMCID: PMC8146697 DOI: 10.3390/diagnostics11050754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
The behavioral variant of frontotemporal dementia (bvFTD) is a clinical syndrome resulting from various causes of neuronal demises associated with frontotemporal lobar degeneration. Symptoms include behavioral and personality changes, social cognitive impairment, and executive function deficits. There is a significant clinical overlap between this syndrome and various primary psychiatric disorders (PPD). Structural and functional neuroimaging are considered helpful to support the diagnosis of bvFTD, but their sensitivity and specificity remain imperfect. There is growing evidence concerning the potential of neurofilaments as biomarkers reflecting axonal and neuronal lesions. Ultrasensitive analytic platforms have recently enabled neurofilament light chains’ (NfL) detection not only from cerebrospinal fluid but also from peripheral blood samples in FTD patients. In this short review, we present recent advances and perspectives for the use of NfL assessments as biomarkers of neuroaxonal damage to differentiate bvFTD from primary psychiatric disorders.
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3
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Meijboom R, Steketee RME, Ham LS, Mantini D, Bron EE, van der Lugt A, van Swieten JC, Smits M. Exploring quantitative group-wise differentiation of Alzheimer's disease and behavioural variant frontotemporal dementia using tract-specific microstructural white matter and functional connectivity measures at multiple time points. Eur Radiol 2019; 29:5148-5159. [PMID: 30859283 PMCID: PMC6719324 DOI: 10.1007/s00330-019-06061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/07/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
Objectives This study explored group-wise quantitative measures of tract-specific white matter (WM) microstructure and functional default mode network (DMN) connectivity to establish an initial indication of their clinical applicability for early-stage and follow-up differential diagnosis of Alzheimer’s disease (AD) and behavioural variant frontotemporal dementia (bvFTD). Methods Eleven AD and 12 bvFTD early-stage patients and 18 controls underwent diffusion tensor imaging and resting state functional magnetic resonance imaging at 3 T. All AD and 6 bvFTD patients underwent the same protocol at 1-year follow-up. Functional connectivity measures of DMN and WM tract-specific diffusivity measures were determined for all groups. Exploratory analyses were performed to compare all measures between the three groups at baseline and between patients at follow-up. Additionally, the difference between baseline and follow-up diffusivity measures in AD and bvFTD patients was compared. Results Functional connectivity of the DMN was not different between groups at baseline and at follow-up. Diffusion abnormalities were observed widely in bvFTD and regionally in the hippocampal cingulum in AD. The extent of the differences between bvFTD and AD was diminished at follow-up, yet abnormalities were still more pronounced in bvFTD. The rate of change was similar in bvFTD and AD. Conclusions This study provides a tentative indication that quantitative tract-specific microstructural WM abnormalities, but not quantitative functional connectivity of the DMN, may aid early-stage and follow-up differential diagnosis of bvFTD and AD. Specifically, pronounced microstructural changes in anterior WM tracts may characterise bvFTD, whereas microstructural abnormalities of the hippocampal cingulum may characterise AD. Key Points • The clinical applicability of quantitative brain imaging measures for early-stage and follow-up differential diagnosis of dementia subtypes was explored using a group-wise approach. • Quantitative tract-specific microstructural white matter abnormalities, but not quantitative functional connectivity of the default mode network, may aid early-stage and follow-up differential diagnosis of behavioural variant frontotemporal dementia and Alzheimer’s disease. • Pronounced microstructural white matter (WM) changes in anterior WM tracts characterise behavioural variant frontotemporal dementia, whereas microstructural WM abnormalities of the hippocampal cingulum in the absence of other WM changes characterise Alzheimer’s disease. Electronic supplementary material The online version of this article (10.1007/s00330-019-06061-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Meijboom
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - R M E Steketee
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L S Ham
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - D Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.,Functional Neuroimaging Laboratory, IRCCS San Camillo Hospital Foundation, Lido, Italy
| | - E E Bron
- Biomedical Imaging Group Rotterdam - Departments of Medical Informatics and Radiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J C van Swieten
- Department of Neurology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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4
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Jiskoot LC, Panman JL, Meeter LH, Dopper EGP, Donker Kaat L, Franzen S, van der Ende EL, van Minkelen R, Rombouts SARB, Papma JM, van Swieten JC. Longitudinal multimodal MRI as prognostic and diagnostic biomarker in presymptomatic familial frontotemporal dementia. Brain 2019; 142:193-208. [PMID: 30508042 PMCID: PMC6308313 DOI: 10.1093/brain/awy288] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022] Open
Abstract
Developing and validating sensitive biomarkers for the presymptomatic stage of familial frontotemporal dementia is an important step in early diagnosis and for the design of future therapeutic trials. In the longitudinal Frontotemporal Dementia Risk Cohort, presymptomatic mutation carriers and non-carriers from families with familial frontotemporal dementia due to microtubule-associated protein tau (MAPT) and progranulin (GRN) mutations underwent a clinical assessment and multimodal MRI at baseline, 2-, and 4-year follow-up. Of the cohort of 73 participants, eight mutation carriers (three GRN, five MAPT) developed clinical features of frontotemporal dementia ('converters'). Longitudinal whole-brain measures of white matter integrity (fractional anisotropy) and grey matter volume in these converters (n = 8) were compared with healthy mutation carriers ('non-converters'; n = 35) and non-carriers (n = 30) from the same families. We also assessed the prognostic performance of decline within white matter and grey matter regions of interest by means of receiver operating characteristic analyses followed by stepwise logistic regression. Longitudinal whole-brain analyses demonstrated lower fractional anisotropy values in extensive white matter regions (genu corpus callosum, forceps minor, uncinate fasciculus, and superior longitudinal fasciculus) and smaller grey matter volumes (prefrontal, temporal, cingulate, and insular cortex) over time in converters, present from 2 years before symptom onset. White matter integrity loss of the right uncinate fasciculus and genu corpus callosum provided significant classifiers between converters, non-converters, and non-carriers. Converters' within-individual disease trajectories showed a relatively gradual onset of clinical features in MAPT, whereas GRN mutations had more rapid changes around symptom onset. MAPT converters showed more decline in the uncinate fasciculus than GRN converters, and more decline in the genu corpus callosum in GRN than MAPT converters. Our study confirms the presence of spreading predominant frontotemporal pathology towards symptom onset and highlights the value of multimodal MRI as a prognostic biomarker in familial frontotemporal dementia.
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Affiliation(s)
- Lize C Jiskoot
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jessica L Panman
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke H Meeter
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elise G P Dopper
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Laura Donker Kaat
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne Franzen
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rick van Minkelen
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
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5
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Pozzebon M, Douglas J, Ames D. Spousal recollections of early signs of primary progressive aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:282-293. [PMID: 29178408 DOI: 10.1111/1460-6984.12347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although primary progressive aphasia (PPA) is characterized by progressive loss of language and communication skills, knowledge about the earliest emerging signs announcing the onset of this condition is limited. AIMS To explore spousal recollections regarding the earliest signs of PPA and to compare the nature of the earliest perceived symptoms across the three PPA variants. METHODS & PROCEDURES In-depth interviews focusing on the earliest signs of illness onset were conducted with 13 spouses whose partners were diagnosed with PPA. The earliest recollections and observations described by the spouses were analyzed and coded according to the DSM-5 criteria for a mild neurocognitive disorder. These data were then compared across and within each of the three PPA variants. OUTCOMES & RESULTS Spousal retrospective accounts indicated the three PPA variants (semantic, logopenic and non-fluent) had a signature profile announcing illness onset. Changes in social cognition presented in all three variants of PPA, but at different points in the illness trajectory. In particular, the findings suggest the possibility that PPA initially presents as subtle changes in social cognition for semantic variant PPA (svPPA) and logopenic variant PPA (IvPPA) rather than overt language impairments as defined in the current diagnostic criteria. CONCLUSIONS & IMPLICATIONS Understanding the nature of symptoms perceived in the earliest stages of PPA has potential to inform earlier and accurate diagnosis and interventions to assist those living with the illness.
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Affiliation(s)
- Margaret Pozzebon
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jacinta Douglas
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Bundoora, VIC, Australia
- Summer Foundation, Melbourne, VIC, Australia
| | - David Ames
- Royal Melbourne Hospital, Melbourne, VIC, Australia
- National Ageing Research Institute and University of Melbourne, Melbourne, VIC, Australia
- University of Melbourne, Academic Unit for Psychiatry of Old Age, St George's Hospital, Kew, VIC, Australia
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Clouston S, Pietrzak RH, Kotov R, Richards M, Spiro A, Scott S, Deri Y, Mukherjee S, Stewart C, Bromet E, Luft BJ. Traumatic exposures, posttraumatic stress disorder, and cognitive functioning in World Trade Center responders. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:593-602. [PMID: 29201993 PMCID: PMC5700827 DOI: 10.1016/j.trci.2017.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study examined whether World Trade Center (WTC)-related exposures and posttraumatic stress disorder (PTSD) were associated with cognitive function and whether WTC responders' cognition differed from normative data. METHODS A computer-assisted neuropsychological battery was administered to a prospective cohort study of 1193 WTC responders with no history of stroke or WTC-related head injuries. Data were linked to information collected prospectively since 2002. Sample averages were compared to published norms. RESULTS Approximately 14.8% of sampled responders had cognitive dysfunction. WTC responders had worse cognitive function compared to normative data. PTSD symptom severity and working >5 weeks on-site was associated with lower cognition. DISCUSSION Results from this sample highlight the potential for WTC responders to be experiencing an increased burden of cognitive dysfunction and linked lowered cognitive functioning to physical exposures and to PTSD. Future research is warranted to understand the extent to which cognitive dysfunction is evident in neural dysfunction.
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Affiliation(s)
| | | | - Roman Kotov
- Stony Brook University, Stony Brook, NY, USA
| | | | | | | | - Yael Deri
- Stony Brook University, Stony Brook, NY, USA
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Gossink FT, Dols A, Krudop WA, Sikkes SA, Kerssens CJ, Prins ND, Scheltens P, Stek ML, Pijnenburg YAL. Formal Psychiatric Disorders are not Overrepresented in Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis 2016; 51:1249-56. [PMID: 26967225 DOI: 10.3233/jad-151198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While psychiatric misdiagnosis is well-known in behavioral variant frontotemporal dementia (bvFTD), a systematic evaluation of standardized criteria for psychiatric disorders in bvFTD is still missing. Our aim was to define frequency and character of DSM-IV psychiatric disorders among patients with probable and definite bvFTD compared to possible bvFTD, other neurodegenerative diseases, and psychiatric diagnoses, using MINI-International Neuropsychiatric Interview. We additionally compared psychiatric prodromes between these groups. Subjects were participants of the late-onset frontal lobe (LOF) study, a longitudinal multicenter study. In each patient, after baseline diagnostic procedure, a neurologist and geriatric psychiatrist made a joint clinical diagnosis. Independently, a structured diagnostic interview according to DSM-IV and ICD-10 criteria (MINI-Plus) was performed by a trained professional blinded to clinical diagnosis. Out of 91 patients, 23 with probable and definite bvFTD, 3 with possible bvFTD, 25 with a non bvFTD neurodegenerative disease, and 40 with a clinical psychiatric diagnosis were included. Overall frequency of formal current and past psychiatric disorders in probable and definite bvFTD (21.7% current, 8.7% past) did not differ from other neurodegenerative diseases (12.0% current, 16.0% past) or possible bvFTD (66.7% current, 66.7% past), but was less than in patients with a clinical psychiatric diagnosis (57.5% current, 62.5% past; p < 0.01). In probable and definite bvFTD unipolar mood disorders were most common. Formally diagnosed psychiatric disorders are not overrepresented in probable bvFTD, suggesting that psychiatric misdiagnosis in bvFTD can be reduced by strictly applying diagnostic criteria. In suspected bvFTD close collaboration between neurologists and psychiatrists will advance diagnostics and subsequent treatment.
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Affiliation(s)
- Flora T Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Welmoed A Krudop
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sietske A Sikkes
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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8
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Goldman JS, Huey ED, Thorne DZ. The Confluence of Psychiatric Symptoms and Neurodegenerative Disease: Impact on Genetic Counseling. J Genet Couns 2016; 26:435-441. [PMID: 28013481 DOI: 10.1007/s10897-016-0056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 12/07/2016] [Indexed: 01/09/2023]
Abstract
Hereditary neurodegenerative diseases can present with a psychiatric prodrome that overlaps with psychiatric symptoms that are not primary to these diseases. When individuals present for predictive testing while experiencing such symptoms, clinicians including genetic counselors, must proceed with caution and evaluate each situation on a case-by-case basis. Legitimate reasons may exist for moving forward with testing. Additionally predicting the consequences of testing is unrealistic so that the clinicians must do their best to prepare patients for both positive and negative results. A multidisciplinary team following the Huntington disease protocol remains the gold standard care for predictive testing for such patients. We discuss 3 case histories that demonstrate the complex nature of genetic counseling and testing in the presence of psychiatric symptoms, whether emanating from the disease itself or the results of living in an affected family.
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Affiliation(s)
- Jill S Goldman
- Taub Institute, Columbia University Medical Center, 630 W. 168th St., Box 16, New York, NY, 10032, USA.
| | - Edward D Huey
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Deborah Z Thorne
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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9
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Abstract
Today, frontotemporal dementia (FTD) remains one of the most common forms of early-onset dementia, that is, before the age of 65, thus posing several diagnostic challenges to clinicians since symptoms are often mistaken for psychiatric or neurological diseases causing a delay in correct diagnosis, and the majority of patients with FTD present with symptoms at ages between 50 and 60. Genetic components are established risk factors for FTD, but the influence of lifestyle, comorbidity, and environmental factors on the risk of FTD is still unclear. Approximately 40% of individuals with FTD have a family history of dementia but less than 10% have a clear autosomal dominant pattern of inheritance. Lack of insight is often an early clue to FTD. A tailored treatment option at an early phase can mitigate suffering and improve patients' and caregivers' quality of life.
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Affiliation(s)
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| | - Zeina Chemali
- Department of Neurology and Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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10
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Abstract
Frontotemporal dementia (FTD) was one of the lesser known dementias until the recent advancements revealing its genetic and pathological foundation. This common neurodegenerative disorder has three clinical subtypes- behavioral, semantic and progressive non fluent aphasia. The behavioral variant mostly exhibits personality changes, while the other two encompass various language deficits. This review discusses the basic pathology, genetics, clinical and histological presentation and the diagnosis of the 3 subtypes. It also deliberates the different therapeutic modalities currently available for frontotemporal dementia and the challenges faced by the caregivers. Lastly it explores the scope of further research into the diagnosis and management of FTD.
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Affiliation(s)
- Sayantani Ghosh
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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11
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Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement 2015; 12:195-202. [PMID: 26096665 DOI: 10.1016/j.jalz.2015.05.017] [Citation(s) in RCA: 460] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/26/2015] [Accepted: 05/08/2015] [Indexed: 12/19/2022]
Abstract
Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS. NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms. We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives.
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12
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Guimarães HC, Vale TC, Pimentel V, de Sá NC, Beato RG, Caramelli P. Analysis of a case series of behavioral variant frontotemporal dementia: emphasis on diagnostic delay. Dement Neuropsychol 2013; 7:55-59. [PMID: 29213820 PMCID: PMC5619545 DOI: 10.1590/s1980-57642013dn70100009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Despite many advances in the characterization of the behavioral variant of
frontotemporal dementia (bvFTD), the diagnosis of this syndrome poses a
significant challenge, while delays or diagnostic mistakes may impact the
proper clinical management of these patients. OBJECTIVE To describe the clinical profile at first evaluation of a sample of patients
with bvFTD from a specialized outpatient neurological unit, with emphasis on
the analysis of the delay between the onset of symptoms and diagnosis. METHODS We selected 31 patients that fulfilled international consensus criteria for
possible or probable bvFTD. Patients' medical admission sheets were
thoroughly reviewed. RESULTS Patients' mean age was 67.9±8.2 years; 16 (51.6%) were men. Mean
number of years of formal education was 7.7±4.0 years. Mean age at
onset was 62.2±7.7 years, indicating a mean of 5.8 years of
diagnostic delay. Thirteen patients (41.9%) presented with initial
behavioral complaints only, eleven patients (35.5%) had mixed behavioral and
memory complaints, five patients (16.1%) presented with memory complaints
only, and two patient (6.4%) had behavioral and speech problems. Nine
patients (29%) were admitted with alternative diagnoses. Mean and standard
deviation scores for the mini-mental state examination, animal category
fluency and memory test for drawings (five-minute delayed recall) were
19.3±6.3, 8.3±4.1and 3.7±2.7, respectively. CONCLUSION Most patients from this sample were evaluated almost six years after the
onset of symptoms and performed poorly on both cognitive screening tests and
functional evaluation measures.
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Affiliation(s)
- Henrique Cerqueira Guimarães
- Cognitive and Behavioral Neurology Unit, Neurology Service, Hospital das Clínicas of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Thiago Cardoso Vale
- Cognitive and Behavioral Neurology Unit, Neurology Service, Hospital das Clínicas of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Victor Pimentel
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Nayara Carvalho de Sá
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Rogério Gomes Beato
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Cognitive and Behavioral Neurology Unit, Neurology Service, Hospital das Clínicas of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil. Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
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13
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Helping the FTD Patient-Caregiver Dyad. Can J Neurol Sci 2011; 38:671-2. [DOI: 10.1017/s0317167100118591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Woolley JD, Khan BK, Murthy NK, Miller BL, Rankin KP. The diagnostic challenge of psychiatric symptoms in neurodegenerative disease: rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. J Clin Psychiatry 2011; 72:126-33. [PMID: 21382304 PMCID: PMC3076589 DOI: 10.4088/jcp.10m06382oli] [Citation(s) in RCA: 315] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify rates of and risk factors for psychiatric diagnosis preceding the diagnosis of neurodegenerative disease. METHOD Systematic, retrospective, blinded chart review was performed of 252 patients with a neurodegenerative disease diagnosis seen in our specialty clinic between 1999 and 2008. Neurodegenerative disease diagnoses included behavioral-variant frontotemporal dementia (n = 69), semantic dementia (n = 41), and progressive nonfluent aphasia (n = 17) (all meeting Neary research criteria); Alzheimer's disease (n = 65) (National Institute of Neurologic and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association research criteria); corticobasal degeneration (n = 25) (Boxer research criteria); progressive supranuclear palsy (n = 15) (Litvan research criteria); and amyotrophic lateral sclerosis (n = 20) (El Escorial research criteria). Reviewers remained blinded to each patient's final neurodegenerative disease diagnosis while reviewing charts. Extensive caregiver interviews were conducted to ensure accurate and reliable diagnostic histories. For each patient, we recorded history of psychiatric diagnosis, family psychiatric and neurologic history, age at symptom onset, and demographic information. RESULTS A total of 28.2% of patients with a neurodegenerative disease received a prior psychiatric diagnosis. Depression was the most common psychiatric diagnosis in all groups. Behavioral-variant frontotemporal dementia patients received a prior psychiatric diagnosis significantly more often (50.7%; P < .001) than patients with Alzheimer's disease (23.1%), semantic dementia (24.4%), or progressive nonfluent aphasia (11.8%) and were more likely to receive diagnoses of bipolar disorder or schizophrenia than were patients with other neurodegenerative diseases (P < .001). Younger age (P < .001), higher education (P < .05), and a family history of psychiatric illness (P < .05) increased the rate of prior psychiatric diagnosis in patients with behavioral-variant frontotemporal dementia. Cognitive, behavioral, and emotional characteristics did not distinguish patients who did or did not receive a prior psychiatric diagnosis. CONCLUSIONS Neurodegenerative disease is often misclassified as psychiatric disease, with behavioral-variant frontotemporal dementia patients at highest risk. While this study cannot rule out the possibility that psychiatric disease is an independent risk factor for neurodegenerative disease, when patients with neurodegenerative disease are initially classified with psychiatric disease, the patient may receive delayed, inappropriate treatment and be subject to increased distress. Physicians should consider referring mid- to late-life patients with new-onset neuropsychiatric symptoms for neurodegenerative disease evaluation.
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Affiliation(s)
- Josh D. Woolley
- University of California San Francisco, Langley Porter, Department of Psychiatry, 401 Parnassus Avenue, Room 159, San Francisco, CA 94143
| | - Baber K. Khan
- University of California San Francisco, Memory and Aging Center, Department of Neurology, 350 Parnassus Avenue, San Francisco, CA 94143
| | - Nikhil K. Murthy
- University of California San Francisco, Memory and Aging Center, Department of Neurology, 350 Parnassus Avenue, San Francisco, CA 94143
| | - Bruce L. Miller
- University of California San Francisco, Memory and Aging Center, Department of Neurology, 350 Parnassus Avenue, San Francisco, CA 94143
| | - Katherine P. Rankin
- University of California San Francisco, Memory and Aging Center, Department of Neurology, 350 Parnassus Avenue, San Francisco, CA 94143
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15
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Impairment versus deficiency in neuropsychological assessment: Implications for ecological validity. J Int Neuropsychol Soc 2009; 15:94-102. [PMID: 19128532 DOI: 10.1017/s1355617708090139] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuropsychological test interpretation has relied on pre- and postmorbid comparisons, as exemplified by the use of demographically adjusted normative data. We argue that, when the assessment goal is to predict real-world functioning, this interpretive method should be supplemented by "absolute" scores. Such scores are derived from comparisons with the general healthy adult population (i.e., demographically unadjusted normative data) and reflect examinees' current ability, that is, the interaction between premorbid and injury/disease-related factors. In support of this view, we found that substantial discrepancies between demographically adjusted and absolute scores were common in a traumatic brain injury sample, especially in participants with certain demographic profiles. Absolute scores predicted selected measures of functional outcome better than demographically adjusted scores and also classified participants' functional status more accurately, to the extent that these scores diverged. In conclusion, the ecological validity of neuropsychological tests may be improved by the consideration of absolute scores. (JINS, 2009, 15, 94-102.).
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