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Muñoz-Ruiz MÁ, Hall A, Mattila J, Koikkalainen J, Herukka SK, Husso M, Hänninen T, Vanninen R, Liu Y, Hallikainen M, Lötjönen J, Remes AM, Alafuzoff I, Soininen H, Hartikainen P. Using the Disease State Fingerprint Tool for Differential Diagnosis of Frontotemporal Dementia and Alzheimer's Disease. Dement Geriatr Cogn Dis Extra 2016; 6:313-329. [PMID: 27703465 PMCID: PMC5040932 DOI: 10.1159/000447122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Disease State Index (DSI) and its visualization, Disease State Fingerprint (DSF), form a computer-assisted clinical decision making tool that combines patient data and compares them with cases with known outcomes. AIMS To investigate the ability of the DSI to diagnose frontotemporal dementia (FTD) and Alzheimer's disease (AD). METHODS The study cohort consisted of 38 patients with FTD, 57 with AD and 22 controls. Autopsy verification of FTD with TDP-43 positive pathology was available for 14 and AD pathology for 12 cases. We utilized data from neuropsychological tests, volumetric magnetic resonance imaging, single-photon emission tomography, cerebrospinal fluid biomarkers and the APOE genotype. The DSI classification results were calculated with a combination of leave-one-out cross-validation and bootstrapping. A DSF visualization of a FTD patient is presented as an example. RESULTS The DSI distinguishes controls from FTD (area under the receiver-operator curve, AUC = 0.99) and AD (AUC = 1.00) very well and achieves a good differential diagnosis between AD and FTD (AUC = 0.89). In subsamples of autopsy-confirmed cases (AUC = 0.97) and clinically diagnosed cases (AUC = 0.94), differential diagnosis of AD and FTD performs very well. CONCLUSIONS DSI is a promising computer-assisted biomarker approach for aiding in the diagnostic process of dementing diseases. Here, DSI separates controls from dementia and differentiates between AD and FTD.
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Affiliation(s)
- Miguel Ángel Muñoz-Ruiz
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland
| | - Anette Hall
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland
| | - Jussi Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland
| | | | - Sanna-Kaisa Herukka
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland; Neurology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Minna Husso
- Radiology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Tuomo Hänninen
- Neurology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Ritva Vanninen
- Radiology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Yawu Liu
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland; Radiology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Merja Hallikainen
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland
| | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Anne M Remes
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland; Neurology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Rudbeck Laboratory, Department of Clinical/Surgical Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Hilkka Soininen
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland; Neurology, Kuopio University Hospital, Kuopio, Tampere, Finland
| | - Päivi Hartikainen
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, and Departments of, Tampere, Finland; Neurology, Kuopio University Hospital, Kuopio, Tampere, Finland
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Premi E, Cauda F, Gasparotti R, Diano M, Archetti S, Padovani A, Borroni B. Multimodal FMRI resting-state functional connectivity in granulin mutations: the case of fronto-parietal dementia. PLoS One 2014; 9:e106500. [PMID: 25188321 PMCID: PMC4154688 DOI: 10.1371/journal.pone.0106500] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monogenic dementias represent a great opportunity to trace disease progression from preclinical to symptomatic stages. Frontotemporal Dementia related to Granulin (GRN) mutations presents a specific framework of brain damage, involving fronto-temporal regions and long inter-hemispheric white matter bundles. Multimodal resting-state functional MRI (rs-fMRI) is a promising tool to carefully describe disease signature from the earliest disease phase. OBJECTIVE To define local connectivity alterations in GRN related pathology moving from the presymptomatic (asymptomatic GRN mutation carriers) to the clinical phase of the disease (GRN- related Frontotemporal Dementia). METHODS Thirty-one GRN Thr272fs mutation carriers (14 patients with Frontotemporal Dementia and 17 asymptomatic carriers) and 38 healthy controls were recruited. Local connectivity measures (Regional Homogeneity (ReHo), Fractional Amplitude of Low Frequency Fluctuation (fALFF) and Degree Centrality (DC)) were computed, considering age and gender as nuisance variables as well as the influence of voxel-level gray matter atrophy. RESULTS Asymptomatic GRN carriers had selective reduced ReHo in the left parietal region and increased ReHo in frontal regions compared to healthy controls. Considering Frontotemporal Dementia patients, all measures (ReHo, fALFF and DC) were reduced in inferior parietal, frontal lobes and posterior cingulate cortex. Considering GRN mutation carriers, an inverse correlation with age in the posterior cingulate cortex, inferior parietal lobule and orbitofrontal cortex was found. CONCLUSIONS GRN pathology is characterized by functional brain network alterations even decades before the clinical onset; they involve the parietal region primarily and then spread to the anterior regions of the brain, supporting the concept of molecular nexopathies.
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Affiliation(s)
- Enrico Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Franco Cauda
- Clinical and Experimental Center for Functional Magnetic Resonance Imaging, Koelliker Hospital, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Matteo Diano
- Clinical and Experimental Center for Functional Magnetic Resonance Imaging, Koelliker Hospital, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
- * E-mail:
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Léger GC, Banks SJ. Neuropsychiatric symptom profile differs based on pathology in patients with clinically diagnosed behavioral variant frontotemporal dementia. Dement Geriatr Cogn Disord 2014; 37:104-12. [PMID: 24135712 PMCID: PMC4041327 DOI: 10.1159/000354368] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) is pathologically heterogeneous. With emerging therapeutics, determining underlying pathology during life is increasingly important. Neuropsychiatric symptoms are prevalent and diagnostic in bvFTD. METHODS We assessed the neuropsychiatric profile of patients with clinically diagnosed bvFTD as a function of pathology at autopsy. Patients with a clinical diagnosis of bvFTD at the initial visit were selected from the National Alzheimer's Coordinating Center (NACC) database. Neuropsychiatric symptoms endorsed on the Neuropsychiatric Inventory Questionnaire (NPI-Q) were analyzed. RESULTS Of 149 patients with clinically diagnosed bvFTD, pathology was primarily Alzheimer's disease (AD) in 20.5%. These patients differed from those with underlying frontotemporal lobar degeneration: patients with AD pathology (plaques and tangles) were more likely to have hallucinations, delusions, or agitation. Patients were further differentiated into tau-positive (30% of cases, including Pick's disease, FTD and parkinsonism with tau-positive or argyrophilic inclusions, and other tauopathies) or tau-negative cases (70% of cases, including bvFTD tau-negative ubiquitin-positive inclusions). These patients also differed in some of the neuropsychiatric symptoms seen. Tau-negative cases were more likely to demonstrate depression, delusions, and changes in appetite and eating. CONCLUSIONS These preliminary findings contribute to our increasing ability to predict, using simple clinical tools, the neuropathological underpinnings of bvFTD during life.
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Affiliation(s)
- Gabriel C Léger
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
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