1
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Brown CW, Chen HY, Panegyres PK. Electroencephalography in young onset dementia. BMC Neurol 2023; 23:202. [PMID: 37221470 DOI: 10.1186/s12883-023-03248-w] [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: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Young onset dementia (YOD) is a major diagnostic and management problem. METHODS We set out to explore if electroencephalography (EEG) might be useful in the diagnosis of young onset Alzheimer's disease (YOAD) and young onset frontotemporal dementia (YOFTD). The ARTEMIS project is a 25-year prospective study of YOD based in Perth, Western Australia. 231 participants were included: YOAD: n = 103, YOFTD: n = 28, controls: n = 100. EEGs were performed prospectively, with 30-minute recording time for each subject, without knowledge of diagnosis or other diagnostic data. RESULTS 80.9% of patients with YOD had abnormal EEGs (P < 0.00001). Slow wave changes were more frequent in YOAD that YOFTD (P < 0.00001), but no difference in the frequency of epileptiform activity (P = 0.32), with 38.8% of YOAD and 28.6% of YOFTD patients having epileptiform activity. Slow wave changes were more generalized in YOAD (P = 0.001). Slow wave changes and epileptiform activity were not sensitive to the diagnosis of YOD, but highly specific (97-99%). The absence of slow wave changes and epileptiform activity had a 100% negative predictive value and likelihood radio 0.14 and 0.62 respectively, meaning that those without slow wave changes or epileptiform activity had low probability of having YOD. No relationship was established between EEG findings and the patient's presenting problem. Eleven patients with YOAD developed seizures during the study, and only one with YOFTD. CONCLUSIONS The EEG is highly specific for the diagnosis of YOD with the absence of slow wave changes and epileptiform phenomena making the diagnosis unlikely, with 100% negative predictive value and with low probability for the dementia diagnosis.
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Affiliation(s)
- Casey W Brown
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, 6009, Australia
| | - Huei-Yang Chen
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, West Perth, WA, 6005, Australia
| | - Peter K Panegyres
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, 6009, Australia.
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, West Perth, WA, 6005, Australia.
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2
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Díaz-Rivera MN, Birba A, Fittipaldi S, Mola D, Morera Y, de Vega M, Moguilner S, Lillo P, Slachevsky A, González Campo C, Ibáñez A, García AM. Multidimensional inhibitory signatures of sentential negation in behavioral variant frontotemporal dementia. Cereb Cortex 2022; 33:403-420. [PMID: 35253864 PMCID: PMC9837611 DOI: 10.1093/cercor/bhac074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Processing of linguistic negation has been associated to inhibitory brain mechanisms. However, no study has tapped this link via multimodal measures in patients with core inhibitory alterations, a critical approach to reveal direct neural correlates and potential disease markers. METHODS Here we examined oscillatory, neuroanatomical, and functional connectivity signatures of a recently reported Go/No-go negation task in healthy controls and behavioral variant frontotemporal dementia (bvFTD) patients, typified by primary and generalized inhibitory disruptions. To test for specificity, we also recruited persons with Alzheimer's disease (AD), a disease involving frequent but nonprimary inhibitory deficits. RESULTS In controls, negative sentences in the No-go condition distinctly involved frontocentral delta (2-3 Hz) suppression, a canonical inhibitory marker. In bvFTD patients, this modulation was selectively abolished and significantly correlated with the volume and functional connectivity of regions supporting inhibition (e.g. precentral gyrus, caudate nucleus, and cerebellum). Such canonical delta suppression was preserved in the AD group and associated with widespread anatomo-functional patterns across non-inhibitory regions. DISCUSSION These findings suggest that negation hinges on the integrity and interaction of spatiotemporal inhibitory mechanisms. Moreover, our results reveal potential neurocognitive markers of bvFTD, opening a new agenda at the crossing of cognitive neuroscience and behavioral neurology.
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Affiliation(s)
- Mariano N Díaz-Rivera
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT), C1425FQD, Godoy Cruz 2370, Buenos Aires, Argentina
| | - Agustina Birba
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,National Scientific and Technical Research Council (CONICET), C1425FQD, Godoy Cruz 2290, Buenos Aires, Argentina
| | - Sol Fittipaldi
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,National Scientific and Technical Research Council (CONICET), C1425FQD, Godoy Cruz 2290, Buenos Aires, Argentina
| | - Débora Mola
- Instituto de Investigaciones Psicológicas, CONICET, 5000, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Yurena Morera
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, Campus de Guajara, 38205 La Laguna, Santa Cruz de Tenerife, Spain
| | - Manuel de Vega
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, Campus de Guajara, 38205 La Laguna, Santa Cruz de Tenerife, Spain
| | - Sebastian Moguilner
- Global Brain Health Institute, University of California, San Francisco, CA94158, US; and Trinity College, Dublin D02DP21, , Ireland.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, 8320000, Santiago, Chile
| | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, 8380000, Santiago, Chile.,Unidad de Neurología, Hospital San José, 8380000, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), 7800003, Santiago, Chile
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), 7800003, Santiago, Chile.,Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, Neuroscience and East Neuroscience Departments, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), University of Chile, 8380000, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, 7500000, Santiago, Chile.,Departamento de Medicina, Servicio de Neurología, Clínica Alemana-Universidad del Desarrollo, 7550000, Santiago, Chile
| | - Cecilia González Campo
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,National Scientific and Technical Research Council (CONICET), C1425FQD, Godoy Cruz 2290, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,National Scientific and Technical Research Council (CONICET), C1425FQD, Godoy Cruz 2290, Buenos Aires, Argentina.,Global Brain Health Institute, University of California, San Francisco, CA94158, US; and Trinity College, Dublin D02DP21, , Ireland.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, 8320000, Santiago, Chile
| | - Adolfo M García
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Vito Dumas 284, Buenos Aires B1644BID, Argentina.,National Scientific and Technical Research Council (CONICET), C1425FQD, Godoy Cruz 2290, Buenos Aires, Argentina.,Global Brain Health Institute, University of California, San Francisco, CA94158, US; and Trinity College, Dublin D02DP21, , Ireland.,Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, 7550000, Santiago, Chile
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3
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Horvath AA, Csernus EA, Lality S, Kaminski RM, Kamondi A. Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach. Front Neurosci 2020; 14:557416. [PMID: 33177974 PMCID: PMC7593384 DOI: 10.3389/fnins.2020.557416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is a common and seriously debilitating symptom of various mental and neurological disorders including autism, attention deficit hyperactivity disorder, multiple sclerosis, epilepsy, and neurodegenerative diseases, like Alzheimer's disease. In these conditions, high prevalence of epileptiform activity emerges as a common pathophysiological hallmark. Growing body of evidence suggests that this discrete but abnormal activity might have a long-term negative impact on cognitive performance due to neuronal circuitries' remodeling, altered sleep structure, pathological hippocampo-cortical coupling, and even progressive neuronal loss. In animal models, epileptiform activity was shown to enhance the formation of pathological amyloid and tau proteins that in turn trigger network hyperexcitability. Abolishing epileptiform discharges might slow down the cognitive deterioration. These findings might provide basis for therapeutic use of antiepileptic drugs in neurodegenerative cognitive disorders. The aim of our review is to describe the data on the prevalence of epileptiform activity in various cognitive disorders, to summarize the current knowledge of the mechanisms of epileptic activity in relation to cognitive impairment, and to explore the utility of antiepileptic drugs in the therapy of cognitive disorders. We also propose future directions for drug development and novel therapeutic interventions targeting epileptiform discharges in these disorders.
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Affiliation(s)
- Andras Attila Horvath
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Sara Lality
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Rafal M. Kaminski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Anita Kamondi
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
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4
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Katisko K, Cajanus A, Korhonen T, Remes AM, Haapasalo A, Solje E. Prodromal and Early bvFTD: Evaluating Clinical Features and Current Biomarkers. Front Neurosci 2019; 13:658. [PMID: 31293376 PMCID: PMC6598427 DOI: 10.3389/fnins.2019.00658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022] Open
Abstract
Despite the current diagnostic criteria, early diagnostics of behavioral variant of frontotemporal dementia (bvFTD) has remained challenging. Patients with bvFTD often present with misleading psychiatric phenotype, and, on the other hand, impairment in memory functions have increasingly been reported. However, impaired episodic memory is currently considered as an exclusion criterion for bvFTD. Single biofluid-based or imaging biomarkers do not currently provide sufficient sensitivity or specificity for early bvFTD diagnosis at single-subject level, although studies have suggested improved accuracy with different biomarker combinations. In this mini review, we evaluate the core clinical features of early bvFTD and summarize the most potential imaging and fluid biomarkers for bvFTD diagnostics.
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Affiliation(s)
- Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Titta Korhonen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
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5
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Sami S, Williams N, Hughes LE, Cope TE, Rittman T, Coyle-Gilchrist ITS, Henson RN, Rowe JB. Neurophysiological signatures of Alzheimer's disease and frontotemporal lobar degeneration: pathology versus phenotype. Brain 2018; 141:2500-2510. [PMID: 30060017 PMCID: PMC6061803 DOI: 10.1093/brain/awy180] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 01/21/2023] Open
Abstract
The disruption of brain networks is characteristic of neurodegenerative dementias. However, it is controversial whether changes in connectivity reflect only the functional anatomy of disease, with selective vulnerability of brain networks, or the specific neurophysiological consequences of different neuropathologies within brain networks. We proposed that the oscillatory dynamics of cortical circuits reflect the tuning of local neural interactions, such that different pathologies are selective in their impact on the frequency spectrum of oscillations, whereas clinical syndromes reflect the anatomical distribution of pathology and physiological change. To test this hypothesis, we used magnetoencephalography from five patient groups, representing dissociated pathological subtypes and distributions across frontal, parietal and temporal lobes: amnestic Alzheimer's disease, posterior cortical atrophy, and three syndromes associated with frontotemporal lobar degeneration. We measured effective connectivity with graph theory-based measures of local efficiency, using partial directed coherence between sensors. As expected, each disease caused large-scale changes of neurophysiological brain networks, with reductions in local efficiency compared to controls. Critically however, the frequency range of altered connectivity was consistent across clinical syndromes that shared a likely underlying pathology, whilst the localization of changes differed between clinical syndromes. Multivariate pattern analysis of the frequency-specific topographies of local efficiency separated the disorders from each other and from controls (accuracy 62% to 100%, according to the groups' differences in likely pathology and clinical syndrome). The data indicate that magnetoencephalography has the potential to reveal specific changes in neurophysiology resulting from neurodegenerative disease. Our findings confirm that while clinical syndromes have characteristic anatomical patterns of abnormal connectivity that may be identified with other methods like structural brain imaging, the different mechanisms of neurodegeneration also cause characteristic spectral signatures of physiological coupling that are not accessible with structural imaging nor confounded by the neurovascular signalling of functional MRI. We suggest that these spectral characteristics of altered connectivity are the result of differential disruption of neuronal microstructure and synaptic physiology by Alzheimer's disease versus frontotemporal lobar degeneration.
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Affiliation(s)
- Saber Sami
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Laura E Hughes
- Department of Clinical Neurosciences, University of Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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6
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Borroni B, Benussi A, Premi E, Alberici A, Marcello E, Gardoni F, Di Luca M, Padovani A. Biological, Neuroimaging, and Neurophysiological Markers in Frontotemporal Dementia: Three Faces of the Same Coin. J Alzheimers Dis 2018; 62:1113-1123. [PMID: 29171998 PMCID: PMC5870000 DOI: 10.3233/jad-170584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) is a heterogeneous clinical, genetic, and neuropathological disorder. Clinical diagnosis and prediction of neuropathological substrates are hampered by heterogeneous pictures. Diagnostic markers are key in clinical trials to differentiate FTD from other neurodegenerative dementias. In the same view, identifying the neuropathological hallmarks of the disease is key in light of future disease-modifying treatments. The aim of the present review is to unravel the progress in biomarker discovery, discussing the potential applications of available biological, imaging, and neurophysiological markers.
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Affiliation(s)
- Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Enrico Premi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Antonella Alberici
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Elena Marcello
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Fabrizio Gardoni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Monica Di Luca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
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7
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Goossens J, Laton J, Van Schependom J, Gielen J, Struyfs H, Van Mossevelde S, Van den Bossche T, Goeman J, De Deyn PP, Sieben A, Martin JJ, Van Broeckhoven C, van der Zee J, Engelborghs S, Nagels G. EEG Dominant Frequency Peak Differentiates Between Alzheimer’s Disease and Frontotemporal Lobar Degeneration. J Alzheimers Dis 2016; 55:53-58. [DOI: 10.3233/jad-160188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joery Goossens
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Jorne Laton
- Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Jeroen Gielen
- Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Sara Van Mossevelde
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerpen, Belgium
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Wilrijk, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Tobi Van den Bossche
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerpen, Belgium
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Wilrijk, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Johan Goeman
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerpen, Belgium
| | - Peter Paul De Deyn
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerpen, Belgium
- Biobank, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Anne Sieben
- Biobank, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | | | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Wilrijk, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Julie van der Zee
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Wilrijk, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerpen, Belgium
| | - Guy Nagels
- Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium
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8
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Rossor M, Collinge J, Fox N, Mead S, Mummery C, Rohrer J, Schott J, Warren J. Dementia and Cognitive Impairment. Neurology 2016. [DOI: 10.1002/9781118486160.ch8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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9
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Rosenberg S, Périn B, Michel V, Debs R, Navarro V, Convers P. EEG in adults in the laboratory or at the patient's bedside. Neurophysiol Clin 2015; 45:19-37. [DOI: 10.1016/j.neucli.2014.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 12/25/2022] Open
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10
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[French guidelines on electroencephalogram]. Neurophysiol Clin 2014; 44:515-612. [PMID: 25435392 DOI: 10.1016/j.neucli.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 12/11/2022] Open
Abstract
Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.
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11
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12
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Micanovic C, Pal S. The diagnostic utility of EEG in early-onset dementia: a systematic review of the literature with narrative analysis. J Neural Transm (Vienna) 2013; 121:59-69. [PMID: 23900731 DOI: 10.1007/s00702-013-1070-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
Abstract
Early-onset dementia (EOD) is characterized by functionally impairing deterioration in memory, language, personality or visuospatial skills emerging under the age of 65. Cerebral functioning can be assessed by visual electroencephalography (EEG) interpretation. The aim of this systematic review is to evaluate the diagnostic utility of visual EEG in EOD focusing on Alzheimer's disease (AD), vascular dementia (VAD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). Medline, Embase, Scopus, Web of Knowledge, and Google Scholar were systematically searched for studies where EEGs were included in the diagnostic evaluation of patients with dementia under the age of 65. Each paper was quality assessed and the results grouped according to dementia cause with a narrative summary. 4,157 papers were screened, 12 studies met the eligibility criteria with a total of 965 patients. An abnormal EEG was common to all causes of EOD. EEG abnormalities are more severe in early-onset AD patients. EEG severity grade is independent of disease duration. Slow wave activity is common to all dementias, but is most prominent in DLB. Frontal intermittent rhythmic delta activity could be considered as supportive for the diagnosis of DLB as can a Grand Total EEG score of over 9.5. EEG is usually normal in FTD. Focal changes can be seen in advanced VAD. Studies employed small patient groups, varying diagnostic criteria, and only a minority of patient diagnoses was pathologically confirmed. EEG may be useful as an adjunct in the diagnosis of DLB and AD. Further prospective well-powered studies are required to investigate diagnostic utility more robustly.
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Affiliation(s)
- Christina Micanovic
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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13
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Caso F, Cursi M, Magnani G, Fanelli G, Falautano M, Comi G, Leocani L, Minicucci F. Quantitative EEG and LORETA: valuable tools in discerning FTD from AD? Neurobiol Aging 2012; 33:2343-56. [PMID: 22244088 DOI: 10.1016/j.neurobiolaging.2011.12.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 11/18/2011] [Accepted: 12/05/2011] [Indexed: 11/30/2022]
Abstract
Drawing a clinical distinction between frontotemporal dementia (FTD) and Alzheimer's disease (AD) is tricky, particularly at the early stages of disease. This study evaluates the possibility in differentiating 39 FTD, 39 AD, and 39 controls (CTR) by means of power spectral analysis and standardized low resolution brain electromagnetic tomography (sLORETA) within delta, theta, alpha 1 and 2, beta 1, 2, and 3 frequency bands. Both analyses revealed in AD patients, relative to CTR, higher expression of diffuse delta/theta and lower central/posterior fast frequency (from alpha1 to beta2) bands. FTD patients showed diffuse increased theta power compared with CTR and lower delta relative to AD patients. Compared with FTD, AD patients showed diffuse higher theta power at spectral analysis and, at sLORETA, decreased alpha2 and beta1 values in central/temporal regions. Spectral analysis and sLORETA provided complementary information that might help characterizing different patterns of electroencephalogram (EEG) oscillatory activity in AD and FTD. Nevertheless, this differentiation was possible only at the group level because single patients could not be discerned with sufficient accuracy.
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Affiliation(s)
- Francesca Caso
- Department of Neurology, Institute of Experimental Neurology-INSPE, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.
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14
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Nishida K, Yoshimura M, Isotani T, Yoshida T, Kitaura Y, Saito A, Mii H, Kato M, Takekita Y, Suwa A, Morita S, Kinoshita T. Differences in quantitative EEG between frontotemporal dementia and Alzheimer’s disease as revealed by LORETA. Clin Neurophysiol 2011; 122:1718-25. [DOI: 10.1016/j.clinph.2011.02.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 01/19/2011] [Accepted: 02/14/2011] [Indexed: 11/25/2022]
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15
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Abstract
A diagnosis of dementia is devastating at any age but diagnosis in younger patients presents a particular challenge. The differential diagnosis is broad as late presentation of metabolic disease is common and the burden of inherited dementia is higher in these patients than in patients with late-onset dementia. The presentation of the common degenerative diseases of late life, such as Alzheimer's disease, can be different when presenting in the fifth or sixth decade. Moreover, many of the young-onset dementias are treatable. The identification of causative genes for many of the inherited degenerative dementias has led to an understanding of the molecular pathology, which is also applicable to later-onset sporadic disease. This understanding offers the potential for future treatments to be tailored to a specific diagnosis of both young-onset and late-onset dementia.
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Affiliation(s)
- Martin N Rossor
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, Queen Square, London, UK.
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Hu WT. PATIENT MANAGEMENT PROBLEM. Continuum (Minneap Minn) 2010; 16:153-64. [DOI: 10.1212/01.con.0000368275.78318.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jelic V, Kowalski J. Evidence-based evaluation of diagnostic accuracy of resting EEG in dementia and mild cognitive impairment. Clin EEG Neurosci 2009; 40:129-42. [PMID: 19534305 DOI: 10.1177/155005940904000211] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cognitive impairment is the most frequent chronic condition in the elderly, and dementia is the most disabling form of cognitive impairment in elderly. In the absence of specific and reliable markers of etiologically different dementia syndromes and their preclinical stages, diagnosis in living patients is probabilistic and based on standardized clinical diagnostic criteria. There is still not enough information on the validity of the EEG method in dementia work-up, and an updated evidence-based consensus on appropriateness of this method in the initial evaluation of patients with suspected cognitive disorder and dementia is missing. Using an evidence-based technique we searched for articles on diagnostic accuracy of spontaneous EEG in dementia disorders published from 1980 until June 2008. Inclusion criteria were: original article published in English with 10 or more subjects per diagnostic group, diagnosed according to the established consensus clinical diagnostic criteria used as a "gold standard." In addition, it should have been possible to calculate from the reported results indexes of diagnostic test accuracy: sensitivity, specificity, likelihood ratios and diagnostic odds ratios. Forty-six articles were retrieved that satisfied eligibility criteria. Thirty-four (74%) studies employed case-control design where study population was recruited from consecutive patients at specialist clinic settings, 12 (26%) were prospective in terms of reported clinical followup of study population. Four (9%) studies used population-based samples and 5 (11%) studies stated in methods the recruitment procedures for patients and healthy subjects. Number of patients included in diagnostic groups and healthy subjects varied in included studies between 10 and 180 and 10 and 171, respectively. Figures on sensitivity and specificity across the studies varied widely. Positive likelihood ratio in studies reporting classification accuracies between Alzheimer's disease and controls ranged between 2.3 and 38.5, and diagnostic odds ratios consequently showed large variations between 7 and 219. In conclusion, despite the wealth of published research and reported high indexes of diagnostic accuracy of EEG, and qEEG in particular, in individual studies, evidence of diagnostic utility of resting EEG in dementia and mild cognitive impairment (MCI) is still not sufficient to establish this method for the initial evaluation of subjects with cognitive impairment in the routine clinical practice. Joint effort of preferably multicenter studies using uniform standards should develop optimized methods, investigate added diagnostic value of EEG in clinically established dementia diagnosis and predictive utility of EEG in MCI and questionable dementia.
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Affiliation(s)
- Vesna Jelic
- Karolinska Institute, Department of NVS, Alzheimer's Disease Research Centre, Stockholm, Sweden.
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Pijnenburg YAL, Strijers RLM, Made YV, van der Flier WM, Scheltens P, Stam CJ. Investigation of resting-state EEG functional connectivity in frontotemporal lobar degeneration. Clin Neurophysiol 2008; 119:1732-1738. [PMID: 18490193 DOI: 10.1016/j.clinph.2008.02.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 02/18/2008] [Accepted: 02/22/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the presence of EEG abnormalities in frontotemporal lobar degeneration (FTLD) in comparison with Alzheimer's disease (AD) and non-demented individuals with subjective memory complaints (SMC), using an elaborated visual EEG rating scale; furthermore, to investigate whether assessment of resting-state functional connectivity of the EEG is superior to visual evaluation in distinguishing between FTLD, AD and non-demented controls. METHODS EEGs of 15 patients with FTLD, 20 with AD and 23 individuals with SMC were visually compared using the Grand Total EEG (GTE) score. The synchronization likelihood (SL) as a measure of functional connectivity between different EEG channels was calculated for the 0.5-4Hz, 4-8Hz, 8-10Hz, 10-13Hz, 13-30Hz and 30-45Hz frequency bands. Patients had mild to moderate dementia. RESULTS In AD, as expected, the GTE revealed significant differences from FTLD and SMC, indicating more EEG slowing and loss of reactivity. Patients with FTLD, however, could not be discriminated from individuals with SMC by the GTE score. Analysis of resting-state functional connectivity showed decreased SL in AD compared to both FTLD and SMC in the lower and higher alpha frequency band and decreased SL in AD compared to SMC in the beta frequency band, whereas no differences between FTLD and AD or SMC were found. CONCLUSIONS In patients with mild to moderate FTLD both the visually rated EEG and EEG measures of resting-state functional connectivity are normal. SIGNIFICANCE Although widespread neuronal degeneration takes place in frontotemporal lobar degeneration, this is not reflected in the EEG during the mild to moderate stages of the disease. An abnormal EEG in a mildly demented subject favours a diagnosis of AD.
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Affiliation(s)
- Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Rob L M Strijers
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Yolande Vd Made
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD): current limitations and future directions. Alzheimer Dis Assoc Disord 2008; 21:S14-8. [PMID: 18090417 DOI: 10.1097/wad.0b013e31815c3445] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most widely established diagnostic criteria for the behavioral variant of frontotemporal dementia have now been in use for almost a decade. Although consensus criteria have provided a much needed standard for frontotemporal dementia research, a growing body of evidence suggests that revisions are needed to improve their applicability. In this article, we discuss the limitations of current diagnostic criteria and propose the establishment of an international consortium to revise diagnostic and research criteria for the behavioral variant of frontotemporal dementia.
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Rabinovici GD, Rascovsky K, Miller BL. Frontotemporal lobar degeneration: clinical and pathologic overview. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:343-64. [PMID: 18631759 DOI: 10.1016/s0072-9752(07)01233-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Frontotemporal lobar degeneration (FTLD) is a syndromic diagnosis that encompasses at least three different variants. Imaging modalities are clinically useful in FTLD, although pathology remains the gold standard for definitive diagnosis. To date, four different genes have been identified that account for FTLD.
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Shelley BP, Al-Khabouri J, Hussein SS, Raniga SB. Frontotemporal dementia in Oman: Cognitive behavioural profile and neuroimaging characteristics; A prospective hospital-based study. J Neurol Sci 2007; 260:167-74. [PMID: 17544447 DOI: 10.1016/j.jns.2007.04.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 04/21/2007] [Accepted: 04/25/2007] [Indexed: 12/20/2022]
Abstract
Frontotemporal dementia is increasingly recognised as an important cause of early-onset dementia and is considered to be the second commonest neurodegenerative dementia after Alzheimer's disease. We describe the cognitive, behavioural profile and neuroimaging characteristics of 6 patients with frontal variant of Frontotemporal dementia that were evaluated at the cognitive behavioural clinic at this tertiary referral teaching hospital. All patients underwent clinical, neuropsychological, structural/functional neuroimaging, and laboratory evaluations. The male to female ratio was 1:1; mean age of onset was 54 years, and the mean duration of symptoms were 30 months. The mean scores for Addenbrooke's cognitive examination, Frontal Assessment Battery, and Mini-Mental State Examination were 70.5, 6.33 and 23.6 respectively. The mean VLOM ratio was 2.04. MRI revealed significant asymmetrical regional frontal/temporal atrophy supplemented by the evidence of circumscribed hypoperfusion in SPECT imaging. We conclude that a combination of behavioural and cognitive assessment using short bedside tests, along with structural and functional neuroimaging does facilitate early identification, and increase the diagnostic specificity of Frontotemporal dementia.
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Affiliation(s)
- Bhaskara P Shelley
- Department of Neurology, The Royal Hospital, Ministry of Health, P.O Box 1331,Seeb CPO, Muscat, PC 111, Oman.
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Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol 2007; 14:e1-26. [PMID: 17222085 DOI: 10.1111/j.1468-1331.2006.01605.x] [Citation(s) in RCA: 338] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care.
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Affiliation(s)
- G Waldemar
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
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Abstract
BACKGROUND Young-onset dementia is best defined as dementia presenting at age less than 65 years. And, while cognitive impairment in the elderly is dominated by dementia of the Alzheimer type, young-onset dementia has a vast differential diagnosis. REVIEW SUMMARY This article reviews an extensive differential diagnosis for young-onset dementia by utilizing different clues in the historical records and laboratory findings to aid with diagnosis. Laboratory testing should be completed in at least 2 stages. In the first stage, referred to as the first "wave," we suggest more routine testing, particularly for treatable causes of dementia. The second "wave," which we also outline, emphasizes more esoteric testing that may require referral to a tertiary care medical facility. The manuscript is divided into 2 parts, with part 1 focusing on clues from the historical data, while part 2 focuses on laboratory abnormalities. CONCLUSION Unlike dementia presenting in the elderly, the differential diagnosis in young-onset dementia is vast. A thorough historical review of the symptoms, with special emphasis on the pattern of cognitive impairment, temporal profile of the disease, detailed family history, and extensive but coordinated laboratory and ancillary testing, may yield subtle clues to the diagnosis.
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Affiliation(s)
- Basil Ridha
- Dementia Research Center, Institute of Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
Frontotemporal dementia (FTD) is a focal clinical syndrome characterised by profound changes in personality and social conduct and associated with circumscribed degeneration of the prefrontal and anterior temporal cortex. Onset is typically in the middle years of life and survival is about 8 years. The presence of microtubule-associated-protein-tau-based pathological features in some patients and the discovery, in some familial cases, of mutations in the tau gene links FTD to other forms of tauopathy, such as progressive supranuclear palsy and corticobasal degeneration. However, more than half of all patients with FTD, including some with a strong family history, show no apparent abnormality in the tau gene or protein, indicating pathological and aetiological heterogeneity. FTD provides a challenge both for clinical management and for theoretical understanding of its neurobiological substrate.
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Affiliation(s)
- David Neary
- Clinical Neuroscience Group, Hope Hospital, Salford, Greater Manchester M6 8HD, UK.
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Abstract
PURPOSE OF REVIEW A precise diagnosis of the cause of dementia during life is needed for proper management, in order to explain the symptoms to the patient and to the close relatives, and to give appropriate indications on the prognosis and possibly on the genetic risk. Frontotemporal dementia remains under-diagnosed and often misdiagnosed for Alzheimer's disease, the most common cause of dementia. More and more studies explore the differences between the two syndromes. RECENT FINDINGS Progress in neuropsychological testing improves the ability to distinguish between syndromes and knowledge on brain functioning. More attention has been paid over these last months--or years--on emotion, insight, behavior, artistic creativity and quality of responses. Yet, biomarkers do not improve the diagnostic accuracy of trained clinicians, and do not help to distinguish between histological subtypes of frontotemporal dementia. SUMMARY Improvement in knowledge on cognitive and emotional impairment in frontotemporal dementia and Alzheimer's disease is essential for the management of the patient--information can be given to the patients and the families that helps them to understand and to behave in consequence.
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Affiliation(s)
- Florence Pasquier
- Memory Clinic, Department of Neurology, University Hospital, Lille, France.
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Abstract
BACKGROUND Despite being simple and cheap, the EEG is not often used in clinical practice. METHODOLOGY Literature search using PUBMED and Medline. RESULTS Quantitative EEG can help to identify mild dementia and mild cognitive impairment and can increase diagnostic accuracy when used with other imaging techniques. EEG helps differentiate organic from functional brain disease and predict response to cholinesterase inhibitors and is central in the diagnosis of Creutzfeldt Jacob disease. The accuracy of EEG may be greater than that of CT or MRI scans alone. DISCUSSION Quantitative EEG may save on specialist interpretation time and enable more routine use of EEG in diagnosis and care. More widespread use of EEG's is indicated. Agreement on the parameters that are best measured on qEEG is still awaited.
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Affiliation(s)
- Dimitrios Adamis
- Deptartment of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Passant U, Rosén I, Gustafson L, Englund E. The heterogeneity of frontotemporal dementia with regard to initial symptoms, qEEG and neuropathology. Int J Geriatr Psychiatry 2005; 20:983-8. [PMID: 16163750 DOI: 10.1002/gps.1388] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/METHODS Ten patients with neuropathologically verified frontotemporal dementia (FTD) were analysed for neuropathological features in relation to first presenting and dominating symptoms, age at onset and duration of dementia, as well as to EEG/quantitative EEG. RESULTS Cases with a late onset (> 65 years) initially presented language disturbances, while the early onset group (< 65 years) showed predominantly behavioural symptoms and mood alterations as early features. The late onset group presented combined cortical-subcortical degeneration including white matter pathology, while early onset cases showed pathology predominantly in the cortex. EEG was normal in the late onset group, while it was mildly and variably abnormal in those with early onset. CONCLUSIONS Within this small sample of clinical and neuropathological FTD, cases with late vs early onset differed with respect to initial symptoms, EEG findings and regional distribution of brain pathology.
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Affiliation(s)
- Ulla Passant
- Department of Psychogeriatrics, Lund University Hospital, Lund, Sweden.
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Smith SJM. EEG in neurological conditions other than epilepsy: when does it help, what does it add? J Neurol Neurosurg Psychiatry 2005; 76 Suppl 2:ii8-12. [PMID: 15961870 PMCID: PMC1765689 DOI: 10.1136/jnnp.2005.068486] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- S J M Smith
- Department of Clinical Neurophysiology, The National Hospital, Queen Square, London WC1N 3BG, UK.
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Abstract
Dementia is affecting an increasing proportion of the population in the developed world. It is important to reach a correct diagnosis of dementia, because this has implications on the treatment. The electroencephalogram (EEG) is, in general, not a sensitive test for detecting dementia and is not recommended in the standard workup of dementia. In spite of this, however, EEG is useful in patients with deteriorating mental status in whom dementia is suspected mainly to rule out delirium, depression, atypical complex partial seizures, and prion disease. An EEG also provides insight into the physiology of different dementia types. The EEG is most useful when interpreted within a well-defined clinical context, such as knowing the patient's degree of cognitive impairment. It is a noninvasive and inexpensive test, and the threshold should be low for ordering it. This article summarizes EEG findings with aging, different dementia types, and conditions masked as dementia.
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Affiliation(s)
- Sigmund Jenssen
- Drexel Medical College, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
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