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Thomas JA, Tröster AI. Neuropsychology and Movement Disorders. Neurol Clin 2024; 42:821-833. [PMID: 39343477 DOI: 10.1016/j.ncl.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Neuropsychology is important in differential diagnosis, treatment planning, surgical work-up, and support of patients with movement disorders and their families. The cognitive profiles of several movement disorders are reviewed here. The authors also review relevant neuropsychologic literature related to neurosurgic intervention and cognitive-enhancing medication for patients with movement disorders.
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Affiliation(s)
- Julia A Thomas
- Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 West Thomas Road, Suite 315, Phoenix, AZ 85013, USA
| | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 West Thomas Road, Suite 315, Phoenix, AZ 85013, USA.
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Tahara D, Tahara N, Akagi A, Riku Y, Sone J, Miyahara H, Nagai A, Yoshida M, Iwasaki Y. Clinical characteristics of Japanese patients with corticobasal degeneration. J Neurol Sci 2024; 466:123212. [PMID: 39243604 DOI: 10.1016/j.jns.2024.123212] [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: 07/12/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Corticobasal degeneration (CBD) is a clinically heterogeneous neurodegenerative disorder, for which pathological investigations are essential for a definitive diagnosis. This study explored the clinical characteristics of Japanese patients with pathologically confirmed CBD. METHODS We reviewed the data of Japanese patients with pathologically confirmed CBD who were consecutively autopsied at our institute. Clinical data were obtained from medical records and clinicopathological conferences. RESULTS Of the 34 patients initially reviewed, three were excluded because of a lack of detailed clinical data. Of the remaining 31 patients, 16 were men and 15 were women. The mean ages at onset and death were 63.3 ± 6.7 (51-79) years and 69.1 ± 6.9 (54-86), respectively. The median disease duration was 6.0 (2.5-12) years. The clinical phenotypes were as follows: progressive supranuclear palsy syndrome (PSPS; n = 20, 64.5 %), probable or possible corticobasal syndrome (n = 6, 19.4 %), frontal behavioral-spatial syndrome (n = 4, 12.9 %), nonfluent/agrammatic variant of primary progressive aphasia (n = 1, 3.2 %). Furthermore, 28 (90.3 %) patients exhibited dysphagia with a median latency of 3.5 (1.0-10.0) years, and 22 (71.0 %) patients who underwent tube feeding survived longer than those who did not (P = 0.013). CONCLUSIONS Compared with Western populations, a high prevalence of PSPS may be a clinical characteristic of Japanese patients with CBD. Additionally, dysphagia occurs in many patients with early latency and may shorten survival. Tube feeding contributes to the prolonged survival of patients with CBD.
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Affiliation(s)
- Daisuke Tahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Nao Tahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Yuichi Riku
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Atsushi Nagai
- Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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Aiba I, Hayashi Y, Shimohata T, Yoshida M, Saito Y, Wakabayashi K, Komori T, Hasegawa M, Ikeuchi T, Tokumaru AM, Sakurai K, Murayama S, Hasegawa K, Uchihara T, Toyoshima Y, Saito Y, Yabe I, Tanikawa S, Sugaya K, Hayashi K, Sano T, Takao M, Sakai M, Fujimura H, Takigawa H, Adachi T, Hanajima R, Yokota O, Miki T, Iwasaki Y, Kobayashi M, Arai N, Ohkubo T, Yokota T, Mori K, Ito M, Ishida C, Tanaka M, Idezuka J, Kanazawa M, Aoki K, Aoki M, Hasegawa T, Watanabe H, Hashizume A, Niwa H, Yasui K, Ito K, Washimi Y, Mukai E, Kubota A, Toda T, Nakashima K. Clinical course of pathologically confirmed corticobasal degeneration and corticobasal syndrome. Brain Commun 2023; 5:fcad296. [PMID: 38090279 PMCID: PMC10715783 DOI: 10.1093/braincomms/fcad296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/01/2023] [Accepted: 11/02/2023] [Indexed: 12/28/2023] Open
Abstract
The clinical presentation of corticobasal degeneration is diverse, while the background pathology of corticobasal syndrome is also heterogeneous. Therefore, predicting the pathological background of corticobasal syndrome is extremely difficult. Herein, we investigated the clinical findings and course in patients with pathologically, genetically and biochemically verified corticobasal degeneration and corticobasal syndrome with background pathology to determine findings suggestive of background disorder. Thirty-two patients were identified as having corticobasal degeneration. The median intervals from the initial symptoms to the onset of key milestones were as follows: gait disturbance, 0.0 year; behavioural changes, 1.0 year; falls, 2.0 years; cognitive impairment, 2.0 years; speech impairment, 2.5 years; supranuclear gaze palsy, 3.0 years; urinary incontinence, 3.0 years; and dysphagia, 5.0 years. The median survival time was 7.0 years; 50% of corticobasal degeneration was diagnosed as corticobasal degeneration/corticobasal syndrome at the final presentation. Background pathologies of corticobasal syndrome (n = 48) included corticobasal degeneration (33.3%), progressive supranuclear palsy (29.2%) and Alzheimer's disease (12.5%). The common course of corticobasal syndrome was initial gait disturbance and early fall. In addition, corticobasal degeneration-corticobasal syndrome manifested behavioural change (2.5 years) and cognitive impairment (3.0 years), as the patient with progressive supranuclear palsy-corticobasal syndrome developed speech impairment (1.0 years) and supranuclear gaze palsy (6.0 years). The Alzheimer's disease-corticobasal syndrome patients showed cognitive impairment (1.0 years). The frequency of frozen gait at onset was higher in the corticobasal degeneration-corticobasal syndrome group than in the progressive supranuclear palsy-corticobasal syndrome group [P = 0.005, odds ratio (95% confidence interval): 31.67 (1.46-685.34)]. Dysarthria at presentation was higher in progressive supranuclear palsy-corticobasal syndrome than in corticobasal degeneration-corticobasal syndrome [P = 0.047, 6.75 (1.16-39.20)]. Pyramidal sign at presentation and personality change during the entire course were higher in Alzheimer's disease-corticobasal syndrome than in progressive supranuclear palsy-corticobasal syndrome [P = 0.011, 27.44 (1.25-601.61), and P = 0.013, 40.00 (1.98-807.14), respectively]. In corticobasal syndrome, decision tree analysis revealed that 'freezing at onset' or 'no dysarthria at presentation and age at onset under 66 years in the case without freezing at onset' predicted corticobasal degeneration pathology with a sensitivity of 81.3% and specificity of 84.4%. 'Dysarthria at presentation and age at onset over 61 years' suggested progressive supranuclear palsy pathology, and 'pyramidal sign at presentation and personality change during the entire course' implied Alzheimer's disease pathology. In conclusion, frozen gait at onset, dysarthria, personality change and pyramidal signs may be useful clinical signs for predicting background pathologies in corticobasal syndrome.
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Affiliation(s)
- Ikuko Aiba
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
- Department of Pathology and Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Masato Hasegawa
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Shigeo Murayama
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Suita, Osaka 565-0871, Japan
- Department of Neurology and Neuropathology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Kazuko Hasegawa
- Department of Neurology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa 252-0392, Japan
| | - Toshiki Uchihara
- Neurology Clinic with Neuromorphomics Laboratory, Nitobe-Memorial Nakano General Hospital, Nakano, Tokyo 164-8607, Japan
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Yasuko Toyoshima
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
- Department of Pathology, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Yufuko Saito
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Satoshi Tanikawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido 001-0021, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Terunori Sano
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Motoko Sakai
- Department of Neurology, NHO Suzuka National Hospital, Suzuka, Mie 513-8501, Japan
| | - Harutoshi Fujimura
- Department of Neurology, NHO Osaka Toneyama Medical Center, Toyonaka, Osaka 560-8552, Japan
| | - Hiroshi Takigawa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Tadashi Adachi
- Division of Neuropathology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Tomoko Miki
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Michio Kobayashi
- Department of Neurology, NHO Akita National Hospital, Yurihonjo, Akita 018-1393, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Chiho Ishida
- Department of Neurology, NHO Iou National Hospital, Kanazawa, Ishikawa 920-0192, Japan
| | - Masaharu Tanaka
- Department of Psychiatry, Mishima Hospital, Nagaoka, Niigata 940-2302, Japan
| | - Jiro Idezuka
- Department of Neurology, Ojiya Sakura Hospital, Ojiya, Niigata 947-0041, Japan
| | - Masato Kanazawa
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Kenju Aoki
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Atsushi Hashizume
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi 466-8650, Japan
| | - Keita Ito
- Department of Neurology, Hekinan Municipal Hospital, Hekinan, Aichi 447-8502, Japan
| | - Yukihiko Washimi
- Department of Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Eiichiro Mukai
- Department of Neurology, Aichi-pref Saiseikai Rehabilitation Hospital, Nagoya, Aichi 451-0052, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Kenji Nakashima
- Department of Neurology, NHO Matsue Medical Center, Matsue, Shimane 690-8556, Japan
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Ananthavarathan P, Patel B, Peeros S, Obrocki R, Malek N. Neurological update: non-motor symptoms in atypical parkinsonian syndromes. J Neurol 2023; 270:4558-4578. [PMID: 37316556 PMCID: PMC10421812 DOI: 10.1007/s00415-023-11807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Among people with Parkinson's disease (PD), non-motor symptoms (NMS) are a well-recognised cause of significant morbidity and poor quality of life. Yet, it is only more recently that NMS have been recognised to affect the lives of patients with atypical parkinsonian syndromes in a similar fashion. The aim of this article is to highlight and compare the relative prevalence of NMS among patients with atypical parkinsonian syndromes in the published literature, which largely remain underreported and unaddressed in routine clinical practice. All NMS that are recognised to occur in PD are also found to commonly occur in atypical parkinsonian syndromes. In particular, excessive daytime sleepiness is more prevalent among atypical parkinsonian syndromes (94.3%) compared to PD (33.9%) or normal controls (10.5%) (p < 0.001). Urinary dysfunction (not limited to urinary incontinence) is not only found to occur in MSA (79.7%) and PD (79.9%), but has also been reported in nearly half of the patients with PSP (49.3%), DLB (42%) and CBD (53.8%) (p < 0.001). Apathy is significantly more common among the atypical parkinsonian syndromes [PSP (56%), MSA (48%), DLB (44%), CBD (43%)] compared to PD (35%) (p = 0.029). Early recognition and addressing of NMS among atypical parkinsonian syndromes may help improve the holistic patient care provided and may encompass a range of conservative and pharmacotherapeutic treatments to address these symptoms.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuroinflammation, Institute of Neurology, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
| | - B Patel
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - S Peeros
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - R Obrocki
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - N Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
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Abdelnour C, Poston KL. Cognitive Impairment in Neurodegenerative Movement Disorders. Semin Neurol 2023; 43:81-94. [PMID: 36940727 DOI: 10.1055/s-0043-1764204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Patients with neurodegenerative movement disorders can develop cognitive impairment during the disease. Cognitive symptoms have been associated with decreased quality of life, higher caregiver burden, and earlier institutionalization, and are therefore critical for physicians to understand and address. The evaluation of cognitive performance of patients with neurodegenerative movement disorders is important for providing adequate diagnosis, management, prognosis, and support patients and their caregivers. In this review, we discuss the features of the cognitive impairment profile of commonly encountered movement disorders: Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and Huntington's disease. In addition, we provide neurologists with practical guidance and evaluation tools for the assessment and management of these challenging patients.
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Affiliation(s)
- Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Polsinelli AJ, Apostolova LG. Atypical Alzheimer Disease Variants. Continuum (Minneap Minn) 2022; 28:676-701. [PMID: 35678398 PMCID: PMC10028410 DOI: 10.1212/con.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses the clinical, neuroimaging, and biomarker profiles of sporadic atypical Alzheimer disease (AD) variants, including early-onset AD, posterior cortical atrophy, logopenic variant primary progressive aphasia, dysexecutive variant and behavioral variant AD, and corticobasal syndrome. RECENT FINDINGS Significant advances are being made in the recognition and characterization of the syndromically diverse AD variants. These variants are identified by the predominant cognitive and clinical features: early-onset amnestic syndrome, aphasia, visuospatial impairments, dysexecutive and behavioral disturbance, or motor symptoms. Although understanding of regional susceptibility to disease remains in its infancy, visualizing amyloid and tau pathology in vivo and CSF examination of amyloid-β and tau proteins are particularly useful in atypical AD, which can be otherwise prone to misdiagnosis. Large-scale research efforts, such as LEADS (the Longitudinal Early-Onset Alzheimer Disease Study), are currently ongoing and will continue to shed light on our understanding of these diverse presentations. SUMMARY Understanding the clinical, neuroimaging, and biomarker profiles of the heterogeneous group of atypical AD syndromes improves diagnostic accuracy in patients who are at increased risk of misdiagnosis. Earlier accurate identification facilitates access to important interventions, social services and disability assistance, and crucial patient and family education.
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Peterson KA, Patterson K, Rowe JB. Language impairment in progressive supranuclear palsy and corticobasal syndrome. J Neurol 2021; 268:796-809. [PMID: 31321513 PMCID: PMC7914167 DOI: 10.1007/s00415-019-09463-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
Although commonly known as movement disorders, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) may present with changes in speech and language alongside or even before motor symptoms. The differential diagnosis of these two disorders can be challenging, especially in the early stages. Here we review their impact on speech and language. We discuss the neurobiological and clinical-phenomenological overlap of PSP and CBS with each other, and with other disorders including non-fluent agrammatic primary progressive aphasia and primary progressive apraxia of speech. Because language impairment is often an early and persistent problem in CBS and PSP, there is a need for improved methods for language screening in primary and secondary care, and more detailed language assessments in tertiary healthcare settings. Improved language assessment may aid differential diagnosis as well as inform clinical management decisions.
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Affiliation(s)
- Katie A Peterson
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK.
| | - Karalyn Patterson
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - James B Rowe
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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Sakae N, Santos OA, Pedraza O, Litvan I, Murray ME, Duara R, Uitti RJ, Wszolek ZK, Graff-Radford NR, Josephs KA, Dickson DW. Clinical and pathologic features of cognitive-predominant corticobasal degeneration. Neurology 2020; 95:e35-e45. [PMID: 32518146 PMCID: PMC7371382 DOI: 10.1212/wnl.0000000000009734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe clinical and pathologic characteristics of corticobasal degeneration (CBD) with cognitive predominant problems during the disease course. METHODS In a series of autopsy-confirmed cases of CBD, we identified patients with cognitive rather than motor predominant features (CBD-Cog), including 5 patients thought to have Alzheimer disease (AD) and 10 patients thought to have behavioral variant frontotemporal dementia (FTD). We compared clinical and pathologic features of CBD-Cog with those from a series of 31 patients with corticobasal syndrome (CBD-CBS). For pathologic comparisons between CBD-Cog and CBD-CBS, we used semiquantitative scoring of neuronal and glial lesion types in multiple brain regions and quantitative assessments of tau burden from image analysis. RESULTS Five of 15 patients with CBD-Cog never had significant motor problems during their disease course. The most common cognitive abnormalities in CBD-Cog were executive and visuospatial dysfunction. The frequency of language problems did not differ between CBD-Cog and CBD-CBS. Argyrophilic grain disease, which is a medial temporal tauopathy associated with mild cognitive impairment, was more frequent in CBD-Cog. Apathy was also more frequent in CBD-Cog. Tau pathology in CBD-Cog was greater in the temporal and less in perirolandic cortices than in CBD-CBS. CONCLUSION A subset of patients with CBD has a cognitive predominant syndrome than can be mistaken for AD or FTD. Our findings suggest that distribution of tau cortical pathology (greater in temporal and less in perirolandic cortices) may be the basis of this uncommon clinical variant of CBD.
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Affiliation(s)
- Nobutaka Sakae
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Octavio A Santos
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Otto Pedraza
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Irene Litvan
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Melissa E Murray
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Ranjan Duara
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Ryan J Uitti
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Zbigniew K Wszolek
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Keith A Josephs
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Dennis W Dickson
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN.
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Saranza GM, Whitwell JL, Kovacs GG, Lang AE. Corticobasal degeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:87-136. [PMID: 31779825 DOI: 10.1016/bs.irn.2019.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by the predominance of pathological 4 repeat tau deposition in various cell types and anatomical regions. Corticobasal syndrome (CBS) is one of the clinical phenotypes associated with CBD pathology, manifesting as a progressive asymmetric akinetic-rigid, poorly levodopa-responsive parkinsonism, with cerebral cortical dysfunction. CBD can manifest as several clinical phenotypes, and similarly, CBS can also have a pathologic diagnosis other than CBD. This chapter discusses the clinical manifestations of pathologically confirmed CBD cases, the current diagnostic criteria, as well as the pathologic and neuroimaging findings of CBD/CBS. At present, therapeutic options for CBD remain symptomatic. Further research is needed to improve the clinical diagnosis of CBD, as well as studies on disease-modifying therapies for this relentlessly progressive neurodegenerative disorder.
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Affiliation(s)
- Gerard M Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Gabor G Kovacs
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Constantinides VC, Paraskevas GP, Paraskevas PG, Stefanis L, Kapaki E. Corticobasal degeneration and corticobasal syndrome: A review. Clin Park Relat Disord 2019; 1:66-71. [PMID: 34316603 PMCID: PMC8288513 DOI: 10.1016/j.prdoa.2019.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Corticobasal degeneration (CBD) is a rare neurodegenerative disorder. The most common presentation of CBD is the corticobasal syndrome (CBS), which is a constellation of cortical and extrapyramidal symptoms and signs. Clinical-pathological studies have illustrated that CBD can present with diverse clinical phenotypes, including a non-fluent, agrammatic primary progressive aphasia syndrome, a behavioral, dysexecutive and visuospatial syndrome, as well as a progressive supranuclear palsy-like syndrome. Conversely, multiple pathologies, such as CBD, Alzheimer's disease and progressive supranuclear palsy may underlie a patient with CBS. This clinical-pathological overlap emphasizes the need for biomarkers that will assist in the accurate diagnosis of patients with CBS. This review presents an overview of the pathological, genetic, clinical and therapeutic characteristics of CBD, with an emphasis on the imaging (structural and functional) and biochemical (cerebrospinal fluid) biomarkers of CBD.
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Affiliation(s)
- Vasilios C. Constantinides
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Greece
| | - George P. Paraskevas
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Greece
| | - Panagiotis G. Paraskevas
- Department of Nursing, Technological Educational Institute of Crete, School of Health and Welfare Services, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Greece
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12
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Xu Z, Arbizu J, Pavese N. PET Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:3-36. [DOI: 10.1016/bs.irn.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Gerstenecker A. The Neuropsychology (Broadly Conceived) of Multiple System Atrophy, Progressive Supranuclear Palsy, and Corticobasal Degeneration. Arch Clin Neuropsychol 2017; 32:861-875. [DOI: 10.1093/arclin/acx093] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
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Abstract
Previous studies of patients with brain damage have suggested a close relationship between aphasia and movement disorders. Neurodegenerative extrapyramidal syndromes associated with cognitive impairment provide an interesting model for studying the neural substrates of cognitive and motor symptoms. In this review, we focused on studies investigating language production abilities in patients with Parkinson's disease (PD), Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP). According to some reports, these patients exhibit a reduction in performance in both action and object naming or verb production compared to healthy individuals. Furthermore, a disproportional impairment of action naming compared to object naming was systematically observed in patients with these disorders. The study of these clinical conditions offers the unique opportunity to examine the close link between linguistic features and motor characteristics of action. This particular pattern of language impairment may contribute to the debate on embodiment theory and on the involvement of the basal ganglia in language and in integrating language and movement. From a translational perspective, we suggest that language ability assessments are useful in the clinical work-up, along with neuropsychological and motor evaluations. Specific protocols should be developed in the near future to better characterize language deficits and to permit an early cognitive diagnosis. Moreover, the link between language deficits and motor impairment opens a new issue for treatment approaches. Treatment of one of these two symptoms may ameliorate the other, and treating both may produce a greater improvement in patients' global clinical conditions.
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15
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Day GS, Lim TS, Hassenstab J, Goate AM, Grant EA, Roe CM, Cairns NJ, Morris JC. Differentiating cognitive impairment due to corticobasal degeneration and Alzheimer disease. Neurology 2017; 88:1273-1281. [PMID: 28235814 DOI: 10.1212/wnl.0000000000003770] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical features that reliably differentiate individuals with cognitive impairment due to corticobasal degeneration (CBD) and Alzheimer disease (AD). METHODS Clinical features were compared between individuals with autopsy-proven CBD (n = 17) and AD (n = 16). All individuals presented with prominent cognitive complaints and were evaluated annually with semistructured interviews, detailed neurologic examinations, and neuropsychological testing. RESULTS Substantial overlap was observed between individuals with dementia due to CBD and AD concerning presenting complaints, median (range) duration of symptoms before assessment (CBD = 3.0 [0-5.0] years, AD = 2.5 [0-8.0] years; p = 0.96), and median (range) baseline dementia severity (Clinical Dementia Rating Sum of Boxes: CBD = 3.5 [0-12.0], AD = 4.25 [0.5-9.0], p = 0.49). Subsequent emergence of asymmetric motor/sensory signs, hyperreflexia, gait abnormalities, parkinsonism, falls, urinary incontinence, and extraocular movement abnormalities identified individuals with CBD, with ≥3 discriminating features detected in 80% of individuals within 3.1 years (95% confidence interval 2.9-3.3) of the initial assessment. Individuals with CBD exhibited accelerated worsening of illness severity and declines in episodic memory, executive functioning, and letter fluency. Semiquantitative pathologic assessment revealed prominent tau pathology within the frontal and parietal lobes of CBD cases. Comorbid AD neuropathologic change was present in 59% (10 of 17) of CBD cases but did not associate with the clinical phenotype, rate of dementia progression, or dementia duration. CONCLUSIONS CBD may mimic AD dementia early in its disease course. Interval screening for discriminating clinical features may improve antemortem diagnosis in individuals with CBD and prominent cognitive symptoms.
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Affiliation(s)
- Gregory S Day
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Tae Sung Lim
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Jason Hassenstab
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Alison M Goate
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Elizabeth A Grant
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Catherine M Roe
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - Nigel J Cairns
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY
| | - John C Morris
- From the Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), Department of Neurology (G.S.D., T.S.L., J.H., C.M.R., N.J.C., J.C.C.), Division of Biostatistics (E.A.G.), and Department of Pathology and Immunology (N.J.C.), Washington University School of Medicine (G.S.D., T.S.L., J.H., A.M.G., E.A.G., C.M.R., N.J.C., J.C.M.), St. Louis, MO; Ajou University School of Medicine (T.S.L.), Suwon, Republic of Korea; and Icahn School of Medicine at Mount Sinai (A.M.G.), New York, NY.
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Lam B, Khan A, Keith J, Rogaeva E, Bilbao J, St. George‐Hyslop P, Ghani M, Freedman M, Stuss DT, Chow T, Black SE, Masellis M. Characterizing familial corticobasal syndrome due to Alzheimer's disease pathology and
PSEN1
mutations. Alzheimers Dement 2016; 13:520-530. [DOI: 10.1016/j.jalz.2016.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Benjamin Lam
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario 33
- Brain Sciences Research Program, Sunnybrook Research Institute University of Toronto Toronto Ontario Canada
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
| | - Aun Khan
- Ziauddin University Karachi Pakistan
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Disease Toronto Ontario Canada
| | - Juan Bilbao
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Peter St. George‐Hyslop
- Tanz Centre for Research in Neurodegenerative Disease Toronto Ontario Canada
- Cambridge Institute for Medical Research, Department of Clinical Neurosciences University of Cambridge Cambridge UK
| | - Mahdi Ghani
- Tanz Centre for Research in Neurodegenerative Disease Toronto Ontario Canada
| | - Morris Freedman
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
- Sam and Ida Ross Memory Clinic Baycrest Toronto Ontario Canada
- Rotman Research Institute, Baycrest University of Toronto Toronto Ontario Canada
- Toronto Dementia Research Alliance Toronto Ontario Canada
| | - Donald T. Stuss
- Brain Sciences Research Program, Sunnybrook Research Institute University of Toronto Toronto Ontario Canada
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
- Rotman Research Institute, Baycrest University of Toronto Toronto Ontario Canada
- Department of Psychology University of Toronto Toronto Ontario Canada
- Ontario Brain Institute Toronto Ontario Canada
| | - Tiffany Chow
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
- Sam and Ida Ross Memory Clinic Baycrest Toronto Ontario Canada
- Rotman Research Institute, Baycrest University of Toronto Toronto Ontario Canada
| | - Sandra E. Black
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario 33
- Brain Sciences Research Program, Sunnybrook Research Institute University of Toronto Toronto Ontario Canada
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
- Rotman Research Institute, Baycrest University of Toronto Toronto Ontario Canada
- Toronto Dementia Research Alliance Toronto Ontario Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario 33
- Brain Sciences Research Program, Sunnybrook Research Institute University of Toronto Toronto Ontario Canada
- Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada
- Toronto Dementia Research Alliance Toronto Ontario Canada
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Pirker S, Perju-Dumbrava L, Kovacs GG, Traub-Weidinger T, Pirker W. Progressive Dopamine Transporter Binding Loss in Autopsy-Confirmed Corticobasal Degeneration. JOURNAL OF PARKINSONS DISEASE 2016; 5:907-12. [PMID: 26485425 DOI: 10.3233/jpd-150625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Corticobasal degeneration (CBD) is characterized by neuronal and glial deposition of 4-repeat tau in the frontal and parietal cerebral cortex, white matter and striatum. There is neuronal loss in affected cortical regions and in the substantia nigra (SN). Recent single photon emission tomography (SPECT) studies have reported normal striatal dopamine transporter (DAT) binding in individual patients with CBD. OBJECTIVE To study the pattern and course of DAT binding loss in CBD. METHODS We retrospectively analyzed DAT SPECT studies in two patients presenting with a corticobasal syndrome in whom a diagnosis of CBD was later confirmed pathologically. RESULTS Baseline scans at 1.5 years after symptom onset revealed only mild abnormalities (reduced uptake in one putamen). Follow up scans at 4.5 years (Case 1) and 5 years (Case 2) after symptom onset showed a marked decline of striatal DAT binding. In both cases, there was a 37% binding reduction from the age-expected striatal binding value. Asymmetry of striatal DAT binding had increased from mild in the first SPECT studies to moderate at the time of their final imaging. CONCLUSION CBD patients can have delayed neuronal loss in the SN. Follow up DAT imaging may be of value in patients with possible CBD and a normal baseline scan.
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Affiliation(s)
- Susanne Pirker
- 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Austria
| | - Tatiana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Wilhelminenspital, Vienna, Austria
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Progressive supranuclear palsy and corticobasal degeneration: Diagnostic challenges and clinicopathological considerations. Rev Neurol (Paris) 2016; 172:488-502. [DOI: 10.1016/j.neurol.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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Corticobasal Degeneration Presenting as Non-Fluent/Agrammatic Primary Progressive Aphasia: A Case Report. Dement Neurocogn Disord 2016; 15:55-58. [PMID: 30906342 PMCID: PMC6427976 DOI: 10.12779/dnd.2016.15.2.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background Non-fluent agrammatic primary progressive aphasia (naPPA) is characterized by progressive non-fluent speech disorder and might be associated with taupathy such as corticobasal degeneration (CBD) and progressive supranuclear palsy. We report a case of overlap syndrome presented with language impairment, and diagnosed as naPPA with possible CBD. Case Report A 58-year-old woman visited a memory and dementia clinic, with a 10-month history of progressive language disturbance. She was diagnosed as naPPA and overlapping CBD, based on the clinical features and neuroimaging findings including florbetaben PET. Conclusions naPPA is pathologically caused by taupathy, and might progress to asymmetrical parkinsonism and apraxia, suggestive of CBD. Overlapping clinical features in our case represent various phenotypes of taupathy.
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Abe Y, Kimura N, Goto M, Aso Y, Matsubara E. Brain Perfusion in Corticobasal Syndrome with Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2016; 6:133-41. [PMID: 27195001 PMCID: PMC4868931 DOI: 10.1159/000443329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Brain perfusion may differ between patients with corticobasal syndrome (CBS) with and without aphasia. Methods Twenty-six (9 males and 17 females; mean age 76 ± 5.3 years) patients with CBS were enrolled in the study. Brain MRI and single-photon emission computed tomography were performed in all subjects. Language was evaluated using the Standard Language Test of Aphasia. The patients were divided into two subgroups according to the presence or absence of progressive aphasia. Differences in the regional cerebral blood flow (rCBF) between the two groups were detected based on voxel-by-voxel group analysis using Statistical Parametric Mapping 8. Results All patients exhibited asymmetric motor symptoms and signs, including limb apraxia, bradykinesia, and akinetic rigidity. Of 26 patients, 9 had a clinically obvious language disturbance, characterized as nonfluent aphasia. Almost all CBS patients with aphasia exhibited cortical atrophy predominantly in the left frontal and temporal lobes with widening of the Sylvian fissure on MRI. The rCBF in the left middle frontal gyrus differed significantly between CBS patients with and without aphasia. Conclusion CBS patients with aphasia exhibit motor symptoms predominantly on the right side and cortical atrophy mainly in the left perisylvian cortices. In particular, left frontal dysfunction might be related to nonfluent aphasia in CBS.
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Affiliation(s)
- Yoshitake Abe
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Megumi Goto
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yasuhiro Aso
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
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Shimohata T, Aiba I, Nishizawa M. [Diagnoses of corticobasal syndrome and corticobasal degeneration]. Rinsho Shinkeigaku 2016; 56:149-57. [PMID: 26876110 DOI: 10.5692/clinicalneurol.cn-000841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Experts use the term corticobasal syndrome (CBS) for patients with a clinical diagnosis of corticobasal degeneration (CBD), and reserve CBD for those whose conditions have been diagnosed on the basis of neuropathological analyses. Several studies demonstrated that patients with CBD may also present with progressive supranuclear syndrome (PSPS), aphasia, Alzheimer disease-like dementia or behavioral change, suggesting that CBS is merely one of the presenting phenotypes of CBD. Although previous CBD diagnostic criteria reflected only CBS, the international consortium proposed new diagnostic criteria for CBD in 2013 (Armstrong's criteria). The new criteria include 4 CBD subtypes; CBS, frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA),and PSPS. These subtypes were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD (cr-CBD) and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies (p-CBD). Two studies have already revealed that the sensitivity and specificity of the criteria were not high. Because therapeutic interventions that target abnormally-phosphorylated tau have started, further refinement of the criteria is needed via biomarker researches with prospective study designs.
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Spotorno N, Healey M, McMillan CT, Rascovsky K, Irwin DJ, Clark R, Grossman M. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration. Front Hum Neurosci 2015; 9:583. [PMID: 26578928 PMCID: PMC4621742 DOI: 10.3389/fnhum.2015.00583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/06/2015] [Indexed: 12/04/2022] Open
Abstract
Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like “he” and “she” (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients’ performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity.
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Affiliation(s)
- Nicola Spotorno
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
| | - Meghan Healey
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
| | - Robin Clark
- Department of Linguistics, University of Pennsylvania Philadelphia, PA, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Perelman School of Medicine Philadelphia, PA, USA
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Nishida N, Yoshida K, Hata Y, Arai Y, Kinoshita K. Pathological features of preclinical or early clinical stages of corticobasal degeneration: a comparison with advanced cases. Neuropathol Appl Neurobiol 2015; 41:893-905. [DOI: 10.1111/nan.12229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Naoki Nishida
- Department of Legal Medicine; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama Japan
| | - Koji Yoshida
- Department of Neurology; Toyama University Hospital; Toyama Japan
| | - Yukiko Hata
- Department of Legal Medicine; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama Japan
| | - Yuichi Arai
- Division of Neurology; Kurobe City Hospital; Toyama Japan
| | - Koshi Kinoshita
- Department of Legal Medicine; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama Japan
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Clerc MT, Deprez M, Leuba G, Lhermitte B, Lopez U, von Gunten A. Atypical association of semantic dementia, corticobasal syndrome, and 4R tauopathy. Neurocase 2015; 21:1-15. [PMID: 24156410 DOI: 10.1080/13554794.2013.841953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 57-year-old male with no family history was diagnosed with semantic dementia. He also showed some unusual cognitive features such as episodic memory and executive dysfunctions, spatial disorientation, and dyscalculia. Rapidly progressive cognitive and physical decline occurred. About 1.5 years later, he developed clinical features of a corticobasal syndrome. He died at the age of 60. Brain autopsy revealed numerous 4R-tau-positive lesions in the frontal, parietal and temporal lobes, basal ganglia, and brainstem. Neuronal loss was severe in the temporal cortex. Such association of semantic dementia with tauopathy and corticobasal syndrome is highly unusual. These findings are discussed in the light of current knowledge about frontotemporal lobar degeneration.
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Affiliation(s)
- Marie-Therese Clerc
- a Service Universitaire de Psychiatrie de l'âge avancé, Département de Psychiatrie , Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
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Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M. Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography. ALZHEIMERS RESEARCH & THERAPY 2014; 6:71. [PMID: 25484929 PMCID: PMC4256921 DOI: 10.1186/s13195-014-0071-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/08/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities. METHODS Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them. RESULTS The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups. CONCLUSIONS Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.
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Affiliation(s)
- Michael R Misch
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Sara Mitchell
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Philip L Francis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kayla Sherborn
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Katayoun Meradje
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kie Honjo
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Jiali Zhao
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Christopher Jm Scott
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Curtis B Caldwell
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Lisa Ehrlich
- Department of Nuclear Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Prathiba Shammi
- Neuropsychology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Juan M Bilbao
- Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Cognition & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Ryan NS, Shakespeare TJ, Lehmann M, Keihaninejad S, Nicholas JM, Leung KK, Fox NC, Crutch SJ. Motor features in posterior cortical atrophy and their imaging correlates. Neurobiol Aging 2014; 35:2845-2857. [PMID: 25086839 PMCID: PMC4236588 DOI: 10.1016/j.neurobiolaging.2014.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/06/2014] [Accepted: 05/31/2014] [Indexed: 12/28/2022]
Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by impaired higher visual processing skills; however, motor features more commonly associated with corticobasal syndrome may also occur. We investigated the frequency and clinical characteristics of motor features in 44 PCA patients and, with 30 controls, conducted voxel-based morphometry, cortical thickness, and subcortical volumetric analyses of their magnetic resonance imaging. Prominent limb rigidity was used to define a PCA-motor subgroup. A total of 30% (13) had PCA-motor; all demonstrating asymmetrical left upper limb rigidity. Limb apraxia was more frequent and asymmetrical in PCA-motor, as was myoclonus. Tremor and alien limb phenomena only occurred in this subgroup. The subgroups did not differ in neuropsychological test performance or apolipoprotein E4 allele frequency. Greater asymmetry of atrophy occurred in PCA-motor, particularly involving right frontoparietal and peri-rolandic cortices, putamen, and thalamus. The 9 patients (including 4 PCA-motor) with pathology or cerebrospinal fluid all showed evidence of Alzheimer's disease. Our data suggest that PCA patients with motor features have greater atrophy of contralateral sensorimotor areas but are still likely to have underlying Alzheimer's disease.
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Affiliation(s)
- Natalie S Ryan
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK.
| | - Timothy J Shakespeare
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Manja Lehmann
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Shiva Keihaninejad
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Jennifer M Nicholas
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK; Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Kelvin K Leung
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
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Spotorno N, McMillan CT, Powers JP, Clark R, Grossman M. Counting or chunking? Mathematical and heuristic abilities in patients with corticobasal syndrome and posterior cortical atrophy. Neuropsychologia 2014; 64:176-83. [PMID: 25278132 DOI: 10.1016/j.neuropsychologia.2014.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 01/29/2023]
Abstract
A growing amount of empirical data is showing that the ability to manipulate quantities in a precise and efficient fashion is rooted in cognitive mechanisms devoted to specific aspects of numbers processing. The analog number system (ANS) has a reasonable representation of quantities up to about 4, and represents larger quantities on the basis of a numerical ratio between quantities. In order to represent the precise cardinality of a number, the ANS may be supported by external algorithms such as language, leading to a "precise number system". In the setting of limited language, other number-related systems can appear. For example the parallel individuation system (PIS) supports a "chunking mechanism" that clusters units of larger numerosities into smaller subsets. In the present study we investigated number processing in non-aphasic patients with corticobasal syndrome (CBS) and posterior cortical atrophy (PCA), two neurodegenerative conditions that are associated with progressive parietal atrophy. The present study investigated these number systems in CBS and PCA by assessing the property of the ANS associated with smaller and larger numerosities, and the chunking property of the PIS. The results revealed that CBS/PCA patients are impaired in simple calculations (e.g., addition and subtraction) and that their performance strongly correlates with the size of the numbers involved in these calculations, revealing a clear magnitude effect. This magnitude effect was correlated with gray matter atrophy in parietal regions. Moreover, a numeral-dots transcoding task showed that CBS/PCA patients were able to take advantage of clustering in the spatial distribution of the dots of the array. The relative advantage associated with chunking compared to a random spatial distribution correlated with both parietal and prefrontal regions. These results shed light on the properties of systems for representing number knowledge in non-aphasic patients with CBS and PCA.
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Affiliation(s)
- Nicola Spotorno
- University of Pennsylvania, Perelman School of Medicine, Penn Frontotemporal Degeneration Center, Philadelphia, PA 19104, USA.
| | - Corey T McMillan
- University of Pennsylvania, Perelman School of Medicine, Penn Frontotemporal Degeneration Center, Philadelphia, PA 19104, USA
| | - John P Powers
- University of Pennsylvania, Perelman School of Medicine, Penn Frontotemporal Degeneration Center, Philadelphia, PA 19104, USA
| | - Robin Clark
- University of Pennsylvania, Department of Linguistics, Philadelphia, PA 19104, USA
| | - Murray Grossman
- University of Pennsylvania, Perelman School of Medicine, Penn Frontotemporal Degeneration Center, Philadelphia, PA 19104, USA
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Ikeda C, Yokota O, Nagao S, Ishizu H, Morisada Y, Terada S, Nakashima Y, Akiyama H, Uchitomi Y. Corticobasal degeneration initially developing motor versus non-motor symptoms: a comparative clinicopathological study. Psychogeriatrics 2014; 14:152-64. [PMID: 25186621 DOI: 10.1111/psyg.12054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/16/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical presentations of pathologically confirmed corticobasal degeneration (CBD) vary, and the heterogeneity makes its clinical diagnosis difficult, especially when a patient lacks any motor disturbance in the early stage. METHODS We compared clinical and pathological features of four pathologically confirmed CBD cases that initially developed non-motor symptoms, including behavioural and psychiatric symptoms but without motor disturbance (CBD-NM), and five CBD cases that initially developed parkinsonism and/or falls (CBD-M). The age range at death for the CBD-NM and CBD-M subjects (58-85 years vs 45-67 years) and the range of disease duration (2-18 years vs 2-6 years) did not significantly differ between the groups. RESULTS Prominent symptoms in the early stage of CBD-NM cases included self-centred behaviours such as frontotemporal dementia (n = 1), apathy with and without auditory hallucination (n = 2), and aggressive behaviours with delusion and visual hallucination (n = 1). Among the four CBD-NM cases, only one developed asymmetric motor disturbance, and two could walk without support throughout the course. Final clinical diagnoses of the CBD-NM cases were frontotemporal dementia (n = 2), senile psychosis with delirium (n = 1), and schizophrenia (n = 1). Neuronal loss was significantly less severe in the subthalamic nucleus and substantia nigra in the CBD-NM cases than in the CBD-M cases. The severity of tau pathology in all regions examined was comparable in the two groups. CONCLUSION CBD cases that initially develop psychiatric and behavioural changes without motor symptoms may have less severe degenerative changes in the subthalamic nucleus and substantia nigra, and some CBD cases can lack motor disturbance not only in the early stage but also in the last stage of the course.
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Affiliation(s)
- Chikako Ikeda
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Clinical Research Institute, National Hospital Organization Minami-Okayama Medical Center, Hayashima, Japan
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29
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Alexander SK, Rittman T, Xuereb JH, Bak TH, Hodges JR, Rowe JB. Validation of the new consensus criteria for the diagnosis of corticobasal degeneration. J Neurol Neurosurg Psychiatry 2014; 85:925-9. [PMID: 24521567 PMCID: PMC4112495 DOI: 10.1136/jnnp-2013-307035] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Corticobasal degeneration (CBD) is a complex neurodegenerative disorder. Accurate diagnosis is increasingly important, with the advent of clinical trials of drugs aimed at modifying the underlying tau pathology. CBD often presents with a 'corticobasal syndrome' including impairments of movement and cognition. However, patients with similar corticobasal syndromes can have neurodegenerative pathologies that are not CBD. In addition, patients with CBD may present with aphasia or behavioural change. The clinical diversity of CBD and mimicry by non-CBD pathologies hinders accurate diagnosis. METHODS We applied the new consensus criteria of Armstrong and colleagues et al 1 to a cohort of patients with detailed longitudinal clinical evaluation and neuropathology. RESULTS In patients with pathologically confirmed CBD, accuracy of diagnosis was similar under the new and previous criteria: 9/19 (47%) met criteria for probable CBD at presentation, 13/19 (68%) at last clinical assessment. Patients with a corticobasal syndrome but without CBD pathology all (14/14) met the new diagnostic criteria of probable or possible CBD, demonstrating that the new criteria lacks the necessary specificity for an accurate ante mortem clinical diagnosis of CBD. None of the clinical features used in the new criteria were more common in the patients with CBD pathology (n=19) than without (n=14). CONCLUSIONS The Armstrong criteria usefully broadens the recognised clinical phenotype of CBD but does not sufficiently improve the specificity of diagnosis to increase the power of clinical trials or targeted applications of tau-based disease-modifying therapies. Further work is required to show whether biomarkers could be more effective than clinical signs in the diagnosis of CBD.
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Affiliation(s)
| | - T Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J H Xuereb
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - T H Bak
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - J R Hodges
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - J B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Huang N, Hornberger M, Hodges JR, Burrell JR. Measuring disease progression in corticobasal syndrome. J Neurol 2014; 261:1598-605. [PMID: 24893591 DOI: 10.1007/s00415-014-7389-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
Corticobasal syndrome (CBS) is a complex neurodegenerative disorder with marked clinical, neuropsychological, and pathological heterogeneity. Measurement of disease progression in CBS is complex and little understood. This study aimed to establish clinical and neuropsychological indicators of prognosis in CBS. Patients with CBS were retrospectively recruited from a frontotemporal dementia specific research clinic. All patients underwent detailed clinical and neuropsychological testing including the frontotemporal dementia rating scale (FRS). Using the differences in FRS logit scores over a period of 12 months, CBS patients were divided into rapid and slow progressor groups. Demographic, clinical and neuropsychological features were compared between the two groups. Sixteen participants who met defined criteria were included (9 males, 7 females; mean age 65.8 ± 22 years; median symptom duration 51.8 ± 22 years; mean duration of follow-up 11.4 ± 2.8 months). There were no significant differences between the rapid and slow progressors in age, gender, symptom duration, motor/cognitive presentation, and ACE-R scores at baseline. Clinically, slow progressors were significantly more likely to have a motor speech disorder, with a trend for more frequent dysgraphia, whereas rapid progressors were more likely to exhibit surface dyslexia. Rapid and slow progressor groups did not differ on neuropsychological performance. The presence of motor speech disorder, dysgraphia, and surface dyslexia may be useful in differentiating patients with rapid progression of CBS from those with a more indolent disease course.
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Affiliation(s)
- Nancy Huang
- Neuroscience Research Australia, Barker Street, Randwick, Sydney, NSW 2031, Australia
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Burrell JR, Hodges JR, Rowe JB. Cognition in corticobasal syndrome and progressive supranuclear palsy: A review. Mov Disord 2014; 29:684-93. [DOI: 10.1002/mds.25872] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- James R. Burrell
- Neuroscience Research Australia; Sydney Australia
- University of New South Wales; Sydney Australia
| | - John R. Hodges
- Neuroscience Research Australia; Sydney Australia
- University of New South Wales; Sydney Australia
| | - James B. Rowe
- Department of Clinical Neurosciences; Cambridge University; Cambridge United Kingdom
- Behavioral and Clinical Neuroscience Institute; Cambridge United Kingdom
- Medical Research Council; Cognition and Brain Sciences Unit; Cambridge United Kingdom
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Abstract
OPINION STATEMENT Corticobasal degeneration is a pathologic entity. Presenting clinical phenotypes include corticobasal syndrome (CBS), frontal behavioral spatial syndrome, aphasia, progressive supranuclear palsy-like syndrome (PSPS), and a predominantly cognitive phenotype often mistaken for Alzheimer's disease (AD). Treatment of CBD is symptomatic, particularly given recently negative neuroprotective studies. Given the relentless progression in CBD, all interested patients should be offered the opportunity to enroll in clinical neuroprotective trials as they arise. For symptomatic therapy, treatment options are necessarily based on evidence from other disorders given the lack of studies in CBD. In patients with CBS and PSPS, parkinsonism is treated with levodopa/carbidopa. This generally has modest and transient benefits at best and often results in no improvement. Botulinum toxin injections are the treatment of choice for limb dystonia. Clonazepam and levetiracetam are commonly used for myoclonus. Physical therapy is an important part of motor treatment, particularly for fall prevention strategies and assist device assessment. Whether medications such as cholinesterase inhibitors or memantine have any role in CBD is unclear given the various responses described in related phenotypes and diseases. Treating the behavioral symptoms associated with CBD is critical in an attempt to treat symptoms for which we have good pharmacologic interventions and to hopefully improve quality of life. General supportive care is important, including assessing for sores related to dystonia or immobility, monitoring dysphagia, and identifying needs for support services. Finally, as with other relentlessly progressive neurodegenerative diseases, it is critical to provide family and caregiver support and to assess for when palliative care services will serve the patient best.
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Affiliation(s)
- Melissa J Armstrong
- Division of Movement Disorders, Department of Neurology, University of Maryland School of Medicine, 110 S. Paca Street, 3rd Floor, Baltimore, MD, 21201, USA,
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Murray ME, Kouri N, Lin WL, Jack CR, Dickson DW, Vemuri P. Clinicopathologic assessment and imaging of tauopathies in neurodegenerative dementias. ALZHEIMERS RESEARCH & THERAPY 2014; 6:1. [PMID: 24382028 PMCID: PMC3978456 DOI: 10.1186/alzrt231] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microtubule-associated protein tau encoded by the MAPT gene binds to microtubules and is important for maintaining neuronal morphology and function. Alternative splicing of MAPT pre-mRNA generates six major tau isoforms in the adult central nervous system resulting in tau proteins with three or four microtubule-binding repeat domains. In a group of neurodegenerative disorders called tauopathies, tau becomes aberrantly hyperphosphorylated and dissociates from microtubules, resulting in a progressive accumulation of intracellular tau aggregates. The spectrum of sporadic frontotemporal lobar degeneration associated with tau pathology includes progressive supranuclear palsy, corticobasal degeneration, and Pick’s disease. Alzheimer’s disease is considered the most prevalent tauopathy. This review is divided into two broad sections. In the first section we discuss the molecular classification of sporadic tauopathies, with a focus on describing clinicopathologic relationships. In the second section we discuss the neuroimaging methodologies that are available for measuring tau pathology (directly using tau positron emission tomography ligands) and tau-mediated neuronal injury (magnetic resonance imaging and fluorodeoxyglucose positron emission tomography). Both sections have detailed descriptions of the following neurodegenerative dementias – Alzheimer’s disease, progressive supranuclear palsy, corticobasal degeneration and Pick’s disease.
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Affiliation(s)
- Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Wen-Lang Lin
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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Masellis M, Sherborn K, Neto P, Sadovnick DA, Hsiung GYR, Black SE, Prasad S, Williams M, Gauthier S. Early-onset dementias: diagnostic and etiological considerations. ALZHEIMERS RESEARCH & THERAPY 2013; 5:S7. [PMID: 24565469 PMCID: PMC3936399 DOI: 10.1186/alzrt197] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This paper summarizes the body of literature about early-onset dementia (EOD) that led to recommendations from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. A broader differential diagnosis is required for EOD compared with late-onset dementia. Delays in diagnosis are common, and the social impact of EOD requires special care teams. The etiologies underlying EOD syndromes should take into account family history and comorbid diseases, such as cerebrovascular risk factors, that may influence the clinical presentation and age at onset. For example, although many EODs are more likely to have Mendelian genetic and/or metabolic causes, the presence of comorbidities may drive the individual at risk for late-onset dementia to manifest the symptoms at an earlier age, which contributes further to the observed heterogeneity and may confound diagnostic investigation. A personalized medicine approach to diagnosis should therefore be considered depending on the age at onset, clinical presentation, and comorbidities. Genetic counseling and testing as well as specialized biochemical screening are often required, especially in those under the age of 40 and in those with a family history of autosomal dominant or recessive disease. Novel treatments in the drug development pipeline for EOD, such as genetic forms of Alzheimer's disease, should target the specific pathogenic cascade implicated by the mutation or biochemical defect.
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Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Tröster AI, Vidailhet M, Weiner WJ. Criteria for the diagnosis of corticobasal degeneration. Neurology 2013; 80:496-503. [PMID: 23359374 DOI: 10.1212/wnl.0b013e31827f0fd1] [Citation(s) in RCA: 1184] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current criteria for the clinical diagnosis of pathologically confirmed corticobasal degeneration (CBD) no longer reflect the expanding understanding of this disease and its clinicopathologic correlations. An international consortium of behavioral neurology, neuropsychology, and movement disorders specialists developed new criteria based on consensus and a systematic literature review. Clinical diagnoses (early or late) were identified for 267 nonoverlapping pathologically confirmed CBD cases from published reports and brain banks. Combined with consensus, 4 CBD phenotypes emerged: corticobasal syndrome (CBS), frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA), and progressive supranuclear palsy syndrome (PSPS). Clinical features of CBD cases were extracted from descriptions of 209 brain bank and published patients, providing a comprehensive description of CBD and correcting common misconceptions. Clinical CBD phenotypes and features were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies. Probable CBD criteria require insidious onset and gradual progression for at least 1 year, age at onset ≥ 50 years, no similar family history or known tau mutations, and a clinical phenotype of probable CBS or either FBS or naPPA with at least 1 CBS feature. The possible CBD category uses similar criteria but has no restrictions on age or family history, allows tau mutations, permits less rigorous phenotype fulfillment, and includes a PSPS phenotype. Future validation and refinement of the proposed criteria are needed.
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Pirker S, Perju-Dumbrava L, Kovacs GG, Traub-Weidinger T, Asenbaum S, Pirker W. Dopamine D2 receptor SPECT in corticobasal syndrome and autopsy-confirmed corticobasal degeneration. Parkinsonism Relat Disord 2013; 19:222-6. [DOI: 10.1016/j.parkreldis.2012.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/07/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022]
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Hassan A, Whitwell JL, Josephs KA. The corticobasal syndrome-Alzheimer's disease conundrum. Expert Rev Neurother 2012; 11:1569-78. [PMID: 22014136 DOI: 10.1586/ern.11.153] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Corticobasal syndrome (CBS), once thought to be pathognomonic for corticobasal degeneration pathology, is increasingly reported with various underlying pathologies. Alzheimer's disease is one such pathology, also once believed to be unique for its clinical syndrome of dementia of the Alzheimer's type. CBS is believed to result from topography of asymmetric parietofrontal cortical lesion involvement, rather than lesion subtype. However, this topographical pattern is strikingly different to that typically associated with AD for unclear reasons. This article will focus on CBS with underlying AD pathology (CBS-AD), and will review associated clinical, imaging and demographic factors. Predicting AD pathology is of marked interest as disease-modifying therapies loom on the horizon, with biomarkers and imaging research underway. By reviewing the literature for CBS-AD case reports and series and contrasting them with CBS with underlying corticobasal degeneration pathology cases, the article aims to examine factors that may predict AD pathology. How AD pathology may produce this clinical phenotype, rather than the prototype dementia of the Alzheimer's type, will also be reviewed.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Stamelou M, Alonso-Canovas A, Bhatia KP. Dystonia in corticobasal degeneration: A review of the literature on 404 pathologically proven cases. Mov Disord 2012; 27:696-702. [DOI: 10.1002/mds.24992] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/23/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022] Open
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Jung HH, Bremer J, Streffer J, Virdee K, Spillantini MG, Crowther RA, Brugger P, Van Broeckhoven C, Aguzzi A, Tolnay M. Phenotypic variation of autosomal-dominant corticobasal degeneration. Eur Neurol 2012; 67:142-50. [PMID: 22261560 DOI: 10.1159/000334731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/23/2011] [Indexed: 11/19/2022]
Abstract
Neurodegenerative tauopathies may be inherited as autosomal-dominant disorders with variable clinicopathological phenotypes, and causative mutations in the microtubule-associated protein tau (MAPT) gene are not regularly seen. Herein, we describe a patient with clinically typical and autopsy-proven corticobasal degeneration (CBD). Her mother was diagnosed to have Parkinson's disease, but autopsy showed CBD pathology as in the index patient. The sister of the index patient had the clinical symptoms of primary progressive aphasia (PPA), but no pathology was available to date. Molecular analysis did not reveal any mutation in the MAPT or progranulin (GRN) genes. Our findings illustrate that CBD, progressive supranuclear palsy and PPA may be overlapping diseases with a common pathological basis rather than distinct entities. Clinical presentation and course might be determined by additional, yet unknown, genetic modifying factors.
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Affiliation(s)
- Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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Liepelt-Scarfone I, Jamour M, Maetzler W. Co-occurrence of parkinsonism and dementia in clinical practice. Z Gerontol Geriatr 2012; 45:23-33. [DOI: 10.1007/s00391-011-0261-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kouri N, Murray ME, Hassan A, Rademakers R, Uitti RJ, Boeve BF, Graff-Radford NR, Wszolek ZK, Litvan I, Josephs KA, Dickson DW. Neuropathological features of corticobasal degeneration presenting as corticobasal syndrome or Richardson syndrome. Brain 2011; 134:3264-75. [PMID: 21933807 PMCID: PMC3212714 DOI: 10.1093/brain/awr234] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/21/2011] [Accepted: 07/09/2011] [Indexed: 01/29/2023] Open
Abstract
Patients with corticobasal degeneration can present with several different clinical syndromes, making ante-mortem diagnosis a challenge. Corticobasal syndrome is the clinical phenotype originally described for corticobasal degeneration, characterized by asymmetric rigidity and apraxia, cortical sensory deficits, dystonia and myoclonus. Some patients do not develop these features, but instead have clinical features consistent with the Richardson syndrome presentation of progressive supranuclear palsy, characterized by postural instability, early unexplained falls, vertical supranuclear gaze palsy, symmetric motor disability and dysphagia. The aim of this study was to identify differences in corticobasal degeneration presenting with corticobasal syndrome (n = 11) or Richardson syndrome (n = 15) with respect to demographic, clinical and neuropathological features. Corticobasal degeneration cases were also compared with patients with pathologically proven progressive supranuclear palsy with Richardson syndrome (n = 15). Cases with corticobasal degeneration, regardless of presentation, shared histopathological and tau biochemical characteristics, but they had differing densities of tau pathology in neuroanatomical regions that correlated with their clinical presentation. In particular, those with corticobasal syndrome had greater tau pathology in the primary motor and somatosensory cortices and putamen, while those with Richardson syndrome had greater tau pathology in limbic and hindbrain structures. Compared with progressive supranuclear palsy, patients with corticobasal degeneration and Richardson syndrome had less neuronal loss in the subthalamic nucleus, but more severe neuronal loss in the medial substantia nigra and greater atrophy of the anterior corpus callosum. Clinically, they had more cognitive impairment and frontal behavioural dysfunction. The results suggest that Richardson syndrome can be a clinicopathological presentation of corticobasal degeneration. Atrophy of anterior corpus callosum may be a potential neuroimaging marker to differentiate corticobasal degeneration from progressive supranuclear palsy in patients with Richardson syndrome.
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Affiliation(s)
- Naomi Kouri
- 1 Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Melissa E. Murray
- 1 Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anhar Hassan
- 2 Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rosa Rademakers
- 1 Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ryan J. Uitti
- 3 Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Bradley F. Boeve
- 2 Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Irene Litvan
- 4 Department of Neurology, University of Louisville, Louisville, KY 40292, USA
| | - Keith A. Josephs
- 2 Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dennis W. Dickson
- 1 Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
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Rankin KP, Mayo MC, Seeley WW, Lee S, Rabinovici G, Gorno-Tempini ML, Boxer AL, Weiner MW, Trojanowski JQ, DeArmond SJ, Miller BL. Behavioral variant frontotemporal dementia with corticobasal degeneration pathology: phenotypic comparison to bvFTD with Pick's disease. J Mol Neurosci 2011; 45:594-608. [PMID: 21881831 PMCID: PMC3208125 DOI: 10.1007/s12031-011-9615-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
Abstract
Patients with corticobasal degeneration (CBD) pathology present with diverse clinical syndromes also associated with other neuropathologies, including corticobasal syndrome, progressive nonfluent aphasia, and an Alzheimer's-type dementia. Some present with behavioral variant frontotemporal dementia (bvFTD), though this subtype still requires more detailed clinical characterization. All patients with CBD pathology and clinical assessment were reviewed (N = 17) and selected if they initially met criteria for bvFTD [bvFTD(CBD), N = 5]. Available bvFTD patients with Pick's [bvFTD(Pick's), N = 5] were selected as controls. Patients were also compared to healthy older controls [N = 53] on neuropsychological and neuroimaging measures. At initial presentation, bvFTD(CBD) showed few neuropsychological or motor differences from bvFTD(Pick's). Neuropsychiatrically, they were predominantly apathetic with less florid social disinhibition and eating disturbances, and were more anxious than bvFTD(Pick's) patients. Voxel-based morphometry revealed similar patterns of predominantly frontal atrophy between bvFTD groups, though overall degree of atrophy was less severe in bvFTD(CBD), who also showed comparative preservation of the frontoinsular rim, with dorsal > ventral frontal atrophy, and sparing of temporal and parietal structures relative to bvFTD(Pick's) patients. Despite a remarkable overlap between the two patient types, bvFTD patients with underlying CBD pathology show subtle clinical features that may distinguish them from patients with Pick's disease neuropathology.
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Lee SE, Rabinovici GD, Mayo MC, Wilson SM, Seeley WW, DeArmond SJ, Huang EJ, Trojanowski JQ, Growdon ME, Jang JY, Sidhu M, See TM, Karydas AM, Gorno-Tempini ML, Boxer AL, Weiner MW, Geschwind MD, Rankin KP, Miller BL. Clinicopathological correlations in corticobasal degeneration. Ann Neurol 2011; 70:327-40. [PMID: 21823158 DOI: 10.1002/ana.22424] [Citation(s) in RCA: 299] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize cognitive and behavioral features, physical findings, and brain atrophy patterns in pathology-proven corticobasal degeneration (CBD) and corticobasal syndrome (CBS) with known histopathology. METHODS We reviewed clinical and magnetic resonance imaging data in all patients evaluated at our center with either an autopsy diagnosis of CBD (n = 18) or clinical CBS at first presentation with known histopathology (n = 40). Atrophy patterns were compared using voxel-based morphometry. RESULTS CBD was associated with 4 clinical syndromes: progressive nonfluent aphasia (n = 5), behavioral variant frontotemporal dementia (n = 5), executive-motor (n = 7), and posterior cortical atrophy (n = 1). Behavioral or cognitive problems were the initial symptoms in 15 of 18 patients; less than half exhibited early motor findings. Compared to controls, CBD patients showed atrophy in dorsal prefrontal and perirolandic cortex, striatum, and brainstem (p < 0.001 uncorrected). The most common pathologic substrates for clinical CBS were CBD (35%), Alzheimer disease (AD, 23%), progressive supranuclear palsy (13%), and frontotemporal lobar degeneration (FTLD) with TDP inclusions (13%). CBS was associated with perirolandic atrophy irrespective of underlying pathology. In CBS due to FTLD (tau or TDP), atrophy extended into prefrontal cortex, striatum, and brainstem, whereas in CBS due to AD, atrophy extended into temporoparietal cortex and precuneus (p < 0.001 uncorrected). INTERPRETATION Frontal lobe involvement is characteristic of CBD, and in many patients frontal, not parietal or basal ganglia, symptoms dominate early stage disease. CBS is driven by medial perirolandic dysfunction, but this anatomy is not specific to a single underlying histopathology. Antemortem prediction of CBD will remain challenging until clinical features of CBD are redefined, and sensitive, specific biomarkers are identified.
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Affiliation(s)
- Suzee E Lee
- Memory and Aging Center, University of California San Francisco, San Francisco, CA 94143, USA.
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Abstract
Tauopathies are a group of disorders that have in common abnormal accumulation of tau protein in the brain. Although the different tauopathies have long been considered to be separate diseases, it is now clear that progressive supranuclear palsy, corticobasal degeneration and some forms of tau-positive frontotemporal lobar degeneration share clinical, pathological and genetic features. The important overlap between these disorders suggest they may represent different phenotypes of a single disease process, the clinical result depending on the topography of pathological lesions as well as other unknown factors.
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Morgan B, Gross RG, Clark R, Dreyfuss M, Boller A, Camp E, Liang TW, Avants B, McMillan CT, Grossman M. Some is not enough: quantifier comprehension in corticobasal syndrome and behavioral variant frontotemporal dementia. Neuropsychologia 2011; 49:3532-41. [PMID: 21930136 DOI: 10.1016/j.neuropsychologia.2011.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 07/19/2011] [Accepted: 09/05/2011] [Indexed: 12/12/2022]
Abstract
Quantifiers are very common in everyday speech, but we know little about their cognitive basis or neural representation. The present study examined comprehension of three classes of quantifiers that depend on different cognitive components in patients with focal neurodegenerative diseases. Patients evaluated the truth-value of a sentence containing a quantifier relative to a picture illustrating a small number of familiar objects, and performance was related to MRI grey matter atrophy using voxel-based morphometry. We found that patients with corticobasal syndrome (CBS) and posterior cortical atrophy (PCA) are significantly impaired in their comprehension of cardinal quantifiers (e.g. "At least three birds are on the branch"), due in part to their deficit in quantity knowledge. MRI analyses related this deficit to temporal-parietal atrophy found in CBS/PCA. We also found that patients with behavioral variant frontotemporal dementia (bvFTD) are significantly impaired in their comprehension of logical quantifiers (e.g. "Some of the birds are on the branch"), associated with a simple form of perceptual logic, and this correlated with their deficit on executive measures. This deficit was related to disease in rostral prefrontal cortex in bvFTD. These patients were also impaired in their comprehension of majority quantifiers (e.g. "At least half of the birds are on the branch"), and this too was correlated with their deficit on executive measures. This was related to disease in the basal ganglia interrupting a frontal-striatal loop critical for executive functioning. These findings suggest that a large-scale frontal-parietal neural network plays a crucial role in quantifier comprehension, and that comprehension of specific classes of quantifiers may be selectively impaired in patients with focal neurodegenerative conditions in these areas.
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Affiliation(s)
- Brianna Morgan
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104-4283, United States
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Kertesz A, McMonagle P, Jesso S. Extrapyramidal syndromes in frontotemporal degeneration. J Mol Neurosci 2011; 45:336-42. [PMID: 21887521 DOI: 10.1007/s12031-011-9616-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022]
Abstract
Descriptions of extrapyramidal (EP) involvement in Pick's disease (renamed recently as FTD) appeared 80 years ago. CBD pathology was confirmed as a common substrate for primary progressive aphasia (PPA). We suggested that CBD and PPA should be included with frontal lobe dementia as Pick complex. PSP was prototype for "subcortical dementia", and aphasia and apraxia, considered unusual for PSP, are now seen as a rule. The overlap of PSP and CBD is considerable. We recently reviewed our cohort with EPS in FTD and identified 22 patients with the movement disorder as a first syndrome and another larger group of 48 patients who developed EPS after an initial onset with a cognitive disorder: aphasic, behavioral or both. All cognitive onset CBD/PSP patients and all but two with motor onset developed aphasia during the course of their illness. General cognitive and behavioral measures are similar for each presentation, but language scores are worse in cognitive onset cases, reflecting the frequency of aphasic presentations. Anomic patients become non-fluent, logopenic, agrammatic and mute. Using the Frontal Behavioral Inventory (FBI), a questionnaire specifically designed for the spectrum of apathy and disinhibition displayed by patients with FTD, we have documented the behavior change in CBD/PSP with motor and cognitive onsets. The significant personality changes consisted of apathy, disinhibition, perseveration and inattention, some of the core symptoms of FTD. In 18 autopsied cases, 15 had tau pathology. The overlap of CBD/PSP with PPA and bvFTD suggests a spectrum of related entities and predicts tau-positive pathology. Cross-sectional studies without significant follow-up may not observe the subsequent development language or behavior deficit, or the evolution from PPA and/or FTD-bv to CBD/PSP.
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Affiliation(s)
- Andrew Kertesz
- Department of Neurology, University of Western Ontario, London, ON, Canada.
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Mathew R, Bak TH, Hodges JR. Screening for cognitive dysfunction in corticobasal syndrome: utility of Addenbrooke's cognitive examination. Dement Geriatr Cogn Disord 2011; 31:254-8. [PMID: 21474935 DOI: 10.1159/000327169] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The motor features of corticobasal syndrome (CBS) are well recognized but the fact that many, if not all, affected patients develop cognitive impairment is still underrecognized. The dementia of CBS overlaps most with a language variant of frontotemporal dementia: progressive nonfluent aphasia (PNFA). The aim of this study was to determine the usefulness of Addenbrooke's Cognitive Examination-Revised (ACE-R) in the evaluation of CBS and to document similarities and differences between CBS and PNFA. MATERIALS AND METHODS Patients with well-defined CBS or PNFA from two tertiary referral centers were selected along with matched controls. RESULTS Twenty-one patients with CBS, 23 patients with PNFA and 47 age- and education- matched controls were included. Both CBS and PNFA groups showed substantial impairment on the ACE-R (f = 17.3-80.2, p < 0.001) and were significantly impaired in all domains (p < 0.001). The only significant difference between CBS and PNFA was in the visuospatial domain (p < 0.009), being worse in CBS. Using a cutoff of 88/89 out of 100, 90% of CBS and 82.6% of PNFA patients were impaired. At this cutoff of 88/89, ACE-R in CBS had sensitivity and specificity values of 91 and 98%, respectively.
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Affiliation(s)
- Robert Mathew
- Neuroscience Research Australia, Sydney, NSW, Australia
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Cilia R, Rossi C, Frosini D, Volterrani D, Siri C, Pagni C, Benti R, Pezzoli G, Bonuccelli U, Antonini A, Ceravolo R. Dopamine Transporter SPECT Imaging in Corticobasal Syndrome. PLoS One 2011; 6:e18301. [PMID: 21559307 PMCID: PMC3085517 DOI: 10.1371/journal.pone.0018301] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/02/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate dopaminergic function in a large cohort of patients with corticobasal syndrome (CBS) and describe its relationship with clinical features in comparison to Parkinson's disease and healthy control subjects. In addition, we assessed prevalence and features of individuals with CBS and in vivo evidence of preserved nigral neuronal density. BACKGROUND Substantia nigra pars compacta (SNc) neuronal degeneration is a mandatory pathological criterion for definite corticobasal degeneration, though sporadic autopsy-proven cases with ante-mortem imaging evidence of preserved nigral terminals have been recently described. METHODS In this multicenter study, we investigated presynaptic nigrostriatal function in 36 outpatients fulfilling clinical criteria for "probable corticobasal degeneration" (age 71±7.3 years; disease duration 3.9±1.6 years), 37 PD and 24 healthy control subjects using FP-CIT single photon emission computed tomography. Clinical, neuropsychological, and magnetic resonance imaging assessment was performed to characterize CBS patients. Linear discriminant analysis was used to categorize normal vs. pathological scans. RESULTS FP-CIT binding reduction in patients with CBS was characterized by larger variability, more uniform reduction throughout the striatum and greater hemispheric asymmetry compared to PD. Moreover, there was no significant correlation between tracer uptake values and clinical features such as disease duration and severity. Despite all CBS subjects showed obvious bilateral extrapyramidal signs, FP-CIT uptake was found to be normal bilaterally in four CBS patients and only unilaterally in other four cases. Extensive clinical, neuropsychological and imaging assessment did not reveal remarkable differences between CBS subjects with normal vs. pathological FP-CIT uptake. CONCLUSIONS Our findings support the hypothesis that extrapyramidal motor symptoms in CBS are not invariably associated with SNc neuronal degeneration and that supranigral factors may play a major role in several cases. CBS individuals with normal FP-CIT uptake do not show any clinical or cognitive feature suggesting a different pathology than CBD.
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Affiliation(s)
- Roberto Cilia
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Carlo Rossi
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | - Daniela Frosini
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | | | - Chiara Siri
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Cristina Pagni
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | | | - Gianni Pezzoli
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Ubaldo Bonuccelli
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
- Neurological Unit, Viareggio, Italy
| | - Angelo Antonini
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
- Institute of Neurology, IRCCS San Camillo, Venice, Italy
- University of Padua, Padua, Italy
| | - Roberto Ceravolo
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
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Abstract
Corticobasal degeneration (CBD) is a rare, progressive neurodegenerative disorder with onset in the 5(th) to 7(th) decade of life. It is associated with heterogeneous motor, sensory, behavioral and cognitive symptoms, which make its diagnosis difficult in a living patient. The etiology of CBD is unknown; however, neuropathological and genetic evidence supports a pathogenetic role for microtubule-associated protein tau. CBD pathology is characterized by circumscribed cortical atrophy with spongiosis and ballooned neurons; the distribution of these changes dictates the patient's clinical presentation. Neuronal and glial tau pathology is extensive in gray and white matter of the cortex, basal ganglia, diencephalon and rostral brainstem. Abnormal tau accumulation within astrocytes forms pathognomonic astrocytic plaques. The classic clinical presentation, termed corticobasal syndrome (CBS), comprises asymmetric progressive rigidity and apraxia with limb dystonia and myoclonus. CBS also occurs in conjunction with other diseases, including Alzheimer disease and progressive supranuclear palsy. Moreover, the pathology of CBD is associated with clinical presentations other than CBS, including Richardson syndrome, behavioral variant frontotemporal dementia, primary progressive aphasia and posterior cortical syndrome. Progress in biomarker development to differentiate CBD from other disorders has been slow, but is essential in improving diagnosis and in development of disease-modifying therapies.
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