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Shir D, Corriveau-Lecavalier N, Bermudez Noguera C, Barnard L, Pham NTT, Botha H, Duffy JR, Clark HM, Utianski RL, Knopman DS, Petersen RC, Boeve BF, Murray ME, Nguyen AT, Reichard RR, Dickson DW, Day GS, Kremers WK, Graff-Radford NR, Jones DT, Machulda MM, Fields JA, Whitwell JL, Josephs KA, Graff-Radford J. Clinicoradiological and neuropathological evaluation of primary progressive aphasia. J Neurol Neurosurg Psychiatry 2024; 95:812-821. [PMID: 38514176 DOI: 10.1136/jnnp-2023-332862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) defines a group of neurodegenerative disorders characterised by language decline. Three PPA variants correlate with distinct underlying pathologies: semantic variant PPA (svPPA) with transactive response DNA-binding protein of 43 kD (TDP-43) proteinopathy, agrammatic variant PPA (agPPA) with tau deposition and logopenic variant PPA (lvPPA) with Alzheimer's disease (AD). Our objectives were to differentiate PPA variants using clinical and neuroimaging features, assess progression and evaluate structural MRI and a novel 18-F fluorodeoxyglucose positron emission tomography (FDG-PET) image decomposition machine learning algorithm for neuropathology prediction. METHODS We analysed 82 autopsied patients diagnosed with PPA from 1998 to 2022. Clinical histories, language characteristics, neuropsychological results and brain imaging were reviewed. A machine learning framework using a k-nearest neighbours classifier assessed FDG-PET scans from 45 patients compared with a large reference database. RESULTS PPA variant distribution: 35 lvPPA (80% AD), 28 agPPA (89% tauopathy) and 18 svPPA (72% frontotemporal lobar degeneration-TAR DNA-binding protein (FTLD-TDP)). Apraxia of speech was associated with 4R-tauopathy in agPPA, while pure agrammatic PPA without apraxia was linked to 3R-tauopathy. Longitudinal data revealed language dysfunction remained the predominant deficit for patients with lvPPA, agPPA evolved to corticobasal or progressive supranuclear palsy syndrome (64%) and svPPA progressed to behavioural variant frontotemporal dementia (44%). agPPA-4R-tauopathy exhibited limited pre-supplementary motor area atrophy, lvPPA-AD displayed temporal atrophy extending to the superior temporal sulcus and svPPA-FTLD-TDP had severe temporal pole atrophy. The FDG-PET-based machine learning algorithm accurately predicted clinical diagnoses and underlying pathologies. CONCLUSIONS Distinguishing 3R-taupathy and 4R-tauopathy in agPPA may rely on apraxia of speech presence. Additional linguistic and clinical features can aid neuropathology prediction. Our data-driven brain metabolism decomposition approach effectively predicts underlying neuropathology.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Leland Barnard
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Macoir J, Laforce R, Lavoie M. The impact of phonological short-term memory impairment on verbal repetition in the logopenic variant of primary progressive aphasia. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:723-741. [PMID: 37615549 DOI: 10.1080/13825585.2023.2249198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/22/2023] [Indexed: 08/25/2023]
Abstract
The logopenic variant of primary progressive aphasia (lvPPA) is characterized mainly by anomia, production of phonological errors, and impairment in repetition of sentences. The functional origin of these language impairments is mainly attributed to the breakdown of phonological short-term memory. The present study examined the effects of phonological short-term memory impairment on language processing in lvPPA. In two studies, 11 participants with lvPPA and 11 healthy control participants were presented with repetition tasks in which the type and length of stimuli and the mode of administration were manipulated. Study 1 aimed to examine the influence of length and lexicality (words vs. pseudowords) on immediate and delayed repetition, whereas Study 2 aimed to examine the influence of length, syntactic complexity (nominalized vs. pronominalized sentences), and serial position on immediate sentence repetition. Study 1 showed that participants' performance with lvPPA was impaired only on immediate repetition of five-syllable pseudowords and on delayed repetition of words and pseudowords. Study 2 showed that participants' performance with lvPPA was impaired in the repetition of nominalized sentences where a recency effect was observed. Repetition of pronominalized sentences was also impaired in the lvPPA group. This study provides additional support for arguments regarding phonological short-term memory as a cause of language impairment in lvPPA. Clinically, the results of the study suggest that instruments for assessing repetition ability in lvPPA should include not only lists of short or long nominalized sentences, but also delayed repetition of words and pseudowords and pronominalized sentences.
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Affiliation(s)
- Joël Macoir
- Faculté de médecine, École des Sciences de la Réadaptation, Université Laval, Québec, QC, Canada
- Centre de recherche CERVO, Brain Research Centre, Québec, QC, Canada
| | - Robert Laforce
- Chaire de recherche sur les aphasies primaires progressives, Fondation de la famille Lemaire, Québec, QC, Canada
- Faculté de Médecine, Département de Médecine, Université Laval, Québec, QC, Canada
- Clinique Interdisciplinaire de la Mémoire, Centre hospitalier de l'Université Laval, Québec, QC, Canada
| | - Monica Lavoie
- Chaire de recherche sur les aphasies primaires progressives, Fondation de la famille Lemaire, Québec, QC, Canada
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Roheger M, Riemann S, Brauer A, McGowan E, Grittner U, Flöel A, Meinzer M. Non-pharmacological interventions for improving language and communication in people with primary progressive aphasia. Cochrane Database Syst Rev 2024; 5:CD015067. [PMID: 38808659 PMCID: PMC11134511 DOI: 10.1002/14651858.cd015067.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) accounts for approximately 43% of frontotemporal dementias and is mainly characterised by a progressive impairment of speech and communication abilities. Three clinical variants have been identified: (a) non-fluent/agrammatic, (b) semantic, and (c) logopenic/phonological PPA variants. There is currently no curative treatment for PPA, and the disease progresses inexorably over time, with devastating effects on speech and communication ability, functional status, and quality of life. Several non-pharmacological interventions that may improve symptoms (e.g. different forms of language training and non-invasive brain stimulation) have been investigated in people with PPA. OBJECTIVES To assess the effects of non-pharmacological interventions for people with PPA on word retrieval (our primary outcome), global language functions, cognition, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's trial register, MEDLINE (Ovid SP), Embase (Ovid SP), four other databases and two other trial registers. The latest searches were run on 26 January 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of non-pharmacological interventions in people with PPA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS There were insufficient data available to conduct the network meta-analyses that we had originally planned (due to trial data being insufficiently reported or not reported at all, as well as the heterogeneous content of the included interventions). Therefore, we provide a descriptive summary of the included studies and results. We included 10 studies, with a total of 132 participants, evaluating non-pharmacological interventions. These were: transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) as stand-alone treatments (used by two and one studies, respectively); tDCS combined with semantic and phonological word-retrieval training (five studies); tDCS combined with semantic word-retrieval training (one study); and tDCS combined with phonological word-retrieval training (one study). Results for our primary outcome of word retrieval were mixed. For the two studies that investigated the effects of tDCS as stand-alone treatment compared to placebo ("sham") tDCS, we rated the results as having very low-certainty evidence. One study found a significant beneficial effect on word retrieval after active tDCS; one study did not report any significant effects in favour of the active tDCS group. Five studies investigated tDCS administered to the dorsolateral prefrontal cortex, inferior frontal cortex, left frontotemporal region, or the temporoparietal cortex, combined with semantic and phonological word-retrieval training. The most consistent finding was enhancement of word-retrieval ability for trained items immediately after the intervention, when behavioural training was combined with active tDCS compared to behavioural training plus sham tDCS. We found mixed effects for untrained items and maintenance of treatment effects during follow-up assessments. We rated the certainty of the evidence as very low in all studies. One study investigated tDCS combined with semantic word-retrieval training. Training was provided across 15 sessions with a frequency of three to five sessions per week, depending on the personal preferences of the participants. tDCS targeted the left frontotemporal region. The study included three participants: two received 1 mA stimulation and one received 2 mA stimulation. The study showed mixed results. We rated it as very low-certainty evidence. One study investigated tDCS combined with phonological word-retrieval training. Training was again provided across 15 sessions over a period of three weeks. tDCS targeted the left inferior frontal gyrus. This study showed a significantly more pronounced improvement for trained and untrained words in favour of the group that had received active tDCS, but we rated the certainty of the evidence as very low. One study compared active rTMS applied to an individually determined target site to active rTMS applied to a control site (vertex) for effects on participants' word retrieval. This study demonstrated better word retrieval for active rTMS administered to individually determined target brain regions than in the control intervention, but we rated the results as having a very low certainty of evidence. Four studies assessed overall language ability, three studies assessed cognition, five studies assessed potential adverse effects of brain stimulation, and one study investigated quality of life. AUTHORS' CONCLUSIONS There is currently no high-certainty evidence to inform clinical decision-making regarding non-pharmacological treatment selection for people with PPA. Preliminary evidence suggests that the combination of active tDCS with specific language therapy may improve impaired word retrieval for specifically trained items beyond the effects of behavioural treatment alone. However, more research is needed, including high-quality RCTs with detailed descriptions of participants and methods, and consideration of outcomes such as quality of life, depressive symptoms, and overall cognitive functioning. Moreover, studies assessing optimal treatments (i.e. behavioural interventions, brain stimulation interventions, and their combinations) for individual patients and PPA subtypes are needed. We were not able to conduct the planned (network) meta-analyses due to missing data that could not be obtained from most of the authors, a general lack of RCTs in the field, and heterogeneous interventions in eligible trials. Journals should implement a mandatory data-sharing requirement to assure transparency and accessibility of data from clinical trials.
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Affiliation(s)
- Mandy Roheger
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Steffen Riemann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Brauer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Ellen McGowan
- Speech and Language Therapy, Older People's Mental Health, Stockport, Pennine Care NHS Foundation Trust, Pennine Care NHS Foundation Trust, Stockport, UK
| | - Ulrike Grittner
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [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: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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5
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Lannom O. Bridging the gap between scientific research of rare diseases and the affected patients and families. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-3. [PMID: 38305271 DOI: 10.1080/17538068.2024.2309708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
In 2015, my father was diagnosed with primary progressive aphasia (PPA), a type of frontotemporal dementia that my family and I knew nothing about. Medical professionals told us that there was no research on the disease, and I believed this until very recently. I took a class in neurobiology, leading me to attempt to document this lack of research and create a call to action for the research and treatment of rare disorders. However, I was met with an overwhelming amount of information regarding PPA that I was not expecting to find. I was frustrated that I was not given this information; moreover, I did not understand why it was all being 'hidden' from me. After discussion with my mother, I realized that my science education allowed me to find and interpret this information, but more importantly, that not everyone has this same privilege. My call to action pivoted into a call for better communication and for open access to biomedical information. Regardless of the existence and quality of literature about rare diseases, most of the information is out of reach of the public.The public often does not have the scientific literacy to understand the complexities of the genre that is required for comprehension. I recognize that not every patient and family may wish to access the information generated by biomedical research. I argue that they have a right to examine these findings because they are the ones that are being the most deeply affected by these disorders. While the translation of information may seem cumbersome , the impact it could have on patients, caregivers, and providers is worth the effort.
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Affiliation(s)
- Olivia Lannom
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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6
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Gajardo-Vidal A, Montembeault M, Lorca-Puls DL, Licata AE, Bogley R, Erlhoff S, Ratnasiri B, Ezzes Z, Battistella G, Tsoy E, Pereira CW, DeLeon J, Tee BL, Henry ML, Miller ZA, Rankin KP, Mandelli ML, Possin KL, Gorno-Tempini ML. Assessing processing speed and its neural correlates in the three variants of primary progressive aphasia with a non-verbal tablet-based task. Cortex 2024; 171:165-177. [PMID: 38000139 PMCID: PMC10922977 DOI: 10.1016/j.cortex.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
Prior research has revealed distinctive patterns of impaired language abilities across the three variants of Primary Progressive Aphasia (PPA): nonfluent/agrammatic (nfvPPA), logopenic (lvPPA) and semantic (svPPA). However, little is known about whether, and to what extent, non-verbal cognitive abilities, such as processing speed, are impacted in PPA patients. This is because neuropsychological tests typically contain linguistic stimuli and require spoken output, being therefore sensitive to verbal deficits in aphasic patients. The aim of this study is to investigate potential differences in processing speed between PPA patients and healthy controls, and among the three PPA variants, using a brief non-verbal tablet-based task (Match) modeled after the WAIS-III digit symbol coding test, and to determine its neural correlates. Here, we compared performance on the Match task between PPA patients (n = 61) and healthy controls (n = 59) and across the three PPA variants. We correlated performance on Match with voxelwise gray and white matter volumes. We found that lvPPA and nfvPPA patients performed significantly worse on Match than healthy controls and svPPA patients. Worse performance on Match across PPA patients was associated with reduced gray matter volume in specific parts of the left middle frontal gyrus, superior parietal lobule, and precuneus, and reduced white matter volume in the left parietal lobe. To conclude, our behavioral findings reveal that processing speed is differentially impacted across the three PPA variants and provide support for the potential clinical utility of a tabled-based task (Match) to assess non-verbal cognition. In addition, our neuroimaging findings confirm the importance of a set of fronto-parietal regions that previous research has associated with processing speed and executive control. Finally, our behavioral and neuroimaging findings combined indicate that differences in processing speed are largely explained by the unequal distribution of atrophy in these fronto-parietal regions across the three PPA variants.
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Affiliation(s)
- Andrea Gajardo-Vidal
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile.
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Montréal, QC H3A 1A1, Canada
| | - Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sabrina Erlhoff
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christa Watson Pereira
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica DeLeon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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7
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Chen P, Zhang S, Zhao K, Kang X, Rittman T, Liu Y. Robustly uncovering the heterogeneity of neurodegenerative disease by using data-driven subtyping in neuroimaging: A review. Brain Res 2024; 1823:148675. [PMID: 37979603 DOI: 10.1016/j.brainres.2023.148675] [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: 08/02/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
Neurodegenerative diseases are associated with heterogeneity in genetics, pathology, and clinical manifestation. Understanding this heterogeneity is particularly relevant for clinical prognosis and stratifying patients for disease modifying treatments. Recently, data-driven methods based on neuroimaging have been applied to investigate the subtyping of neurodegenerative disease, helping to disentangle this heterogeneity. We reviewed brain-based subtyping studies in aging and representative neurodegenerative diseases, including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, and Lewy body dementia, from January 2000 to November 2022. We summarized clustering methods, validation, robustness, reproducibility, and clinical relevance of 71 eligible studies in the present study. We found vast variations in approaches between studies, including ten neuroimaging modalities, 24 cluster algorithms, and 41 methods of cluster number determination. The clinical relevance of subtyping studies was evaluated by summarizing the analysis method of clinical measurements, showing a relatively low clinical utility in the current studies. Finally, we conclude that future studies of heterogeneity in neurodegenerative disease should focus on validation, comparison between subtyping approaches, and prioritise clinical utility.
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Affiliation(s)
- Pindong Chen
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Shirui Zhang
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Kun Zhao
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaopeng Kang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Yong Liu
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China.
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8
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Cotelli M, Baglio F, Manenti R, Blasi V, Galimberti D, Gobbi E, Pagnoni I, Rossetto F, Rotondo E, Esposito V, De Icco R, Giudice C, Tassorelli C, Catricalà E, Perini G, Alaimo C, Campana E, Benussi L, Ghidoni R, Binetti G, Carandini T, Cappa SF. A Multimodal Approach for Clinical Diagnosis and Treatment of Primary Progressive Aphasia (MAINSTREAM): A Study Protocol. Brain Sci 2023; 13:1060. [PMID: 37508992 PMCID: PMC10377301 DOI: 10.3390/brainsci13071060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Primary Progressive Aphasia (PPA) is a syndrome due to different neurodegenerative disorders selectively disrupting language functions. PPA specialist care is underdeveloped. There are very few specialists (neurologists, psychiatrists, neuropsychologists, and speech therapists) and few hospital- or community-based services dedicated to the diagnosis and continuing care of people with PPA. Currently, healthcare systems struggle to provide adequate coverage of care that is too often fragmented, uncoordinated, and unresponsive to the needs of people with PPA and their families. Recently, attention has been gained by non-invasive brain stimulation techniques that allow a personalized treatment approach, such as transcranial Direct Current Stimulation (tDCS). The MAINSTREAM trial looks forward to introducing and evaluating therapeutic innovations such as tDCS coupled with language therapy in rehabilitation settings. A Multimodal Approach for Clinical Diagnosis and Treatment of Primary Progressive Aphasia, MAINSTREAM (ID: 3430931) was registered in the clinicaltrials.gov database (identifier: NCT05730023) on 15 February 2023.
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Affiliation(s)
- Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | | | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Deparment of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | | | - Emanuela Rotondo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Carla Giudice
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Eleonora Catricalà
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, 27100 Pavia, Italy
| | - Giulia Perini
- Dementia Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Alaimo
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Elena Campana
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Giuliano Binetti
- MAC-Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Tiziana Carandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefano Francesco Cappa
- Dementia Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, 27100 Pavia, Italy
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9
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Douglas JT. My experience of living with nonfluent/agrammatic variant primary progressive aphasia: Challenges, compensatory strategies and adaptations. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:542-554. [PMID: 36239167 DOI: 10.1111/1460-6984.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a rare neurodegenerative brain disorder characterized by declining language ability. There is currently no way to reverse or slow the course of the progressive brain degeneration, nor is there a cure for PPA. Throughout the course of the disease, any treatment must therefore be palliative in nature and should be designed to manage symptoms and improve the quality of life of the affected person. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people with PPA written from the perspective of those living with this condition. AIMS I have a clinical diagnosis of the nonfluent/agrammatic variant of PPA (nfvPPA), supported by imaging. In this report I discuss my experience of the progressive loss of language and communication skills, and detail the challenges I have been facing. I also describe how my quality of life has been enhanced by the early initiation of treatment focusing on communication strategies targeted to my specific impairments and designed to support my individual interests and goals. METHODS & PROCEDURES I was fortunate to obtain an early diagnosis from a cognitive neurologist experienced with PPA. From the onset of my language difficulties, I have received excellent personalized care from a multidisciplinary medical team including speech-language pathologists, a cognitive neurologist and other doctors. MAIN CONTRIBUTIONS My life during the early stage of nfvPPA has been enriched by personalized care focused on supporting the particular activities, interests and goals that are most important and meaningful to me. As my disease has progressed, I have benefited from an evolving range of strategies and adaptations targeted to the specific deficits in the areas of speaking, writing and reading that I have been facing at any given time. In addition, I have adopted methods to enhance the benefit of these language-directed strategies. And I have been employing evidence-based approaches that improve general brain health and thereby indirectly support my language. CONCLUSIONS & IMPLICATIONS My experience represents a model for the personalized care of people in the early stage of nfvPPA. WHAT THIS PAPER ADDS What is already known on the subject There is minimal information in the medical literature describing the subjective experience of a person with PPA. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people in the early stage of PPA. What this paper adds to existing knowledge I have a clinical diagnosis of nfvPPA, supported by imaging. In this paper I give a first-person account of my experience of the progressive loss of language and communication skills, and I detail the challenges I have been facing. I describe how my quality of life during the early stage of nfvPPA has been enhanced by an evolving range of strategies and adaptations tailored to my speech and language deficits as they have arisen. These compensatory strategies have focused on supporting the particular activities, interests and goals that are most important and meaningful to me. What are the potential or actual clinical implications of this work? The description of my subjective experience of the progressive loss of language and communication skills offers insight for speech-language pathologists, neurologists and other professionals involved in the clinical care of people in the early stage of nfvPPA. My experience represents a model for the personalized clinical care of people in the early stage of this disorder.
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Affiliation(s)
- Joanne T Douglas
- Volunteer, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA
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10
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Differences of Modality Use between Telepractice and Face-to-Face Administration of the Scenario-Test in Persons with Dementia-Related Speech Disorder. Brain Sci 2023; 13:brainsci13020204. [PMID: 36831747 PMCID: PMC9954369 DOI: 10.3390/brainsci13020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Telepractice is increasingly finding its way into the care of people with dementia. Web-based delivery of speech and language therapy (SLT) is feasible and has the potential to improve communication in people with dementia-related speech disorders. Although experts are discussing the strengths and weaknesses of telepractice, a precise analysis of the differences between analogue and digital communication for this heterogeneous group of patients is still missing. The three current single cases investigated verbal and nonverbal aspects of communication in a face-to-face (F2F) and digital setting through a qualitative research design. Using the scenario-test (ST) in person and via big blue button (BBB; video conferencing system), several decisive factors were detected, influencing the effectiveness of communication in a F2F compared to a digital setting. The most important results of the qualitative content analysis are described for each case individually. Additionally, the influence of person-related factors, such as age, diagnosis, presence of depression, and level of education, is presented. Perceptual, executive, and affective disorders, as well as aids of relatives, are considered separately. The results indicate that executive functions, affects, and perceptual deficits need to be taken into account if telepractice is to be applied. Age, education, and distinct forms of dementia might be decisive for successful telepractice as well.
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11
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Vignaroli F, Mele A, Tondo G, De Giorgis V, Manfredi M, Comi C, Mazzini L, De Marchi F. The Need for Biomarkers in the ALS-FTD Spectrum: A Clinical Point of View on the Role of Proteomics. Proteomes 2023; 11:proteomes11010001. [PMID: 36648959 PMCID: PMC9844364 DOI: 10.3390/proteomes11010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) are severely debilitating and progressive neurodegenerative disorders. A distinctive pathological feature of several neurodegenerative diseases, including ALS and FTD, is the deposition of aberrant protein inclusions in neuronal cells, which leads to cellular dysfunction and neuronal damage and loss. Despite this, to date, the biological process behind developing these protein inclusions must be better clarified, making the development of disease-modifying treatment impossible until this is done. Proteomics is a powerful tool to characterize the expression, structure, functions, interactions, and modifications of proteins of tissue and biological fluid, including plasma, serum, and cerebrospinal fluid. This protein-profiling characterization aims to identify disease-specific protein alteration or specific pathology-based mechanisms which may be used as markers of these conditions. Our narrative review aims to highlight the need for biomarkers and the potential use of proteomics in clinical practice for ALS-FTD spectrum disorders, considering the emerging rationale in proteomics for new drug development. Certainly, new data will emerge in the near future in this regard and support clinicians in the development of personalized medicine.
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Affiliation(s)
| | - Angelica Mele
- Neurology Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Giacomo Tondo
- Department of Neurology, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Veronica De Giorgis
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research and Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale, 28100 Novara, Italy
| | - Marcello Manfredi
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research and Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale, 28100 Novara, Italy
| | - Cristoforo Comi
- Department of Neurology, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Letizia Mazzini
- Neurology Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Fabiola De Marchi
- Neurology Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3733962
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12
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Foxe D, Irish M, Ramanan S, Stark S, Cordato NJ, Burrell JR, Piguet O. Longitudinal changes in behaviour, mood and functional capacity in the primary progressive aphasia variants. Eur J Neurosci 2022; 56:5601-5614. [PMID: 34888957 DOI: 10.1111/ejn.15557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterised by a progressive decline in speech and language functions. Deficits in behaviour, mood and functional capacity are reported in PPA but are less well understood. This study examined the PPA variants' profiles on these domains at initial presentation and over time and evaluated their relations to overall cognitive ability. Behaviour, mood and functional capacity were measured annually (over ~6 years) in 145 individuals diagnosed with PPA (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA] and 60 semantic variants [sv-PPA]) using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Overall cognition was assessed annually with the Addenbrooke's Cognitive Examination-III. Distinct profiles were observed across PPA syndromes. Notably, sv-PPA carers reported greater behavioural, eating and motivational disturbances than the other PPA variants throughout the disease course. Reported memory problems were also greater in sv-PPA and lv-PPA than in nfv-PPA across all time points. These disturbances occurred in the context of the sv-PPA group demonstrating a slower rate of cognitive decline than the lv-PPA group and a parallel rate to that found in the nfv-PPA group. Associations between overall cognition and the CBI-R domains were trivial at baseline assessment; however, distinct profiles emerged when mapping each syndrome's overall cognitive decline with their behavioural, mood and functional trajectories. Our findings demonstrate that the evolving behaviour, mood and functional capacity profiles of the PPA variants are distinct and extend beyond the primary disorder of language. These findings have important implications for clinical management and caregiver education in PPA.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Siddharth Ramanan
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,MRC Cognition and Brain Sciences Unit, The University of Cambridge, Cambridge, UK
| | - Samuel Stark
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas J Cordato
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,The Department of Aged Care, St George Hospital, Sydney, New South Wales, Australia.,Calvary Community Health, Calvary Health Care Kogarah, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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13
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Premi E, Cotelli M, Gobbi E, Pagnoni I, Binetti G, Gadola Y, Libri I, Mattioli I, Pengo M, Iraji A, Calhoun VD, Alberici A, Borroni B, Manenti R. Neuroanatomical correlates of screening for aphasia in NeuroDegeneration (SAND) battery in non-fluent/agrammatic variant of primary progressive aphasia. Front Aging Neurosci 2022; 14:942095. [PMID: 36389058 PMCID: PMC9660243 DOI: 10.3389/fnagi.2022.942095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/11/2022] [Indexed: 06/04/2024] Open
Abstract
Background Non-fluent/agrammatic variant of Primary Progressive Aphasia (avPPA) is primarily characterized by language impairment due to atrophy of the inferior frontal gyrus and the insula cortex in the dominant hemisphere. The Screening for Aphasia in NeuroDegeneration (SAND) battery has been recently proposed as a screening tool for PPA, with several tasks designed to be specific for different language features. Applying multivariate approaches to neuroimaging data and verbal fluency tasks, Aachener Aphasie Test (AAT) naming subtest and SAND data may help in elucidating the neuroanatomical correlates of language deficits in avPPA. Objective To investigate the neuroanatomical correlates of language deficits in avPPA using verbal fluency tasks, AAT naming subtest and SAND scores as proxies of brain structural imaging abnormalities. Methods Thirty-one avPPA patients were consecutively enrolled and underwent extensive neuropsychological assessment and MRI scan. Raw scores of verbal fluency tasks, AAT naming subtest, and SAND subtests, namely living and non-living picture naming, auditory sentence comprehension, single-word comprehension, words and non-words repetition and sentence repetition, were used as proxies to explore structural (gray matter volume) neuroanatomical correlates. We assessed univariate (voxel-based morphometry, VBM) as well as multivariate (source-based morphometry, SBM) approaches. Age, gender, educational level, and disease severity were considered nuisance variables. Results SAND picture naming (total, living and non-living scores) and AAT naming scores showed a direct correlation with the left temporal network derived from SBM. At univariate analysis, the left middle temporal gyrus was directly correlated with SAND picture naming (total and non-living scores) and AAT naming score. When words and non-words repetition (total score) was considered, a direct correlation with the left temporal network (SBM) and with the left fusiform gyrus (VBM) was also evident. Conclusion Naming impairments that characterize avPPA are related to specific network-based involvement of the left temporal network, potentially expanding our knowledge on the neuroanatomical basis of this neurodegenerative condition.
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Affiliation(s)
- Enrico Premi
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Yasmine Gadola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Irene Mattioli
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Marta Pengo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Armin Iraji
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
- Departments of Psychology and Computer Science, Georgia State University, Atlanta, GA, United States
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
- Departments of Psychology and Computer Science, Georgia State University, Atlanta, GA, United States
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Antonella Alberici
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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14
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Ramanan S, Irish M, Patterson K, Rowe JB, Gorno-Tempini ML, Lambon Ralph MA. Understanding the multidimensional cognitive deficits of logopenic variant primary progressive aphasia. Brain 2022; 145:2955-2966. [PMID: 35857482 PMCID: PMC9473356 DOI: 10.1093/brain/awac208] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023] Open
Abstract
The logopenic variant of primary progressive aphasia is characterized by early deficits in language production and phonological short-term memory, attributed to left-lateralized temporoparietal, inferior parietal and posterior temporal neurodegeneration. Despite patients primarily complaining of language difficulties, emerging evidence points to performance deficits in non-linguistic domains. Temporoparietal cortex, and functional brain networks anchored to this region, are implicated as putative neural substrates of non-linguistic cognitive deficits in logopenic variant primary progressive aphasia, suggesting that degeneration of a shared set of brain regions may result in co-occurring linguistic and non-linguistic dysfunction early in the disease course. Here, we provide a Review aimed at broadening the understanding of logopenic variant primary progressive aphasia beyond the lens of an exclusive language disorder. By considering behavioural and neuroimaging research on non-linguistic dysfunction in logopenic variant primary progressive aphasia, we propose that a significant portion of multidimensional cognitive features can be explained by degeneration of temporal/inferior parietal cortices and connected regions. Drawing on insights from normative cognitive neuroscience, we propose that these regions underpin a combination of domain-general and domain-selective cognitive processes, whose disruption results in multifaceted cognitive deficits including aphasia. This account explains the common emergence of linguistic and non-linguistic cognitive difficulties in logopenic variant primary progressive aphasia, and predicts phenotypic diversification associated with progression of pathology in posterior neocortex.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre and School of Psychology, Sydney, Australia
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Cambridge University Centre for Frontotemporal Dementia, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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15
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Thurin K, Patel V, Perez DL, Dickerson BC, Hochberg D, Quimby M, Miller MB, Feany M, Silbersweig D, McGinnis SM, Daffner KR, Gale SA. Case Study 2: A 60-Year-Old Man With Progressive Deficits in Language Output. J Neuropsychiatry Clin Neurosci 2022; 34:196-203. [PMID: 35921620 DOI: 10.1176/appi.neuropsych.22010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kristina Thurin
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Viharkumar Patel
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - David L Perez
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Bradford C Dickerson
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Daisy Hochberg
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Megan Quimby
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Michael B Miller
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Mel Feany
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - David Silbersweig
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Scott M McGinnis
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Kirk R Daffner
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
| | - Seth A Gale
- Department of Psychiatry and Department of Neurology, Center for Cognitive and Memory Disorders, Ohio State University Wexner Medical Center, Columbus, Ohio (Thurin); Departments of Psychiatry (Thurin, Silbersweig) and Neurology (Thurin, McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Departments of Neurology and Psychiatry, Divisions of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School (Perez); Departments of Neurology and Psychiatry, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School (Dickerson, Hochberg, Quimby)
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Foxe D, Hu A, Cheung SC, Ahmed RM, Cordato NJ, Devenney E, Hwang YT, Halliday GM, Mueller N, Leyton CE, Hodges JR, Burrell JR, Irish M, Piguet O. Utility of the Addenbrooke’s Cognitive Examination III online calculator to differentiate the primary progressive aphasia variants. Brain Commun 2022; 4:fcac161. [PMID: 35912134 PMCID: PMC9336588 DOI: 10.1093/braincomms/fcac161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/22/2022] Open
Abstract
The Addenbrooke’s Cognitive Examination III is a brief cognitive screening tool that is widely used for the detection and monitoring of dementia. Recent findings suggest that the three variants of primary progressive aphasia can be distinguished based on their distinct profiles on the five subdomain scores of this test. Here, we investigated the utility of the Addenbrooke’s Cognitive Examination III to differentiate the primary progressive aphasia variants based on their item-by-item performance profiles on this test. From these results, we created an interactive primary progressive aphasia Addenbrooke’s Cognitive Examination III calculator which predicts the variant based on a patient’s unique item-by-item profile. Twenty-eight logopenic variant, 25 non-fluent variant and 37 semantic variant primary progressive aphasia patients and 104 healthy controls completed the Addenbrooke’s Cognitive Examination III at first clinical presentation. Multinomial regression analyses were conducted to establish performance profiles among groups, and R Shiny from RStudio was used to create the interactive Addenbrooke’s Cognitive Examination III diagnostic calculator. To verify its accuracy, probability values of the regression model were derived based on a 5-fold cross-validation of cases. The calculator’s accuracy was then verified in an independent sample of 17 logopenic, 19 non-fluent and 13 semantic variant primary progressive aphasia patients and 68 Alzheimer’s disease patients who had completed the Addenbrooke’s Cognitive Examination III (or an older version of this test: Revised) and had in vivo amyloid-PET imaging and/or brain autopsy pathological confirmation. Cross-validation of cases in the calculator model revealed different rates of sensitivity in classifying variants: semantic = 100%, non-fluent = 80.6% and logopenic = 79.9%; healthy controls were distinguished from primary progressive aphasia patients with 100% sensitivity. Verification of in vivo amyloid and/or autopsy-confirmed patients showed that the calculator correctly classified 10/13 (77%) semantic variant, 3/19 (16%) non-fluent variant and 4/17 (24%) logopenic variant patients. Importantly, for patients who were not classified, diagnostic probability values mostly pointed toward the correct clinical diagnosis. Furthermore, misclassified diagnoses of the primary progressive aphasia cohort were rare (1/49; 2%). Although 22 of the 68 Alzheimer’s disease patients (32%) were misclassified with primary progressive aphasia, 19/22 were misclassified with the logopenic variant (i.e. falling within the same neuropathological entity). The Addenbrooke’s Cognitive Examination III primary progressive aphasia diagnostic calculator demonstrates sound accuracy in differentiating the variants based on an item-by-item Addenbrooke’s Cognitive Examination III profile. This calculator represents a new frontier in using data-driven approaches to differentiate the primary progressive aphasia variants.
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Affiliation(s)
- D Foxe
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - A Hu
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- School of Mathematics and Statistics, The University of Sydney , Sydney, NSW 2006 , Australia
| | - S C Cheung
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - R M Ahmed
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N J Cordato
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- St George Clinical School, University of New South Wales , Sydney, NSW 2217 , Australia
- The Department of Aged Care, St George Hospital , Sydney, NSW 2217 , Australia
- Calvary Health Care Kogarah, Calvary Community Health , Sydney, NSW 2217 , Australia
| | - E Devenney
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - Y T Hwang
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - G M Halliday
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N Mueller
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - C E Leyton
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Hodges
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Burrell
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Concord Clinical School, Sydney Medical School, The University of Sydney , Sydney, NSW 2139 , Australia
| | - M Irish
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - O Piguet
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
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17
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Mulder-Heijstra MMP, Jokel RR, Chertkow HH, Conn DDK, Mah LL. Primary Progressive Aphasia Presenting With Neuropsychiatric Symptoms. J Geriatr Psychiatry Neurol 2022; 35:574-579. [PMID: 34382469 DOI: 10.1177/08919887211036189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a case of primary progressive aphasia (PPA) with an underlying neurodegenerative motor disorder (possible ALS or PSP), presenting with symptoms of irritability and frustration, that were misdiagnosed and treated as a primary psychiatric disorder, i.e. depression. PPA is a rare neurodegenerative disorder characterized by insidious onset and gradual progression of speech and language impairment. We emphasize that PPA can initially masquerade as or be accompanied by neuropsychiatric symptoms potentially leading to misdiagnosis. Most prevalent neuropsychiatric symptoms reported in the PPA literature are agitation, depression, anxiety, apathy, irritability, abnormal appetite and disinhibition. To ensure early diagnosis of PPA, if a patient presents with new psychiatric symptoms accompanied by new onset speech and/or language impairment, referral to a specialist (i.e., neurologist and/or speech-language pathologist) is recommended.
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Affiliation(s)
- Mirjam M P Mulder-Heijstra
- Rotman Research Institute, 63671Baycrest Health Sciences, Toronto, Ontario, Canada.,GGZ Rivierduinen, Leiden, the Netherlands
| | - Regina R Jokel
- Rotman Research Institute, 63671Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Howard H Chertkow
- Rotman Research Institute, 63671Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - David D K Conn
- Baycrest Centre and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Linda L Mah
- Rotman Research Institute, 63671Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Psychiatry, Baycrest, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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18
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Stockbridge MD, Tippett DC, Breining BL, Hillis AE. When words first fail: Predicting the emergence of primary progressive aphasia variants from unclassifiable anomic performance in early disease. APHASIOLOGY 2022; 37:1173-1185. [PMID: 37377938 PMCID: PMC10292722 DOI: 10.1080/02687038.2022.2084706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Background The majority of patients with primary progressive aphasia (PPA) can be distinguished into one of three variants: semantic, non-fluent/agrammatic, or logopenic. However, many do not meet criteria for any one variant. Aim To identify aspects of cognitive-linguistic performance that yield an early unclassifiable PPA designation that predicted the later emergence of a given variant. Methods & Procedures Of 256 individuals with PPA evaluated, 19 initially were unclassifiable and later met criteria for a variant. Receiver operating characteristic curves were used to evaluate the binary ability of a given task to predict eventual classification as a given variant. Tasks with a high area under the curve were examined using regression analyses to determine their ability to predict variant. Outcomes & Results High mean predictive value was observed for multiple naming assessments targeting nouns and verbs. The Boston Naming Test (BNT) was the only test that, in isolation, resulted in a significant model and high classification accuracy. Conclusions Although naming impairment is common across PPA variants, very low initial BNT scores emerged as a uniquely accurate basis for predicting eventual semantic variant, and normal BNT scores predicted eventual nonfluent/agrammatic variant. High performance on picture-verb verification was useful in identifying future lvPPA.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Bonnie L. Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218
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19
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Seckin M, Ricard I, Raiser T, Heitkamp N, Ebert A, Prix C, Levin J, Diehl-Schmid J, Riedl L, Roßmeier C, Hoen N, Schroeter ML, Marschhauser A, Obrig H, Benke T, Kornhuber J, Fliessbach K, Schneider A, Wiltfang J, Jahn H, Fassbender K, Prudlo J, Lauer M, Duning T, Wilke C, Synofzik M, Anderl-Straub S, Semler E, Lombardi J, Landwehrmeyer B, Ludolph A, Otto M, Danek A. Utility of the Repeat and Point Test for Subtyping Patients With Primary Progressive Aphasia. Alzheimer Dis Assoc Disord 2022; 36:44-51. [PMID: 35001030 DOI: 10.1097/wad.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary progressive aphasia (PPA) may present with three distinct clinical sybtypes: semantic variant PPA (svPPA), nonfluent/agrammatic variant PPA (nfvPPA), and logopenic variant PPA (lvPPA). OBJECTIVE The aim was to examine the utility of the German version of the Repeat and Point (R&P) Test for subtyping patients with PPA. METHOD During the R&P Test, the examiner reads out aloud a noun and the participants are asked to repeat the word and subsequently point to the corresponding picture. Data from 204 patients (68 svPPA, 85 nfvPPA, and 51 lvPPA) and 33 healthy controls were analyzed. RESULTS Controls completed both tasks with >90% accuracy. Patients with svPPA had high scores in repetition (mean=9.2±1.32) but low scores in pointing (mean=6±2.52). In contrast, patients with nfvPPA and lvPPA performed comparably in both tasks with lower scores in repetition (mean=7.4±2.7 for nfvPPA and 8.2±2.34 for lvPPA) but higher scores in pointing (mean=8.9±1.41 for nfvPPA and 8.6±1.62 for lvPPA). The R&P Test had high accuracy discriminating svPPA from nfvPPA (83% accuracy) and lvPPA (79% accuracy). However, there was low accuracy discriminating nfvPPA from lvPPA (<60%). CONCLUSION The R&P Test helps to differentiate svPPA from 2 nonsemantic variants (nfvPPA and lvPPA). However, additional tests are required for the differentiation of nfvPPA and lvPPA.
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Affiliation(s)
- Mustafa Seckin
- Neurologische Klinik und Poliklinik
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Department of Neurology, İstanbul, Turkey
| | - Ingrid Ricard
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Unversität München
| | | | | | - Anne Ebert
- Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim
| | | | - Johannes Levin
- Neurologische Klinik und Poliklinik
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)
- Munich Cluster for Systems Neurology (SyNergy)
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Carola Roßmeier
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Nora Hoen
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Anke Marschhauser
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Hellmuth Obrig
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Thomas Benke
- Universitätsklinik für Neurologie, Kognitive Neurologie und Neuropsychologie, Innsbruck, Austria
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen
| | - Klaus Fliessbach
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinikum Bonn & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn
| | - Anja Schneider
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinikum Bonn & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn
| | - Jens Wiltfang
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Holger Jahn
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus Fassbender
- Neurologische Klinik und Poliklinik, Universität des Saarlandes, KirrbergerStraße, Homburg
| | - Johannes Prudlo
- Klinik für Neurologie und Poliklinik, Universitätsklinikum Rostock, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock
| | - Martin Lauer
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität Würzburg, Würzburg
| | - Thomas Duning
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Westfälische-Wilhelms-Universität, Münster
| | - Carlo Wilke
- Department of Neurodegenerative Diseases, Centre for Neurology and Hertie-Institute for Clinical Brain Research, University Hospital
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Centre for Neurology and Hertie-Institute for Clinical Brain Research, University Hospital
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen
| | | | - Elisa Semler
- Neurologische Klinik und Poliklinik, Universität Ulm
| | | | | | - Albert Ludolph
- Neurologische Klinik und Poliklinik, Universität Ulm
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ulm
| | - Markus Otto
- Neurologische Klinik und Poliklinik, Universität Ulm
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20
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Tippett DC, Keser Z. Clinical and neuroimaging characteristics of primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:81-97. [PMID: 35078612 PMCID: PMC9951770 DOI: 10.1016/b978-0-12-823384-9.00016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The chapter covers the clinical syndrome of a primary progressive aphasia (PPA), the demographics of this rare neurodegenerative disease, defining clinical and neuroanatomic characteristics of each PPA variant, disease progression, and behavioral features. The chapter begins with a brief introduction that includes references to seminal papers that defined this clinical syndrome and its three variants. The classic PPA subtypes discussed in the chapter are semantic variant PPA (svPPA), nonfluent/agrammatic PPA (nfaPPA), and logopenic variant PPA (lvPPA). The key language and cognitive characteristics, and language tasks that can elicit these language impairments, are detailed. Overlap in the clinical profiles of the PPA variants, which make differential diagnosis challenging, are explained. Disease progression is described, revealing that the PPA variants become more similar over time. Although PPA is language-predominant dementia, there are behavioral manifestations, particularly in svPPA. Changes in behavior in this variant are addressed as well as behavioral changes in nfaPPA and lvPPA that are less well recognized. The patterns of atrophy in the left temporal, parietal, and/or frontal cortices unique to each PPA variant are described. The underlying neuropathologies of the PPA variants are discussed, specifically tauopathies and non-tauopathies associated with svPPA and nfaPPA and Alzheimer's disease pathology in lvPPA.
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Affiliation(s)
- Donna C. Tippett
- Departments of Neurology, Otolaryngology—Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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21
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Cognitive and Neural Mechanisms of Social Communication Dysfunction in Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11121600. [PMID: 34942902 PMCID: PMC8699060 DOI: 10.3390/brainsci11121600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Mounting evidence suggests that, in parallel with well-defined changes in language, primary progressive aphasia (PPA) syndromes display co-occurring social cognitive impairments. Here, we explored multidimensional profiles of carer-rated social communication using the La Trobe Communication Questionnaire (LCQ) in 11 semantic dementia (SD), 12 logopenic progressive aphasia (LPA) and 9 progressive non-fluent aphasia (PNFA) cases and contrasted their performance with 19 Alzheimer’s disease (AD) cases, 26 behavioural variant frontotemporal dementia (bvFTD) cases and 31 healthy older controls. Relative to the controls, the majority of patient groups displayed significant overall social communication difficulties, with common and unique profiles of impairment evident on the LCQ subscales. Correlation analyses revealed a differential impact of social communication disturbances on functional outcomes in patient and carer well-being, most pronounced for SD and bvFTD. Finally, voxel-based morphometry analyses based on a structural brain MRI pointed to the degradation of a distributed brain network in mediating social communication dysfunction in dementia. Our findings suggest that social communication difficulties are an important feature of PPA, with significant implications for patient function and carer well-being. The origins of these changes are likely to be multifactorial, reflecting the breakdown of fronto-thalamic brain circuits specialised in the integration of complex information.
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22
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Stockbridge MD, Tippett DC, Breining BL, Vitti E, Hillis AE. Task performance to discriminate among variants of primary progressive aphasia. Cortex 2021; 145:201-211. [PMID: 34742101 PMCID: PMC8633174 DOI: 10.1016/j.cortex.2021.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 12/16/2022]
Abstract
Primary progressive aphasia can be distinguished into one of three variants: semantic, non-fluent/agrammatic, and logopenic. While a considerable body of work exists characterizing each variant, few prior studies have addressed the problem of optimizing behavioral assessment in a typical outpatient evaluation setting. Our aim is to examine the sensitivity and specificity of a battery of cognitive and linguistic assessments and determine optimal scores for distinguishing patients' subtype based on these instruments. This was a retrospective analysis of outpatient clinical testing of individuals with known or suspected primary progressive aphasia. Evaluations included the National Alzheimer's Coordinating Center frontotemporal lobar degeneration module and additional measures of naming, semantic association, word verification, and picture description. Receiver operating characteristic analysis was used to examine the utility of each task in distinguishing each variant from the others. Logistic regressions were used to examine the combined utility of tasks for distinguishing a given subtype. We examined 435 evaluations of 222 patients retrospectively. The battery was most consistent in distinguishing semantic variant by low scores and non-fluent/agrammatic variant by high scores on a similar subset of tasks. Tasks best distinguishing semantic variant produced a model that correctly classified 86% of cases. Tasks best distinguishing non-fluent/agrammatic variant correctly classified 77% of cases. The battery of tasks was weakest in identifying logopenic variant; only the ratio of sentence reading to sentence repetition performance was identified as a reasonable predictor, and it had predictive accuracy of 67%. Naming assessments were the strongest basis for distinguishing all variants, particularly semantic variant from non-fluent/agrammatic variant. These data illustrate that a number of commonly used assessments perform at chance in distinguishing variant and preliminarily support an abbreviated battery that marginally favors tools not currently included in the frontotemporal lobar degeneration module.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Donna C Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
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23
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Macoir J, Martel-Sauvageau V, Bouvier L, Laforce R, Monetta L. Heterogeneity of repetition abilities in logopenic variant primary progressive aphasia. Dement Neuropsychol 2021; 15:405-412. [PMID: 34630930 PMCID: PMC8485642 DOI: 10.1590/1980-57642021dn15-030014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/09/2021] [Indexed: 11/21/2022] Open
Abstract
The differential diagnosis of primary progressive aphasia (PPA) is challenging due to overlapping clinical manifestations of the different variants of the disease. This is particularly true for the logopenic variant of PPA (lvPPA), in which such overlap was reported with regard to impairments in repetition abilities. In this study, four individuals with lvPPA underwent standard neuropsychological and language assessments. The influence of psycholinguistic variables on their performance of in word, nonword and sentence repetition tasks was also specifically explored. Some level of heterogeneity was found in cognitive functions and in language. The four participants showed impairment in sentence repetition in which their performance was negatively affected by semantic reversibility and syntactic complexity. This study supports the heterogeneity of lvPPA with respect to the cognitive and linguistic status of participants. It also shows that sentence repetition is influenced not only by length, but also by semantic reversibility and syntactic complexity, two psycholinguistic variables known to place additional demands on phonological working memory.
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Affiliation(s)
- Joel Macoir
- Faculty of Medicine, Department of Rehabilitation, Laval University - Quebec, QC, Canada.,CERVO, Brain Research Centre - Quebec, QC, Canada
| | - Vicent Martel-Sauvageau
- Faculty of Medicine, Department of Rehabilitation, Laval University - Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration - Quebec, QC, Canada
| | - Liziane Bouvier
- Faculty of Medicine, Department of Rehabilitation, Laval University - Quebec, QC, Canada.,CERVO, Brain Research Centre - Quebec, QC, Canada
| | - Robert Laforce
- Faculty of Medicine, Department of Medicine, Laval University - Quebec, QC, Canada.,Interdisciplinary Memory Clinic, Laval University Hospital Center - Quebec, QC, Canada.,Research Chair in Progressive Primary Aphasias, Lemaire Family Foundation - Quebec, QC, Canada
| | - Laura Monetta
- Faculty of Medicine, Department of Rehabilitation, Laval University - Quebec, QC, Canada.,CERVO, Brain Research Centre - Quebec, QC, Canada
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24
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López-Cáceres A, Velasco-Rueda M, Garcia-Cifuentes E, Zarante I, Matallana D. Analysis of Heritability Across the Clinical Phenotypes of Frontotemporal Dementia and the Frequency of the C9ORF72 in a Colombian Population. Front Neurol 2021; 12:681595. [PMID: 34526954 PMCID: PMC8435669 DOI: 10.3389/fneur.2021.681595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
Frontotemporal dementia (FTD) is a highly heritable condition. Up to 40% of FTD is familial and an estimated 15% to 40% is due to single-gene mutations. It has been estimated that the G4C2 hexanucleotide repeat expansions in the C9ORF72 gene can explain up to 37.5% of the familial cases of FTD, especially in populations of Caucasian origin. The purpose of this paper is to evaluate hereditary risk across the clinical phenotypes of FTD and the frequency of the G4C2 expansion in a Colombian cohort diagnosed with FTD. Methods: A total of 132 FTD patients were diagnosed according to established criteria in the behavioral variant FTD, logopenic variant PPA, non-fluent agrammatic PPA, and semantic variant PPA. Hereditary risk across the clinical phenotypes was established in four categories that indicate the pathogenic relationship of the mutation: high, medium, low, and apparently sporadic, based on those proposed by Wood and collaborators. All subjects were also examined for C9ORF72 hexanucleotide expansion (defined as >30 repetitions). Results: There were no significant differences in the demographic characteristics of the patients between the clinical phenotypes of FTD. The higher rate phenotype was bvFTD (62.12%). In accordance with the risk classification, we found that 72 (54.4%) complied with the criteria for the sporadic cases; for the familial cases, 23 (17.4%) fulfilled the high-risk criteria, 23 (17.4%) fulfilled the low risk criteria, and 14 (10.6%) fulfilled the criteria to be classified as subject to medium risk. C9ORF72 expansion frequency was 0.76% (1/132). Conclusion: The FTD heritability presented in this research was very similar to the results reported in the literature. The C9ORF72 expansion frequency was low. Colombia is a triethnic country, with a high frequency of genetic Amerindian markers; this shows consistency with the present results of a low repetition frequency. This study provides an initial report of the frequency for the hexanucleotide repeat expansions in C9ORF72 in patients with FTD in a Colombian population and paves the way for further study of the possible genetic causes of FTD in Colombia.
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Affiliation(s)
- Andrea López-Cáceres
- School of Medicine, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
- Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - María Velasco-Rueda
- School of Medicine, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin Garcia-Cifuentes
- School of Medicine, Departamento de Neurociencias, Unidad de neurología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ignacio Zarante
- School of Medicine, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Matallana
- Fundación Santa Fé de Bogotá, Bogotá, Colombia
- School of Medicine, Instituto de Envejecimiento, Doctorado de Neurociencias, Psychiatry and Mental Health Department, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
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Cousins KA, Bove J, Giannini LAA, Kinney NG, Balgenorth YR, Rascovsky K, Lee EB, Trojanowski JQ, Grossman M, Irwin DJ. Longitudinal naming and repetition relates to AD pathology and burden in autopsy-confirmed primary progressive aphasia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12188. [PMID: 34368417 PMCID: PMC8327471 DOI: 10.1002/trc2.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In primary progressive aphasia (PPA) patients with autopsy-confirmed Alzheimer's disease (AD) or frontotemporal lobar degeneration (FLTD), we tested how the core clinical features of logopenic PPA-naming and repetition-change over time and relate to pathologic burden. METHODS In PPA with AD (n = 13) or FTLD (n = 16) pathology, Boston Naming Test and Forward Digit Span measured longitudinal naming and repetition; as reference, Mini-Mental State Examination (MMSE) measured global cognition. Pathologic burden in left peri-Sylvian regions was related to longitudinal cognitive decline. RESULTS PPA with AD showed greater decline in naming (P = 0.021) and repetition (P = 0.020), compared to FTLD; there was no difference in MMSE decline (P = 0.99). Across all PPA, declining naming (P = 0.0084) and repetition (P = 0.011) were associated with angular, superior-middle temporal (naming P = 0.014; repetition P = 0.011) and middle frontal (naming P = 0.041; repetition P = 0.030) pathologic burden. DISCUSSION Unique longitudinal profiles of naming and repetition performance in PPA with AD are related to left peri-Sylvian pathology.
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Affiliation(s)
- Katheryn A.Q. Cousins
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
| | - Jessica Bove
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Lucia A. A. Giannini
- Alzheimer CenterDepartment of NeurologyErasmus Medical CenterRotterdamthe Netherlands
| | - Nikolas G. Kinney
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
| | - Yvonne R. Balgenorth
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
| | - Katya Rascovsky
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Translational Neuropathology Research LaboratoryPerelman School of MedicineDepartment of Pathology and Laboratory MedicinePhiladelphiaPennsylvaniaUSA
| | - John Q. Trojanowski
- Center for Neurodegenerative Disease ResearchPerelman School of MedicineDepartment of Pathology and Laboratory MedicinePhiladelphiaPennsylvaniaUSA
| | - Murray Grossman
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
| | - David J. Irwin
- Frontotemporal Degeneration Center, Perelman School of MedicineDepartment of NeurologyPhiladelphiaPennsylvaniaUSA
- Digital Neuropathology LaboratoryPerelman School of MedicineDepartment of NeurologyPhiladelphiaPAUSA
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Sikora J, Stein C, Ubellacker D, Walker A, Tippett DC. Longitudinal decline in spoken word recognition and object knowledge in primary progressive aphasia. Medicine (Baltimore) 2021; 100:e26163. [PMID: 34087875 PMCID: PMC8183769 DOI: 10.1097/md.0000000000026163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/11/2021] [Indexed: 11/26/2022] Open
Abstract
The premise of this study is that spoken word recognition and object knowledge are impaired in semantic variant primary progressive aphasia (PPA) (svPPA) and are spared in logopenic variant (lvPPA) and nonfluent agrammatic primary progressive aphasia (nfaPPA) at disease onset. Over time, however, there may be heterogeneity in these abilities in lvPPA and nfaPPA. We hypothesized that individuals with svPPA would demonstrate poorer performance on baseline spoken word recognition and object knowledge than those with lvPPA and nfaPPA) as documented in the literature, but that rates of decline over time on spoken word recognition and object knowledge would be similar in all 3 PPA variants because these become less distinguishable with disease progression.The aim of this study was to investigate longitudinal patterns of decline in spoken word recognition and object knowledge across PPA variants.Ninety-five individuals with PPA completed the Semantic Word Picture Matching and Semantic Associates tests at baseline to establish expected performance in these areas. Thirty-five individuals completed follow-up testing.The distributions of trichotomized mean rates of decline in object knowledge were similar for lvPPA and svPPA (P = .05). There were weak negative correlations between symptom duration and baseline scores on Semantic Word Picture Matching (r[37] = -0.399, P = .01), and baseline scores on Semantic Associates (r[37] = -0.394, P = .01) in lvPPA.Degradation of spoken word recognition and object knowledge occurs over time in lvPPA. Further investigation of the receptive language deficits in PPA is warranted to characterize language changes that lessen the distinctions between PPA variants with disease progression.
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Affiliation(s)
| | | | | | | | - Donna C. Tippett
- Department of Neurology
- Department of Otolaryngology–Head and Neck Surgery
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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27
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Longitudinal cognitive and functional changes in primary progressive aphasia. J Neurol 2021; 268:1951-1961. [PMID: 33417000 DOI: 10.1007/s00415-020-10382-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The variants of primary progressive aphasia (PPA) are predominantly diagnosed on the basis of specific profiles of language impairments. Deficits in other cognitive domains and their evolution over time are less well documented. This study examined the cognitive profiles of the PPA variants over time and determined the contribution of cognition on functional capacity. METHODS Longitudinal performance on the Addenbrooke's Cognitive Examination-III (ACE-III) total and cognitive subdomains were investigated in 147 PPA individuals (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA], and 62 semantic variants [sv-PPA]). The relative contribution of ACE-III subdomain scores to overall functional capacity over time was identified using mixed and hierarchical regression modelling. RESULTS The annual rate of global ACE-III decline was twice that in lv-PPA than in nfv-PPA and sv-PPA, despite lv-PPA performing intermediate to the other variants at baseline assessment. Notably, attention and visuospatial subdomains declined faster in lv-PPA than in nfv-PPA and sv-PPA; and memory impairment was more severe in lv-PPA than in nfv-PPA at all time points. Functional decline was comparable across PPA variants; however, the contribution of cognition on functional capacity varied across variants and over time. CONCLUSION The cognitive profiles of the PPA variants are distinct at baseline and over time. Crucially, cognitive decline in lv-PPA was more widespread and pervasive than in nfv-PPA and sv-PPA. Our findings also demonstrate the complex interplay between cognition and functional capacity. This study underscores the importance of routinely assessing cognition and functional capacity in PPA to improve diagnostic accuracy and provide targeted support services.
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