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Zecca C, Tortelli R, Carrera P, Dell'Abate MT, Logroscino G, Ferrari M. Genotype-phenotype correlation in the spectrum of frontotemporal dementia-parkinsonian syndromes and advanced diagnostic approaches. Crit Rev Clin Lab Sci 2022; 60:171-188. [PMID: 36510705 DOI: 10.1080/10408363.2022.2150833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The term frontotemporal dementia (FTD) refers to a group of progressive neurodegenerative disorders characterized mainly by atrophy of the frontal and anterior temporal lobes. Based on clinical presentation, three main clinical syndromes have traditionally been described: behavioral variant frontotemporal dementia (bvFTD), non-fluent/agrammatic primary progressive aphasia (nfPPA), and semantic variant PPA (svPPA). However, over the last 20 years, it has been recognized that cognitive phenotypes often overlap with motor phenotypes, either motor neuron diseases or parkinsonian signs and/or syndromes like progressive supranuclear palsy (PSP) and cortico-basal syndrome (CBS). Furthermore, FTD-related genes are characterized by genetic pleiotropy and can cause, even in the same family, pure motor phenotypes, findings that underlie the clinical continuum of the spectrum, which has pure cognitive and pure motor phenotypes as the extremes. The genotype-phenotype correlation of the spectrum, FTD-motor neuron disease, has been well defined and extensively investigated, while the continuum, FTD-parkinsonism, lacks a comprehensive review. In this narrative review, we describe the current knowledge about the genotype-phenotype correlation of the spectrum, FTD-parkinsonism, focusing on the phenotypes that are less frequent than bvFTD, namely nfPPA, svPPA, PSP, CBS, and cognitive-motor overlapping phenotypes (i.e. PPA + PSP). From a pathological point of view, they are characterized mainly by the presence of phosphorylated-tau inclusions, either 4 R or 3 R. The genetic correlate of the spectrum can be heterogeneous, although some variants seem to lead preferentially to specific clinical syndromes. Furthermore, we critically review the contribution of genome-wide association studies (GWAS) and next-generation sequencing (NGS) in disentangling the complex heritability of the FTD-parkinsonism spectrum and in defining the genotype-phenotype correlation of the entire clinical scenario, owing to the ability of these techniques to test multiple genes, and so to allow detailed investigations of the overlapping phenotypes. Finally, we conclude with the importance of a detailed genetic characterization and we offer to patients and families the chance to be included in future randomized clinical trials focused on autosomal dominant forms of FTLD.
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Affiliation(s)
- Chiara Zecca
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", Pia Fondazione Card G. Panico Hospital, Tricase, Italy
| | - Rosanna Tortelli
- Neuroscience and Rare Diseases Discovery and Translational Area, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Paola Carrera
- Unit of Genomics for Human Disease Diagnosis and Clinical Molecular Biology Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Teresa Dell'Abate
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", Pia Fondazione Card G. Panico Hospital, Tricase, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", Pia Fondazione Card G. Panico Hospital, Tricase, Italy.,Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Sexton C, Solis M, Aharon-Peretz J, Alexopoulos P, Apostolova LG, Bayen E, Birkenhager B, Cappa S, Constantinidou F, Fortea J, Gerritsen DL, Hassanin HI, Ibanez A, Ioannidis P, Karageorgiou E, Korczyn A, Leroi I, Lichtwarck B, Logroscino G, Lynch C, Mecocci P, Molinuevo JL, Papatriantafyllou J, Papegeorgiou S, Politis A, Raman R, Ritchie K, Sanchez-Juan P, Sano M, Scarmeas N, Spiru L, Stathi A, Tsolaki M, Yener G, Zaganas I, Zygouris S, Carrillo M. Alzheimer's disease research progress in the Mediterranean region: The Alzheimer's Association International Conference Satellite Symposium. Alzheimers Dement 2022; 18:1957-1968. [PMID: 35184367 PMCID: PMC11066754 DOI: 10.1002/alz.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/28/2023]
Abstract
As research and services in the Mediterranean region continue to increase, so do opportunities for global collaboration. To support such collaborations, the Alzheimer's Association was due to hold its seventh Alzheimer's Association International Conference Satellite Symposium in Athens, Greece in 2021. Due to the COVID-19 pandemic, the meeting was held virtually, which enabled attendees from around the world to hear about research efforts in Greece and the surrounding Mediterranean countries. Research updates spanned understanding the biology of, treatments for, and care of people with Alzheimer's disease (AD_ and other dementias. Researchers in the Mediterranean region have outlined the local epidemiology of AD and dementia, and have identified regional populations that may expedite genetic studies. Development of biomarkers is expected to aid early and accurate diagnosis. Numerous efforts have been made to develop culturally specific interventions to both reduce risk of dementia, and to improve quality of life for people living with dementia.
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Affiliation(s)
- Claire Sexton
- Alzheimer's Association, 225 N Michigan Avenue, 17th Fl, Chicago, Illinois, USA
| | | | | | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | | | - Eléonore Bayen
- Laboratoire d'imagerie biomédicale, Sorbonne Université, department of physical rehabilitation medicine, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Betty Birkenhager
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stefano Cappa
- University School for Advanced Studies (IUSS-Pavia) and IRCCS Mondino Foundation, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, PV, Italy
| | - Fofi Constantinidou
- Department of Psychology & Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Juan Fortea
- Sant Pau Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Hany I Hassanin
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
- Geriatric Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Agustin Ibanez
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile
- Universidad de San Andres & National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | | | | | | | - Iracema Leroi
- Trinity College Dublin, Global Brain Health Institute, Dublin, Ireland
| | - Bjorn Lichtwarck
- The Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card G. Panico" Hospital Tricase (Le), Bari, Italy
- Department of Basic Medicine Neuroscience and Sense Organs University Aldo Moro Bari, Bari, Italy
| | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - John Papatriantafyllou
- Third Age Center IASIS, Athens-Glyfada, Athens, Greece
- 1st University Neurology Department, Eginitio Hospital, Athens, Greece
- Ana Aslan International Foundation
| | - Sokratis Papegeorgiou
- 1st University Neurology Department, Eginitio Hospital, Athens, Greece
- National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Politis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California, CA, USA
| | | | - Pascual Sanchez-Juan
- Institute for Research Marqués de Valdecilla (IDIVAL), CIBERNED, University of Cantabria and Department of Neurology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Mary Sano
- The Mount Sinai Hospital, New York, NY, USA
| | - Nikolas Scarmeas
- National and Kapodistrian University of Athens, Athens, Greece
- Columbia University, New York, NY, USA
| | - Luiza Spiru
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
- Ana Aslan International Foundation
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Magda Tsolaki
- 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Görsev Yener
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Ioannis Zaganas
- Neurogenetics Laboratory, Medical School, University of Crete
| | - Stelios Zygouris
- Centre for Research and Technology Hellas/ Information Technologies Institute, Thessaloniki, Greece
| | - Maria Carrillo
- Alzheimer's Association, 225 N Michigan Avenue, 17th Fl, Chicago, Illinois, USA
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Perrone F, Cacace R, van der Zee J, Van Broeckhoven C. Emerging genetic complexity and rare genetic variants in neurodegenerative brain diseases. Genome Med 2021; 13:59. [PMID: 33853652 PMCID: PMC8048219 DOI: 10.1186/s13073-021-00878-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Knowledge of the molecular etiology of neurodegenerative brain diseases (NBD) has substantially increased over the past three decades. Early genetic studies of NBD families identified rare and highly penetrant deleterious mutations in causal genes that segregate with disease. Large genome-wide association studies uncovered common genetic variants that influenced disease risk. Major developments in next-generation sequencing (NGS) technologies accelerated gene discoveries at an unprecedented rate and revealed novel pathways underlying NBD pathogenesis. NGS technology exposed large numbers of rare genetic variants of uncertain significance (VUS) in coding regions, highlighting the genetic complexity of NBD. Since experimental studies of these coding rare VUS are largely lacking, the potential contributions of VUS to NBD etiology remain unknown. In this review, we summarize novel findings in NBD genetic etiology driven by NGS and the impact of rare VUS on NBD etiology. We consider different mechanisms by which rare VUS can act and influence NBD pathophysiology and discuss why a better understanding of rare VUS is instrumental for deriving novel insights into the molecular complexity and heterogeneity of NBD. New knowledge might open avenues for effective personalized therapies.
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Affiliation(s)
- Federica Perrone
- Neurodegenerative Brain Diseases Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp – CDE, Universiteitsplein 1, BE-2610 Antwerp, Belgium
| | - Rita Cacace
- Neurodegenerative Brain Diseases Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp – CDE, Universiteitsplein 1, BE-2610 Antwerp, Belgium
| | - Julie van der Zee
- Neurodegenerative Brain Diseases Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp – CDE, Universiteitsplein 1, BE-2610 Antwerp, Belgium
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp – CDE, Universiteitsplein 1, BE-2610 Antwerp, Belgium
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Young JJ, Lavakumar M, Tampi D, Balachandran S, Tampi RR. Frontotemporal dementia: latest evidence and clinical implications. Ther Adv Psychopharmacol 2018; 8:33-48. [PMID: 29344342 PMCID: PMC5761910 DOI: 10.1177/2045125317739818] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/26/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Frontotemporal dementia (FTD) describes a cluster of neurocognitive syndromes that present with impairment of executive functioning, changes in behavior, and a decrease in language proficiency. FTD is the second most common form of dementia in those younger than 65 years and is expected to increase in prevalence as the population ages. This goal in our review is to describe advances in the understanding of neurobiological pathology, classification, assessment, and treatment of FTD syndromes. METHODS PubMed was searched to obtain reviews and studies that pertain to advancements in genetics, neurobiology, neuroimaging, classification, and treatment of FTD syndromes. Articles were chosen with a predilection to more recent preclinical/clinical trials and systematic reviews. RESULTS Recent reviews and trials indicate a significant advancement in the understanding of molecular and neurobiological clinical correlates to variants of FTD. Genetic and histopathologic markers have only recently been discovered in the past decade. Current therapeutic modalities are limited, with most studies reporting improvement in symptoms with nonpharmacological interventions. However, a small number of studies have reported improvement of behavioral symptoms with selective serotonin reuptake inhibitor (SSRI) treatment. Stimulants may help with disinhibition, apathy, and risk-taking behavior. Memantine and cholinesterase inhibitors have not demonstrated efficacy in ameliorating FTD symptoms. Antipsychotics have been used to treat agitation and psychosis, but safety concerns and side effect profiles limit utilization in the general FTD population. Nevertheless, recent breakthroughs in the understanding of FTD pathology have led to developments in pharmacological interventions that focus on producing treatments with autoimmune, genetic, and molecular targets. CONCLUSION FTD is an underdiagnosed group of neurological syndromes comprising multiple variants with distinct neurobiological profiles and presentations. Recent advances suggest there is an array of potential novel therapeutic targets, although data concerning their effectiveness are still preliminary or preclinical. Further studies are required to develop pharmacological interventions, as there are currently no US Food and Drug administration approved treatments to manage FTD syndromes.
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Affiliation(s)
- Juan Joseph Young
- Department of Psychiatry, MetroHealth Medical Center, Cleveland, OH, USA Case Western Reserve University, Cleveland, OH, USA
| | - Mallika Lavakumar
- Department of Psychiatry, MetroHealth Medical Center, Cleveland, OH, USA Case Western Reserve University, Cleveland, OH, USA
| | - Deena Tampi
- Mercy Regional Medical Center, 3700 Kolbe Rd, Lorain, OH 44053, USA
| | - Silpa Balachandran
- Department of Psychiatry, MetroHealth Medical Center, Cleveland, OH, USA Case Western Reserve University, Cleveland, OH, USA
| | - Rajesh R Tampi
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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