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Toller G, Cobigo Y, Ljubenkov PA, Appleby BS, Dickerson BC, Domoto-Reilly K, Fong JC, Forsberg LK, Gavrilova RH, Ghoshal N, Heuer HW, Knopman DS, Kornak J, Lapid MI, Litvan I, Lucente DE, Mackenzie IR, McGinnis SM, Miller BL, Pedraza O, Rojas JC, Staffaroni AM, Wong B, Wszolek ZK, Boeve BF, Boxer AL, Rosen HJ, Rankin KP. Sensitivity of the Social Behavior Observer Checklist to Early Symptoms of Patients With Frontotemporal Dementia. Neurology 2022; 99:e488-e499. [PMID: 35584922 PMCID: PMC9421596 DOI: 10.1212/wnl.0000000000200582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/08/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Changes in social behavior are common symptoms of frontotemporal lobar degeneration (FTLD) and Alzheimer disease syndromes. For early identification of individual patients and differential diagnosis, sensitive clinical measures are required that are able to assess patterns of behaviors and detect syndromic differences in both asymptomatic and symptomatic stages. We investigated whether the examiner-based Social Behavior Observer Checklist (SBOCL) is sensitive to early behavior changes and reflects disease severity within and between neurodegenerative syndromes. METHODS Asymptomatic individuals and patients with neurodegenerative disease were selected from the multisite ALLFTD cohort study. In a sample of participants with at least 1 time point of SBOCL data, we investigated whether the Disorganized, Reactive, and Insensitive subscales of the SBOCL change as a function of disease stage within and between these syndromes. In a longitudinal subsample with both SBOCL and neuroimaging data, we examined whether change over time on each subscale corresponds to progressive gray matter atrophy. RESULTS A total of 1,082 FTLD pathogenic variant carriers and noncarriers were enrolled (282 asymptomatic, 341 behavioral variant frontotemporal dementia, 114 semantic and 95 nonfluent variant primary progressive aphasia, 137 progressive supranuclear palsy, and 113 Alzheimer disease syndrome). The Disorganized score increased between asymptomatic to very mild (p = 0.016, estimate = -1.10, 95% CI = -1.99 to -0.22), very mild to mild (p = 0.013, estimate = -1.17, 95% CI = -2.08 to -0.26), and mild to moderate/severe (p < 0.001, estimate = -2.00, 95% CI = -2.55 to -1.45) disease stages in behavioral variant frontotemporal dementia regardless of pathogenic variant status. Asymptomatic GRN pathogenic gene variant carriers showed more reactive behaviors (preoccupation with time: p = 0.001, estimate = 1.11, 95% CI = 1.06 to 1.16; self-consciousness: p = 0.003, estimate = 1.77, 95% CI = 1.52 to 2.01) than asymptomatic noncarriers (estimate = 1.01, 95% CI = 0.98 to 1.03; estimate = 1.31, 95% CI = 1.20 to 1.41). The Insensitive score increased to a clinically abnormal level in advanced stages of behavioral variant frontotemporal dementia (p = 0.003, estimate = -0.73, 95% CI = -1.18 to -0.29). Higher scores on each subscale corresponded with higher caregiver burden (p < 0.001). Greater change over time corresponded to greater fronto-subcortical atrophy in the semantic-appraisal and fronto-parietal intrinsically connected networks. DISCUSSION The SBOCL is sensitive to early symptoms and reflects disease severity, with some evidence for progression across asymptomatic and symptomatic stages of FTLD syndromes; thus, it may hold promise for early measurement and monitoring of behavioral symptoms in clinical practice and treatment trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the SBOCL is sensitive to early behavioral changes in FTLD pathogenic variants and early symptomatic individuals in a highly educated patient cohort.
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Affiliation(s)
- Gianina Toller
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL.
| | - Yann Cobigo
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Peter A Ljubenkov
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Brian S Appleby
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bradford C Dickerson
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Kimiko Domoto-Reilly
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Jamie C Fong
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Leah K Forsberg
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Ralitza H Gavrilova
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Nupur Ghoshal
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Hilary W Heuer
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - John Kornak
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Maria I Lapid
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Irene Litvan
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Diane E Lucente
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Ian R Mackenzie
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Scott M McGinnis
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bruce L Miller
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Otto Pedraza
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Julio C Rojas
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Adam M Staffaroni
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Bonnie Wong
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Zbigniew K Wszolek
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Brad F Boeve
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Adam L Boxer
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Howard J Rosen
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Katherine P Rankin
- From the Department of Neurology (G.T., Y.C., P.A.L., J.C.F., H.W.H., B.L.M., J.C.R., A.M.S., A.L.B., H.J.R., K.P.R.), Memory and Aging Center, University of California, San Francisco; Department of Neurology (B.S.A.), Case Western Reserve University, Cleveland, OH; Frontotemporal Disorders Unit (B.C.D., D.E.L., S.M.M., B.W.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (K.D.-R.), University of Washington, Seattle; Department of Neurology (L.K.F., R.H.G., D.S.K., B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology (N.G.), Washington University, St. Louis, MO; Department of Epidemiology and Biostatistics (J.K.), University of California, San Francisco; Department of Psychiatry and Psychology (M.I.L.), Mayo Clinic, Rochester, MN; Department of Neurology (I.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pathology and Laboratory Medicine (I.R.M.), University of British Columbia, Vancouver, Canada; Departments of Psychiatry and Psychology (O.P.), and Neurology (Z.K.W.), Mayo Clinic, Jacksonville, FL
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