1
|
Mulroy E, Core LB, Chokesuwattanaskul A, Johnson JC, Fletcher PD, Marshall CR, Volkmer A, Rohrer JD, Hardy CJ, Rossor MN, Warren JD. Binary reversals: a diagnostic sign in primary progressive aphasia. J Neurol Neurosurg Psychiatry 2024; 95:477-480. [PMID: 38071563 DOI: 10.1136/jnnp-2023-331662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/08/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Binary reversals (exemplified by 'yes'/'no' confusions) have been described in patients with primary progressive aphasia (PPA) but their diagnostic value and phenotypic correlates have not been defined. METHODS We conducted a retrospective cohort study analysing demographic, clinical, neuropsychological, linguistic and behavioural data from patients representing all major PPA syndromes (non-fluent/agrammatic variant, nfvPPA; logopenic variant, lvPPA; semantic variant, svPPA) and behavioural variant frontotemporal dementia (bvFTD). The prevalence of binary reversals and behavioural abnormalities, illness duration, parkinsonian features and neuropsychological test scores were compared between neurodegenerative syndromes, and the diagnostic predictive value of binary reversals was assessed using logistic regression. RESULTS Data were obtained for 83 patients (21 nfvPPA, 13 lvPPA, 22 svPPA, 27 bvFTD). Binary reversals occurred in all patients with nfvPPA, but significantly less frequently and later in lvPPA (54%), svPPA (9%) and bvFTD (44%). Patients with bvFTD with binary reversals had significantly more severe language (but not general executive or behavioural) deficits than those without reversals. Controlling for potentially confounding variables, binary reversals strongly predicted a diagnosis of nfvPPA over other syndromes. CONCLUSIONS Binary reversals are a sensitive (though not specific) neurolinguistic feature of nfvPPA, and should suggest this diagnosis if present as a prominent early symptom.
Collapse
Affiliation(s)
- Eoin Mulroy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lucy B Core
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeremy Cs Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Phillip D Fletcher
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
2
|
Parker TD, Hardy C, Keuss S, Coath W, Cash DM, Lu K, Nicholas JM, James SN, Sudre C, Crutch S, Bamiou DE, Warren JD, Fox NC, Richards M, Schott JM. Peripheral hearing loss at age 70 predicts brain atrophy and associated cognitive change. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333101. [PMID: 38569877 DOI: 10.1136/jnnp-2023-333101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Hearing loss has been proposed as a modifiable risk factor for dementia. However, the relationship between hearing, neurodegeneration, and cognitive change, and the extent to which pathological processes such as Alzheimer's disease and cerebrovascular disease influence these relationships, is unclear. METHODS Data from 287 adults born in the same week of 1946 who underwent baseline pure tone audiometry (mean age=70.6 years) and two time point cognitive assessment/multimodal brain imaging (mean interval 2.4 years) were analysed. Hearing impairment at baseline was defined as a pure tone average of greater than 25 decibels in the best hearing ear. Rates of change for whole brain, hippocampal and ventricle volume were estimated from structural MRI using the Boundary Shift Integral. Cognition was assessed using the Pre-clinical Alzheimer's Cognitive Composite. Regression models were performed to evaluate how baseline hearing impairment associated with subsequent brain atrophy and cognitive decline after adjustment for a range of confounders including baseline β-amyloid deposition and white matter hyperintensity volume. RESULTS 111 out of 287 participants had hearing impairment. Compared with those with preserved hearing, hearing impaired individuals had faster rates of whole brain atrophy, and worse hearing (higher pure tone average) predicted faster rates of hippocampal atrophy. In participants with hearing impairment, faster rates of whole brain atrophy predicted greater cognitive change. All observed relationships were independent of β-amyloid deposition and white matter hyperintensity volume. CONCLUSIONS Hearing loss may influence dementia risk via pathways distinct from those typically implicated in Alzheimer's and cerebrovascular disease in cognitively unimpaired older adults.
Collapse
Affiliation(s)
- Thomas D Parker
- Department of Brain Sciences, Imperial College London, London, UK
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, London, UK
| | - Chris Hardy
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Sarah Keuss
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - William Coath
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - David M Cash
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- UK Dementia Research Institute at UCL, University College London, London, UK
| | - Kirsty Lu
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Jennifer M Nicholas
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Carole Sudre
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastian Crutch
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCLH Biomedical Research Centre, National Institute for Health Research, University College London, London, UK
| | - Jason D Warren
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Nick C Fox
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Jonathan M Schott
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| |
Collapse
|
3
|
Belder CRS, Marshall CR, Jiang J, Mazzeo S, Chokesuwattanaskul A, Rohrer JD, Volkmer A, Hardy CJD, Warren JD. Primary progressive aphasia: six questions in search of an answer. J Neurol 2024; 271:1028-1046. [PMID: 37906327 PMCID: PMC10827918 DOI: 10.1007/s00415-023-12030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
Here, we review recent progress in the diagnosis and management of primary progressive aphasia-the language-led dementias. We pose six key unanswered questions that challenge current assumptions and highlight the unresolved difficulties that surround these diseases. How many syndromes of primary progressive aphasia are there-and is syndromic diagnosis even useful? Are these truly 'language-led' dementias? How can we diagnose (and track) primary progressive aphasia better? Can brain pathology be predicted in these diseases? What is their core pathophysiology? In addition, how can primary progressive aphasia best be treated? We propose that pathophysiological mechanisms linking proteinopathies to phenotypes may help resolve the clinical complexity of primary progressive aphasia, and may suggest novel diagnostic tools and markers and guide the deployment of effective therapies.
Collapse
Affiliation(s)
- Christopher R S Belder
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, UCL Queen Square Institute of Neurology, University College London, London, UK
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Salvatore Mazzeo
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
4
|
Volkmer A, Beeke S, Warren JD, Spector A, Walton H. Development of fidelity of delivery and enactment measures for interventions in communication disorders. Br J Health Psychol 2024; 29:112-133. [PMID: 37792862 DOI: 10.1111/bjhp.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES This study was part of a process evaluation for a single-blind, randomized controlled pilot study comparing Better Conversations with Primary Progressive Aphasia (BCPPA), an approach to communication partner training, with no speech and language therapy treatment. It was necessary to explore fidelity of delivery (delivery of intervention components) and intervention enactment (participants' use of intervention skills in the form of conversation behaviours comprising facilitators, that enhance the conversational flow, and barriers, that impeded the flow of conversation). This study aimed to: (1) Outline an adapted methodological process that uses video observation, to measure both fidelity of delivery and enactment. (2) Measure the extent to which the BCPPA pilot study was delivered as planned, and enacted. DESIGN Observational methods were used alongside statistical analysis to explore the fidelity of intervention and enactment using video recordings obtained from the BCPPA pilot study. METHODS A 5-step methodology, was developed to measure fidelity of delivery and enactment for the BCPPA study using video-recorded data. To identify delivery of intervention components, a random sample of eight video recorded and transcribed BCPPA intervention sessions was coded. To examine the enactment of conversation behaviours, 108 transcribed 10 -min-video recorded conversations were coded from 18 participants across the control and intervention group. RESULTS Checklists and guidelines for measurement of fidelity of treatment delivery and coding spreadsheets and guidelines for measurement of enactment are presented. Local collaborators demonstrated 87.2% fidelity to the BCPPA protocol. Participants in the BCPPA treatment group increased their use of facilitator behaviours enacted in conversation from a mean of 13.5 pre-intervention to 14.2 post-intervention, whilst control group facilitators decreased from a mean of 15.5 to 14.4, over the same timescale. CONCLUSIONS This study proposes a novel and robust methods, using video recorded intervention sessions and conversation samples, to measure both fidelity of intervention delivery and enactment. The learnings from this intervention are transferable to other communication interventions.
Collapse
Affiliation(s)
- Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Suzanne Beeke
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Jason D Warren
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Aimee Spector
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Holly Walton
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
5
|
van’t Hooft JJ, Benhamou E, Albero Herreros C, Jiang J, Levett B, Core LB, Requena-Komuro MC, Hardy CJD, Tijms BM, Pijnenburg YAL, Warren JD. Musical experience influences socio-emotional functioning in behavioural variant frontotemporal dementia. Front Neurol 2024; 15:1341661. [PMID: 38333611 PMCID: PMC10851745 DOI: 10.3389/fneur.2024.1341661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Objectives On phenotypic and neuroanatomical grounds, music exposure might potentially affect the clinical expression of behavioural variant frontotemporal dementia (bvFTD). However, this has not been clarified. Methods 14 consecutive patients with bvFTD fulfilling consensus diagnostic criteria were recruited via a specialist cognitive clinic. Earlier life musical experience, current musical listening habits and general socio-emotional behaviours were scored using a bespoke semi-quantitative musical survey and standardised functional scales, completed with the assistance of patients' primary caregivers. Associations of musical scores with behavioural scales were assessed using a linear regression model adjusted for age, sex, educational attainment and level of executive and general cognitive impairment. Results Greater earlier life musical experience was associated with significantly lower Cambridge Behavioural Inventory (Revised) scores (β ± SE = -17.2 ± 5.2; p = 0.01) and higher Modified Interpersonal Reactivity Index (MIRI) perspective-taking scores (β ± SE = 2.8 ± 1.1; p = 0.03), after adjusting for general cognitive ability. Number of hours each week currently spent listening to music was associated with higher MIRI empathic concern (β ± SE = 0.7 ± 0.21; p = 0.015) and MIRI total scores (β ± SE = 1.1 ± 0.34; p = 0.014). Discussion Musical experience in earlier life and potentially ongoing regular music listening may ameliorate socio-emotional functioning in bvFTD. Future work in larger cohorts is required to substantiate the robustness of this association, establish its mechanism and evaluate its clinical potential.
Collapse
Affiliation(s)
- Jochum J. van’t Hooft
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Alzheimer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience—Neurodegeneration, Amsterdam, Netherlands
| | - Elia Benhamou
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Claudia Albero Herreros
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Benjamin Levett
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lucy B. Core
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mai-Carmen Requena-Komuro
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris J. D. Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Betty M. Tijms
- Alzheimer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience—Neurodegeneration, Amsterdam, Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience—Neurodegeneration, Amsterdam, Netherlands
| | - Jason D. Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
6
|
Hardy CJD, Taylor‐Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for semantic and non-fluent/agrammatic variants of primary progressive aphasia. Alzheimers Dement 2024; 20:195-210. [PMID: 37548125 PMCID: PMC10917001 DOI: 10.1002/alz.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Here we set out to create a symptom-led staging system for the canonical semantic and non-fluent/agrammatic variants of primary progressive aphasia (PPA), which present unique diagnostic and management challenges not well captured by functional scales developed for Alzheimer's disease and other dementias. METHODS An international PPA caregiver cohort was surveyed on symptom development under six provisional clinical stages and feedback was analyzed using a mixed-methods sequential explanatory design. RESULTS Both PPA syndromes were characterized by initial communication dysfunction and non-verbal behavioral changes, with increasing syndromic convergence and functional dependency at later stages. Milestone symptoms were distilled to create a prototypical progression and severity scale of functional impairment: the PPA Progression Planning Aid ("PPA-Squared"). DISCUSSION This work introduces a symptom-led staging scheme and functional scale for semantic and non-fluent/agrammatic variants of PPA. Our findings have implications for diagnostic and care pathway guidelines, trial design, and personalized prognosis and treatment for PPA. HIGHLIGHTS We introduce new symptom-led perspectives on primary progressive aphasia (PPA). The focus is on non-fluent/agrammatic (nfvPPA) and semantic (svPPA) variants. Foregrounding of early and non-verbal features of PPA and clinical trajectories is featured. We introduce a symptom-led staging scheme for PPA. We propose a prototype for a functional impairment scale, the PPA Progression Planning Aid.
Collapse
Affiliation(s)
- Chris J. D. Hardy
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Cathleen Taylor‐Rubin
- Uniting War Memorial HospitalSydneyAustralia
- Faculty of MedicineHealth and Human SciencesMacquarie UniversitySydneyAustralia
| | - Beatrice Taylor
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Emma Harding
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | - Jessica Jiang
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Division of NeurologyDepartment of Internal MedicineKing Chulalongkorn Memorial HospitalBangkokThailand
- Cognitive Clinical and Computational Neuroscience Research UnitFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Suzie Barker
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Emilie Brotherhood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Claire Waddington
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Olivia Wood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nikki Zimmermann
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Paul M. Camic
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Joshua Stott
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- ADAPT LabResearch Department of ClinicalEducational and Health PsychologyUCLLondonUK
| | | | - Neil P. Oxtoby
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Jonathan D. Rohrer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Anna Volkmer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Psychology and Language Sciences (PALS)UCLLondonUK
| | | | - Jason D. Warren
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| |
Collapse
|
7
|
van Leeuwen JEP, McDougall A, Mylonas D, Suárez-González A, Crutch SJ, Warren JD. Pupil responses to colorfulness are selectively reduced in healthy older adults. Sci Rep 2023; 13:22139. [PMID: 38092848 PMCID: PMC10719259 DOI: 10.1038/s41598-023-48513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
The alignment between visual pathway signaling and pupil dynamics offers a promising non-invasive method to further illuminate the mechanisms of human color perception. However, only limited research has been done in this area and the effects of healthy aging on pupil responses to the different color components have not been studied yet. Here we aim to address this by modelling the effects of color lightness and chroma (colorfulness) on pupil responses in young and older adults, in a closely controlled passive viewing experiment with 26 broad-spectrum digital color fields. We show that pupil responses to color lightness and chroma are independent from each other in both young and older adults. Pupil responses to color lightness levels are unaffected by healthy aging, when correcting for smaller baseline pupil sizes in older adults. Older adults exhibit weaker pupil responses to chroma increases, predominantly along the Green-Magenta axis, while relatively sparing the Blue-Yellow axis. Our findings complement behavioral studies in providing physiological evidence that colors fade with age, with implications for color-based applications and interventions both in healthy aging and later-life neurodegenerative disorders.
Collapse
Affiliation(s)
- Janneke E P van Leeuwen
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
- The Thinking Eye, ACAVA Limehouse Arts Foundation, London, UK.
| | - Amy McDougall
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Dimitris Mylonas
- Faculty of Philosophy, Northeastern University London, London, UK
| | - Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
| |
Collapse
|
8
|
Jiang J, Johnson JCS, Requena-Komuro MC, Benhamou E, Sivasathiaseelan H, Chokesuwattanaskul A, Nelson A, Nortley R, Weil RS, Volkmer A, Marshall CR, Bamiou DE, Warren JD, Hardy CJD. Comprehension of acoustically degraded speech in Alzheimer's disease and primary progressive aphasia. Brain 2023; 146:4065-4076. [PMID: 37184986 PMCID: PMC10545509 DOI: 10.1093/brain/awad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Successful communication in daily life depends on accurate decoding of speech signals that are acoustically degraded by challenging listening conditions. This process presents the brain with a demanding computational task that is vulnerable to neurodegenerative pathologies. However, despite recent intense interest in the link between hearing impairment and dementia, comprehension of acoustically degraded speech in these diseases has been little studied. Here we addressed this issue in a cohort of 19 patients with typical Alzheimer's disease and 30 patients representing the three canonical syndromes of primary progressive aphasia (non-fluent/agrammatic variant primary progressive aphasia; semantic variant primary progressive aphasia; logopenic variant primary progressive aphasia), compared to 25 healthy age-matched controls. As a paradigm for the acoustically degraded speech signals of daily life, we used noise-vocoding: synthetic division of the speech signal into frequency channels constituted from amplitude-modulated white noise, such that fewer channels convey less spectrotemporal detail thereby reducing intelligibility. We investigated the impact of noise-vocoding on recognition of spoken three-digit numbers and used psychometric modelling to ascertain the threshold number of noise-vocoding channels required for 50% intelligibility by each participant. Associations of noise-vocoded speech intelligibility threshold with general demographic, clinical and neuropsychological characteristics and regional grey matter volume (defined by voxel-based morphometry of patients' brain images) were also assessed. Mean noise-vocoded speech intelligibility threshold was significantly higher in all patient groups than healthy controls, and significantly higher in Alzheimer's disease and logopenic variant primary progressive aphasia than semantic variant primary progressive aphasia (all P < 0.05). In a receiver operating characteristic analysis, vocoded intelligibility threshold discriminated Alzheimer's disease, non-fluent variant and logopenic variant primary progressive aphasia patients very well from healthy controls. Further, this central hearing measure correlated with overall disease severity but not with peripheral hearing or clear speech perception. Neuroanatomically, after correcting for multiple voxel-wise comparisons in predefined regions of interest, impaired noise-vocoded speech comprehension across syndromes was significantly associated (P < 0.05) with atrophy of left planum temporale, angular gyrus and anterior cingulate gyrus: a cortical network that has previously been widely implicated in processing degraded speech signals. Our findings suggest that the comprehension of acoustically altered speech captures an auditory brain process relevant to daily hearing and communication in major dementia syndromes, with novel diagnostic and therapeutic implications.
Collapse
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Maï-Carmen Requena-Komuro
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Kidney Cancer Program, UT Southwestern Medical Centre, Dallas, TX 75390, USA
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Annabel Nelson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Ross Nortley
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough SL2 4HL, UK
| | - Rimona S Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCL/UCLH Biomedical Research Centre, National Institute of Health Research, University College London, London WC1X 8EE, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| |
Collapse
|
9
|
van Leeuwen JEP, Crutch SJ, Warren JD. Thinking eyes: visual thinking strategies and the social brain. Front Psychol 2023; 14:1222608. [PMID: 37829065 PMCID: PMC10565500 DOI: 10.3389/fpsyg.2023.1222608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023] Open
Abstract
The foundation of art processes in the social brain can guide the scientific study of how human beings perceive and interact with their environment. Here, we applied the theoretical frameworks of the social and artistic brain connectomes to an eye-tracking paradigm with the aim to elucidate how different viewing conditions and social cues influence gaze patterns and personal resonance with artworks and complex imagery in healthy adults. We compared two viewing conditions that encourage personal or social perspective taking-modeled on the well-known Visual Thinking Strategies (VTS) method-to a viewing condition during which only contextual information about the image was provided. Our findings showed that the viewing conditions that used VTS techniques directed the gaze more toward highly salient social cues (Animate elements) in artworks and complex imagery, compared to when only contextual information was provided. We furthermore found that audio cues also directed visual attention, whereby listening to a personal reflection by another person (VTS) had a stronger effect than contextual information. However, we found no effect of viewing condition on the personal resonance with the artworks and complex images when taking the random effects of the image selection into account. Our study provides a neurobiological grounding of the VTS method in the social brain, revealing that this pedagogical method of engaging viewers with artworks measurably shapes people's visual exploration patterns. This is not only of relevance to (art) education but also has implications for art-based diagnostic and therapeutic applications.
Collapse
Affiliation(s)
- Janneke E. P. van Leeuwen
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The Thinking Eye, ACAVA Limehouse Art Foundation, London, United Kingdom
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D. Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
10
|
Magen I, Yacovzada NS, Warren JD, Heller C, Swift I, Bobeva Y, Malaspina A, Rohrer JD, Fratta P, Hornstein E. microRNA-based predictor for diagnosis of frontotemporal dementia. Neuropathol Appl Neurobiol 2023; 49:e12916. [PMID: 37317649 DOI: 10.1111/nan.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
AIMS This study aimed to explore the non-linear relationships between cell-free microRNAs (miRNAs) and their contribution to prediction of Frontotemporal dementia (FTD), an early onset dementia that is clinically heterogeneous, and too often suffers from delayed diagnosis. METHODS We initially studied a training cohort of 219 subjects (135 FTD and 84 non-neurodegenerative controls) and then validated the results in a cohort of 74 subjects (33 FTD and 41 controls). RESULTS On the basis of cell-free plasma miRNA profiling by next generation sequencing and machine learning approaches, we develop a non-linear prediction model that accurately distinguishes FTD from non-neurodegenerative controls in ~90% of cases. CONCLUSIONS The fascinating potential of diagnostic miRNA biomarkers might enable early-stage detection and a cost-effective screening approach for clinical trials that can facilitate drug development.
Collapse
Affiliation(s)
- Iddo Magen
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Nancy-Sarah Yacovzada
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Carolin Heller
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Imogen Swift
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Yoana Bobeva
- Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea Malaspina
- Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Pietro Fratta
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Eran Hornstein
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| |
Collapse
|
11
|
Volkmer A, Walton H, Swinburn K, Spector A, Warren JD, Beeke S. Results from a randomised controlled pilot study of the Better Conversations with Primary Progressive Aphasia (BCPPA) communication partner training program for people with PPA and their communication partners. Pilot Feasibility Stud 2023; 9:87. [PMID: 37221614 PMCID: PMC10203671 DOI: 10.1186/s40814-023-01301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND There has been a growing focus on functional communication interventions for primary progressive aphasia (PPA). These interventions aim to support individuals to participate in life situations. One such intervention, communication partner training (CPT) aims to change conversation behaviours in both the person with PPA and their communication partner (CP). CPT has a growing evidence base in stroke aphasia; however, these programmes are not designed to meet the needs of people with progressive communication difficulties. To address this, the authors developed a CPT program entitled Better Conversations with PPA (BCPPA) and undertook a pilot trial to establish for a future full trial; predicted recruitment rates, acceptability, an assessment of treatment fidelity and an appropriate primary outcome measure. METHODOLOGY This was a single-blind, randomised controlled pilot study comparing BCPPA to no treatment, delivered across 11 National Health Service Trusts in the UK. A random sample of eight recordings of local collaborators delivering the intervention were analysed to examine fidelity. Participants completed feedback forms reporting on acceptability. Pre- and post-intervention measures targeted conversation behaviours, communication goals and quality of life. RESULTS Eighteen people with PPA and their CPs (9 randomised to BCPPA, 9 randomised to no treatment) completed the study. Participants in the intervention group rated BCPPA positively. Treatment fidelity was 87.2%. Twenty-nine of 30 intervention goals were achieved or over-achieved and 16 of 30 coded conversation behaviours demonstrated change in the intended direction. The Aphasia Impact Questionnaire was identified as the preferred outcome measure. CONCLUSION The first randomised controlled UK pilot study of a CPT program for people with PPA and their families demonstrates BCPPA is a promising intervention. The intervention was acceptable, treatment fidelity high and an appropriate measure identified. Results of this study indicate a future RCT of BCPPA is feasible. TRIAL REGISTRATION Registered 28/02/2018 ISRCTN10148247 .
Collapse
Affiliation(s)
- A Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK.
| | - H Walton
- Department of Applied Health Research, UCL, London, UK
| | - K Swinburn
- Division of Psychology and Language Sciences, University College London, London, UK
| | - A Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - J D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - S Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
| |
Collapse
|
12
|
Loizidou M, Brotherhood E, Harding E, Crutch S, Warren JD, Hardy CJ, Volkmer A. 'Like going into a chocolate shop, blindfolded': What do people with primary progressive aphasia want from speech and language therapy? Int J Lang Commun Disord 2023; 58:737-755. [PMID: 36448629 PMCID: PMC10947572 DOI: 10.1111/1460-6984.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/17/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) describes a group of language-led dementias. PPAs are complex, diverse and difficult to diagnose, and therefore conventional models of aphasia and dementia treatment do not meet their needs. The research evidence on intervention for PPA is developing, but to date there are only a few case studies exploring the experiences of people with PPA (PwPPA) themselves. AIMS To explore the experiences and opinions of PwPPA and their communication partners (CPs) to understand how speech and language therapy (SLT) services can better meet their needs. METHODS & PROCEDURES A qualitative research approach was used whereby PwPPA and their friends or family members were recruited to participate in focus groups, via advertisements in the Rare Dementia Support PPA group newsletters. Consenting participants were allocated to attend one of four focus groups hosted on an online video conferencing platform. Participants were asked about their communication difficulties, and how SLT could address these needs. All meetings were transcribed, and data were examined using reflexive thematic analysis. OUTCOMES & RESULTS Six PwPPA and 14 CPs representing all three PPA variants and mixed PPA participated in the focus groups. Four main themes were identified during the analysis of the focus group discussions: (1) CPs' burden, (2) adjusting to the diagnosis, (3) communication abilities and difficulties and (4) beyond language. A further 10 subthemes were identified. CONCLUSIONS & IMPLICATIONS This study provides a greater understanding of the experiences and needs of PwPPA and their families in relation to SLT. This work underlines the importance of a person-centred approach that considers the broader needs of both the PwPPA and the people around them. This will enable service providers to deliver SLT that meets the needs of PwPPA and their families and will also inform future research in this field. WHAT THIS PAPER ADDS What is already known on this subject We know that PwPPA can maintain or even make improvements in word retrieval and speech fluency with SLT exercises. There is also developing evidence of the benefits of interventions such as CP training, communication aid support and other functional interventions. What this paper adds to existing knowledge This study provides an understanding of the experiences and opinions of people living with PPA and their families in relation to SLT. Results demonstrate that PwPPA and their families have to navigate a complex journey, identifying strategies to support communication but also the influence of personality and other cognitive symptoms. SLT was useful, but not always available. What are the potential or actual clinical implications of this work? This study will enable service providers to better plan, justify funding for and delivery of SLT that will meet the needs of PwPPA and their families. Most importantly this work underlines the importance of a person-centred approach, incorporating the broader needs of the person with PPA and those around them.
Collapse
Affiliation(s)
- Maria Loizidou
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Emilie Brotherhood
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Emma Harding
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Sebastian Crutch
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Jason D. Warren
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Chris J.D. Hardy
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Anna Volkmer
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| |
Collapse
|
13
|
Barnes RJ, Warren JD. Shouting from far away: three poems about living with speechlessness. Pract Neurol 2023; 23:176-177. [PMID: 36572531 DOI: 10.1136/pn-2022-003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
We present three poems written from personal experience of living with primary progressive non-fluent aphasia (primary progressive apraxia of speech). The poems provide a window on this illness 'from the inside', and vividly illustrate how intellect and inner life may survive strikingly intact, even after speech is lost.
Collapse
Affiliation(s)
- Rory Jq Barnes
- Specialist Cognitive Disorders Clinic, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
14
|
Hardy CJD, Taylor-Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for primary progressive aphasia. medRxiv 2023:2023.03.13.23286972. [PMID: 36993460 PMCID: PMC10055437 DOI: 10.1101/2023.03.13.23286972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The primary progressive aphasias (PPA) present complex and diverse challenges of diagnosis, management and prognosis. A clinically-informed, syndromic staging system for PPA would take a substantial step toward meeting these challenges. This study addressed this need using detailed, multi-domain mixed-methods symptom surveys of people with lived experience in a large international PPA cohort. We administered structured online surveys to caregivers of patients with a canonical PPA syndromic variant (nonfluent/agrammatic (nvPPA), semantic (svPPA) or logopenic (lvPPA)). In an 'exploratory' survey, a putative list and ordering of verbal communication and nonverbal functioning (nonverbal thinking, conduct and wellbeing, physical) symptoms was administered to 118 caregiver members of the UK national PPA Support Group. Based on feedback, we expanded the symptom list and created six provisional clinical stages for each PPA subtype. In a 'consolidation' survey, these stages were presented to 110 caregiver members of UK and Australian PPA Support Groups, and refined based on quantitative and qualitative feedback. Symptoms were retained if rated as 'present' by a majority (at least 50%) of respondents representing that PPA syndrome, and assigned to a consolidated stage based on majority consensus; the confidence of assignment was estimated for each symptom as the proportion of respondents in agreement with the final staging for that symptom. Qualitative responses were analysed using framework analysis. For each PPA syndrome, six stages ranging from 1 ('Very mild') to 6 ('Profound') were identified; earliest stages were distinguished by syndromic hallmark symptoms of communication dysfunction, with increasing trans-syndromic convergence and dependency for basic activities of daily living at later stages. Spelling errors, hearing changes and nonverbal behavioural features were reported at early stages in all syndromes. As the illness evolved, swallowing and mobility problems were reported earlier in nfvPPA than other syndromes, while difficulty recognising familiar people and household items characterised svPPA and visuospatial symptoms were more prominent in lvPPA. Overall confidence of symptom staging was higher for svPPA than other syndromes. Across syndromes, functional milestones were identified as key deficits that predict the sequence of major daily life impacts and associated management needs. Qualitatively, we identified five major themes encompassing 15 subthemes capturing respondents' experiences of PPA and suggestions for staging implementation. This work introduces a prototypical, symptom-led staging scheme for canonical PPA syndromes: the PPA Progression Planning Aid (PPA 2 ). Our findings have implications for diagnostic and care pathway guidelines, trial design and personalised prognosis and treatment for people living with these diseases.
Collapse
Affiliation(s)
- Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Cathleen Taylor-Rubin
- Uniting War Memorial Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Beatrice Taylor
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Keir XX Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Josh Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- ADAPTlab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Anna Volkmer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Psychology and Language Sciences (PALS), UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| |
Collapse
|
15
|
Samra K, MacDougall AM, Bouzigues A, Bocchetta M, Cash DM, Greaves CV, Convery RS, Hardy C, van Swieten JC, Seelaar H, Jiskoot LC, Moreno F, Sanchez-Valle R, Laforce R, Graff C, Masellis M, Tartaglia MC, Rowe JB, Borroni B, Finger E, Synofzik M, Galimberti D, Vandenberghe R, de Mendonça A, Butler CR, Gerhard A, Ducharme S, Le Ber I, Santana I, Pasquier F, Levin J, Otto M, Sorbi S, Warren JD, Rohrer JD, Russell LL. Genetic forms of primary progressive aphasia within the GENetic Frontotemporal dementia Initiative (GENFI) cohort: comparison with sporadic primary progressive aphasia. Brain Commun 2023; 5:fcad036. [PMID: 36938528 PMCID: PMC10019761 DOI: 10.1093/braincomms/fcad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Primary progressive aphasia is most commonly a sporadic disorder, but in some cases, it can be genetic. This study aimed to understand the clinical, cognitive and imaging phenotype of the genetic forms of primary progressive aphasia in comparison to the canonical nonfluent, semantic and logopenic subtypes seen in sporadic disease. Participants with genetic primary progressive aphasia were recruited from the international multicentre GENetic Frontotemporal dementia Initiative study and compared with healthy controls as well as a cohort of people with sporadic primary progressive aphasia. Symptoms were assessed using the GENetic Frontotemporal dementia Initiative language, behavioural, neuropsychiatric and motor scales. Participants also underwent a cognitive assessment and 3 T volumetric T1-weighted MRI. One C9orf72 (2%), 1 MAPT (6%) and 17 GRN (44%) symptomatic mutation carriers had a diagnosis of primary progressive aphasia. In the GRN cohort, 47% had a diagnosis of nonfluent variant primary progressive aphasia, and 53% had a primary progressive aphasia syndrome that did not fit diagnostic criteria for any of the three subtypes, called primary progressive aphasia-not otherwise specified here. The phenotype of the genetic nonfluent variant primary progressive aphasia group largely overlapped with that of sporadic nonfluent variant primary progressive aphasia, although the presence of an associated atypical parkinsonian syndrome was characteristic of sporadic and not genetic disease. The primary progressive aphasia -not otherwise specified group however was distinct from the sporadic subtypes with impaired grammar/syntax in the presence of relatively intact articulation, alongside other linguistic deficits. The pattern of atrophy seen on MRI in the genetic nonfluent variant primary progressive aphasia group overlapped with that of the sporadic nonfluent variant primary progressive aphasia cohort, although with more posterior cortical involvement, whilst the primary progressive aphasia-not otherwise specified group was strikingly asymmetrical with involvement particularly of the insula and dorsolateral prefrontal cortex but also atrophy of the orbitofrontal cortex and the medial temporal lobes. Whilst there are overlapping symptoms between genetic and sporadic primary progressive aphasia syndromes, there are also distinct features. Future iterations of the primary progressive aphasia consensus criteria should encompass such information with further research needed to understand the earliest features of these disorders, particularly during the prodromal period of genetic disease.
Collapse
Affiliation(s)
- Kiran Samra
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Amy M MacDougall
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Arabella Bouzigues
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Chris Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | | | - Harro Seelaar
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia Universitary Hospital, San Sebastian, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Raquel Sanchez-Valle
- Alzheimer’s disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d’Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec City, Canada
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Galimberti
- Fondazione Ca’ Granda, IRCCS Ospedale Policlinico, Milan, Italy
- University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Service, University Hospitals Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Germany
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Québec, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute – Institut du Cerveau – ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Centre de référence des démences rares ou précoces, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Florence Pasquier
- Univ Lille, Inserm 1172, Lille, France
- Inserm 1172, Lille, France
- CHU, CNR-MAJ, Labex Distalz, LiCEND Lille, France
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
16
|
Chokesuwattanaskul A, Jiang H, Bond RL, Jimenez DA, Russell LL, Sivasathiaseelan H, Johnson JCS, Benhamou E, Agustus JL, van Leeuwen JEP, Chokesuwattanaskul P, Hardy CJD, Marshall CR, Rohrer JD, Warren JD. The architecture of abnormal reward behaviour in dementia: multimodal hedonic phenotypes and brain substrate. Brain Commun 2023; 5:fcad027. [PMID: 36942157 PMCID: PMC10023829 DOI: 10.1093/braincomms/fcad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/11/2022] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Abnormal reward processing is a hallmark of neurodegenerative diseases, most strikingly in frontotemporal dementia. However, the phenotypic repertoire and neuroanatomical substrates of abnormal reward behaviour in these diseases remain incompletely characterized and poorly understood. Here we addressed these issues in a large, intensively phenotyped patient cohort representing all major syndromes of sporadic frontotemporal dementia and Alzheimer's disease. We studied 27 patients with behavioural variant frontotemporal dementia, 58 with primary progressive aphasia (22 semantic variant, 24 non-fluent/agrammatic variant and 12 logopenic) and 34 with typical amnestic Alzheimer's disease, in relation to 42 healthy older individuals. Changes in behavioural responsiveness were assessed for canonical primary rewards (appetite, sweet tooth, sexual activity) and non-primary rewards (music, religion, art, colours), using a semi-structured survey completed by patients' primary caregivers. Changes in more general socio-emotional behaviours were also recorded. We applied multiple correspondence analysis and k-means clustering to map relationships between hedonic domains and extract core factors defining aberrant hedonic phenotypes. Neuroanatomical associations were assessed using voxel-based morphometry of brain MRI images across the combined patient cohort. Altered (increased and/or decreased) reward responsiveness was exhibited by most patients in the behavioural and semantic variants of frontotemporal dementia and around two-thirds of patients in other dementia groups, significantly (P < 0.05) more frequently than in healthy controls. While food-directed changes were most prevalent across the patient cohort, behavioural changes directed toward non-primary rewards occurred significantly more frequently (P < 0.05) in the behavioural and semantic variants of frontotemporal dementia than in other patient groups. Hedonic behavioural changes across the patient cohort were underpinned by two principal factors: a 'gating' factor determining the emergence of altered reward behaviour and a 'modulatory' factor determining how that behaviour is directed. These factors were expressed jointly in a set of four core, trans-diagnostic and multimodal hedonic phenotypes: 'reward-seeking', 'reward-restricted', 'eating-predominant' and 'control-like'-variably represented across the cohort and associated with more pervasive socio-emotional behavioural abnormalities. The principal gating factor was associated (P < 0.05 after correction for multiple voxel-wise comparisons over the whole brain) with a common profile of grey matter atrophy in anterior cingulate, bilateral temporal poles, right middle frontal and fusiform gyri: the cortical circuitry that mediates behavioural salience and semantic and affective appraisal of sensory stimuli. Our findings define a multi-domain phenotypic architecture for aberrant reward behaviours in major dementias, with novel implications for the neurobiological understanding and clinical management of these diseases.
Collapse
Affiliation(s)
- Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Harmony Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca L Bond
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Daniel A Jimenez
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jennifer L Agustus
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Janneke E P van Leeuwen
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
17
|
Drazich-Taylor EHS, Todd E, Convery R, Bocchetta M, Clarke M, Warren JD, Fox NC, Revesz T, Rohrer JD. Q351R MAPT mutation is associated with a mixed 3R/4R tauopathy and a slowly progressive cognitive, behavioural and parkinsonian syndrome. J Neurol Neurosurg Psychiatry 2023; 94:169-171. [PMID: 36229194 DOI: 10.1136/jnnp-2022-329330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Affiliation(s)
| | - Emily Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Mica Clarke
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Tamas Revesz
- UCL Queen Square Institute of Neurology, Queen Square Brain Bank for Neurological Disorders, London, UK
| | - Jonathan Daniel Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
18
|
Jiang J, Requena‐Komuro M, Benhamou E, Johnson J, Sivasathiaseelan H, Chokesuwattanaskul A, Russell LL, Warren JD, Hardy CJD. Processing of acoustically degraded speech in primary progressive aphasia and Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | | | - Elia Benhamou
- Dementia Research Centre, Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jeremy Johnson
- Dementia Research Centre, Institute of Neurology, University College London London United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| |
Collapse
|
19
|
Chokesuwattanaskul A, Marshall CR, van Harskamp N, Houlden H, Rohrer JD, Hardy CJ, Warren JD. Primary progressive aphasia: ReADing the clinical GRANularity. Pract Neurol 2022; 22:509-514. [PMID: 35710752 DOI: 10.1136/practneurol-2022-003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
Primary progressive aphasia remains a diagnostic challenge despite (or even because of) the increasing availability of ancillary tests and biomarkers. We present a 67-year-old man with apparently sporadic logopenic aphasia and positive Alzheimer biomarkers who was subsequently found also to have a pathogenic mutation in the progranulin gene. This was signalled by early atypical features (mild expressive agrammatism and behavioural change, rapid clinical deterioration) around the core logopenic aphasia syndrome. Each of the canonical progressive aphasia syndromes has a 'halo' of less typical variants that may herald alternative or additional pathologies. The accurate diagnosis of primary progressive aphasia depends on careful clinical analysis to direct investigations appropriately.
Collapse
Affiliation(s)
- Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natasja van Harskamp
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Henry Houlden
- Department of Neurogenetics, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
20
|
Jiang J, Johnson J, Requena‐Komuro M, Benhamou E, Sivasathiaseelan H, Volkmer A, Crutch SJ, Hardy CJD, Warren JD. Phonemic restoration in Alzheimer’s disease and semantic dementia. Alzheimers Dement 2022. [DOI: 10.1002/alz.064219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jeremy Johnson
- Dementia Research Centre, Institute of Neurology, University College London London United Kingdom
| | | | - Elia Benhamou
- Dementia Research Centre, Queen Square Institute of Neurology, University College London London United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | | | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| |
Collapse
|
21
|
Jiang J, Requena‐Komuro M, Benhamou E, Johnson J, Sivasathiaseelan H, Chokesuwattanaskul A, Russell LL, Warren JD, Hardy CJD. Processing of acoustically degraded emotional prosody in primary progressive aphasia and Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | | | - Elia Benhamou
- Dementia Research Centre, Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jeremy Johnson
- Dementia Research Centre, Institute of Neurology, University College London London United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| |
Collapse
|
22
|
Requena-Komuro MC, Jiang J, Dobson L, Benhamou E, Russell L, Bond RL, Brotherhood EV, Greaves C, Barker S, Rohrer JD, Crutch SJ, Warren JD, Hardy CJ. Remote versus face-to-face neuropsychological testing for dementia research: a comparative study in people with Alzheimer's disease, frontotemporal dementia and healthy older individuals. BMJ Open 2022; 12:e064576. [PMID: 36428012 PMCID: PMC9702828 DOI: 10.1136/bmjopen-2022-064576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES We explored whether adapting neuropsychological tests for online administration during the COVID-19 pandemic was feasible for dementia research. DESIGN We used a longitudinal design for healthy controls, who completed face-to-face assessments 3-4 years before remote assessments. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched for age/education/severity. SETTING Remote assessments were conducted using video-conferencing/online testing platforms, with participants using a personal computer/tablet at home. Face-to-face assessments were conducted in testing rooms at our research centre. PARTICIPANTS The remote cohort comprised 25 patients (n=8 Alzheimer's disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive non-fluent aphasia (PNFA); n=5 logopenic aphasia (LPA)). The face-to-face patient cohort comprised 64 patients (n=25 AD; n=12 bvFTD; n=9 SD; n=12 PNFA; n=6 LPA). Ten controls who previously participated in face-to-face research also took part remotely. OUTCOME MEASURES The outcome measures comprised the strength of evidence under a Bayesian framework for differences in performances between testing environments on general neuropsychological and neurolinguistic measures. RESULTS There was substantial evidence suggesting no difference across environments in both the healthy control and combined patient cohorts (including measures of working memory, single-word comprehension, arithmetic and naming; Bayes Factors (BF)01 >3), in the healthy control group alone (including measures of letter/category fluency, semantic knowledge and bisyllabic word repetition; all BF01 >3), and in the combined patient cohort alone (including measures of working memory, episodic memory, short-term verbal memory, visual perception, non-word reading, sentence comprehension and bisyllabic/trisyllabic word repetition; all BF01 >3). In the control cohort alone, there was substantial evidence in support of a difference across environments for tests of visual perception (BF01=0.0404) and monosyllabic word repetition (BF01=0.0487). CONCLUSIONS Our findings suggest that remote delivery of neuropsychological tests for dementia research is feasible.
Collapse
Affiliation(s)
- Maï-Carmen Requena-Komuro
- Dementia Research Centre, University College London, London, UK
- Kidney Cancer Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Jiang
- Dementia Research Centre, University College London, London, UK
| | - Lucianne Dobson
- Dementia Research Centre, University College London, London, UK
| | - Elia Benhamou
- Dementia Research Centre, University College London, London, UK
- Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Lucy Russell
- Dementia Research Centre, University College London, London, UK
| | - Rebecca L Bond
- Dementia Research Centre, University College London, London, UK
| | | | | | - Suzie Barker
- Dementia Research Centre, University College London, London, UK
| | | | | | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, University College London, London, UK
| |
Collapse
|
23
|
van ‘t Hooft JJ, Fieldhouse JLP, Singleton EH, Jaschke AC, Warren JD, Tijms BM, Pijnenburg YAL. Music appreciation phenotypes in patients with frontotemporal dementia: A pilot study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5793. [PMID: 35962477 PMCID: PMC9544804 DOI: 10.1002/gps.5793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Frontotemporal dementia (FTD) can present with changes in music appreciation. Research has suggested a relationship of altered music appreciation phenotypes with typical socio-emotional changes. We aimed to determine the prevalence and severity of music appreciation phenotypes in FTD and study the relationship with emotion recognition capacities in order to examine whether they could serve as a proxy for changes in socio-emotional functioning. METHODS/DESIGN Based on reported musical changes in the literature, we developed an informant-based questionnaire to assess musical changes and a music test to assess music emotion recognition. Social cognition was assessed with the Ekman 60 faces test in a subgroup of patients (n = 23). Relationships between measures were assessed with linear regressions. RESULTS We included 47 patients (44.7% female, mean age 65.0 ± 8.4, 31 behavioral variant FTD (bvFTD), 10 semantic dementia (SD), and six progressive nonfluent aphasia (PNFA)). Thirty-six caregivers were included in the music emotion recognition test as controls. Altered music appreciation phenotypes were observed in 79% of the FTD patients. Musicophilia was present in a third of bvFTD patients, and only in up to 10% in language FTD variants. Changes in music appreciation were not associated with decreased music emotion recognition or visual emotion recognition. Compared to controls, bvFTD performed worse on the music emotion recognition task (p < 0.003), and no differences were found with SD (p = 0.06) and PNFA patients (p = 0.8). CONCLUSIONS Music appreciation phenotypes are highly prevalent in FTD patients. Future studies should further investigate the potential diagnostic value of changes in music processing.
Collapse
Affiliation(s)
- Jochum J. van ‘t Hooft
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Jay L. P. Fieldhouse
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Ellen H. Singleton
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Artur C. Jaschke
- Music TherapyArtEZ University of the ArtsEnschedeThe Netherlands,Clinical NeuropsychologyVU University AmsterdamAmsterdamThe Netherlands,NeonatologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jason D. Warren
- Dementia Research CentreUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Betty M. Tijms
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| |
Collapse
|
24
|
Jiang J, Johnson JCS, Requena-Komuro MC, Benhamou E, Sivasathiaseelan H, Sheppard DL, Volkmer A, Crutch SJ, Hardy CJD, Warren JD. Phonemic restoration in Alzheimer's disease and semantic dementia: a preliminary investigation. Brain Commun 2022; 4:fcac118. [PMID: 35611314 PMCID: PMC9123842 DOI: 10.1093/braincomms/fcac118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Phonemic restoration-perceiving speech sounds that are actually missing-is a fundamental perceptual process that 'repairs' interrupted spoken messages during noisy everyday listening. As a dynamic, integrative process, phonemic restoration is potentially affected by neurodegenerative pathologies, but this has not been clarified. Here, we studied this phenomenon in 5 patients with typical Alzheimer's disease and 4 patients with semantic dementia, relative to 22 age-matched healthy controls. Participants heard isolated sounds, spoken real words and pseudowords in which noise bursts either overlaid a consonant or replaced it; a tendency to hear replaced (missing) speech sounds as present signified phonemic restoration. All groups perceived isolated noises normally and showed phonemic restoration of real words, most marked in Alzheimer's patients. For pseudowords, healthy controls showed no phonemic restoration, while Alzheimer's patients showed marked suppression of phonemic restoration and patients with semantic dementia contrastingly showed phonemic restoration comparable to real words. Our findings provide the first evidence that phonemic restoration is preserved or even enhanced in neurodegenerative diseases, with distinct syndromic profiles that may reflect the relative integrity of bottom-up phonological representation and top-down lexical disambiguation mechanisms in different diseases. This work has theoretical implications for predictive coding models of language and neurodegenerative disease and for understanding cognitive 'repair' processes in dementia. Future research should expand on these preliminary observations with larger cohorts.
Collapse
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Maï-Carmen Requena-Komuro
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Damion L. Sheppard
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Anna Volkmer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK,Correspondence to: Prof. Jason D. Warren Dementia Research Centre UCL Institute of Neurology First Floor 8–11 Queen Square London WC1N 3AR, UK E-mail:
| |
Collapse
|
25
|
Bolton LM, Jiang J, Warren JD. Music as a person centred intervention for dementia. BMJ 2022; 376:o518. [PMID: 35232723 DOI: 10.1136/bmj.o518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Jessica Jiang
- Dementia Research Centre, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| |
Collapse
|
26
|
van Leeuwen JEP, Boomgaard J, Bzdok D, Crutch SJ, Warren JD. More Than Meets the Eye: Art Engages the Social Brain. Front Neurosci 2022; 16:738865. [PMID: 35281491 PMCID: PMC8914233 DOI: 10.3389/fnins.2022.738865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Here we present the viewpoint that art essentially engages the social brain, by demonstrating how art processing maps onto the social brain connectome-the most comprehensive diagram of the neural dynamics that regulate human social cognition to date. We start with a brief history of the rise of neuroaesthetics as the scientific study of art perception and appreciation, in relation to developments in contemporary art practice and theory during the same period. Building further on a growing awareness of the importance of social context in art production and appreciation, we then set out how art engages the social brain and outline candidate components of the "artistic brain connectome." We explain how our functional model for art as a social brain phenomenon may operate when engaging with artworks. We call for closer collaborations between the burgeoning field of neuroaesthetics and arts professionals, cultural institutions and diverse audiences in order to fully delineate and contextualize this model. Complementary to the unquestionable value of art for art's sake, we argue that its neural grounding in the social brain raises important practical implications for mental health, and the care of people living with dementia and other neurological conditions.
Collapse
Affiliation(s)
- Janneke E. P. van Leeuwen
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The Thinking Eye, ACAVA Limehouse Arts Foundation, London, United Kingdom
| | - Jeroen Boomgaard
- Research Group Art and Public Space, Gerrit Rietveld Academie, Amsterdam, Netherlands
| | - Danilo Bzdok
- Department of Biomedical Engineering, McGill University, Montréal, ON, Canada
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D. Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
27
|
Belder CRS, Chokesuwattanaskul A, Marshall CR, Hardy CJD, Rohrer JD, Warren JD. The problematic syndrome of right temporal lobe atrophy: Unweaving the phenotypic rainbow. Front Neurol 2022; 13:1082828. [PMID: 36698890 PMCID: PMC9868162 DOI: 10.3389/fneur.2022.1082828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Christopher R S Belder
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Anthipa Chokesuwattanaskul
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
28
|
Shapiro NL, Todd EG, Billot B, Cash DM, Iglesias JE, Warren JD, Rohrer JD, Bocchetta M. In vivo hypothalamic regional volumetry across the frontotemporal dementia spectrum. Neuroimage Clin 2022; 35:103084. [PMID: 35717886 PMCID: PMC9218583 DOI: 10.1016/j.nicl.2022.103084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) is a spectrum of diseases characterised by language, behavioural and motor symptoms. Among the different subcortical regions implicated in the FTD symptomatology, the hypothalamus regulates various bodily functions, including eating behaviours which are commonly present across the FTD spectrum. The pattern of specific hypothalamic involvement across the clinical, pathological, and genetic forms of FTD has yet to be fully investigated, and its possible associations with abnormal eating behaviours have yet to be fully explored. METHODS Using an automated segmentation tool for volumetric T1-weighted MR images, we measured hypothalamic regional volumes in a cohort of 439 patients with FTD (197 behavioural variant FTD [bvFTD]; 7 FTD with associated motor neurone disease [FTD-MND]; 99 semantic variant primary progressive aphasia [svPPA]; 117 non-fluent variant PPA [nfvPPA]; 19 PPA not otherwise specified [PPA-NOS]) and 118 age-matched controls. We compared volumes across the clinical, genetic (29 MAPT, 32 C9orf72, 23 GRN), and pathological diagnoses (61 tauopathy, 40 TDP-43opathy, 4 FUSopathy). We correlated the volumes with presence of abnormal eating behaviours assessed with the revised version of the Cambridge Behavioural Inventory (CBI-R). RESULTS On average, FTD patients showed 14% smaller hypothalamic volumes than controls. The groups with the smallest hypothalamic regions were FTD-MND (20%), MAPT (25%) and FUS (33%), with differences mainly localised in the anterior and posterior regions. The inferior tuberal region was only significantly smaller in tauopathies (MAPT and Pick's disease) and in TDP-43 type C compared to controls and was the only regions that did not correlate with eating symptoms. PPA-NOS and nfvPPA were the groups with the least frequent eating behaviours and the least hypothalamic involvement. CONCLUSIONS Abnormal hypothalamic volumes are present in all the FTD forms, but different hypothalamic regions might play a different role in the development of abnormal eating behavioural and metabolic symptoms. These findings might therefore help in the identification of different underlying pathological mechanisms, suggesting the potential use of hypothalamic imaging biomarkers and the research of potential therapeutic targets within the hypothalamic neuropeptides.
Collapse
Affiliation(s)
- Noah L Shapiro
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK
| | - Emily G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK
| | - Benjamin Billot
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK; UK Dementia Research Institute at UCL, UCL, London, UK
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK; Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, USA
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, UK.
| |
Collapse
|
29
|
Russell LL, Greaves CV, Convery RS, Bocchetta M, Warren JD, Kaski D, Rohrer JD. Eye movements in frontotemporal dementia: Abnormalities of fixation, saccades and anti-saccades. Alzheimers Dement (N Y) 2021; 7:e12218. [PMID: 35005203 PMCID: PMC8719345 DOI: 10.1002/trc2.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/29/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Oculomotor function has not been systematically studied in frontotemporal dementia (FTD) and yet may offer a simple target to monitor disease activity. METHODS We assessed fixation stability, smooth pursuit, pro-saccades, and anti-saccades using the Eyelink 1000-plus eye-tracker in 19 individuals with behavioral variant FTD (bvFTD) and 22 controls. Neuroanatomical correlates were assessed using a region of interest magnetic resonance imaging (MRI) analysis. RESULTS Measures of fixation stability were impaired in the bvFTD group compared with controls. However, performance did not differ from controls in the pro-saccade tasks except in the vertical overlap condition. The bvFTD group performed worse in the anti-saccade task, which correlated strongly with executive function. Neural correlates included the orbitofrontal and ventromedial prefrontal cortices and striatum for fixation stability, and the dorsolateral prefrontal and parietal cortices and striatum for anti-saccades. DISCUSSION Overall, oculomotor function is abnormal in bvFTD, with performance likely related to impairment of inhibitory control and executive dysfunction.
Collapse
Affiliation(s)
- Lucy L. Russell
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| | - Caroline V. Greaves
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| | - Rhian S. Convery
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Motor NeurosciencesUCL Queen Square Institute of NeurologyLondonUK
| | - Jonathan D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK
| |
Collapse
|
30
|
Agustus JL, Volkmer A, Jeong TH, Jiang J, Brotherhood EV, Dobson L, Harding E, Gonzalez AS, Crutch SJ, Warren JD, Hardy CJD. Communication during Covid‐19: Use of video conferencing technology by people living with dementia. Alzheimers Dement 2021. [PMCID: PMC9011500 DOI: 10.1002/alz.057803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The use of videoconferencing technology has increased as an alternative communication method for people to retain social and clinical contact during Covid‐19 restrictions. This study investigated the uptake, limitations and benefits of videoconferencing for people living with dementia (PLWD). Method Twenty‐three PLWD, 87 caregivers (on behalf of PLWD) and 39 healthy control participants anonymously reported their experiences of using videoconferencing technology during the Covid‐19 pandemic (PLWD: 38‐90 years; controls: 32‐100 years). The online survey ran between December 2020 and April 2021. Respondents represented experiences of people living with Alzheimer’s Disease (AD; 27), Frontotemporal Dementia (FTD; 23), Primary Progressive Aphasia (PPA; 24), Posterior Cortical Atrophy (PCA; 22), Lewy Body Dementia (LDB; 7). Mann‐Whitney U tests were used to compare Likert ratings of videoconferencing experiences between PLWD or diagnostic subgroups and controls. Result The majority of survey respondents that use videoconferencing technology reported an increased usage during the Covid‐19 pandemic than before (85%). However, 28% of PLWD did not use videoconferencing at all, compared to 3% of healthy controls. Only 53% of PLWD reported they liked using videoconferencing technology compared to 67% of controls, and this was lowest for people with LBD (33%) or PCA (40%). Interestingly, 64% of people with FTD liked videoconferencing and rated it more engaging than traditional telephone calls compared to healthy controls (p=0.045). People with AD, PCA and FTD found online meetings with multiple people more difficult than controls (p=0.036; p<0.001; p=0.030). Qualitative responses to questions on telemedicine were mixed, with PLWD three times more likely to report overall negative consequences (e.g. “communication better face‐to‐face”) than positive benefits (e.g. “less tiring”) for cognitive clinic and dementia‐related GP appointments, compared to face‐to‐face visits. Conclusion The use of videoconferencing by PLWD and healthy controls has increased during the Covid‐19 pandemic. However, a significant proportion of PLWD surveyed are not able to use these technologies, with different profiles of uptake and enthusiasm across dementia subtypes. Our findings suggest that whilst representing a helpful alternative to face‐to‐face communication during the pandemic, videoconferencing (particularly in clinical settings) may be a significant barrier to communication for some people with cognitive impairment.
Collapse
Affiliation(s)
- Jennifer L Agustus
- UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | | | - Tina Hyerim Jeong
- UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Lucianne Dobson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| |
Collapse
|
31
|
van 't Hooft JJ, Fieldhouse JL, Singleton EH, Jaschke AC, Warren JD, Tijms BM, Pijnenburg YA. Altered music processing phenotypes in patients with frontotemporal dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.051375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jochum J. van 't Hooft
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Jay L.P. Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Ellen H. Singleton
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Artur C. Jaschke
- Music Therapy, ArtEZ University of the Arts Enschede Netherlands
- Clinical Neuropsychology, VU University Amsterdam Amsterdam Netherlands
- Neonatology, University Medical Center Groningen Groningen Netherlands
| | - Jason D. Warren
- Dementia Research Centre, Institute of Neurology, University College London London United Kingdom
| | - Betty M. Tijms
- Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| |
Collapse
|
32
|
Jeong TH, Volkmer A, Jiang J, Brotherhood EV, Dobson L, Harding E, Suarez‐Gonzalez A, Crutch SJ, Warren JD, Hardy CJD, Agustus JL. Communication during Covid‐19: Impacts of face coverings on people living with dementia. Alzheimers Dement 2021. [PMCID: PMC9011681 DOI: 10.1002/alz.057733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The compulsory introduction of wearing face coverings and social distancing to curb the spread of Covid‐19 in the United Kingdom has reduced both the quality of auditory information and availability of visual and non‐verbal cues during conversations with others. This is likely to have a greater impact on efficiency and effectiveness of communication for people living with dementia and particularly those with a language‐led dementia: Primary Progressive Aphasia (PPA). Method Twenty‐four people living with dementia (PLWD), 95 caregivers (on behalf of PLWD) and 38 healthy older controls anonymously reported their experiences of wearing face coverings and the associated impacts on communication via an online survey that ran between December 2020 and April 2021 (age ranges: PLWD 38‐90 years; controls 32‐100 years). The majority of questions were self‐reflective experiences compared to when not wearing face coverings. Mann‐Whitney U tests were used to compare Likert ratings for impact of wearing face coverings on aspects of speaking, listening and holding conversations between PLWD or diagnosis subgroups (27 PPA; 26 Frontotemporal Dementia, FTD; 29 Alzheimer’s disease, AD; 24 Posterior Cortical Atrophy, PCA) and the controls. Result Wearing a face covering made both speaking (80%) and listening (90%) more effortful for the majority of survey respondents and had a greater impact on people living with PPA. Overall PLWD were more likely to require help communicating and those with PPA relied more on non‐verbal strategies (e.g. body language or gestures) than when not wearing a face covering, compared to controls (p=0.001) and other diagnosis subgroups. People with PPA also experienced greater difficulty understanding across diverse everyday listening conditions and most aspects of conversation than controls (p<0.05). People with PCA (p=0.039) also had more difficulty knowing when it was their turn to speak and those with FTD had more difficulty speaking over others (p=0.032), compared to controls. The use of face coverings during the Covid‐19 pandemic also prevented more PLWD from taking part in activities than controls. Conclusion PLWD, and in particular those with a diagnosis of PPA, are particularly susceptible to the negative impacts of the use of face coverings on communication.
Collapse
Affiliation(s)
- Tina Hyerim Jeong
- UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | | | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Lucianne Dobson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Aida Suarez‐Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jennifer L Agustus
- UCL Queen Square Institute of Neurology, University College London London United Kingdom
| |
Collapse
|
33
|
Volkmer A, Spector A, Swinburn K, Warren JD, Beeke S. Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA. BMC Geriatr 2021; 21:642. [PMID: 34781875 PMCID: PMC8591912 DOI: 10.1186/s12877-021-02561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia. Methods The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement. Results Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future. Conclusions Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02561-8.
Collapse
Affiliation(s)
- Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK. .,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK.
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Kate Swinburn
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
| |
Collapse
|
34
|
Sogorb-Esteve A, Swift IJ, Woollacott IOC, Warren JD, Zetterberg H, Rohrer JD. Differential chemokine alteration in the variants of primary progressive aphasia-a role for neuroinflammation. J Neuroinflammation 2021; 18:224. [PMID: 34602080 PMCID: PMC8489077 DOI: 10.1186/s12974-021-02247-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary progressive aphasias (PPA) represent a group of usually sporadic neurodegenerative disorders with three main variants: the nonfluent or agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA). They are usually associated with a specific underlying pathology: nfvPPA with a primary tauopathy, svPPA with a TDP-43 proteinopathy, and lvPPA with underlying Alzheimer's disease (AD). Little is known about their cause or pathophysiology, but prior studies in both AD and svPPA have suggested a role for neuroinflammation. In this study, we set out to investigate the role of chemokines across the PPA spectrum, with a primary focus on central changes in cerebrospinal fluid (CSF) METHODS: Thirty-six participants with sporadic PPA (11 svPPA, 13 nfvPPA, and 12 lvPPA) as well as 19 healthy controls were recruited to the study and donated CSF and plasma samples. All patients with lvPPA had a tau/Aβ42 biomarker profile consistent with AD, whilst this was normal in the other PPA groups and controls. We assessed twenty chemokines in CSF and plasma using Proximity Extension Assay technology: CCL2 (MCP-1), CCL3 (MIP-1a), CCL4 (MIP-1β), CCL7 (MCP-3), CCL8 (MCP-2), CCL11 (eotaxin), CCL13 (MCP-4), CCL19, CCL20, CCL23, CCL25, CCL28, CX3CL1 (fractalkine), CXCL1, CXCL5, CXCL6, CXCL8 (IL-8), CXCL9, CXCL10, and CXCL11. RESULTS In CSF, CCL19 and CXCL6 were decreased in both svPPA and nfvPPA compared with controls whilst CXCL5 was decreased in the nfvPPA group with a borderline significant decrease in the svPPA group. In contrast, CCL2, CCL3 and CX3CL1 were increased in lvPPA compared with controls and nfvPPA (and greater than svPPA for CX3CL1). CXCL1 was also increased in lvPPA compared with nfvPPA but not the other groups. CX3CL1 was significantly correlated with CSF total tau concentrations in the controls and each of the PPA groups. Fewer significant differences were seen between groups in plasma, although in general, results were in the opposite direction to CSF, i.e. decreased in lvPPA compared with controls (CCL3 and CCL19), and increased in svPPA (CCL8) and nfvPPA (CCL13). CONCLUSION Differential alteration of chemokines across the PPA variants is seen in both CSF and plasma. Importantly, these results suggest a role for neuroinflammation in these poorly understood sporadic disorders, and therefore also a potential future therapeutic target.
Collapse
Affiliation(s)
- Aitana Sogorb-Esteve
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, University College London, London, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Imogen J Swift
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, University College London, London, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Ione O C Woollacott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jason D Warren
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
| |
Collapse
|
35
|
Sivasathiaseelan H, Marshall CR, Benhamou E, van Leeuwen JEP, Bond RL, Russell LL, Greaves C, Moore KM, Hardy CJD, Frost C, Rohrer JD, Scott SK, Warren JD. Laughter as a paradigm of socio-emotional signal processing in dementia. Cortex 2021; 142:186-203. [PMID: 34273798 PMCID: PMC8438290 DOI: 10.1016/j.cortex.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/01/2021] [Accepted: 05/21/2021] [Indexed: 11/03/2022]
Abstract
Laughter is a fundamental communicative signal in our relations with other people and is used to convey a diverse repertoire of social and emotional information. It is therefore potentially a useful probe of impaired socio-emotional signal processing in neurodegenerative diseases. Here we investigated the cognitive and affective processing of laughter in forty-seven patients representing all major syndromes of frontotemporal dementia, a disease spectrum characterised by severe socio-emotional dysfunction (twenty-two with behavioural variant frontotemporal dementia, twelve with semantic variant primary progressive aphasia, thirteen with nonfluent-agrammatic variant primary progressive aphasia), in relation to fifteen patients with typical amnestic Alzheimer's disease and twenty healthy age-matched individuals. We assessed cognitive labelling (identification) and valence rating (affective evaluation) of samples of spontaneous (mirthful and hostile) and volitional (posed) laughter versus two auditory control conditions (a synthetic laughter-like stimulus and spoken numbers). Neuroanatomical associations of laughter processing were assessed using voxel-based morphometry of patients' brain MR images. While all dementia syndromes were associated with impaired identification of laughter subtypes relative to healthy controls, this was significantly more severe overall in frontotemporal dementia than in Alzheimer's disease and particularly in the behavioural and semantic variants, which also showed abnormal affective evaluation of laughter. Over the patient cohort, laughter identification accuracy was correlated with measures of daily-life socio-emotional functioning. Certain striking syndromic signatures emerged, including enhanced liking for hostile laughter in behavioural variant frontotemporal dementia, impaired processing of synthetic laughter in the nonfluent-agrammatic variant (consistent with a generic complex auditory perceptual deficit) and enhanced liking for numbers ('numerophilia') in the semantic variant. Across the patient cohort, overall laughter identification accuracy correlated with regional grey matter in a core network encompassing inferior frontal and cingulo-insular cortices; and more specific correlates of laughter identification accuracy were delineated in cortical regions mediating affective disambiguation (identification of hostile and posed laughter in orbitofrontal cortex) and authenticity (social intent) decoding (identification of mirthful and posed laughter in anteromedial prefrontal cortex) (all p < .05 after correction for multiple voxel-wise comparisons over the whole brain). These findings reveal a rich diversity of cognitive and affective laughter phenotypes in canonical dementia syndromes and suggest that laughter is an informative probe of neural mechanisms underpinning socio-emotional dysfunction in neurodegenerative disease.
Collapse
Affiliation(s)
- Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Elia Benhamou
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Janneke E P van Leeuwen
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Caroline Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katrina M Moore
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris J D Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris Frost
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sophie K Scott
- Institute of Cognitive Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
36
|
Benhamou E, Zhao S, Sivasathiaseelan H, Johnson JCS, Requena-Komuro MC, Bond RL, van Leeuwen JEP, Russell LL, Greaves CV, Nelson A, Nicholas JM, Hardy CJD, Rohrer JD, Warren JD. Decoding expectation and surprise in dementia: the paradigm of music. Brain Commun 2021; 3:fcab173. [PMID: 34423301 PMCID: PMC8376684 DOI: 10.1093/braincomms/fcab173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Making predictions about the world and responding appropriately to unexpected events are essential functions of the healthy brain. In neurodegenerative disorders, such as frontotemporal dementia and Alzheimer's disease, impaired processing of 'surprise' may underpin a diverse array of symptoms, particularly abnormalities of social and emotional behaviour, but is challenging to characterize. Here, we addressed this issue using a novel paradigm: music. We studied 62 patients (24 female; aged 53-88) representing major syndromes of frontotemporal dementia (behavioural variant, semantic variant primary progressive aphasia, non-fluent-agrammatic variant primary progressive aphasia) and typical amnestic Alzheimer's disease, in relation to 33 healthy controls (18 female; aged 54-78). Participants heard famous melodies containing no deviants or one of three types of deviant note-acoustic (white-noise burst), syntactic (key-violating pitch change) or semantic (key-preserving pitch change). Using a regression model that took elementary perceptual, executive and musical competence into account, we assessed accuracy detecting melodic deviants and simultaneously recorded pupillary responses and related these to deviant surprise value (information-content) and carrier melody predictability (entropy), calculated using an unsupervised machine learning model of music. Neuroanatomical associations of deviant detection accuracy and coupling of detection to deviant surprise value were assessed using voxel-based morphometry of patients' brain MRI. Whereas Alzheimer's disease was associated with normal deviant detection accuracy, behavioural and semantic variant frontotemporal dementia syndromes were associated with strikingly similar profiles of impaired syntactic and semantic deviant detection accuracy and impaired behavioural and autonomic sensitivity to deviant information-content (all P < 0.05). On the other hand, non-fluent-agrammatic primary progressive aphasia was associated with generalized impairment of deviant discriminability (P < 0.05) due to excessive false-alarms, despite retained behavioural and autonomic sensitivity to deviant information-content and melody predictability. Across the patient cohort, grey matter correlates of acoustic deviant detection accuracy were identified in precuneus, mid and mesial temporal regions; correlates of syntactic deviant detection accuracy and information-content processing, in inferior frontal and anterior temporal cortices, putamen and nucleus accumbens; and a common correlate of musical salience coding in supplementary motor area (all P < 0.05, corrected for multiple comparisons in pre-specified regions of interest). Our findings suggest that major dementias have distinct profiles of sensory 'surprise' processing, as instantiated in music. Music may be a useful and informative paradigm for probing the predictive decoding of complex sensory environments in neurodegenerative proteinopathies, with implications for understanding and measuring the core pathophysiology of these diseases.
Collapse
Affiliation(s)
- Elia Benhamou
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jeremy C S Johnson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Maï-Carmen Requena-Komuro
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Janneke E P van Leeuwen
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Caroline V Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Annabel Nelson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jennifer M Nicholas
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris J D Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| |
Collapse
|
37
|
Johnson JCS, McWhirter L, Hardy CJD, Crutch SJ, Marshall CR, Mummery CJ, Rohrer JD, Rossor MN, Schott JM, Weil RS, Fox NC, Warren JD. Suspecting dementia: canaries, chameleons and zebras. Pract Neurol 2021; 21:practneurol-2021-003019. [PMID: 34215701 DOI: 10.1136/practneurol-2021-003019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
The early and accurate diagnosis of dementia is more important than ever before but remains challenging. Dementia is increasingly the business of neurologists and, with ageing populations worldwide, will become even more so in future. Here we outline a practical, symptom-led, bedside approach to suspecting dementia and its likely diagnosis, inspired by clinical experience and based on recognition of characteristic syndromic patterns. We show how clinical intuition reflects underlying signature profiles of brain involvement by the diseases that cause dementia and suggest next steps that can be taken to define the diagnosis. We propose 'canaries' that provide an early warning signal of emerging dementia and highlight the 'chameleons' that disguise or mimic this, as well as the 'zebras' that herald a rare (and sometimes curable) diagnostic opportunity.
Collapse
Affiliation(s)
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, London, UK
- Department of Neurology, Royal London Hospital, London, UK
| | | | | | | | | | | | - Nick C Fox
- Dementia Research Centre, UCL, London, UK
| | | |
Collapse
|
38
|
Jiang J, Benhamou E, Waters S, Johnson JCS, Volkmer A, Weil RS, Marshall CR, Warren JD, Hardy CJD. Processing of Degraded Speech in Brain Disorders. Brain Sci 2021; 11:394. [PMID: 33804653 PMCID: PMC8003678 DOI: 10.3390/brainsci11030394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
The speech we hear every day is typically "degraded" by competing sounds and the idiosyncratic vocal characteristics of individual speakers. While the comprehension of "degraded" speech is normally automatic, it depends on dynamic and adaptive processing across distributed neural networks. This presents the brain with an immense computational challenge, making degraded speech processing vulnerable to a range of brain disorders. Therefore, it is likely to be a sensitive marker of neural circuit dysfunction and an index of retained neural plasticity. Considering experimental methods for studying degraded speech and factors that affect its processing in healthy individuals, we review the evidence for altered degraded speech processing in major neurodegenerative diseases, traumatic brain injury and stroke. We develop a predictive coding framework for understanding deficits of degraded speech processing in these disorders, focussing on the "language-led dementias"-the primary progressive aphasias. We conclude by considering prospects for using degraded speech as a probe of language network pathophysiology, a diagnostic tool and a target for therapeutic intervention.
Collapse
Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK;
| | - Rimona S. Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Charles R. Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| |
Collapse
|
39
|
Johnson JCS, Marshall CR, Weil RS, Bamiou DE, Hardy CJD, Warren JD. Hearing and dementia: from ears to brain. Brain 2021; 144:391-401. [PMID: 33351095 PMCID: PMC7940169 DOI: 10.1093/brain/awaa429] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022] Open
Abstract
The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between 'peripheral' and 'central' hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer's disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory 'cognitive stress tests' and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.
Collapse
Affiliation(s)
- Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Rimona S Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Movement Disorders Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCL/UCLH Biomedical Research Centre, National Institute for Health Research, University College London, London, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
40
|
Russell LL, Greaves CV, Convery RS, Nicholas J, Warren JD, Kaski D, Rohrer JD. Novel instructionless eye tracking tasks identify emotion recognition deficits in frontotemporal dementia. Alzheimers Res Ther 2021; 13:39. [PMID: 33557926 PMCID: PMC7871635 DOI: 10.1186/s13195-021-00775-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022]
Abstract
Background Current tasks measuring social cognition are usually ‘pen and paper’ tasks, have ceiling effects and include complicated test instructions that may be difficult to understand for those with cognitive impairment. We therefore aimed to develop a set of simple, instructionless, quantitative, tasks of emotion recognition using the methodology of eye tracking, with the subsequent aim of assessing their utility in individuals with behavioural variant frontotemporal dementia (bvFTD). Methods Using the Eyelink 1000 Plus eye tracker, 18 bvFTD and 22 controls completed tasks of simple and complex emotion recognition that involved viewing four images (one target face (simple) or pair of eyes (complex) and the others non-target) followed by a target emotion word and lastly the original four images alongside the emotion word. A dwell time change score was then calculated as the main outcome measure by subtracting the percentage dwell time for the target image before the emotion word appeared away from the percentage dwell time for the target image after the emotion word appeared. All participants also underwent a standard cognitive battery and volumetric T1-weighted magnetic resonance imaging. Results Analysis using a mixed effects model showed that the average (standard deviation) mean dwell time change score in the target interest area was 35 (27)% for the control group compared with only 4 (18)% for the bvFTD group (p < 0.05) for the simple emotion recognition task, and 15 (26)% for the control group compared with only 2 (18)% for the bvFTD group (p < 0.05) for the complex emotion recognition task. Worse performance in the bvFTD group correlated with atrophy in the right ventromedial prefrontal and orbitofrontal cortices, brain regions previously implicated in social cognition. Conclusions In summary, eye tracking is a viable tool for assessing social cognition in individuals with bvFTD, being well-tolerated and able to overcome some of the problems associated with standard psychometric tasks. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00775-x.
Collapse
Affiliation(s)
- Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| |
Collapse
|
41
|
Ruksenaite J, Volkmer A, Jiang J, Johnson JC, Marshall CR, Warren JD, Hardy CJ. Primary Progressive Aphasia: Toward a Pathophysiological Synthesis. Curr Neurol Neurosci Rep 2021; 21:7. [PMID: 33543347 PMCID: PMC7861583 DOI: 10.1007/s11910-021-01097-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The term primary progressive aphasia (PPA) refers to a diverse group of dementias that present with prominent and early problems with speech and language. They present considerable challenges to clinicians and researchers. RECENT FINDINGS Here, we review critical issues around diagnosis of the three major PPA variants (semantic variant PPA, nonfluent/agrammatic variant PPA, logopenic variant PPA), as well as considering 'fragmentary' syndromes. We next consider issues around assessing disease stage, before discussing physiological phenotyping of proteinopathies across the PPA spectrum. We also review evidence for core central auditory impairments in PPA, outline critical challenges associated with treatment, discuss pathophysiological features of each major PPA variant, and conclude with thoughts on key challenges that remain to be addressed. New findings elucidating the pathophysiology of PPA represent a major step forward in our understanding of these diseases, with implications for diagnosis, care, management, and therapies.
Collapse
Affiliation(s)
- Justina Ruksenaite
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jeremy Cs Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris Jd Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
42
|
Holmes E, Utoomprurkporn N, Hoskote C, Warren JD, Bamiou DE, Griffiths TD. Simultaneous auditory agnosia: Systematic description of a new type of auditory segregation deficit following a right hemisphere lesion. Cortex 2021; 135:92-107. [PMID: 33360763 PMCID: PMC7856551 DOI: 10.1016/j.cortex.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/17/2020] [Accepted: 10/22/2020] [Indexed: 11/27/2022]
Abstract
We investigated auditory processing in a young patient who experienced a single embolus causing an infarct in the right middle cerebral artery territory. This led to damage to auditory cortex including planum temporale that spared medial Heschl's gyrus, and included damage to the posterior insula and inferior parietal lobule. She reported chronic difficulties with segregating speech from noise and segregating elements of music. Clinical tests showed no evidence for abnormal cochlear function. Follow-up tests confirmed difficulties with auditory segregation in her left ear that spanned multiple domains, including words-in-noise and music streaming. Testing with a stochastic figure-ground task-a way of estimating generic acoustic foreground and background segregation-demonstrated that this was also abnormal. This is the first demonstration of an acquired deficit in the segregation of complex acoustic patterns due to cortical damage, which we argue is a causal explanation for the symptomatic deficits in the segregation of speech and music. These symptoms are analogous to the visual symptom of simultaneous agnosia. Consistent with functional imaging studies on normal listeners, the work implicates non-primary auditory cortex. Further, the work demonstrates a (partial) lateralisation of the necessary anatomical substrate for segregation that has not been previously highlighted.
Collapse
Affiliation(s)
- Emma Holmes
- Wellcome Centre for Human Neuroimaging, UCL, London, UK.
| | - Nattawan Utoomprurkporn
- UCL Ear Institute, UCL, London, UK; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, UCL, London, UK; Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, UCL, London, UK
| | | | - Doris-Eva Bamiou
- UCL Ear Institute, UCL, London, UK; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, UCL, London, UK
| | - Timothy D Griffiths
- Wellcome Centre for Human Neuroimaging, UCL, London, UK; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
43
|
Convery RS, Bocchetta M, Greaves CV, Moore KM, Cash DM, Van Swieten J, Moreno F, Sánchez-Valle R, Borroni B, Laforce R, Masellis M, Tartaglia MC, Graff C, Galimberti D, Rowe JB, Finger E, Synofzik M, Vandenberghe R, de Mendonca A, Tagliavini F, Santana I, Ducharme S, Butler C, Gerhard A, Levin J, Danek A, Otto M, Warren JD, Rohrer JD. Abnormal pain perception is associated with thalamo-cortico-striatal atrophy in C9orf72 expansion carriers in the GENFI cohort. J Neurol Neurosurg Psychiatry 2020; 91:1325-1328. [PMID: 32759310 DOI: 10.1136/jnnp-2020-323279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Frontotemporal dementia (FTD) is typically associated with changes in behaviour, language and movement. However, recent studies have shown that patients can also develop an abnormal response to pain, either heightened or diminished. We aimed to investigate this symptom in mutation carriers within the Genetic FTD Initiative (GENFI). METHODS Abnormal responsiveness to pain was measured in 462 GENFI participants: 281 mutation carriers and 181 mutation-negative controls. Changes in responsiveness to pain were scored as absent (0), questionable or very mild (0.5), mild (1), moderate (2) or severe (3). Mutation carriers were classified into C9orf72 (104), GRN (128) and MAPT (49) groups, and into presymptomatic and symptomatic stages. An ordinal logistic regression model was used to compare groups, adjusting for age and sex. Voxel-based morphometry was performed to identify neuroanatomical correlates of abnormal pain perception. RESULTS Altered responsiveness to pain was present to a significantly greater extent in symptomatic C9orf72 expansion carriers than in controls: mean score 0.40 (SD 0.71) vs 0.00 (0.04), reported in 29% vs 1%. No significant differences were seen between the other symptomatic groups and controls, or any of the presymptomatic mutation carriers and controls. Neural correlates of altered pain perception in C9orf72 expansion carriers were the bilateral thalamus and striatum as well as a predominantly right-sided network of regions involving the orbitofrontal cortex, inferomedial temporal lobe and cerebellum. CONCLUSION Changes in pain perception are a feature of C9orf72 expansion carriers, likely representing a disruption in somatosensory, homeostatic and semantic processing, underpinned by atrophy in a thalamo-cortico-striatal network.
Collapse
Affiliation(s)
- Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Katrina M Moore
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.,Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - John Van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia University Hospital Gipuzkoa Building, San Sebastian, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, Laval University, Quebec, Quebec City, Canada
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Graff
- Department of Geriatric Medicine, Karolinska University Hospital-Huddinge, Stockholm, Sweden
| | - Daniela Galimberti
- La Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy.,Centro Dino Ferrari, University of Milan, Milano, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Matthis Synofzik
- Hertie-Institute for Clinical Brain Research and Center of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases, Tübingen, Germany
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Alexandre de Mendonca
- Laboratory of Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Fabrizio Tagliavini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milano, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre of Neurosciences and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alex Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK.,Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Johannes Levin
- German Centre for Neurodegenerative Diseases Site Munich, Munchen, Germany.,Neurologische Klinik, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Adrian Danek
- Neurologische Klinik, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | |
Collapse
|
44
|
Koriath C, Kenny J, Adamson G, Druyeh R, Taylor W, Beck J, Quinn L, Mok TH, Dimitriadis A, Norsworthy P, Bass N, Carter J, Walker Z, Kipps C, Coulthard E, Polke JM, Bernal-Quiros M, Denning N, Thomas R, Raybould R, Williams J, Mummery CJ, Wild EJ, Houlden H, Tabrizi SJ, Rossor MN, Hummerich H, Warren JD, Rowe JB, Rohrer JD, Schott JM, Fox NC, Collinge J, Mead S. Predictors for a dementia gene mutation based on gene-panel next-generation sequencing of a large dementia referral series. Mol Psychiatry 2020; 25:3399-3412. [PMID: 30279455 PMCID: PMC6330090 DOI: 10.1038/s41380-018-0224-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 11/09/2022]
Abstract
Next-generation genetic sequencing (NGS) technologies facilitate the screening of multiple genes linked to neurodegenerative dementia, but there are few reports about their use in clinical practice. Which patients would most profit from testing, and information on the likelihood of discovery of a causal variant in a clinical syndrome, are conspicuously absent from the literature, mostly for a lack of large-scale studies. We applied a validated NGS dementia panel to 3241 patients with dementia and healthy aged controls; 13,152 variants were classified by likelihood of pathogenicity. We identified 354 deleterious variants (DV, 12.6% of patients); 39 were novel DVs. Age at clinical onset, clinical syndrome and family history each strongly predict the likelihood of finding a DV, but healthcare setting and gender did not. DVs were frequently found in genes not usually associated with the clinical syndrome. Patients recruited from primary referral centres were compared with those seen at higher-level research centres and a national clinical neurogenetic laboratory; rates of discovery were comparable, making selection bias unlikely and the results generalisable to clinical practice. We estimated penetrance of DVs using large-scale online genomic population databases and found 71 with evidence of reduced penetrance. Two DVs in the same patient were found more frequently than expected. These data should provide a basis for more informed counselling and clinical decision making.
Collapse
Affiliation(s)
- C Koriath
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Kenny
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - G Adamson
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - R Druyeh
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - W Taylor
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Beck
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - L Quinn
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - T H Mok
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - A Dimitriadis
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - P Norsworthy
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - N Bass
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - J Carter
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - Z Walker
- UCL Division of Psychiatry, Maple House, University College London, London, UK
- Essex Partnership University NHS Foundation Trust, Essex, SS11 7XX, UK
| | - C Kipps
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Coulthard
- Institute of Clinical Neuroscience, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK
| | - J M Polke
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - M Bernal-Quiros
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - N Denning
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Thomas
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Raybould
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - J Williams
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - C J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - E J Wild
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Houlden
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - S J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - M N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Hummerich
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - J D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - N C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J Collinge
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - S Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK.
| |
Collapse
|
45
|
McLoughlin B, Benhamou E, Sivasathiaseelan H, Hardy CJ, Bond RL, Russell LL, Rohrer JD, Warren JD, Agustus JL. Audiovisual integration improves task performance in AD and bvFTD. Alzheimers Dement 2020. [DOI: 10.1002/alz.042118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bethany McLoughlin
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Elia Benhamou
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Chris J.D. Hardy
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Rebecca L. Bond
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Lucy L. Russell
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Jonathan D. Rohrer
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Jason D. Warren
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Jennifer L. Agustus
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| |
Collapse
|
46
|
Russell LL, Greaves CV, Bocchetta M, Nicholas J, Convery RS, Moore K, Cash DM, van Swieten J, Jiskoot L, Moreno F, Sanchez-Valle R, Borroni B, Laforce R, Masellis M, Tartaglia MC, Graff C, Rotondo E, Galimberti D, Rowe JB, Finger E, Synofzik M, Vandenberghe R, de Mendonça A, Tagliavini F, Santana I, Ducharme S, Butler C, Gerhard A, Levin J, Danek A, Otto M, Warren JD, Rohrer JD. Social cognition impairment in genetic frontotemporal dementia within the GENFI cohort. Cortex 2020; 133:384-398. [PMID: 33221702 PMCID: PMC7754789 DOI: 10.1016/j.cortex.2020.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/06/2020] [Accepted: 08/22/2020] [Indexed: 12/12/2022]
Abstract
A key symptom of frontotemporal dementia (FTD) is difficulty interacting socially with others. Social cognition problems in FTD include impaired emotion processing and theory of mind difficulties, and whilst these have been studied extensively in sporadic FTD, few studies have investigated them in familial FTD. Facial Emotion Recognition (FER) and Faux Pas (FP) recognition tests were used to study social cognition within the Genetic Frontotemporal Dementia Initiative (GENFI), a large familial FTD cohort of C9orf72, GRN, and MAPT mutation carriers. 627 participants undertook at least one of the tasks, and were separated into mutation-negative healthy controls, presymptomatic mutation carriers (split into early and late groups) and symptomatic mutation carriers. Groups were compared using a linear regression model with bootstrapping, adjusting for age, sex, education, and for the FP recognition test, language. Neural correlates of social cognition deficits were explored using a voxel-based morphometry (VBM) study. All three of the symptomatic genetic groups were impaired on both tasks with no significant difference between them. However, prior to onset, only the late presymptomatic C9orf72 mutation carriers on the FER test were impaired compared to the control group, with a subanalysis showing differences particularly in fear and sadness. The VBM analysis revealed that impaired social cognition was mainly associated with a left hemisphere predominant network of regions involving particularly the striatum, orbitofrontal cortex and insula, and to a lesser extent the inferomedial temporal lobe and other areas of the frontal lobe. In conclusion, theory of mind and emotion processing abilities are impaired in familial FTD, with early changes occurring prior to symptom onset in C9orf72 presymptomatic mutation carriers. Future work should investigate how performance changes over time, in order to gain a clearer insight into social cognitive impairment over the course of the disease.
Collapse
Affiliation(s)
- Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK; Institute of Prion Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - Katrina Moore
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - John van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Lize Jiskoot
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK; Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia University Hospital, San Sebastian, Gipuzkoa, Spain
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques du CHU de Québec, Université Laval, Québec, Canada
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Caroline Graff
- Department of Geriatric Medicine, Karolinska University Hospital-Huddinge, Stockholm, Sweden
| | | | - Daniela Galimberti
- University of Milan, Centro Dino Ferrari, Milan, Italy; Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Fabrizio Tagliavini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologica Carlo Besta, Milano, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Simon Ducharme
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Chris Butler
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Alex Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK; Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg- Essen, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, London, UK.
| | | |
Collapse
|
47
|
Heller C, Chan E, Foiani MS, Todd E, Russell LL, Greaves CV, Heslegrave AJ, Warren JD, Zetterberg H, Bocchetta M, Rohrer JD. Plasma glial fibrillary acidic protein and neurofilament light chain are measures of disease severity in semantic variant primary progressive aphasia. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-325085. [PMID: 33219041 DOI: 10.1136/jnnp-2020-325085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Carolin Heller
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Elise Chan
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Martha S Foiani
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Emily Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Amanda J Heslegrave
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at University College London, UCL Queen Square Institute of Neurology, London, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
48
|
de Pablo-Fernández E, González-Herrero B, Cerdán Santacruz D, Rossor MN, Schott JM, Lashley T, Holton JL, Fox NC, Revesz T, Warren JD, Jaunmuktane Z, Rohrer JD, Warner TT. A Clinicopathologic Study of Movement Disorders in Frontotemporal Lobar Degeneration. Mov Disord 2020; 36:632-641. [PMID: 33155746 DOI: 10.1002/mds.28356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the considerable overlap with atypical parkinsonism, a systematic characterization of the movement disorders associated with frontotemporal lobar degeneration (FTLD) is lacking. OBJECTIVE The aim of this study is to provide a detailed description of the phenomenology and neuropathologic correlations of movement disorders in FTLD. METHODS In this cohort study, movement disorder clinical data were retrospectively collected from medical records of consecutive patients with a postmortem diagnosis of FTLD from the Queen Square Brain Bank between January 2010 and December 2018. At postmortem, neurodegenerative pathologies were systematically evaluated following consensus criteria. Degeneration of the substantia nigra was assessed as a marker of presynaptic dopaminergic parkinsonism using semiquantitative methods. RESULTS A total of 55 patients (35 men [64%]) were included with median (interquartile range) age at diagnosis of 58.8 (52.6-63.9) years and a disease duration of 9.6 (6.2-12.9) years. Movement disorders were present in 19 (35%) patients without differences among disease subtypes. The most common syndromes were parkinsonism (9 patients [16%]), usually as an additional late feature, and corticobasal syndrome (CBS, 7 patients [13%]), commonly as a presenting feature. Substantia nigra degeneration was present in 37 (67%) patients although it did not show a good clinical correlation with movement disorders. Those with Pick's disease showed milder substantia nigra degeneration and better response to levodopa. CONCLUSIONS Movement disorders can present in all FTLD subtypes, more commonly as a late additional feature (parkinsonism) or as a presenting symptom (CBS). The underlying pathophysiology is complex and likely to involve structures outside the presynaptic striatonigral system. © 2020 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Eduardo de Pablo-Fernández
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Belén González-Herrero
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Bellvitge University Hospital and Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Debora Cerdán Santacruz
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Neurology Department, Complejo Asistencial de Segovia, Segovia, Spain
| | - Martin N Rossor
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan M Schott
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tammaryn Lashley
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Janice L Holton
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Nick C Fox
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jason D Warren
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan D Rohrer
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| |
Collapse
|
49
|
Benhamou E, Marshall CR, Russell LL, Hardy CJD, Bond RL, Sivasathiaseelan H, Greaves CV, Friston KJ, Rohrer JD, Warren JD, Razi A. The neurophysiological architecture of semantic dementia: spectral dynamic causal modelling of a neurodegenerative proteinopathy. Sci Rep 2020; 10:16321. [PMID: 33004840 PMCID: PMC7530731 DOI: 10.1038/s41598-020-72847-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/08/2020] [Indexed: 01/11/2023] Open
Abstract
The selective destruction of large-scale brain networks by pathogenic protein spread is a ubiquitous theme in neurodegenerative disease. Characterising the circuit architecture of these diseases could illuminate both their pathophysiology and the computational architecture of the cognitive processes they target. However, this is challenging using standard neuroimaging techniques. Here we addressed this issue using a novel technique-spectral dynamic causal modelling-that estimates the effective connectivity between brain regions from resting-state fMRI data. We studied patients with semantic dementia-the paradigmatic disorder of the brain system mediating world knowledge-relative to healthy older individuals. We assessed how the effective connectivity of the semantic appraisal network targeted by this disease was modulated by pathogenic protein deposition and by two key phenotypic factors, semantic impairment and behavioural disinhibition. The presence of pathogenic protein in SD weakened the normal inhibitory self-coupling of network hubs in both antero-mesial temporal lobes, with development of an abnormal excitatory fronto-temporal projection in the left cerebral hemisphere. Semantic impairment and social disinhibition were linked to a similar but more extensive profile of abnormally attenuated inhibitory self-coupling within temporal lobe regions and excitatory projections between temporal and inferior frontal regions. Our findings demonstrate that population-level dynamic causal modelling can disclose a core pathophysiological feature of proteinopathic network architecture-attenuation of inhibitory connectivity-and the key elements of distributed neuronal processing that underwrite semantic memory.
Collapse
Affiliation(s)
- Elia Benhamou
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Chris J D Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Caroline V Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Adeel Razi
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, UK
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Melbourne, Australia
| |
Collapse
|
50
|
Jimenez DA, Bond RL, Requena-Komuro MC, Sivasathiaseelan H, Marshall CR, Russell LL, Greaves C, Moore KM, Woollacott IO, Shafei R, Hardy CJ, Rohrer JD, Warren JD. Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis. Cortex 2020; 130:100-110. [PMID: 32650059 PMCID: PMC7447974 DOI: 10.1016/j.cortex.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Abnormal behavioural and physiological reactivity to emotional stimuli is a hallmark of frontotemporal dementia (FTD), particularly the behavioural variant (bvFTD). As part of this repertoire, altered phobic responses have been reported in some patients with FTD but are poorly characterised. METHODS We collected data (based on caregiver reports) concerning the prevalence and nature of any behavioural changes related to specific phobias in a cohort of patients representing canonical syndromes of FTD and Alzheimer's disease (AD), relative to healthy older controls. Neuroanatomical correlates of altered phobic reactivity were assessed using voxel-based morphometry. RESULTS 46 patients with bvFTD, 20 with semantic variant primary progressive aphasia, 25 with non-fluent variant primary progressive aphasia, 29 with AD and 55 healthy age-matched individuals participated. Changes in specific phobia were significantly more prevalent in the combined FTD cohort (15.4% of cases) and in the bvFTD group (17.4%) compared both to healthy controls (3.6%) and patients with AD (3.5%). Attenuation of phobic reactivity was reported for individuals in all participant groups, however new phobias developed only in the FTD cohort. Altered phobic reactivity was significantly associated with relative preservation of grey matter in left posterior middle temporal gyrus, right temporo-occipital junction and right anterior cingulate gyrus, brain regions previously implicated in contextual decoding, salience processing and reward valuation. CONCLUSION Altered phobic reactivity is a relatively common issue in patients with FTD, particularly bvFTD. This novel paradigm of strong fear experience has broad implications: clinically, for diagnosis and patient well-being; and neurobiologically, for our understanding of the pathophysiology of aversive sensory signal processing in FTD and the neural mechanisms of fear more generally.
Collapse
Affiliation(s)
- Daniel A Jimenez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mai-Carmen Requena-Komuro
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Caroline Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katrina M Moore
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ione Oc Woollacott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachelle Shafei
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris Jd Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
| |
Collapse
|