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Friedberg A, Pasquini L, Diggs R, Glaubitz EA, Lopez L, Illán-Gala I, Iaccarino L, La Joie R, Mundada N, Knudtson M, Neylan K, Brown J, Allen IE, Rankin KP, Bonham LW, Yokoyama JS, Ramos EM, Geschwind DH, Spina S, Grinberg LT, Miller ZA, Kramer JH, Rosen H, Gorno-Tempini ML, Rabinovici G, Seeley WW, Miller BL. Prevalence, Timing, and Network Localization of Emergent Visual Creativity in Frontotemporal Dementia. JAMA Neurol 2023; 80:377-387. [PMID: 36848111 PMCID: PMC9972248 DOI: 10.1001/jamaneurol.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/28/2022] [Indexed: 03/01/2023]
Abstract
Importance The neurological substrates of visual artistic creativity (VAC) are unknown. VAC is demonstrated here to occur early in frontotemporal dementia (FTD), and multimodal neuroimaging is used to generate a novel mechanistic hypothesis involving dorsomedial occipital cortex enhancement. These findings may illuminate a novel mechanism underlying human visual creativity. Objective To determine the anatomical and physiological underpinnings of VAC in FTD. Design, Setting, and Participants This case-control study analyzed records of 689 patients who met research criteria for an FTD spectrum disorder between 2002 and 2019. Individuals with FTD and emergence of visual artistic creativity (VAC-FTD) were matched to 2 control groups based on demographic and clinical parameters: (1) not visually artistic FTD (NVA-FTD) and (2) healthy controls (HC). Analysis took place between September 2019 to December 2021. Main Outcomes and Measures Clinical, neuropsychological, genetic, and neuroimaging data were analyzed to characterize VAC-FTD and compare VAC-FTD with control groups. Results Of 689 patients with FTD, 17 (2.5%) met VAC-FTD inclusion criteria (mean [SD] age, 65 [9.7] years; 10 [58.8%] female). NVA-FTD (n = 51; mean [SD] age, 64.8 [7] years; 25 [49.0%] female) and HC (n = 51; mean [SD] age, 64.5 [7.2] years; 25 [49%] female) groups were well matched to VAC-FTD demographically. Emergence of VAC occurred around the time of onset of symptoms and was disproportionately seen in patients with temporal lobe predominant degeneration (8 of 17 [47.1%]). Atrophy network mapping identified a dorsomedial occipital region whose activity inversely correlated, in healthy brains, with activity in regions found within the patient-specific atrophy patterns in VAC-FTD (17 of 17) and NVA-FTD (45 of 51 [88.2%]). Structural covariance analysis revealed that the volume of this dorsal occipital region was strongly correlated in VAC-FTD, but not in NVA-FTD or HC, with a volume in the primary motor cortex corresponding to the right-hand representation. Conclusions and Relevance This study generated a novel hypothesis about the mechanisms underlying the emergence of VAC in FTD. These findings suggest that early lesion-induced activation of dorsal visual association areas may predispose some patients to the emergence of VAC under certain environmental or genetic conditions. This work sets the stage for further exploration of enhanced capacities arising early in the course of neurodegeneration.
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Affiliation(s)
- Adit Friedberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Lorenzo Pasquini
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Neuroscape, University of California, San Francisco
| | - Ryan Diggs
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Erika A. Glaubitz
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Ignacio Illán-Gala
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- now with Eli Lilly and Company, Philadelphia, Pennsylvania
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Nidhi Mundada
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Marguerite Knudtson
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Kyra Neylan
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jesse Brown
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Isabel Elaine Allen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Luke W. Bonham
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jennifer S. Yokoyama
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Eliana M. Ramos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
| | - Daniel H. Geschwind
- Program in Neurogenetics, Center for Autism Research and Treatment Semel Institute for Neuroscience and Human Behavior, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles
- Institute for Precision Health, University of California, Los Angeles
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Pathology, University of California, San Francisco
| | - Zachary A. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Howard Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Gil Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Pathology, University of California, San Francisco
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
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Nolan A, De Paula Franca Resende E, Petersen C, Neylan K, Spina S, Huang E, Seeley W, Miller Z, Grinberg LT. Astrocytic Tau Deposition Is Frequent in Typical and Atypical Alzheimer Disease Presentations. J Neuropathol Exp Neurol 2020; 78:1112-1123. [PMID: 31626288 DOI: 10.1093/jnen/nlz094] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Typical Alzheimer disease (AD) features an amnestic syndrome that reflects the progression of pathology through specific neural networks. However, a subset of patients exhibits atypical onset with prominent language, behavioral, or visuospatial deficits that are not explained by current neuropathological staging schemes. Astrogliopathy featuring tau inclusions with thorn-shaped and granular fuzzy morphologies is common in the aging brain and collectively known as aging-related tau astrogliopathy (ARTAG). Prior studies have identified tau-positive thorn-shaped astrocytes in the white matter that associate with a primary progressive aphasia phenotype in an AD cohort. However, a possible contribution of ARTAG copathology to AD clinical heterogeneity has yet to be systematically examined. To investigate whether ARTAG pathology contributes to atypical presentations, we mapped the presence and density of ARTAG subtypes throughout cortical and subcortical regions in a well-characterized cohort of AD cases enriched for atypical presentations. In our cohort, ARTAG pathology is frequent and correlates with older age and higher Braak stage. ARTAG subtypes exhibit distinct distribution patterns with subpial and subependymal deposition occurring in the amygdala, while white and grey matter astrocytic deposition are distributed throughout cortical regions. However, ARTAG pathology is equally prevalent in cases with typical and atypical clinical presentations.
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Affiliation(s)
- Amber Nolan
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Elisa De Paula Franca Resende
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Cathrine Petersen
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Kyra Neylan
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Salvatore Spina
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Eric Huang
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - William Seeley
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Zachary Miller
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Lea T Grinberg
- Department of Anatomic Pathology, University of California, San Francisco, CA; Memory and Aging Center, University of California, San Francisco, California; and Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
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