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den Haan J, Csinscik L, Parker T, Paterson RW, Slattery CF, Foulkes A, Bouwman FH, Verbraak FD, Scheltens P, Peto T, Lengyel I, Schott JM, Crutch SJ, Shakespeare TJ, Yong KXX. Retinal thickness as potential biomarker in posterior cortical atrophy and typical Alzheimer's disease. Alzheimers Res Ther 2019; 11:62. [PMID: 31319885 PMCID: PMC6639972 DOI: 10.1186/s13195-019-0516-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/21/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Retinal thickness can be measured non-invasively with optical coherence tomography (OCT) and may offer compelling potential as a biomarker for Alzheimer's disease (AD). Retinal thinning is hypothesized to be a result of retrograde atrophy and/or parallel neurodegenerative processes. Changes in the visual pathway are of particular interest in posterior cortical atrophy (PCA), the most common atypical AD phenotype predominantly affecting the parietal-occipital cortices. We therefore evaluated retinal thickness as non-invasive biomarker of neurodegeneration in well-characterized participants with posterior cortical atrophy (PCA) and typical Alzheimer's disease (tAD). METHODS Retinal thickness measures were acquired from 48 patient participants (N = 25 PCA; N = 23 tAD) fulfilling consensus diagnostic criteria and 70 age-matched controls. Participants were recruited between 2014 and 2016. All participants underwent optical coherence tomography (OCT) imaging, including measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness and total macular thickness (mRT). Participants did not show evidence of any significant ophthalmological conditions. Subgroup analyses were performed in participants with available MRI and CSF measures, providing evidence of neurodegeneration and underlying AD pathology respectively. RESULTS There was no evidence of overall between-group differences in pRNFL thickness (mean PCA 98.7 ± 12.2; tAD 99.9 ± 8.7; controls 99.6 ± 10.0 μm, one-way analysis of variance (ANOVA) p = 0.92) or total mRT (mean PCA 266.9 ± 16.3; tAD 267.8 ± 13.6; controls 269.3 ± 13.6 μm, one-way ANOVA p = 0.75). Similarly, subgroup analysis with MRI biomarkers (PCA = 18, tAD = 17, controls = 31) showing neurodegeneration, and CSF biomarkers (PCA = 18, tAD = 14, controls = 13) supporting underlying AD pathology did not provide evidence of overall between-group differences in pRNFL or mRT measures (all p > 0.3). CONCLUSIONS Retinal thickness did not discriminate tAD and PCA from controls or from one another despite unequivocal differences on standard clinical, neuro-imaging and CSF measures. Findings from this well-characterized sample, including cases with PCA, do not support the hypothesis that retinal neurodegeneration, measured using conventional OCT, is a useful biomarker for AD or PCA.
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Affiliation(s)
- Jurre den Haan
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Mailbox 7057, 1007 MB Amsterdam, The Netherlands
| | - Lajos Csinscik
- Centre for Experimental Medicine, Queen’s University, Belfast, UK
- Institute of Ophthalmology UCL, London, UK
| | - Tom Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Ross W. Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | | | - Alexander Foulkes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Femke H. Bouwman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Mailbox 7057, 1007 MB Amsterdam, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Mailbox 7057, 1007 MB Amsterdam, The Netherlands
| | - Tunde Peto
- Centre for Experimental Medicine, Queen’s University, Belfast, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL, London, UK
| | - Imre Lengyel
- Centre for Experimental Medicine, Queen’s University, Belfast, UK
- Institute of Ophthalmology UCL, London, UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | | | - Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
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Firth NC, Primativo S, Marinescu RV, Shakespeare TJ, Suarez-Gonzalez A, Lehmann M, Carton A, Ocal D, Pavisic I, Paterson RW, Slattery CF, Foulkes AJM, Ridha BH, Gil-Néciga E, Oxtoby NP, Young AL, Modat M, Cardoso MJ, Ourselin S, Ryan NS, Miller BL, Rabinovici GD, Warrington EK, Rossor MN, Fox NC, Warren JD, Alexander DC, Schott JM, Yong KXX, Crutch SJ. Longitudinal neuroanatomical and cognitive progression of posterior cortical atrophy. Brain 2019; 142:2082-2095. [PMID: 31219516 PMCID: PMC6598737 DOI: 10.1093/brain/awz136] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 11/19/2018] [Revised: 02/28/2019] [Accepted: 03/24/2019] [Indexed: 01/27/2023] Open
Abstract
Posterior cortical atrophy is a clinico-radiological syndrome characterized by progressive decline in visual processing and atrophy of posterior brain regions. With the majority of cases attributable to Alzheimer's disease and recent evidence for genetic risk factors specifically related to posterior cortical atrophy, the syndrome can provide important insights into selective vulnerability and phenotypic diversity. The present study describes the first major longitudinal investigation of posterior cortical atrophy disease progression. Three hundred and sixty-one individuals (117 posterior cortical atrophy, 106 typical Alzheimer's disease, 138 controls) fulfilling consensus criteria for posterior cortical atrophy-pure and typical Alzheimer's disease were recruited from three centres in the UK, Spain and USA. Participants underwent up to six annual assessments involving MRI scans and neuropsychological testing. We constructed longitudinal trajectories of regional brain volumes within posterior cortical atrophy and typical Alzheimer's disease using differential equation models. We compared and contrasted the order in which regional brain volumes become abnormal within posterior cortical atrophy and typical Alzheimer's disease using event-based models. We also examined trajectories of cognitive decline and the order in which different cognitive tests show abnormality using the same models. Temporally aligned trajectories for eight regions of interest revealed distinct (P < 0.002) patterns of progression in posterior cortical atrophy and typical Alzheimer's disease. Patients with posterior cortical atrophy showed early occipital and parietal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion leading to tissue loss of comparable extent later. Hippocampal, entorhinal and frontal regions underwent a lower rate of change and never approached the extent of posterior cortical involvement. Patients with typical Alzheimer's disease showed early hippocampal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion. Cognitive models showed tests sensitive to visuospatial dysfunction declined earlier in posterior cortical atrophy than typical Alzheimer's disease whilst tests sensitive to working memory impairment declined earlier in typical Alzheimer's disease than posterior cortical atrophy. These findings indicate that posterior cortical atrophy and typical Alzheimer's disease have distinct sites of onset and different profiles of spatial and temporal progression. The ordering of disease events both motivates investigation of biological factors underpinning phenotypic heterogeneity, and informs the selection of measures for clinical trials in posterior cortical atrophy.
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Affiliation(s)
- Nicholas C Firth
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, Gower Street, London, UK
| | - Silvia Primativo
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
- Department of Human Science, LUMSA University, Via della Traspontina, 21, Rome, Italy
| | - Razvan-Valentin Marinescu
- Centre for Medical Image Computing, Department of Computer Science, University College London, Gower Street, London, UK
| | - Timothy J Shakespeare
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
- Department of Neurology, University Hospital Virgen del Rocio, Seville, Spain
| | - Manja Lehmann
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
- Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Amelia Carton
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Dilek Ocal
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Ivanna Pavisic
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Ross W Paterson
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Alexander J M Foulkes
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Basil H Ridha
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Eulogio Gil-Néciga
- Department of Neurology, University Hospital Virgen del Rocio, Seville, Spain
| | - Neil P Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, University College London, Gower Street, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Computer Science, University College London, Gower Street, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Natalie S Ryan
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Gil D Rabinovici
- Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth K Warrington
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Martin N Rossor
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Nick C Fox
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Jason D Warren
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, Gower Street, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, 8–11 Queen Square, London, UK
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Csincsik L, Quinn N, MacGillivray T, Shakespeare TJ, Crutch SJ, Peto T, Lengyel I. P1-273: ASSESSING HETEROGENEITY OF ALZHEIMER'S DISEASE THROUGH THE EYE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nicola Quinn
- Queen's University Belfast; Belfast United Kingdom
| | | | | | | | - Tunde Peto
- Queen's University Belfast; Belfast United Kingdom
| | - Imre Lengyel
- Queen's University Belfast; Belfast United Kingdom
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Pavisic IM, Firth NC, Parsons S, Rego DM, Shakespeare TJ, Yong KXX, Slattery CF, Paterson RW, Foulkes AJM, Macpherson K, Carton AM, Alexander DC, Shawe-Taylor J, Fox NC, Schott JM, Crutch SJ, Primativo S. Eyetracking Metrics in Young Onset Alzheimer's Disease: A Window into Cognitive Visual Functions. Front Neurol 2017; 8:377. [PMID: 28824534 PMCID: PMC5545969 DOI: 10.3389/fneur.2017.00377] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022] Open
Abstract
Young onset Alzheimer's disease (YOAD) is defined as symptom onset before the age of 65 years and is particularly associated with phenotypic heterogeneity. Atypical presentations, such as the clinic-radiological visual syndrome posterior cortical atrophy (PCA), often lead to delays in accurate diagnosis. Eyetracking has been used to demonstrate basic oculomotor impairments in individuals with dementia. In the present study, we aim to explore the relationship between eyetracking metrics and standard tests of visual cognition in individuals with YOAD. Fifty-seven participants were included: 36 individuals with YOAD (n = 26 typical AD; n = 10 PCA) and 21 age-matched healthy controls. Participants completed three eyetracking experiments: fixation, pro-saccade, and smooth pursuit tasks. Summary metrics were used as outcome measures and their predictive value explored looking at correlations with visuoperceptual and visuospatial metrics. Significant correlations between eyetracking metrics and standard visual cognitive estimates are reported. A machine-learning approach using a classification method based on the smooth pursuit raw eyetracking data discriminates with approximately 95% accuracy patients and controls in cross-validation tests. Results suggest that the eyetracking paradigms of a relatively simple and specific nature provide measures not only reflecting basic oculomotor characteristics but also predicting higher order visuospatial and visuoperceptual impairments. Eyetracking measures can represent extremely useful markers during the diagnostic phase and may be exploited as potential outcome measures for clinical trials.
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Affiliation(s)
- Ivanna M. Pavisic
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Nicholas C. Firth
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Samuel Parsons
- Centre for Computational Statistics and Machine Learning, Faculty of Engineering Science, Department of Computer Science, University College London, London, United Kingdom
| | - David Martinez Rego
- Centre for Computational Statistics and Machine Learning, Faculty of Engineering Science, Department of Computer Science, University College London, London, United Kingdom
| | - Timothy J. Shakespeare
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Keir X. X. Yong
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Catherine F. Slattery
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Ross W. Paterson
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Alexander J. M. Foulkes
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Kirsty Macpherson
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Amelia M. Carton
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - John Shawe-Taylor
- Centre for Computational Statistics and Machine Learning, Faculty of Engineering Science, Department of Computer Science, University College London, London, United Kingdom
| | - Nick C. Fox
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan M. Schott
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
| | - Silvia Primativo
- Dementia Research Centre, Department of Neurodegenerative Diseases, Institute of Neurology, University College London, London, United Kingdom
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Crutch SJ, Schott JM, Rabinovici GD, Murray M, Snowden JS, van der Flier WM, Dickerson BC, Vandenberghe R, Ahmed S, Bak TH, Boeve BF, Butler C, Cappa SF, Ceccaldi M, de Souza LC, Dubois B, Felician O, Galasko D, Graff-Radford J, Graff-Radford NR, Hof PR, Krolak-Salmon P, Lehmann M, Magnin E, Mendez MF, Nestor PJ, Onyike CU, Pelak VS, Pijnenburg Y, Primativo S, Rossor MN, Ryan NS, Scheltens P, Shakespeare TJ, Suárez González A, Tang-Wai DF, Yong KXX, Carrillo M, Fox NC. Consensus classification of posterior cortical atrophy. Alzheimers Dement 2017; 13:870-884. [PMID: 28259709 PMCID: PMC5788455 DOI: 10.1016/j.jalz.2017.01.014] [Citation(s) in RCA: 351] [Impact Index Per Article: 50.1] [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: 11/29/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings. METHODS Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA. RESULTS A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum. DISCUSSION There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work.
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Affiliation(s)
| | | | - Gil D Rabinovici
- Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Julie S Snowden
- Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Wiesje M van der Flier
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Samrah Ahmed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas H Bak
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stefano F Cappa
- Center for Cognitive Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Mathieu Ceccaldi
- INSERM U 1106, Institut des Neurosciences des Systèmes, Aix Marseille Université, Marseilles, France
| | - Leonardo Cruz de Souza
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Dubois
- Institute for Memory and Alzheimer's Disease, UMR-S975, Salpêtrière Hospital, Pierre & Marie Curie University, Paris, France
| | - Olivier Felician
- Aix-Marseille Université, INSERM, Institut de Neurosciences des Systèmes, Marseille, France; AP-HM Hôpitaux de la Timone, Service de Neurologie et Neuropsychologie, Marseille, France
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, USA
| | | | | | - Patrick R Hof
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, INSERM U1028, CNRS UMR5292, University of Lyon, Lyon, France
| | - Manja Lehmann
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eloi Magnin
- Department of Neurology, Regional Memory Centre (CMRR), CHU Besançon, Besançon, France
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter J Nestor
- Cognitive Neurology and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yolande Pijnenburg
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Silvia Primativo
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Philip Scheltens
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Aida Suárez González
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Memory Disorders Unit, Neurology Department, University Hospital Virgen del Rocio, Seville, Spain
| | - David F Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada
| | - Keir X X Yong
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Maria Carrillo
- Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
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Marinescu RV, Primativo S, Young AL, Oxtoby NP, Firth NC, Eshaghi A, Garbarino S, Cardoso JM, Yong K, Fox NC, Lehmann M, Shakespeare TJ, Crutch SJ, Alexander DC. [P4–257]: ANALYSIS OF THE HETEROGENEITY OF POSTERIOR CORTICAL ATROPHY: DATA‐DRIVEN MODEL PREDICTS DISTINCT ATROPHY PATTERNS FOR THREE DIFFERENT COGNITIVE SUBGROUPS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2126] [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: 11/16/2022]
Affiliation(s)
| | - Silvia Primativo
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | | | | | - Nicholas C. Firth
- University College London, Institute of NeurologyLondonUnited Kingdom
| | - Arman Eshaghi
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
| | | | | | - Keir Yong
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Nick C. Fox
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
| | - Manja Lehmann
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
- University of California San FranciscoSan FranciscoCAUSA
| | - Timothy J. Shakespeare
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Sebastian J. Crutch
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Department of Computer Science and Centre for Medical Image ComputingUCLLondonUnited Kingdom
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7
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Pavisic IM, Primativo S, Firth NC, Shakespeare TJ, Yong K, Slattery CF, Paterson RW, Foulkes AJ, Macpherson K, Carton AM, Alexander DC, Parsons S, Rego DM, Schott JM, Crutch SJ, Fox NC. [P4–289]: CAN EYETRACKING METRICS RELATE TO PERFORMANCE ON VISUAL COGNITIVE TESTS OF INDIVIDUALS WITH YOUNG‐ONSET ALZHEIMER's DISEASE? Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2158] [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: 10/18/2022]
Affiliation(s)
- Ivanna M. Pavisic
- University College London, Institute of NeurologyLondonUnited Kingdom
| | - Silvia Primativo
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Nicholas C. Firth
- University College London, Institute of NeurologyLondonUnited Kingdom
| | - Timothy J. Shakespeare
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Keir Yong
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Catherine F. Slattery
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Ross W. Paterson
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Alexander J.M. Foulkes
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Kirsty Macpherson
- University College London, Institute of NeurologyLondonUnited Kingdom
| | - Amelia M. Carton
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Department of Computer Science and Centre for Medical Image ComputingUCLLondonUnited Kingdom
| | - Samuel Parsons
- University College London, Computer ScienceLondonUnited Kingdom
| | | | - Jon M. Schott
- University College London, Institute of NeurologyLondonUnited Kingdom
| | - Sebastian J. Crutch
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Nick C. Fox
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
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8
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Primativo S, Marinescu RV, Firth NC, Yong K, Shakespeare TJ, Gonzalez AS, Carton AM, Lehmann M, Slattery CF, Paterson RW, Foulkes AJ, Ryan NS, Warrington EK, Fox NC, Alexander DC, Schott JM, Crutch SJ. [P4–261]: LONGITUDINAL EVALUATION OF NEUROPSYCHOLOGICAL AND NEUROIMAGING PROGRESSION IN POSTERIOR CORTICAL ATROPHY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2130] [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: 10/18/2022]
Affiliation(s)
- Silvia Primativo
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | | | - Nicholas C. Firth
- Department of Computer Science and Centre for Medical Image ComputingUCLLondonUnited Kingdom
| | - Keir Yong
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Timothy J. Shakespeare
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Aida Suarez Gonzalez
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Amelia M. Carton
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Manja Lehmann
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Catherine F. Slattery
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Ross W. Paterson
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Alexander J.M. Foulkes
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Natalie S. Ryan
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Elizabeth K. Warrington
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Nick C. Fox
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Department of Computer Science and Centre for Medical Image ComputingUCLLondonUnited Kingdom
| | - Jonathan M. Schott
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Sebastian J. Crutch
- Dementia Research CentreInstitute of Neurology, University College LondonLondonUnited Kingdom
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9
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Primativo S, Yong KXX, Shakespeare TJ, Crutch SJ. The oral spelling profile of posterior cortical atrophy and the nature of the graphemic representation. Neuropsychologia 2016; 94:61-74. [PMID: 27913156 DOI: 10.1016/j.neuropsychologia.2016.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022]
Abstract
Spelling is a complex cognitive task where central and peripheral components are involved in engaging resources from many different cognitive processes. The present paper aims to both characterize the oral spelling deficit in a population of patients affected by a neurodegenerative condition and to clarify the nature of the graphemic representation within the currently available spelling models. Indeed, the nature of graphemic representation as a linear or multi-componential structure is still debated. Different hypotheses have been raised about its nature in the orthographic lexicon, with one positing that graphemes are complex objects whereby quantity and identity are separately represented in orthographic representations and can thus be selectively impaired. Posterior cortical atrophy (PCA) is a neurodegenerative condition that mainly affects visuoperceptual and visuospatial functions. Spelling impairments are considered part of the disease. Nonetheless the spelling deficit has received little attention so far and often it has been interpreted in relation to peripheral impairments such as writing difficulties associated with visuoperceptual and visuospatial deficits. In the present study we provide a detailed characterization of the oral spelling profile in PCA. The data suggest that multiple deficits underpin oral spelling problems in PCA, with elements of surface and phonological dysgraphia but also suggesting the involvement of the graphemic buffer. A large phenotypic individual variability is reported. Moreover, the larger proportion and the specific nature of errors involving geminate (i.e., double) as compared to non-geminate (i.e., non-double) letters suggest that a further central impairment might be associated with the abstract graphemic representation of letter numerosity. The present study contributes to the clinical characterization of PCA and to the current debate in the cognitive literature on spelling models; findings, despite not definitive, support the hypothesis that graphemic representations are multidimensional mental objects that separately encode information about grapheme identity and quantity.
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Affiliation(s)
- Silvia Primativo
- Dementia, Research Centre, UCL Institute of Neurology, University College London, London, UK.
| | - Keir X X Yong
- Dementia, Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Timothy J Shakespeare
- Dementia, Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia, Research Centre, UCL Institute of Neurology, University College London, London, UK
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10
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Abstract
Posterior cortical atrophy (PCA) is the canonical “visual dementia,” with affected individuals experiencing a progressive disintegration of their visual world owing to dysfunction and atrophy at the back of the brain. The syndrome, which also affects literacy, numeracy, and gesture, is typically caused by Alzheimer’s disease, but is distinguished from more common amnestic presentations by virtue of relatively preserved episodic memory and insight. Although problems with object and space perception are the most widely reported and investigated symptoms, these higher-order perceptual difficulties are often underpinned by an array of changes in more basic visual and oculomotor processes. Here we review recent studies providing insights into these more elementary aspects of vision in PCA, including fixation stability, saccade generation, point localization, excessive crowding, and factors affecting the effective field of vision. We argue that a more detailed appreciation of these fundamental changes in the early visual system not only will improve the characterization and understanding of this rare clinico-radiological syndrome but will also guide the design of visual aids and strategies aimed at maintaining everyday abilities in individuals with PCA.
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Affiliation(s)
- Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London
| | - Keir X. X. Yong
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London
| | - Timothy J. Shakespeare
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London
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11
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Shakespeare TJ. P3‐340: The Many Faces of Dementia: a Free Online Course Describing Four Less Common Diagnoses. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.2005] [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: 11/16/2022]
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12
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Marinescu RV, Young AL, Oxtoby NP, Firth NC, Lorenzi M, Eshaghi A, Wottschel V, Cardoso MJ, Modat M, Yong K, Primativo S, Fox NC, Lehmann M, Shakespeare TJ, Crutch SJ, Alexander DC. P1‐009: A Data‐Driven Comparison of the Progression of Brain Atrophy in Posterior Cortical Atrophy and Alzheimer's Disease. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | | | | | - Arman Eshaghi
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
| | - Viktor Wottschel
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
| | | | - Marc Modat
- University College LondonLondonUnited Kingdom
| | - Keir Yong
- University College LondonLondonUnited Kingdom
| | | | - Nick C. Fox
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
| | - Manja Lehmann
- University College LondonLondonUnited Kingdom
- UCL Institute of NeurologyLondonUnited Kingdom
- University of California San FranciscoSan FranciscoCA USA
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13
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Suárez-González A, Lehmann M, Shakespeare TJ, Yong KXX, Paterson RW, Slattery CF, Foulkes AJM, Rabinovici GD, Gil-Néciga E, Roldán-Lora F, Schott JM, Fox NC, Crutch SJ. Effect of age at onset on cortical thickness and cognition in posterior cortical atrophy. Neurobiol Aging 2016; 44:108-113. [PMID: 27318138 PMCID: PMC4926954 DOI: 10.1016/j.neurobiolaging.2016.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/04/2015] [Revised: 03/30/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
Age at onset (AAO) has been shown to influence the phenotype of Alzheimer's disease (AD), but how it affects atypical presentations of AD remains unknown. Posterior cortical atrophy (PCA) is the most common form of atypical AD. In this study, we aimed to investigate the effect of AAO on cortical thickness and cognitive function in 98 PCA patients. We used Freesurfer (v5.3.0) to compare cortical thickness with AAO both as a continuous variable, and by dichotomizing the groups based on median age (58 years). In both the continuous and dichotomized analyses, we found a pattern suggestive of thinner cortex in precuneus and parietal areas in earlier-onset PCA, and lower cortical thickness in anterior cingulate and prefrontal cortex in later-onset PCA. These cortical thickness differences between PCA subgroups were consistent with earlier-onset PCA patients performing worse on cognitive tests involving parietal functions. Our results provide a suggestion that AAO may not only affect the clinico-anatomical characteristics in AD but may also affect atrophy patterns and cognition within atypical AD phenotypes.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK; Department of Neurology, University Hospital Virgen del Rocio, Seville, Spain.
| | - Manja Lehmann
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK; Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Timothy J Shakespeare
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Ross W Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Alexander J M Foulkes
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Gil D Rabinovici
- Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Eulogio Gil-Néciga
- Department of Neurology, University Hospital Virgen del Rocio, Seville, Spain
| | | | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
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Shakespeare TJ, Yong KXX, Foxe D, Hodges J, Crutch SJ. Pronounced impairment of everyday skills and self-care in posterior cortical atrophy. J Alzheimers Dis 2015; 43:381-4. [PMID: 25096622 DOI: 10.3233/jad-141071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/15/2022]
Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive visual dysfunction and parietal, occipital, and occipitotemporal atrophy. The aim of this study was to compare the impact of PCA and typical Alzheimer's disease (tAD) on everyday functional abilities and neuropsychiatric status. The Cambridge Behavioural Inventory-Revised was given to carers of 32 PCA and 71 tAD patients. PCA patients showed significantly greater impairment in everyday skills and self-care while the tAD group showed greater impairment in aspects of memory and orientation, and motivation. We suggest that PCA poses specific challenges for those caring for people affected by the condition.
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Affiliation(s)
- Timothy J Shakespeare
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - David Foxe
- Neuroscience Research Australia, Randwick, Sydney, Australia ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - John Hodges
- Neuroscience Research Australia, Randwick, Sydney, Australia ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
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15
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Yong KXX, Rajdev K, Shakespeare TJ, Leff AP, Crutch SJ. Facilitating text reading in posterior cortical atrophy. Neurology 2015; 85:339-48. [PMID: 26138948 PMCID: PMC4520813 DOI: 10.1212/wnl.0000000000001782] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/31/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: We report (1) the quantitative investigation of text reading in posterior cortical atrophy (PCA), and (2) the effects of 2 novel software-based reading aids that result in dramatic improvements in the reading ability of patients with PCA. Methods: Reading performance, eye movements, and fixations were assessed in patients with PCA and typical Alzheimer disease and in healthy controls (experiment 1). Two reading aids (single- and double-word) were evaluated based on the notion that reducing the spatial and oculomotor demands of text reading might support reading in PCA (experiment 2). Results: Mean reading accuracy in patients with PCA was significantly worse (57%) compared with both patients with typical Alzheimer disease (98%) and healthy controls (99%); spatial aspects of passages were the primary determinants of text reading ability in PCA. Both aids led to considerable gains in reading accuracy (PCA mean reading accuracy: single-word reading aid = 96%; individual patient improvement range: 6%–270%) and self-rated measures of reading. Data suggest a greater efficiency of fixations and eye movements under the single-word reading aid in patients with PCA. Conclusions: These findings demonstrate how neurologic characterization of a neurodegenerative syndrome (PCA) and detailed cognitive analysis of an important everyday skill (reading) can combine to yield aids capable of supporting important everyday functional abilities. Classification of evidence: This study provides Class III evidence that for patients with PCA, 2 software-based reading aids (single-word and double-word) improve reading accuracy.
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Affiliation(s)
- Keir X X Yong
- From the Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology (K.X.X.Y., K.R., T.J.S., S.J.C.), Institute of Cognitive Neuroscience (A.P.L.), and Department of Brain Repair and Rehabilitation, Institute of Neurology (A.P.L.), University College London, UK.
| | - Kishan Rajdev
- From the Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology (K.X.X.Y., K.R., T.J.S., S.J.C.), Institute of Cognitive Neuroscience (A.P.L.), and Department of Brain Repair and Rehabilitation, Institute of Neurology (A.P.L.), University College London, UK
| | - Timothy J Shakespeare
- From the Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology (K.X.X.Y., K.R., T.J.S., S.J.C.), Institute of Cognitive Neuroscience (A.P.L.), and Department of Brain Repair and Rehabilitation, Institute of Neurology (A.P.L.), University College London, UK
| | - Alexander P Leff
- From the Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology (K.X.X.Y., K.R., T.J.S., S.J.C.), Institute of Cognitive Neuroscience (A.P.L.), and Department of Brain Repair and Rehabilitation, Institute of Neurology (A.P.L.), University College London, UK
| | - Sebastian J Crutch
- From the Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology (K.X.X.Y., K.R., T.J.S., S.J.C.), Institute of Cognitive Neuroscience (A.P.L.), and Department of Brain Repair and Rehabilitation, Institute of Neurology (A.P.L.), University College London, UK
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16
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Crutch SJ, Shakespeare TJ, Csincsik L, Peto T, Lengyel I. P2‐145: Retinal imaging in early‐onset Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.683] [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: 10/22/2022]
Affiliation(s)
| | | | | | - Tunde Peto
- Moorfields Eye HospitalLondonUnited Kingdom
| | - Imre Lengyel
- UCL Institute of OphthalmologyLondonUnited Kingdom
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17
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Fletcher PD, Nicholas JM, Shakespeare TJ, Downey LE, Golden HL, Agustus JL, Clark CN, Mummery CJ, Schott JM, Crutch SJ, Warren JD. Physiological phenotyping of dementias using emotional sounds. Alzheimers Dement (Amst) 2015; 1:170-178. [PMID: 26634223 PMCID: PMC4629103 DOI: 10.1016/j.dadm.2015.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Emotional behavioral disturbances are hallmarks of many dementias but their pathophysiology is poorly understood. Here we addressed this issue using the paradigm of emotionally salient sounds. METHODS Pupil responses and affective valence ratings for nonverbal sounds of varying emotional salience were assessed in patients with behavioral variant frontotemporal dementia (bvFTD) (n = 14), semantic dementia (SD) (n = 10), progressive nonfluent aphasia (PNFA) (n = 12), and AD (n = 10) versus healthy age-matched individuals (n = 26). RESULTS Referenced to healthy individuals, overall autonomic reactivity to sound was normal in Alzheimer's disease (AD) but reduced in other syndromes. Patients with bvFTD, SD, and AD showed altered coupling between pupillary and affective behavioral responses to emotionally salient sounds. DISCUSSION Emotional sounds are a useful model system for analyzing how dementias affect the processing of salient environmental signals, with implications for defining pathophysiological mechanisms and novel biomarker development.
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Affiliation(s)
- Phillip D. Fletcher
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jennifer M. Nicholas
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Timothy J. Shakespeare
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Laura E. Downey
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Hannah L. Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jennifer L. Agustus
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Camilla N. Clark
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Catherine J. Mummery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jason D. Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Corresponding author. Tel.: +44-(0)203-448-4773; Fax: +44-(0)203-448-3104.
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18
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Shakespeare TJ, Kaski D, Yong KXX, Paterson RW, Slattery CF, Ryan NS, Schott JM, Crutch SJ. Abnormalities of fixation, saccade and pursuit in posterior cortical atrophy. Brain 2015; 138:1976-91. [PMID: 25895507 PMCID: PMC4572483 DOI: 10.1093/brain/awv103] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 10/24/2014] [Accepted: 02/17/2015] [Indexed: 12/13/2022] Open
Abstract
The clinico-neuroradiological syndrome posterior cortical atrophy is the cardinal 'visual dementia' and most common atypical Alzheimer's disease phenotype, offering insights into mechanisms underlying clinical heterogeneity, pathological propagation and basic visual phenomena (e.g. visual crowding). Given the extensive attention paid to patients' (higher order) perceptual function, it is surprising that there have been no systematic analyses of basic oculomotor function in this population. Here 20 patients with posterior cortical atrophy, 17 patients with typical Alzheimer's disease and 22 healthy controls completed tests of fixation, saccade (including fixation/target gap and overlap conditions) and smooth pursuit eye movements using an infrared pupil-tracking system. Participants underwent detailed neuropsychological and neurological examinations, with a proportion also undertaking brain imaging and analysis of molecular pathology. In contrast to informal clinical evaluations of oculomotor dysfunction frequency (previous studies: 38%, current clinical examination: 33%), detailed eyetracking investigations revealed eye movement abnormalities in 80% of patients with posterior cortical atrophy (compared to 17% typical Alzheimer's disease, 5% controls). The greatest differences between posterior cortical atrophy and typical Alzheimer's disease were seen in saccadic performance. Patients with posterior cortical atrophy made significantly shorter saccades especially for distant targets. They also exhibited a significant exacerbation of the normal gap/overlap effect, consistent with 'sticky fixation'. Time to reach saccadic targets was significantly associated with parietal and occipital cortical thickness measures. On fixation stability tasks, patients with typical Alzheimer's disease showed more square wave jerks whose frequency was associated with lower cerebellar grey matter volume, while patients with posterior cortical atrophy showed large saccadic intrusions whose frequency correlated significantly with generalized reductions in cortical thickness. Patients with both posterior cortical atrophy and typical Alzheimer's disease showed lower gain in smooth pursuit compared to controls. The current study establishes that eye movement abnormalities are near-ubiquitous in posterior cortical atrophy, and highlights multiple aspects of saccadic performance which distinguish posterior cortical atrophy from typical Alzheimer's disease. We suggest the posterior cortical atrophy oculomotor profile (e.g. exacerbation of the saccadic gap/overlap effect, preserved saccadic velocity) reflects weak input from degraded occipito-parietal spatial representations of stimulus location into a superior collicular spatial map for eye movement regulation. This may indicate greater impairment of identification of oculomotor targets rather than generation of oculomotor movements. The results highlight the critical role of spatial attention and object identification but also precise stimulus localization in explaining the complex real world perception deficits observed in posterior cortical atrophy and many other patients with dementia-related visual impairment.
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Affiliation(s)
- Timothy J Shakespeare
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Diego Kaski
- 2 Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London UK
| | - Keir X X Yong
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Ross W Paterson
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Catherine F Slattery
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Natalie S Ryan
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Jonathan M Schott
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- 1 Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
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Fletcher PD, Nicholas JM, Shakespeare TJ, Downey LE, Golden HL, Agustus JL, Clark CN, Mummery CJ, Schott JM, Crutch SJ, Warren JD. Dementias show differential physiological responses to salient sounds. Front Behav Neurosci 2015; 9:73. [PMID: 25859194 PMCID: PMC4373266 DOI: 10.3389/fnbeh.2015.00073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 11/28/2014] [Accepted: 03/08/2015] [Indexed: 11/24/2022] Open
Abstract
Abnormal responsiveness to salient sensory signals is often a prominent feature of dementia diseases, particularly the frontotemporal lobar degenerations, but has been little studied. Here we assessed processing of one important class of salient signals, looming sounds, in canonical dementia syndromes. We manipulated tones using intensity cues to create percepts of salient approaching ("looming") or less salient withdrawing sounds. Pupil dilatation responses and behavioral rating responses to these stimuli were compared in patients fulfilling consensus criteria for dementia syndromes (semantic dementia, n = 10; behavioral variant frontotemporal dementia, n = 16, progressive nonfluent aphasia, n = 12; amnestic Alzheimer's disease, n = 10) and a cohort of 26 healthy age-matched individuals. Approaching sounds were rated as more salient than withdrawing sounds by healthy older individuals but this behavioral response to salience did not differentiate healthy individuals from patients with dementia syndromes. Pupil responses to approaching sounds were greater than responses to withdrawing sounds in healthy older individuals and in patients with semantic dementia: this differential pupil response was reduced in patients with progressive nonfluent aphasia and Alzheimer's disease relative both to the healthy control and semantic dementia groups, and did not correlate with nonverbal auditory semantic function. Autonomic responses to auditory salience are differentially affected by dementias and may constitute a novel biomarker of these diseases.
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Affiliation(s)
- Phillip D. Fletcher
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Jennifer M. Nicholas
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
- London School of Hygiene and Tropical Medicine, University of LondonLondon, UK
| | - Timothy J. Shakespeare
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Laura E. Downey
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Hannah L. Golden
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Jennifer L. Agustus
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Camilla N. Clark
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Catherine J. Mummery
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
| | - Jason D. Warren
- Dementia Research Centre, UCL Institute of Neurology, University College LondonLondon, UK
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Shakespeare TJ, Yong KXX, Frost C, Kim LG, Warrington EK, Crutch SJ. Corrigendum: Scene perception in posterior cortical atrophy: categorization, description and fixation patterns. Front Hum Neurosci 2014. [PMCID: PMC4227508 DOI: 10.3389/fnhum.2014.00908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy J. Shakespeare
- Dementia Research Centre, Institute of Neurology, University College LondonLondon, UK
- *Correspondence:
| | - Keir X. X. Yong
- Dementia Research Centre, Institute of Neurology, University College LondonLondon, UK
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, UK
| | - Lois G. Kim
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, UK
| | | | - Sebastian J. Crutch
- Dementia Research Centre, Institute of Neurology, University College LondonLondon, UK
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21
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Yong KXX, Shakespeare TJ, Cash D, Henley SMD, Nicholas JM, Ridgway GR, Golden HL, Warrington EK, Carton AM, Kaski D, Schott JM, Warren JD, Crutch SJ. Prominent effects and neural correlates of visual crowding in a neurodegenerative disease population. ACTA ACUST UNITED AC 2014; 137:3284-99. [PMID: 25351740 PMCID: PMC4240300 DOI: 10.1093/brain/awu293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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] [Indexed: 12/14/2022]
Abstract
Crowding is a breakdown in the ability to identify objects in clutter, and is a major constraint on object recognition. Crowding particularly impairs object perception in peripheral, amblyopic and possibly developing vision. Here we argue that crowding is also a critical factor limiting object perception in central vision of individuals with neurodegeneration of the occipital cortices. In the current study, individuals with posterior cortical atrophy (n=26), typical Alzheimer's disease (n=17) and healthy control subjects (n=14) completed centrally-presented tests of letter identification under six different flanking conditions (unflanked, and with letter, shape, number, same polarity and reverse polarity flankers) with two different target-flanker spacings (condensed, spaced). Patients with posterior cortical atrophy were significantly less accurate and slower to identify targets in the condensed than spaced condition even when the target letters were surrounded by flankers of a different category. Importantly, this spacing effect was observed for same, but not reverse, polarity flankers. The difference in accuracy between spaced and condensed stimuli was significantly associated with lower grey matter volume in the right collateral sulcus, in a region lying between the fusiform and lingual gyri. Detailed error analysis also revealed that similarity between the error response and the averaged target and flanker stimuli (but not individual target or flanker stimuli) was a significant predictor of error rate, more consistent with averaging than substitution accounts of crowding. Our findings suggest that crowding in posterior cortical atrophy can be regarded as a pre-attentive process that uses averaging to regularize the pathologically noisy representation of letter feature position in central vision. These results also help to clarify the cortical localization of feature integration components of crowding. More broadly, we suggest that posterior cortical atrophy provides a neurodegenerative disease model for exploring the basis of crowding. These data have significant implications for patients with, or who will go on to develop, dementia-related visual impairment, in whom acquired excessive crowding likely contributes to deficits in word, object, face and scene perception.
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Affiliation(s)
- Keir X X Yong
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Timothy J Shakespeare
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Dave Cash
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK 2 Centre for Medical Image Computing, University College London, UK
| | - Susie M D Henley
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK 3 University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer M Nicholas
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK 4 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Gerard R Ridgway
- 5 Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 6 Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
| | - Hannah L Golden
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Elizabeth K Warrington
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Amelia M Carton
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Diego Kaski
- 7 Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Jonathan M Schott
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Jason D Warren
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
| | - Sebastian J Crutch
- 1 Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, UK
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Yong KXX, Shakespeare TJ, Cash D, Henley SMD, Warren JD, Crutch SJ. (Con)text-specific effects of visual dysfunction on reading in posterior cortical atrophy. Cortex 2014; 57:92-106. [PMID: 24841985 PMCID: PMC4194349 DOI: 10.1016/j.cortex.2014.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 11/04/2013] [Revised: 02/14/2014] [Accepted: 03/28/2014] [Indexed: 11/13/2022]
Abstract
Reading deficits are a common early feature of the degenerative syndrome posterior cortical atrophy (PCA) but are poorly understood even at the single word level. The current study evaluated the reading accuracy and speed of 26 PCA patients, 17 typical Alzheimer's disease (tAD) patients and 14 healthy controls on a corpus of 192 single words in which the following perceptual properties were manipulated systematically: inter-letter spacing, font size, length, font type, case and confusability. PCA reading was significantly less accurate and slower than tAD patients and controls, with performance significantly adversely affected by increased letter spacing, size, length and font (cursive < non-cursive), and characterised by visual errors (69% of all error responses). By contrast, tAD and control accuracy rates were at or near ceiling, letter spacing was the only perceptual factor to influence reading speed in the same direction as controls, and, in contrast to PCA patients, control reading was faster for larger font sizes. The inverse size effect in PCA (less accurate reading of large than small font size print) was associated with lower grey matter volume in the right superior parietal lobule. Reading accuracy was associated with impairments of early visual (especially crowding), visuoperceptual and visuospatial processes. However, these deficits were not causally related to a universal impairment of reading as some patients showed preserved reading for small, unspaced words despite grave visual deficits. Rather, the impact of specific types of visual dysfunction on reading was found to be (con)text specific, being particularly evident for large, spaced, lengthy words. These findings improve the characterisation of dyslexia in PCA, shed light on the causative and associative factors, and provide clear direction for the development of reading aids and strategies to maximise and sustain reading ability in the early stages of disease.
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Affiliation(s)
- Keir X X Yong
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK.
| | - Timothy J Shakespeare
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK
| | - Dave Cash
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK
| | - Susie M D Henley
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, University College London, London, UK
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23
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Ryan NS, Shakespeare TJ, Lehmann M, Keihaninejad S, Nicholas JM, Leung KK, Fox NC, Crutch SJ. Motor features in posterior cortical atrophy and their imaging correlates. Neurobiol Aging 2014; 35:2845-2857. [PMID: 25086839 PMCID: PMC4236588 DOI: 10.1016/j.neurobiolaging.2014.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/06/2014] [Accepted: 05/31/2014] [Indexed: 12/28/2022]
Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by impaired higher visual processing skills; however, motor features more commonly associated with corticobasal syndrome may also occur. We investigated the frequency and clinical characteristics of motor features in 44 PCA patients and, with 30 controls, conducted voxel-based morphometry, cortical thickness, and subcortical volumetric analyses of their magnetic resonance imaging. Prominent limb rigidity was used to define a PCA-motor subgroup. A total of 30% (13) had PCA-motor; all demonstrating asymmetrical left upper limb rigidity. Limb apraxia was more frequent and asymmetrical in PCA-motor, as was myoclonus. Tremor and alien limb phenomena only occurred in this subgroup. The subgroups did not differ in neuropsychological test performance or apolipoprotein E4 allele frequency. Greater asymmetry of atrophy occurred in PCA-motor, particularly involving right frontoparietal and peri-rolandic cortices, putamen, and thalamus. The 9 patients (including 4 PCA-motor) with pathology or cerebrospinal fluid all showed evidence of Alzheimer's disease. Our data suggest that PCA patients with motor features have greater atrophy of contralateral sensorimotor areas but are still likely to have underlying Alzheimer's disease. We investigated motor features and their neuroimaging correlates in 44 posterior cortical atrophy (PCA) patients. A total of 30% had asymmetrical left upper limb rigidity and were termed the “PCA-motor” group. Limb apraxia was more frequent and asymmetrical in PCA-motor, as was myoclonus. PCA-motor had greater asymmetry of atrophy, involving the right sensorimotor areas. The subgroup with pathology or cerebrospinal fluid all showed evidence of Alzheimer's disease.
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Affiliation(s)
- Natalie S Ryan
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK.
| | - Timothy J Shakespeare
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Manja Lehmann
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Shiva Keihaninejad
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Jennifer M Nicholas
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK; Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Kelvin K Leung
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, Queen Square, London, UK
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Shakespeare TJ, Yong KXX, Frost C, Kim LG, Warrington EK, Crutch SJ. Scene perception in posterior cortical atrophy: categorization, description and fixation patterns. Front Hum Neurosci 2013; 7:621. [PMID: 24106469 PMCID: PMC3788344 DOI: 10.3389/fnhum.2013.00621] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 05/17/2013] [Accepted: 09/09/2013] [Indexed: 12/16/2022] Open
Abstract
Partial or complete Balint's syndrome is a core feature of the clinico-radiological syndrome of posterior cortical atrophy (PCA), in which individuals experience a progressive deterioration of cortical vision. Although multi-object arrays are frequently used to detect simultanagnosia in the clinical assessment and diagnosis of PCA, to date there have been no group studies of scene perception in patients with the syndrome. The current study involved three linked experiments conducted in PCA patients and healthy controls. Experiment 1 evaluated the accuracy and latency of complex scene perception relative to individual faces and objects (color and grayscale) using a categorization paradigm. PCA patients were both less accurate (faces < scenes < objects) and slower (scenes < objects < faces) than controls on all categories, with performance strongly associated with their level of basic visual processing impairment; patients also showed a small advantage for color over grayscale stimuli. Experiment 2 involved free description of real world scenes. PCA patients generated fewer features and more misperceptions than controls, though perceptual errors were always consistent with the patient's global understanding of the scene (whether correct or not). Experiment 3 used eye tracking measures to compare patient and control eye movements over initial and subsequent fixations of scenes. Patients' fixation patterns were significantly different to those of young and age-matched controls, with comparable group differences for both initial and subsequent fixations. Overall, these findings describe the variability in everyday scene perception exhibited by individuals with PCA, and indicate the importance of exposure duration in the perception of complex scenes.
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Affiliation(s)
- Timothy J Shakespeare
- Dementia Research Centre, Institute of Neurology, University College London London, UK
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25
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Shakespeare TJ, Tsui BCH. Intermittent hoarseness with continuous interscalene brachial plexus catheter infusion due to deficient carotid sheath. Acta Anaesthesiol Scand 2013; 57:1085-6. [PMID: 23808964 DOI: 10.1111/aas.12147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Tsui BCH, Shakespeare TJ, Leung DH, Tsui JH, Corry GN. Reproducibility of current perception threshold with the Neurometer(®) vs the Stimpod NMS450 peripheral nerve stimulator in healthy volunteers: an observational study. Can J Anaesth 2013; 60:753-60. [PMID: 23690134 DOI: 10.1007/s12630-013-9965-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 05/02/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Current methods of assessing nerve blocks, such as loss of perception to cold sensation, are subjective at best. Transcutaneous nerve stimulation is an alternative method that has previously been used to measure the current perception threshold (CPT) in individuals with neuropathic conditions, and various devices to measure CPT are commercially available. Nevertheless, the device must provide reproducible results to be used as an objective tool for assessing nerve blocks. METHODS We recruited ten healthy volunteers to examine CPT reproducibility using the Neurometer(®) and the Stimpod NMS450 peripheral nerve stimulator. Each subject's CPT was determined for the median (second digit) and ulnar (fifth digit) nerve sensory distributions on both hands - with the Neurometer at 5 Hz, 250 Hz, and 2000 Hz and with the Stimpod at pulse widths of 0.1 msec, 0.3 msec, 0.5 msec, and 1.0 msec, both at 5 Hz and 2 Hz. Intraclass correlation coefficients (ICC) were also calculated to assess reproducibility; acceptable ICCs were defined as ≥ 0.4. RESULTS The ICC values for the Stimpod ranged from 0.425-0.79, depending on pulse width, digit, and stimulation; ICCs for the Neurometer were 0.615 and 0.735 at 250 and 2,000 Hz, respectively. These values were considered acceptable; however, the Neurometer performed less efficiently at 5 Hz (ICCs for the second and fifth digits were 0.292 and 0.318, respectively). CONCLUSION Overall, the Stimpod device displayed good to excellent reproducibility in measuring CPT in healthy volunteers. The Neurometer displayed poor reproducibility at low frequency (5 Hz). These results suggest that peripheral nerve stimulators may be potential devices for measuring CPT to assess nerve blocks.
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Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada.
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27
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Affiliation(s)
- Pirada Witoonpanich
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Timothy J Shakespeare
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Keir X X Yong
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rohani Omar
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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28
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Ryan NS, Keihaninejad S, Shakespeare TJ, Lehmann M, Crutch SJ, Malone IB, Thornton JS, Mancini L, Hyare H, Yousry T, Ridgway GR, Zhang H, Modat M, Alexander DC, Rossor MN, Ourselin S, Fox NC. Magnetic resonance imaging evidence for presymptomatic change in thalamus and caudate in familial Alzheimer's disease. Brain 2013; 136:1399-414. [PMID: 23539189 PMCID: PMC3634199 DOI: 10.1093/brain/awt065] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [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: 10/22/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 01/06/2023] Open
Abstract
Amyloid imaging studies of presymptomatic familial Alzheimer's disease have revealed the striatum and thalamus to be the earliest sites of amyloid deposition. This study aimed to investigate whether there are associated volume and diffusivity changes in these subcortical structures during the presymptomatic and symptomatic stages of familial Alzheimer's disease. As the thalamus and striatum are involved in neural networks subserving complex cognitive and behavioural functions, we also examined the diffusion characteristics in connecting white matter tracts. A cohort of 20 presenilin 1 mutation carriers underwent volumetric and diffusion tensor magnetic resonance imaging, neuropsychological and clinical assessments; 10 were symptomatic, 10 were presymptomatic and on average 5.6 years younger than their expected age at onset; 20 healthy control subjects were also studied. We conducted region of interest analyses of volume and diffusivity changes in the thalamus, caudate, putamen and hippocampus and examined diffusion behaviour in the white matter tracts of interest (fornix, cingulum and corpus callosum). Voxel-based morphometry and tract-based spatial statistics were also used to provide unbiased whole-brain analyses of group differences in volume and diffusion indices, respectively. We found that reduced volumes of the left thalamus and bilateral caudate were evident at a presymptomatic stage, together with increased fractional anisotropy of bilateral thalamus and left caudate. Although no significant hippocampal volume loss was evident presymptomatically, reduced mean diffusivity was observed in the right hippocampus and reduced mean and axial diffusivity in the right cingulum. In contrast, symptomatic mutation carriers showed increased mean, axial and in particular radial diffusivity, with reduced fractional anisotropy, in all of the white matter tracts of interest. The symptomatic group also showed atrophy and increased mean diffusivity in all of the subcortical grey matter regions of interest, with increased fractional anisotropy in bilateral putamen. We propose that axonal injury may be an early event in presymptomatic Alzheimer's disease, causing an initial fall in axial and mean diffusivity, which then increases with loss of axonal density. The selective degeneration of long-coursing white matter tracts, with relative preservation of short interneurons, may account for the increase in fractional anisotropy that is seen in the thalamus and caudate presymptomatically. It may be owing to their dense connectivity that imaging changes are seen first in the thalamus and striatum, which then progress to involve other regions in a vulnerable neuronal network.
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Affiliation(s)
- Natalie S Ryan
- Dementia Research Centre, Box 16 National Hospital for Neurology and Neurosugery, Queen Square, London WC1N 3BG, UK.
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