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Upadhyay N, Spottke A, Schneider A, Hoffmann DC, Frommann I, Ballarini T, Fliessbach K, Bender B, Heekeren HR, Haynes JD, Ewers M, Düzel E, Glanz W, Dobisch L, Buerger K, Janowitz D, Levin J, Danek A, Teipel S, Kilimann I, Synofzik M, Wilke C, Peters O, Preis L, Priller J, Spruth EJ, Jessen F, Boecker H. Fronto-striatal alterations correlate with apathy severity in behavioral variant frontotemporal dementia. Brain Imaging Behav 2024; 18:66-72. [PMID: 37855956 PMCID: PMC10844138 DOI: 10.1007/s11682-023-00812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
Structural and functional changes in cortical and subcortical regions have been reported in behavioral variant frontotemporal dementia (bvFTD), however, a multimodal approach may provide deeper insights into the neural correlates of neuropsychiatric symptoms. In this multicenter study, we measured cortical thickness (CTh) and subcortical volumes to identify structural abnormalities in 37 bvFTD patients, and 37 age- and sex-matched healthy controls. For seed regions with significant structural changes, whole-brain functional connectivity (FC) was examined in a sub-cohort of N = 22 bvFTD and N = 22 matched control subjects to detect complementary alterations in brain network organization. To explore the functional significance of the observed structural and functional deviations, correlations with clinical and neuropsychological outcomes were tested where available. Significantly decreased CTh was observed in the bvFTD group in caudal middle frontal gyrus, left pars opercularis, bilateral superior frontal and bilateral middle temporal gyrus along with subcortical volume reductions in bilateral basal ganglia, thalamus, hippocampus, and amygdala. Resting-state functional magnetic resonance imaging showed decreased FC in bvFTD between: dorsal striatum and left caudal middle frontal gyrus; putamen and fronto-parietal regions; pallidum and cerebellum. Conversely, bvFTD showed increased FC between: left middle temporal gyrus and paracingulate gyrus; caudate nucleus and insula; amygdala and parahippocampal gyrus. Additionally, cortical thickness in caudal, lateral and superior frontal regions as well as caudate nucleus volume correlated negatively with apathy severity scores of the Neuropsychiatry Inventory Questionnaire. In conclusion, multimodal structural and functional imaging indicates that fronto-striatal regions have a considerable influence on the severity of apathy in bvFTD.
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Affiliation(s)
- Neeraj Upadhyay
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.
- Clinical Functional Imaging Lab, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.
| | - Annika Spottke
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Anja Schneider
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Daniel C Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
| | - Ingo Frommann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Tommaso Ballarini
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
| | - Klaus Fliessbach
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Hauke R Heekeren
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Center for Cognitive Neuroscience Berlin, Freie Universität Berlin, Berlin, Germany
| | - John Dylan Haynes
- Bernstein Center for Computational Neuroscience, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Ewers
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Emrah Düzel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Wenzel Glanz
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Laura Dobisch
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Katharina Buerger
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Johannes Levin
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Adrian Danek
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Matthis Synofzik
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Carlo Wilke
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Oliver Peters
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Lukas Preis
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Josef Priller
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Eike Jakob Spruth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Frank Jessen
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Henning Boecker
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Clinical Functional Imaging Lab, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
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Sheelakumari R, Bineesh C, Varghese T, Kesavadas C, Verghese J, Mathuranath PS. Neuroanatomical correlates of apathy and disinhibition in behavioural variant frontotemporal dementia. Brain Imaging Behav 2021; 14:2004-2011. [PMID: 31273672 DOI: 10.1007/s11682-019-00150-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroanatomical correlates of apathy and disinhibition, behavioral abnormalities in behavioral variant Frontotemporal dementia (bvFTD) remain unclear. In this study 45 participants (25 bvFTD patients and 20 controls) provided data on clinical, neuropsychological, behavioral (on Frontal Systems Behavior (FrSBe) Scale), cortical volume (on voxel-based morphometry (VBM)) and tract based spatial fractional anisotropy ((FA) on magnetic resonance imaging (MRI), allowing examination of the neural correlates of apathy and disinhibition. The patients with bvFTD had predominant grey matter loss and corresponding white matter fractional anisotropy reduction in the frontal and temporal lobe compared to the controls. Grey matter loss in frontal, temporal and limbic structures correlated with apathy and degeneration in temporal limbic brain areas correlated with disinhibition. FA changes in inferior fronto-occipital fasciculus and forceps minor correlated with apathy and fibre integrity changes in the superior longitudinal fasciculus correlated with disinhibition. The current study suggests that apathy and disinhibition arises due to changes in the frontal, temporal and limbic brain areas in bvFTD.
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Affiliation(s)
- Raghavan Sheelakumari
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Tinu Varghese
- Department of Electronics and Instrumentation, Noorul Islam University, Kumaracoil, Thuckalay, Tamilnadu, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Joe Verghese
- Integrated Divisions of Cognitive and Motor Aging (Neurology) and Geriatrics (Medicine), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pavagada S Mathuranath
- Cognition and Behavioural Neurology Section, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Banglore, Karnataka, 560029, India.
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Dev SI, Dickerson BC, Touroutoglou A. Neuroimaging in Frontotemporal Lobar Degeneration: Research and Clinical Utility. Adv Exp Med Biol 2021; 1281:93-112. [PMID: 33433871 DOI: 10.1007/978-3-030-51140-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Frontotemporal lobar dementia (FTLD) is a clinically and pathologically complex disease. Advances in neuroimaging techniques have provided a specialized set of tools to investigate underlying pathophysiology and identify clinical biomarkers that aid in diagnosis, prognostication, monitoring, and identification of appropriate endpoints in clinical trials. In this chapter, we review data discussing the utility of neuroimaging biomarkers in sporadic FTLD, with an emphasis on current and future clinical applications. Among those modalities readily utilized in clinical settings, T1-weighted structural magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are best supported in differential diagnosis and as targets for clinical trial endpoints. However, a number of nonclinical neuroimaging modalities, including diffusion tensor imaging and resting-state functional connectivity MRI, show promise as biomarkers to predict progression and as clinical trial endpoints. Other neuroimaging modalities, including amyloid PET, Tau PET, and arterial spin labeling MRI, are also discussed, though more work is required to establish their utility in FTLD in clinical settings.
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Affiliation(s)
- Sheena I Dev
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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Elahi FM, Marx G, Cobigo Y, Staffaroni AM, Kornak J, Tosun D, Boxer AL, Kramer JH, Miller BL, Rosen HJ. Longitudinal white matter change in frontotemporal dementia subtypes and sporadic late onset Alzheimer's disease. Neuroimage Clin 2017; 16:595-603. [PMID: 28975068 PMCID: PMC5614750 DOI: 10.1016/j.nicl.2017.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/17/2017] [Accepted: 09/06/2017] [Indexed: 12/14/2022]
Abstract
Background Degradation of white matter microstructure has been demonstrated in frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). In preparation for clinical trials, ongoing studies are investigating the utility of longitudinal brain imaging for quantification of disease progression. To date only one study has examined sample size calculations based on longitudinal changes in white matter integrity in FTLD. Objective To quantify longitudinal changes in white matter microstructural integrity in the three canonical subtypes of frontotemporal dementia (FTD) and AD using diffusion tensor imaging (DTI). Methods 60 patients with clinical diagnoses of FTD, including 27 with behavioral variant frontotemporal dementia (bvFTD), 14 with non-fluent variant primary progressive aphasia (nfvPPA), and 19 with semantic variant PPA (svPPA), as well as 19 patients with AD and 69 healthy controls were studied. We used a voxel-wise approach to calculate annual rate of change in fractional anisotropy (FA) and mean diffusivity (MD) in each group using two time points approximately one year apart. Mean rates of change in FA and MD in 48 atlas-based regions-of-interest, as well as global measures of cognitive function were used to calculate sample sizes for clinical trials (80% power, alpha of 5%). Results All FTD groups showed statistically significant baseline and longitudinal white matter degeneration, with predominant involvement of frontal tracts in the bvFTD group, frontal and temporal tracts in the PPA groups and posterior tracts in the AD group. Longitudinal change in MD yielded a larger number of regions with sample sizes below 100 participants per therapeutic arm in comparison with FA. SvPPA had the smallest sample size based on change in MD in the fornix (n = 41 participants per study arm to detect a 40% effect of drug), and nfvPPA and AD had their smallest sample sizes based on rate of change in MD within the left superior longitudinal fasciculus (n = 49 for nfvPPA, and n = 23 for AD). BvFTD generally showed the largest sample size estimates (minimum n = 140 based on MD in the corpus callosum). The corpus callosum appeared to be the best region for a potential study that would include all FTD subtypes. Change in global measure of functional status (CDR box score) yielded the smallest sample size for bvFTD (n = 71), but clinical measures were inferior to white matter change for the other groups. Conclusions All three of the canonical subtypes of FTD are associated with significant change in white matter integrity over one year. These changes are consistent enough that drug effects in future clinical trials could be detected with relatively small numbers of participants. While there are some differences in regions of change across groups, the genu of the corpus callosum is a region that could be used to track progression in studies that include all subtypes. We show longitudinal change in white matter in frontotemporal lobar degeneration (FTLD) and Alzheimer’s disease (AD). We use diffusion tensor imaging (DTI) to quantify rate of white matter degeneration in FTLD and AD. In preparation for clinical trials, utility of longitudinal DTI as surrogate marker of therapeutic efficacy is investigated. We produce sample sizes based on rate of change in DTI metrics in the three canonical subtypes of FTLD and AD.
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Affiliation(s)
- Fanny M Elahi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Gabe Marx
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Adam M Staffaroni
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Duygu Tosun
- Department of Veteran Affairs Medical Center, San Francisco, CA, United States.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, United States
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