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Belder CRS, Marshall CR, Jiang J, Mazzeo S, Chokesuwattanaskul A, Rohrer JD, Volkmer A, Hardy CJD, Warren JD. Primary progressive aphasia: six questions in search of an answer. J Neurol 2024; 271:1028-1046. [PMID: 37906327 PMCID: PMC10827918 DOI: 10.1007/s00415-023-12030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
Here, we review recent progress in the diagnosis and management of primary progressive aphasia-the language-led dementias. We pose six key unanswered questions that challenge current assumptions and highlight the unresolved difficulties that surround these diseases. How many syndromes of primary progressive aphasia are there-and is syndromic diagnosis even useful? Are these truly 'language-led' dementias? How can we diagnose (and track) primary progressive aphasia better? Can brain pathology be predicted in these diseases? What is their core pathophysiology? In addition, how can primary progressive aphasia best be treated? We propose that pathophysiological mechanisms linking proteinopathies to phenotypes may help resolve the clinical complexity of primary progressive aphasia, and may suggest novel diagnostic tools and markers and guide the deployment of effective therapies.
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Affiliation(s)
- Christopher R S Belder
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, UCL Queen Square Institute of Neurology, University College London, London, UK
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Salvatore Mazzeo
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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Quang H, Wong S, Husain M, Piguet O, Hodges JR, Irish M, Kumfor F. Beyond language impairment: Profiles of apathy in primary progressive aphasia. Cortex 2021; 139:73-85. [PMID: 33836304 DOI: 10.1016/j.cortex.2021.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/28/2020] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that apathy can be delineated into multiple dimensions: executive apathy (i.e., deficits in maintaining goals and organisation), emotional apathy (i.e., emotional blunting and indifference) and initiation apathy (i.e., reduced self-initiation). Whether the nature of apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation apathy. Voxel-based morphometry was used to identify associations between dimensions of apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional apathy than both late nfvPPA and late lvPPA groups. Executive and initiation apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional apathy was only seen in early and late svPPA. Distinct neural correlates were identified across apathy dimensions. Executive apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional apathy with the left medial prefrontal, insular and cerebellar regions; and initiation apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of apathy which emerge in PPA.
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Ruksenaite J, Volkmer A, Jiang J, Johnson JC, Marshall CR, Warren JD, Hardy CJ. Primary Progressive Aphasia: Toward a Pathophysiological Synthesis. Curr Neurol Neurosci Rep 2021; 21:7. [PMID: 33543347 PMCID: PMC7861583 DOI: 10.1007/s11910-021-01097-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The term primary progressive aphasia (PPA) refers to a diverse group of dementias that present with prominent and early problems with speech and language. They present considerable challenges to clinicians and researchers. RECENT FINDINGS Here, we review critical issues around diagnosis of the three major PPA variants (semantic variant PPA, nonfluent/agrammatic variant PPA, logopenic variant PPA), as well as considering 'fragmentary' syndromes. We next consider issues around assessing disease stage, before discussing physiological phenotyping of proteinopathies across the PPA spectrum. We also review evidence for core central auditory impairments in PPA, outline critical challenges associated with treatment, discuss pathophysiological features of each major PPA variant, and conclude with thoughts on key challenges that remain to be addressed. New findings elucidating the pathophysiology of PPA represent a major step forward in our understanding of these diseases, with implications for diagnosis, care, management, and therapies.
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Affiliation(s)
- Justina Ruksenaite
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jeremy Cs Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris Jd Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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Kakinuma K, Baba T, Ezura M, Endo K, Saito Y, Narita W, Iizuka O, Nishio Y, Kikuchi A, Hasegawa T, Aoki M, Suzuki K. Logopenic aphasia due to Lewy body disease dramatically improved with donepezil. eNeurologicalSci 2020; 19:100241. [PMID: 32455171 PMCID: PMC7235623 DOI: 10.1016/j.ensci.2020.100241] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/01/2022] Open
Abstract
•Pathological basis of primary progressive aphasia is heterogeneous.•Logopenic primary progressive aphasia can precede dementia with Lewy bodies (DLB).•Cholinesterase inhibitor can improve logopenic aphasia with DLB.
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Affiliation(s)
- Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Baba
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurology, National Hospital Organization Sendai-Nishitaga Hospital, Sendai, Japan
| | - Michinori Ezura
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiko Endo
- Department of Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Yumiko Saito
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Wataru Narita
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Osamu Iizuka
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Nishio
- Department of Psychiatry & Neurology, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Akio Kikuchi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kamath V, Sutherland ER, Chaney GA. A Meta-Analysis of Neuropsychological Functioning in the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants. J Int Neuropsychol Soc 2020; 26:322-30. [PMID: 31658919 DOI: 10.1017/S1355617719001115] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The logopenic variant of primary progressive aphasia (lvPPA) has disparate pathological and anatomical features when compared to the semantic (svPPA) and non-fluent (nfvPPA) variants of PPA. As such, there is increasing need for measures that improve diagnostic accuracy particularly when etiology-specific treatments become available. In the current study, we used meta-analytic methods to establish the neuropsychological profile of lvPPA and compare it to recent findings in svPPA and nfvPPA. METHODS We extracted neuropsychological data from 51 publications representing 663 lvPPA patients and 1379 controls. We calculated Hedges' g effect sizes for nine domains of neuropsychological functioning in lvPPA and assessed the influence of demographic, disease, and task characteristics on effect size magnitude. Results obtained in lvPPA were compared to findings in svPPA and nfvPPA. RESULTS In lvPPA, the magnitude of deficits in attention, math, visuospatial memory, and executive functioning were as prominent as language deficits. Within the language domain, lvPPA patients demonstrated greater naming than repetition deficits. Compared to svPPA and nfvPPA, lvPPA patients demonstrated greater neuropsychological deficits overall and greater impairment on attention, math, and visual set-shifting tests. CONCLUSIONS Tests of attention, delayed visuospatial memory, visual set-shifting, and math distinguish lvPPA from svPPA and nfvPPA likely reflecting the posterior temporoparietal atrophy observed early in the course of lvPPA. These findings support the inclusion of these measures in the clinical neuropsychological assessment of lvPPA and underscore the need for additional clinicopathological and longitudinal studies of arithmetic and visuospatial memory across the PPA variants.
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Takaya M, Ishii K, Kubota I, Shirakawa O. The Landscape Montage Technique for diagnosing frontotemporal dementia starting as primary progressive aphasia: a case report. J Med Case Rep 2020; 14:5. [PMID: 31915061 PMCID: PMC6951018 DOI: 10.1186/s13256-019-2338-7] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
Background The Landscape Montage Technique was originally developed by Hisao Nakai, a Japanese psychiatrist, to pursue the possibility and application of a psychotherapeutic approach using drawing for patients with schizophrenia. Drawing was initially adopted to evaluate patients with an impaired ability for verbal expression, particularly for the diagnosis and treatment of patients with schizophrenia. Since its development, the Landscape Montage Technique has been utilized in various clinical settings throughout Japan. This study aimed to evaluate the psychiatric conditions of a patient diagnosed as having primary progressive aphasia using the Landscape Montage Technique at a 3-year follow-up. Case presentation We present the case of a 64-year-old, right-handed Japanese woman initially diagnosed as having logopenic variant primary progressive aphasia or logopenic aphasia. At a 3-year follow-up, logopenic aphasia progressed to behavioral variant frontotemporal dementia or frontotemporal dementia. According to her husband, she began to have speech difficulties approximately 5 years before her first visit. The results of neurocognitive tests suggested mild cognitive impairment or early stages of dementia. Her clinical dementia rating score was 0.5, suggesting a diagnosis of mild cognitive impairment. She had a Raven’s Colored Progressive Matrices score of 31 out of 36, which indicated a nonverbal cognitive ability that was greater than the 90th percentile for her age. The Japanese Standard Language Test of Aphasia, which was performed at two points during the follow-up, indicated the possibility for a diagnosis of primary progressive aphasia given the progression of her aphasia. Based on her clinical symptoms and Japanese Standard Language Test of Aphasia results, a diagnosis of logopenic variant primary progressive aphasia was established. Magnetic resonance imaging revealed severe predominant left frontal and anterior temporal atrophy, as well as bilateral parietal atrophy. Amyloid beta deposition was negative. At the 3-year follow-up, logopenic variant primary progressive aphasia had progressed to behavioral variant frontotemporal dementia. However, the Landscape Montage Technique allowed for the diagnosis of behavioral variant frontotemporal dementia only 2 years after baseline. Conclusions The present study showed that the Landscape Montage Technique can be useful for diagnosing behavioral variant frontotemporal dementia that starts as logopenic variant primary progressive aphasia at earlier stages.
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Affiliation(s)
- Masahiko Takaya
- Department of Neuropsychiatry, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Kazunari Ishii
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Isao Kubota
- Department of Rehabilitation, Kindai University Hospital, Osaka, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
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Owens TE, Machulda MM, Duffy JR, Strand EA, Clark HM, Boland S, Martin PR, Lowe VJ, Jack CR, Whitwell JL, Josephs KA. Patterns of Neuropsychological Dysfunction and Cortical Volume Changes in Logopenic Aphasia. J Alzheimers Dis 2019; 66:1015-1025. [PMID: 30372673 DOI: 10.3233/jad-171175] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuropsychological assessment can add essential information to the characterization of individuals presenting with the logopenic variant of primary progressive aphasia (lvPPA). OBJECTIVE This study examined the neuropsychological characteristics of lvPPA patients. We also examined differences in regional and whole brain atrophy based on neuropsychological profiles. METHODS We conducted a hierarchical cluster analysis on memory, executive functioning, and visuospatial neuropsychological test data for 56 individuals with lvPPA. We then compared resultant clusters to left middle temporal, inferior parietal, and superior parietal regions-of-interest using multivariate analysis of covariance. We also performed voxel-level analyses. RESULTS We identified three clusters characterized as lvPPA with no neurocognitive impairment (n = 5), lvPPA with mild neurocognitive deficits (n = 23), and lvPPA with marked cognitive deficits (n = 28). WAB-AQ was associated with left middle temporal volume. Superior parietal volumes were smaller for the lvPPA group with marked cognitive symptoms compared to the less severe groups. Voxel-level analyses showed greater atrophy in temporal, parietal, lateral occipital, and frontal regions, left worse than right. Age, disease duration, gender, WAB-AQ, and PiB-PET did not account for differences between groups. CONCLUSIONS LvPPA patients without cognitive deficits in other domains were relatively uncommon while 50% of our sample exhibited pronounced neurocognitive deficits outside the language domain. Pronounced cognitive deficits in lvPPA are associated with widespread atrophy, left worse than right. Our study underscores the importance of examining neuropsychological function in addition to language in patients with lvPPA.
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Leyton CE, Landin-Romero R, Liang CT, Burrell JR, Kumfor F, Hodges JR, Piguet O. Correlates of anomia in non-semantic variants of primary progressive aphasia converge over time. Cortex 2019; 120:201-211. [PMID: 31325799 DOI: 10.1016/j.cortex.2019.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
To track neural correlates of naming performance with disease progression, we estimated key areas affected in nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) primary progressive aphasia variants over time and changes in naming correlates over time. Twenty-nine non-semantic PPA participants (17 nfvPPA and 12 lvPPA) were selected based upon current diagnostic criteria and PiB-PET status and conducted a confrontation-naming task and a structural MRI. Linear mixed-effect models implemented in FreeSurfer were used for tracking cortical thickness and epicenters of atrophy over time. Using averaged cortical thickness of epicenters and naming performance as variables of interest, two sets of multivariate analyses were conducted to compare atrophy progression and naming correlates across groups. While all PPA participants demonstrated naming deterioration and progressive cortical thinning in the left temporal lobe and the left inferior frontal gyrus, the lvPPA cohort showed greater naming deterioration and thinning in the left posterior inferior parietal cortex over time than it did the nfvPPA cohort. The multivariate analyses confirmed a widespread cortical thinning in lvPPA over time, but a more rapid thinning in the right superior frontal gyrus of nfvPPA participants. Impaired naming correlated with common cortical regions in both groups. These regions included the left anterior superior temporal gyrus and the posterior middle temporal gyrus, which was primarily affected in lvPPA. Non-semantic PPA variants initially present with separate epicenters of atrophy and different spatial-temporal patterns of neurodegeneration over time, but the common involvement in key cortical regions of the left temporal lobe accounts for naming deterioration in both groups.
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Affiliation(s)
- Cristian E Leyton
- The University of Sydney, Brain and Mind Centre, Faculty of Health Sciences, Sydney, NSW, Australia; Frontotemporal Disorders Unit, Department of Neurology Massachusetts, General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Ramon Landin-Romero
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Cheng Tao Liang
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - James R Burrell
- Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - Fiona Kumfor
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
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Tetzloff KA, Whitwell JL, Utianski RL, Duffy JR, Clark HM, Machulda MM, Strand EA, Josephs KA. Quantitative assessment of grammar in amyloid-negative logopenic aphasia. Brain Lang 2018; 186:26-31. [PMID: 30205287 PMCID: PMC6299833 DOI: 10.1016/j.bandl.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/25/2018] [Accepted: 09/03/2018] [Indexed: 05/31/2023]
Abstract
Logopenic primary progressive aphasia (lvPPA) typically results from underlying Alzheimer's disease, but subjects have been reported that do not show beta-amyloid (Aβ) deposition. These subjects do not differ on neurological and speech-language testing from Aβ-positive lvPPA, but they impressionistically show increased grammatical deficits. We performed a quantitative linguistic analysis of grammatical characteristics in Aβ-negative lvPPA compared to Aβ-positive lvPPA and agrammatic PPA, which is characterized by increased grammatical difficulties. Aβ-negative lvPPA used fewer function words and correct verbs but more syntactic and semantic errors compared to Aβ-positive lvPPA. These measures did not differ between Aβ-negative lvPPA and agPPA. Both lvPPA cohorts showed a higher mean length of utterance, more complex sentences, and fewer nouns than agPPA. Aβ-negative lvPPA subjects appear unique and share linguistic features with both agPPA and Aβ-positive lvPPA. Quantitative language analysis in lvPPA may be able to distinguish those with and without Aβ deposition.
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Affiliation(s)
| | | | - Rene L Utianski
- Department of Neurology (Division of Speech and Language Pathology), Mayo Clinic, Rochester, MN, United States
| | - Joseph R Duffy
- Department of Neurology (Division of Speech and Language Pathology), Mayo Clinic, Rochester, MN, United States
| | - Heather M Clark
- Department of Neurology (Division of Speech and Language Pathology), Mayo Clinic, Rochester, MN, United States
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Edythe A Strand
- Department of Neurology (Division of Speech and Language Pathology), Mayo Clinic, Rochester, MN, United States
| | - Keith A Josephs
- Department of Neurology (Division of Behavioral Neurology and Movement Disorders), Mayo Clinic, Rochester, MN, United States
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Hardy CJD, Marshall CR, Bond RL, Russell LL, Dick K, Ariti C, Thomas DL, Ross SJ, Agustus JL, Crutch SJ, Rohrer JD, Bamiou DE, Warren JD. Retained capacity for perceptual learning of degraded speech in primary progressive aphasia and Alzheimer's disease. Alzheimers Res Ther 2018; 10:70. [PMID: 30045755 PMCID: PMC6060531 DOI: 10.1186/s13195-018-0399-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/20/2018] [Accepted: 06/27/2018] [Indexed: 11/11/2022]
Abstract
Background Processing of degraded speech is a promising model for understanding communication under challenging listening conditions, core auditory deficits and residual capacity for perceptual learning and cerebral plasticity in major dementias. Methods We compared the processing of sine-wave-degraded speech in 26 patients with primary progressive aphasia (non-fluent, semantic, and logopenic variants), 10 patients with typical Alzheimer’s disease and 17 healthy control subjects. Participants were required to identify sine-wave words that were more predictable (three-digit numbers) or less predictable (place names). The change in identification performance within each session indexed perceptual learning. Neuroanatomical associations of degraded speech processing were assessed using voxel-based morphometry. Results Patients with non-fluent and logopenic progressive aphasia and typical Alzheimer’s disease showed impaired identification of sine-wave numbers, whereas all syndromic groups showed impaired identification of sine-wave place names. A significant overall identification advantage for numbers over place names was shown by patients with typical Alzheimer’s disease, patients with semantic progressive aphasia and healthy control participants. All syndromic groups showed spontaneous perceptual learning effects for sine-wave numbers. For the combined patient cohort, grey matter correlates were identified across a distributed left hemisphere network extending beyond classical speech-processing cortices. Conclusions These findings demonstrate resilience of auditory perceptual learning capacity across dementia syndromes, despite variably impaired perceptual decoding of degraded speech and reduced predictive integration of semantic knowledge. This work has implications for the neurobiology of dynamic sensory processing and plasticity in neurodegenerative diseases and for development of novel biomarkers and therapeutic interventions. Electronic supplementary material The online version of this article (10.1186/s13195-018-0399-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Rebecca L Bond
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Katrina Dick
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Cono Ariti
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,Leonard Wolfson Experimental Neurology Centre, UCL Institute of Neurology, London, UK
| | - Sonya J Ross
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jennifer L Agustus
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCLH Biomedical Research Centre, National Institute for Health Research, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Marshall CR, Hardy CJD, Volkmer A, Russell LL, Bond RL, Fletcher PD, Clark CN, Mummery CJ, Schott JM, Rossor MN, Fox NC, Crutch SJ, Rohrer JD, Warren JD. Primary progressive aphasia: a clinical approach. J Neurol 2018; 265:1474-1490. [PMID: 29392464 PMCID: PMC5990560 DOI: 10.1007/s00415-018-8762-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Abstract
The primary progressive aphasias are a heterogeneous group of focal 'language-led' dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including 'clinical pearls' that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic 'roadmap'. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.
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Affiliation(s)
- Charles R Marshall
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Lucy L Russell
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Rebecca L Bond
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Phillip D Fletcher
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Camilla N Clark
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Catherine J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Martin N Rossor
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sebastian J Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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12
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Whitwell JL, Graff-Radford J, Tosakulwong N, Weigand SD, Machulda MM, Senjem ML, Spychalla AJ, Vemuri P, Jones DT, Drubach DA, Knopman DS, Boeve BF, Ertekin-Taner N, Petersen RC, Lowe VJ, Jack CR, Josephs KA. Imaging correlations of tau, amyloid, metabolism, and atrophy in typical and atypical Alzheimer's disease. Alzheimers Dement 2018; 14:1005-1014. [PMID: 29605222 DOI: 10.1016/j.jalz.2018.02.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuroimaging modalities can measure different aspects of the disease process in Alzheimer's disease, although the relationship between these modalities is unclear. METHODS We assessed subject-level regional correlations between tau on [18F]AV-1451 positron emission tomography (PET), β amyloid on Pittsburgh compound B PET, hypometabolism on [18F] fluorodeoxyglucose PET, and cortical thickness on magnetic resonance imaging in 96 participants with typical and atypical Alzheimer's disease presentations. We also assessed how correlations between modalities varied according to age, presenting syndrome, tau-PET severity, and asymmetry. RESULTS [18F]AV-1451 uptake showed the strongest regional correlation with hypometabolism. Correlations between [18F]AV-1451 uptake and both hypometabolism and cortical thickness were stronger in participants with greater cortical tau severity. In addition, age, tau asymmetry, and clinical diagnosis influenced the strength of the correlation between [18F]AV-1451 uptake and cortical thickness. DISCUSSION These findings support a close relationship between tau and hypometabolism in Alzheimer's disease but show that correlations between neuroimaging modalities vary across participants.
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Affiliation(s)
| | | | | | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Nilüfer Ertekin-Taner
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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13
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Hoffman P, Sajjadi SA, Patterson K, Nestor PJ. Data-driven classification of patients with primary progressive aphasia. Brain Lang 2017; 174:86-93. [PMID: 28803212 PMCID: PMC5626563 DOI: 10.1016/j.bandl.2017.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 05/26/2023]
Abstract
Current diagnostic criteria classify primary progressive aphasia into three variants-semantic (sv), nonfluent (nfv) and logopenic (lv) PPA-though the adequacy of this scheme is debated. This study took a data-driven approach, applying k-means clustering to data from 43 PPA patients. The algorithm grouped patients based on similarities in language, semantic and non-linguistic cognitive scores. The optimum solution consisted of three groups. One group, almost exclusively those diagnosed as svPPA, displayed a selective semantic impairment. A second cluster, with impairments to speech production, repetition and syntactic processing, contained a majority of patients with nfvPPA but also some lvPPA patients. The final group exhibited more severe deficits to speech, repetition and syntax as well as semantic and other cognitive deficits. These results suggest that, amongst cases of non-semantic PPA, differentiation mainly reflects overall degree of language/cognitive impairment. The observed patterns were scarcely affected by inclusion/exclusion of non-linguistic cognitive scores.
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Affiliation(s)
- Paul Hoffman
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE) & Department of Psychology, University of Edinburgh, UK.
| | | | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge & MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - Peter J Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
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14
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Riancho J, Pozueta A, Santos M, Lage C, Carril JM, Banzo I, Martínez-Rodriguez I, Gorno-Tempini M, Sánchez-Juan P. Logopenic Aphasia due to a Strategic Stroke: New Evidence from a Single Case. J Alzheimers Dis 2017; 57:717-721. [PMID: 28304307 DOI: 10.3233/jad-161267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
Among primary progressive aphasias (PPAs), logopenic variant PPA (lv-PPA) is usually related to Alzheimer's disease. Although it has been widely clinically and pathologically evaluated, the topography in LPA is still controversial. We report a patient presenting with a logopenic syndrome due to a strategic lesion located in the superior and middle temporal gyrus and compare our findings with those of a PiB-PET positive lv-PPA patient matched by age, gender, and education. We consider that our study provides new anatomical clues to better understand the cognitive mechanisms underlying the logopenic syndrome.
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Affiliation(s)
- Javier Riancho
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
| | - Ana Pozueta
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
| | - Miguel Santos
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Carmen Lage
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
| | - José M Carril
- Nuclear Medicine Department; Molecular Imaging Group IDIVAL, University Hospital Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - Ignacio Banzo
- Nuclear Medicine Department; Molecular Imaging Group IDIVAL, University Hospital Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - Isabel Martínez-Rodriguez
- Nuclear Medicine Department; Molecular Imaging Group IDIVAL, University Hospital Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - Marilu Gorno-Tempini
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Pascual Sánchez-Juan
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
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15
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Hardy CJD, Agustus JL, Marshall CR, Clark CN, Russell LL, Brotherhood EV, Bond RL, Fiford CM, Ondobaka S, Thomas DL, Crutch SJ, Rohrer JD, Warren JD. Functional neuroanatomy of speech signal decoding in primary progressive aphasias. Neurobiol Aging 2017; 56:190-201. [PMID: 28571652 DOI: 10.1016/j.neurobiolaging.2017.04.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 01/01/2023]
Abstract
The pathophysiology of primary progressive aphasias remains poorly understood. Here, we addressed this issue using activation fMRI in a cohort of 27 patients with primary progressive aphasia (nonfluent, semantic, and logopenic variants) versus 15 healthy controls. Participants listened passively to sequences of spoken syllables in which we manipulated 3-key auditory speech signal characteristics: temporal regularity, phonemic spectral structure, and pitch sequence entropy. Relative to healthy controls, nonfluent variant patients showed reduced activation of medial Heschl's gyrus in response to any auditory stimulation and reduced activation of anterior cingulate to temporal irregularity. Semantic variant patients had relatively reduced activation of caudate and anterior cingulate in response to increased entropy. Logopenic variant patients showed reduced activation of posterior superior temporal cortex to phonemic spectral structure. Taken together, our findings suggest that impaired processing of core speech signal attributes may drive particular progressive aphasia syndromes and could index a generic physiological mechanism of reduced computational efficiency relevant to all these syndromes, with implications for development of new biomarkers and therapeutic interventions.
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16
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Josephs KA, Duffy JR, Strand EA, Machulda MM, Senjem ML, Lowe VJ, Jack CR, Whitwell JL. APOE ε4 influences β-amyloid deposition in primary progressive aphasia and speech apraxia. Alzheimers Dement 2014; 10:630-6. [PMID: 24985533 DOI: 10.1016/j.jalz.2014.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Apolipoprotein E ε4 (APOE ε4) is a risk factor for β-amyloid deposition in Alzheimer's disease dementia. Its influence on β-amyloid deposition in speech and language disorders, including primary progressive aphasia (PPA), is unclear. METHODS One hundred thirty subjects with PPA or progressive speech apraxia underwent APOE genotyping and Pittsburgh compound B (PiB) PET scanning. The relationship between APOE ε4 and PiB status, as well as severity and regional distribution of PiB, was assessed. RESULTS Forty-five subjects had an APOE ε4 allele and 60 subjects were PiB-positive. The odds ratio for a subject with APOE ε4 being PiB-positive compared with a subject without APOE ε4 being PiB-positive was 10.2 (95% confidence interval, 4.4-25.5; P < .0001). The APOE ε4 allele did not influence regional PiB distribution or severity. CONCLUSION APOE ε4 increases the risk of β-amyloid deposition in PPA and progressive speech apraxia but does not influence regional β-amyloid distribution or severity.
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Affiliation(s)
- Keith A Josephs
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Joseph R Duffy
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Edythe A Strand
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Division of Neuropsychology, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Whitwell
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
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17
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Rohrer JD, Caso F, Mahoney C, Henry M, Rosen HJ, Rabinovici G, Rossor MN, Miller B, Warren JD, Fox NC, Ridgway GR, Gorno-Tempini ML. Patterns of longitudinal brain atrophy in the logopenic variant of primary progressive aphasia. Brain Lang 2013; 127:121-6. [PMID: 23395096 PMCID: PMC3880853 DOI: 10.1016/j.bandl.2012.12.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 12/09/2012] [Accepted: 12/16/2012] [Indexed: 05/09/2023]
Abstract
The logopenic variant of primary progressive aphasia (PPA) is characterised by impaired sentence repetition and word retrieval difficulties. Post mortem studies, amyloid imaging and CSF tau/Aβ measurements suggest Alzheimer's disease (AD) pathology as the underlying cause. Relatively little is known about patterns of progression in patients with the logopenic variant of PPA. 21 patients (3 with post mortem confirmation of AD and 5 with positive amyloid PIB-PET scans) were studied with longitudinal T1-weighted MR imaging (mean interscan interval 1.2years) using volumetric analysis and voxel-based morphometry (VBM). Baseline imaging showed asymmetrical (left greater than right) involvement of the posterior superior temporal and inferior parietal lobes as well as posterior cingulate and medial temporal lobes. The whole brain rate of volume loss was 2.0% per year with a greater rate of left hemisphere atrophy (2.3%/year) than right hemisphere (1.6%/year). Longitudinal VBM analysis showed increasing involvement of other areas in the left hemisphere (temporal, parietal, frontal and caudate) and atrophy of areas in the right hemisphere that had been involved earlier in the disease in the left hemisphere, particularly posterior cingulate/precuneus. With disease progression there was worsening of anomia, sentence repetition and sentence comprehension but consistent with the spread of imaging changes also deficits in single word comprehension, single word repetition and verbal memory. This study shows that the logopenic variant of PPA remains an asymmetrical disease, with spread through the left hemisphere language network but also involvement to a lesser degree of regions in the right hemisphere that mirror the earlier left hemisphere changes.
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Affiliation(s)
- Jonathan D. Rohrer
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Francesca Caso
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
| | - Colin Mahoney
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Maya Henry
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
| | - Martin N. Rossor
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
| | - Jason D. Warren
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Nick C. Fox
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Gerard R. Ridgway
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143-1207, United States
- Corresponding author.
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18
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Machulda MM, Whitwell JL, Duffy JR, Strand EA, Dean PM, Senjem ML, Jack CR, Josephs KA. Identification of an atypical variant of logopenic progressive aphasia. Brain Lang 2013; 127:139-144. [PMID: 23566690 PMCID: PMC3725183 DOI: 10.1016/j.bandl.2013.02.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/15/2013] [Accepted: 02/03/2013] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to examine the association between aphasia severity and neurocognitive function, disease duration and temporoparietal atrophy in 21 individuals with the logopenic variant of primary progressive aphasia (lvPPA). We found significant correlations between aphasia severity and degree of neurocognitive impairment as well as temporoparietal atrophy; but not disease duration. Cluster analysis identified three variants of lvPPA: (1) subjects with mild aphasia and short disease duration (mild typical lvPPA); (2) subjects with mild aphasia and long disease duration (mild atypical lvPPA); and, (3) subjects with severe aphasia and relatively long disease duration (severe typical lvPPA). All three variants showed temporoparietal atrophy, with the mild atypical group showing the least atrophy despite the longest disease duration. The mild atypical group also showed mild neuropsychological impairment. The subjects with mild aphasia and neuropsychological impairment despite long disease duration may represent a slowly progressive variant of lvPPA.
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Affiliation(s)
- Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.
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