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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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Falgàs N, Sacchi L, Carandini T, Montagut N, Conte G, Triulzi F, Galimberti D, Arighi A, Sanchez-Valle R, Fumagalli GG. Utility of visual rating scales in primary progressive aphasia. Alzheimers Res Ther 2024; 16:73. [PMID: 38582927 PMCID: PMC10998321 DOI: 10.1186/s13195-024-01442-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Differential diagnosis among subjects with Primary Progressive Aphasia (PPA) can be challenging. Structural MRI can support the clinical profile. Visual rating scales are a simple and reliable tool to assess brain atrophy in the clinical setting. The aims of the study were to establish to what extent the visual rating scales could be useful in the differential diagnosis of PPA, to compare the clinical diagnostic impressions derived from routine MRI interpretations with those obtained using the visual rating scale and to correlate results of the scales in a voxel-based morphometry (VBM) analysis. METHOD Patients diagnosed with primary progressive aphasia (PPA) according to current criteria from two centers-Ospedale Maggiore Policlinico of Milan and Hospital Clínic de Barcelona-were included in the study. Two blinded clinicians evaluated the subjects MRIs for cortical atrophy and white matter hyperintensities using two protocols: routine readings and the visual rating scale. The diagnostic accuracy between patients and controls and within PPA subgroups were compared between the two protocols. RESULTS One hundred fifty Subjects were studied. All the scales showed a good to excellent intra and inter-rater agreement. The left anterior temporal scale could differentiate between semantic PPA and all other variants. The rater impression after the protocol can increase the accuracy just for the logopenic PPA. In the VBM analysis, the scores of visual rating scales correlate with the corresponding area of brain atrophy. CONCLUSION The Left anterior temporal rating scale can distinguish semantic PPA from other variants. The rater impression after structured view improved the diagnostic accuracy of logopenic PPA compared to normal readings. The unstructured view of the MRI was reliable for identifying semantic PPA and controls. Neither the structured nor the unstructured view could identify the nonfluent and undetermined variants.
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Affiliation(s)
- Neus Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Luca Sacchi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tiziana Carandini
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Nuria Montagut
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giorgio Conte
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabio Triulzi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giorgio Giulio Fumagalli
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Corso Bettini 31, Rovereto, 38068, Italy.
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Lukic S, Fan Z, García AM, Welch AE, Ratnasiri BM, Wilson SM, Henry ML, Vonk J, Deleon J, Miller BL, Miller Z, Mandelli ML, Gorno-Tempini ML. Discriminating nonfluent/agrammatic and logopenic PPA variants with automatically extracted morphosyntactic measures from connected speech. Cortex 2024; 173:34-48. [PMID: 38359511 DOI: 10.1016/j.cortex.2023.12.013] [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: 05/24/2023] [Revised: 10/15/2023] [Accepted: 12/12/2023] [Indexed: 02/17/2024]
Abstract
Morphosyntactic assessments are important for characterizing individuals with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard tests are subject to examiner bias and often fail to differentiate between nfvPPA and logopenic variant PPA (lvPPA). Moreover, relevant neural signatures remain underexplored. Here, we leverage natural language processing tools to automatically capture morphosyntactic disturbances and their neuroanatomical correlates in 35 individuals with nfvPPA relative to 10 healthy controls (HC) and 26 individuals with lvPPA. Participants described a picture, and ensuing transcripts were analyzed via part-of-speech tagging to extract sentence-related features (e.g., subordinating and coordinating conjunctions), verbal-related features (e.g., tense markers), and nominal-related features (e.g., subjective and possessive pronouns). Gradient boosting machines were used to classify between groups using all features. We identified the most discriminant morphosyntactic marker via a feature importance algorithm and examined its neural correlates via voxel-based morphometry. Individuals with nfvPPA produced fewer morphosyntactic elements than the other two groups. Such features robustly discriminated them from both individuals with lvPPA and HCs with an AUC of .95 and .82, respectively. The most discriminatory feature corresponded to subordinating conjunctions was correlated with cortical atrophy within the left posterior inferior frontal gyrus across groups (pFWE < .05). Automated morphosyntactic analysis can efficiently differentiate nfvPPA from lvPPA. Also, the most sensitive morphosyntactic markers correlate with a core atrophy region of nfvPPA. Our approach, thus, can contribute to a key challenge in PPA diagnosis.
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Affiliation(s)
- Sladjana Lukic
- University of California, San Francisco Memory and Aging Center, CA, USA; Ruth S. Ammon College of Education and Health Sciences, Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA.
| | - Zekai Fan
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Adolfo M García
- Global Brain Health Institute (GBHI), University of California, San Francisco, CA, USA; Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Ariane E Welch
- Ruth S. Ammon College of Education and Health Sciences, Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | | | - Stephen M Wilson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Maya L Henry
- University of Texas at Austin Moody College of Communication, Austin, TX, USA
| | - Jet Vonk
- University of California, San Francisco Memory and Aging Center, CA, USA
| | - Jessica Deleon
- University of California, San Francisco Memory and Aging Center, CA, USA
| | - Bruce L Miller
- University of California, San Francisco Memory and Aging Center, CA, USA
| | - Zachary Miller
- University of California, San Francisco Memory and Aging Center, CA, USA
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Santi GC, Conca F, Esposito V, Polito C, Caminiti SP, Boccalini C, Morinelli C, Berti V, Mazzeo S, Bessi V, Marcone A, Iannaccone S, Kim SK, Sorbi S, Perani D, Cappa SF, Catricalà E. Heterogeneity and overlap in the continuum of linguistic profile of logopenic and semantic variants of primary progressive aphasia: a Profile Analysis based on Multidimensional Scaling study. Alzheimers Res Ther 2024; 16:49. [PMID: 38448894 PMCID: PMC10918940 DOI: 10.1186/s13195-024-01403-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) diagnostic criteria underestimate the complex presentation of semantic (sv) and logopenic (lv) variants, in which symptoms partially overlap, and mixed clinical presentation (mixed-PPA) and heterogenous profile (lvPPA +) are frequent. Conceptualization of similarities and differences of these clinical conditions is still scarce. METHODS Lexical, semantic, phonological, and working memory errors from nine language tasks of sixty-seven PPA were analyzed using Profile Analysis based on Multidimensional Scaling, which allowed us to create a distributed representation of patients' linguistic performance in a shared space. Patients had been studied with [18F] FDG-PET. Correlations were performed between metabolic and behavioral data. RESULTS Patients' profiles were distributed across a continuum. All PPA, but two, presented a lexical retrieval impairment, in terms of reduced production of verbs and nouns. svPPA patients occupied a fairly clumped space along the continuum, showing a preponderant semantic deficit, which correlated to fusiform gyrus hypometabolism, while only few presented working memory deficits. Adjacently, lvPPA + presented a semantic impairment combined with phonological deficits, which correlated with metabolism in the anterior fusiform gyrus and posterior middle temporal gyrus. Starting from the shared phonological deficit side, a large portion of the space was occupied by all lvPPA, showing a combination of phonological, lexical, and working memory deficits, with the latter correlating with posterior temporo-parietal hypometabolism. Mixed PPA did not show unique profile, distributing across the space. DISCUSSION Different clinical PPA entities exist but overlaps are frequent. Identifying shared and unique clinical markers is critical for research and clinical practice. Further research is needed to identify the role of genetic and pathological factors in such distribution, including also higher sample size of less represented groups.
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Affiliation(s)
- Gaia Chiara Santi
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
| | | | | | | | | | | | - Carmen Morinelli
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Berti
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Salvatore Mazzeo
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valentina Bessi
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alessandra Marcone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Se-Kang Kim
- Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy.
- IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy.
| | - Eleonora Catricalà
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
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5
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Cecchetti G, Basaia S, Canu E, Cividini C, Cursi M, Caso F, Santangelo R, Fanelli GF, Magnani G, Agosta F, Filippi M. EEG Correlates in the 3 Variants of Primary Progressive Aphasia. Neurology 2024; 102:e207993. [PMID: 38165298 DOI: 10.1212/wnl.0000000000207993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The 3 clinical presentations of primary progressive aphasia (PPA) reflect heterogenous neuropathology, which is difficult to be recognized in vivo. Resting-state (RS) EEG is promising for the investigation of brain electrical substrates in neurodegenerative conditions. In this study, we aim to explore EEG cortical sources in the characterization of the 3 variants of PPA. METHODS This is a cross-sectional, single-center, memory center-based cohort study. Patients with PPA and healthy controls were consecutively recruited at the Neurology Unit, IRCCS San Raffaele Scientific Institute (Milan, Italy). Each participant underwent an RS 19-channel EEG. Using standardized low-resolution brain electromagnetic tomography, EEG current source densities were estimated at voxel level and compared among study groups. Using an RS functional MRI-driven model of source reconstruction, linear lagged connectivity (LLC) values within language and extra-language brain networks were obtained and analyzed among groups. RESULTS Eighteen patients with logopenic PPA variant (lvPPA; mean age = 72.7 ± 6.6; % female = 52.4), 21 patients with nonfluent/agrammatic PPA variant (nfvPPA; mean age = 71.7 ± 8.1; % female = 66.6), and 9 patients with semantic PPA variant (svPPA; mean age = 65.0 ± 6.9; % female = 44.4) were enrolled in the study, together with 21 matched healthy controls (mean age = 69.2 ± 6.5; % female = 57.1). Patients with lvPPA showed a higher delta density than healthy controls (p < 0.01) and patients with nfvPPA (p < 0.05) and svPPA (p < 0.05). Patients with lvPPA also displayed a greater theta density over the left posterior hemisphere (p < 0.01) and lower alpha2 values (p < 0.05) over the left frontotemporal regions than controls. Patients with nfvPPA showed a diffuse greater theta density than controls (p < 0.05). LLC was altered in all patients relative to controls (p < 0.05); the alteration was greater at slow frequency bands and within language networks than extra-language networks. Patients with lvPPA also showed greater LLC values at theta band than patients with nfvPPA (p < 0.05). DISCUSSION EEG findings in patients with PPA suggest that lvPPA-related pathology is associated with a characteristic disruption of the cortical electrical activity, which might help in the differential diagnosis from svPPA and nfvPPA. EEG connectivity was disrupted in all PPA variants, with distinct findings in disease-specific PPA groups. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that EEG analysis can distinguish PPA due to probable Alzheimer disease from PPA due to probable FTD from normal aging.
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Affiliation(s)
- Giordano Cecchetti
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Cursi
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Santangelo
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna F Fanelli
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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6
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Gajardo-Vidal A, Montembeault M, Lorca-Puls DL, Licata AE, Bogley R, Erlhoff S, Ratnasiri B, Ezzes Z, Battistella G, Tsoy E, Pereira CW, DeLeon J, Tee BL, Henry ML, Miller ZA, Rankin KP, Mandelli ML, Possin KL, Gorno-Tempini ML. Assessing processing speed and its neural correlates in the three variants of primary progressive aphasia with a non-verbal tablet-based task. Cortex 2024; 171:165-177. [PMID: 38000139 PMCID: PMC10922977 DOI: 10.1016/j.cortex.2023.10.011] [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: 05/26/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
Prior research has revealed distinctive patterns of impaired language abilities across the three variants of Primary Progressive Aphasia (PPA): nonfluent/agrammatic (nfvPPA), logopenic (lvPPA) and semantic (svPPA). However, little is known about whether, and to what extent, non-verbal cognitive abilities, such as processing speed, are impacted in PPA patients. This is because neuropsychological tests typically contain linguistic stimuli and require spoken output, being therefore sensitive to verbal deficits in aphasic patients. The aim of this study is to investigate potential differences in processing speed between PPA patients and healthy controls, and among the three PPA variants, using a brief non-verbal tablet-based task (Match) modeled after the WAIS-III digit symbol coding test, and to determine its neural correlates. Here, we compared performance on the Match task between PPA patients (n = 61) and healthy controls (n = 59) and across the three PPA variants. We correlated performance on Match with voxelwise gray and white matter volumes. We found that lvPPA and nfvPPA patients performed significantly worse on Match than healthy controls and svPPA patients. Worse performance on Match across PPA patients was associated with reduced gray matter volume in specific parts of the left middle frontal gyrus, superior parietal lobule, and precuneus, and reduced white matter volume in the left parietal lobe. To conclude, our behavioral findings reveal that processing speed is differentially impacted across the three PPA variants and provide support for the potential clinical utility of a tabled-based task (Match) to assess non-verbal cognition. In addition, our neuroimaging findings confirm the importance of a set of fronto-parietal regions that previous research has associated with processing speed and executive control. Finally, our behavioral and neuroimaging findings combined indicate that differences in processing speed are largely explained by the unequal distribution of atrophy in these fronto-parietal regions across the three PPA variants.
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Affiliation(s)
- Andrea Gajardo-Vidal
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile.
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Montréal, QC H3A 1A1, Canada
| | - Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sabrina Erlhoff
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christa Watson Pereira
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica DeLeon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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Barbieri E, Lukic S, Rogalski E, Weintraub S, Mesulam MM, Thompson CK. Neural mechanisms of sentence production: a volumetric study of primary progressive aphasia. Cereb Cortex 2024; 34:bhad470. [PMID: 38100360 PMCID: PMC10793577 DOI: 10.1093/cercor/bhad470] [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: 06/06/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
Studies on the neural bases of sentence production have yielded mixed results, partly due to differences in tasks and participant types. In this study, 101 individuals with primary progressive aphasia (PPA) were evaluated using a test that required spoken production following an auditory prime (Northwestern Assessment of Verbs and Sentences-Sentence Production Priming Test, NAVS-SPPT), and one that required building a sentence by ordering word cards (Northwestern Anagram Test, NAT). Voxel-Based Morphometry revealed that gray matter (GM) volume in left inferior/middle frontal gyri (L IFG/MFG) was associated with sentence production accuracy on both tasks, more so for complex sentences, whereas, GM volume in left posterior temporal regions was exclusively associated with NAVS-SPPT performance and predicted by performance on a Digit Span Forward (DSF) task. Verb retrieval deficits partly mediated the relationship between L IFG/MFG and performance on the NAVS-SPPT. These findings underscore the importance of L IFG/MFG for sentence production and suggest that this relationship is partly accounted for by verb retrieval deficits, but not phonological loop integrity. In contrast, it is possible that the posterior temporal cortex is associated with auditory short-term memory ability, to the extent that DSF performance is a valid measure of this in aphasia.
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Affiliation(s)
- Elena Barbieri
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
| | - Sladjana Lukic
- Department of Communication Sciences and Disorders, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, United States
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University, 676 N Saint Clair Street, Chicago, IL 60611, United States
| | - Marek-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
- Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
| | - Cynthia K Thompson
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
- Department of Neurology, Northwestern University, 300 E Superior Street, Chicago, IL 60611, United States
- Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, United States
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8
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Ramanan S, Halai AD, Garcia-Penton L, Perry AG, Patel N, Peterson KA, Ingram RU, Storey I, Cappa SF, Catricala E, Patterson K, Rowe JB, Garrard P, Ralph MAL. The neural substrates of transdiagnostic cognitive-linguistic heterogeneity in primary progressive aphasia. Alzheimers Res Ther 2023; 15:219. [PMID: 38102724 PMCID: PMC10724982 DOI: 10.1186/s13195-023-01350-2] [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: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Clinical variants of primary progressive aphasia (PPA) are diagnosed based on characteristic patterns of language deficits, supported by corresponding neural changes on brain imaging. However, there is (i) considerable phenotypic variability within and between each diagnostic category with partially overlapping profiles of language performance between variants and (ii) accompanying non-linguistic cognitive impairments that may be independent of aphasia magnitude and disease severity. The neurobiological basis of this cognitive-linguistic heterogeneity remains unclear. Understanding the relationship between these variables would improve PPA clinical/research characterisation and strengthen clinical trial and symptomatic treatment design. We address these knowledge gaps using a data-driven transdiagnostic approach to chart cognitive-linguistic differences and their associations with grey/white matter degeneration across multiple PPA variants. METHODS Forty-seven patients (13 semantic, 15 non-fluent, and 19 logopenic variant PPA) underwent assessment of general cognition, errors on language performance, and structural and diffusion magnetic resonance imaging to index whole-brain grey and white matter changes. Behavioural data were entered into varimax-rotated principal component analyses to derive orthogonal dimensions explaining the majority of cognitive variance. To uncover neural correlates of cognitive heterogeneity, derived components were used as covariates in neuroimaging analyses of grey matter (voxel-based morphometry) and white matter (network-based statistics of structural connectomes). RESULTS Four behavioural components emerged: general cognition, semantic memory, working memory, and motor speech/phonology. Performance patterns on the latter three principal components were in keeping with each variant's characteristic profile, but with a spectrum rather than categorical distribution across the cohort. General cognitive changes were most marked in logopenic variant PPA. Regardless of clinical diagnosis, general cognitive impairment was associated with inferior/posterior parietal grey/white matter involvement, semantic memory deficits with bilateral anterior temporal grey/white matter changes, working memory impairment with temporoparietal and frontostriatal grey/white matter involvement, and motor speech/phonology deficits with inferior/middle frontal grey matter alterations. CONCLUSIONS Cognitive-linguistic heterogeneity in PPA closely relates to individual-level variations on multiple behavioural dimensions and grey/white matter degeneration of regions within and beyond the language network. We further show that employment of transdiagnostic approaches may help to understand clinical symptom boundaries and reveal clinical and neural profiles that are shared across categorically defined variants of PPA.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
| | - Ajay D Halai
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Lorna Garcia-Penton
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Alistair G Perry
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Nikil Patel
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Ruth U Ingram
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ian Storey
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Catricala
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Li L, Ji B, Zhao M, Bai L, Chen B. Nonfluent Variant Primary Progressive Aphasia on FDG, 11 C-PIB, and 18 F-APN-1607 PET Imaging. Clin Nucl Med 2023; 48:e539-e541. [PMID: 37756439 DOI: 10.1097/rlu.0000000000004853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT A 61-year-old right-handed man presented with decreased cognitive function, short-term memory, fluent speech disorders, and grammatical errors for 1 year. The patient underwent PET imaging with 11 C-PIB, 18 F-FDG, and 18 F-APN-1607. The 11 C-PIB PET showed no amyloid accumulation; the 18 F-FDG PET showed hypometabolism in the bilateral frontal lobe, temporal lobe, and midbrain; and the 18 F-APN-1607 PET showed tau accumulation in the brainstem, basal ganglia, and left inferior frontal gyrus. These findings suggested a diagnosis of nonfluent variant primary progressive aphasia. This case emphasizes the value of combined imaging of glucose metabolism, Aβ, and tau PET in the diagnosis of nonfluent variant primary progressive aphasia.
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Affiliation(s)
- Lingchao Li
- From the Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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Isella V, Licciardo D, Rebecchi G, Ferri F, Crivellaro C, Appollonio I, Ferrarese C. A cognitive marker for Alzheimer disease pathology in primary progressive aphasia? A validation study in the clinical setting. Neurobiol Aging 2023; 131:153-155. [PMID: 37659287 DOI: 10.1016/j.neurobiolaging.2023.07.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/04/2023]
Abstract
We validated in the clinical setting a putative clinical marker for a biological diagnosis of primary progressive aphasia (PPA) due to amyloid previously identified in an autopsy cohort and including impaired (score ≤4) digit span (DS) as index of phonological loop dysfunction and broadened criteria for logopenic PPA. In 29 PPA patients with an amyloid-positive (A+) biomarker and 28 PPA patients with an amyloid-negative (A-) biomarker, Receiver Operating Characteristics (ROC) curve analysis showed moderate specificity (71%) but insufficient sensitivity (41%) for the proposed marker. Specificity was particularly poor (58%) for the discrimination between A+ PPA and the A- subgroup with nonfluent PPA. DS may be compromised in both logopenic and nonfluent PPA, whose loci of neurodegeneration lie at the 2 ends of the left fronto-parieto-temporal system that underpins phonology. An Statistical Parametric Mapping (SPM) correlation analysis between DS score and metabolism on brain 18-fluoro-deoxy-glucose positron emission tomography also showed a major contribution of the left frontal cortex to impaired span.
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Affiliation(s)
- Valeria Isella
- School of Medicine and Surgery, University of Milano - Bicocca, Monza (MB), Italy.
| | - Daniele Licciardo
- School of Medicine and Surgery, University of Milano - Bicocca, Monza (MB), Italy; Neurology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | - Gaia Rebecchi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza (MB), Italy
| | - Francesca Ferri
- Neurology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | - Cinzia Crivellaro
- Nuclear Medicine Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | - Ildebrando Appollonio
- School of Medicine and Surgery, University of Milano - Bicocca, Monza (MB), Italy; Neurology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano - Bicocca, Monza (MB), Italy; Neurology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
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11
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Kwon MJ, Lee S, Park J, Jo S, Han JW, Oh DJ, Lee JY, Park JH, Kim JH, Kim KW. Textural and Volumetric Changes of the Temporal Lobes in Semantic Variant Primary Progressive Aphasia and Alzheimer's Disease. J Korean Med Sci 2023; 38:e316. [PMID: 37873627 PMCID: PMC10593601 DOI: 10.3346/jkms.2023.38.e316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Texture analysis may capture subtle changes in the gray matter more sensitively than volumetric analysis. We aimed to investigate the patterns of neurodegeneration in semantic variant primary progressive aphasia (svPPA) and Alzheimer's disease (AD) by comparing the temporal gray matter texture and volume between cognitively normal controls and older adults with svPPA and AD. METHODS We enrolled all participants from three university hospitals in Korea. We obtained T1-weighted magnetic resonance images and compared the gray matter texture and volume of regions of interest (ROIs) between the groups using analysis of variance with Bonferroni posthoc comparisons. We also developed models for classifying svPPA, AD and control groups using logistic regression analyses, and validated the models using receiver operator characteristics analysis. RESULTS Compared to the AD group, the svPPA group showed lower volumes in five ROIs (bilateral temporal poles, and the left inferior, middle, and superior temporal cortices) and higher texture in these five ROIs and two additional ROIs (right inferior temporal and left entorhinal cortices). The performances of both texture- and volume-based models were good and comparable in classifying svPPA from normal cognition (mean area under the curve [AUC] = 0.914 for texture; mean AUC = 0.894 for volume). However, only the texture-based model achieved a good level of performance in classifying svPPA and AD (mean AUC = 0.775 for texture; mean AUC = 0.658 for volume). CONCLUSION Texture may be a useful neuroimaging marker for early detection of svPPA in older adults and its differentiation from AD.
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Affiliation(s)
- Min Jeong Kwon
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Korea
| | - Subin Lee
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Korea
| | - Jieun Park
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Korea
| | - Sungman Jo
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Korea
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
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Hinkley LBN, Thompson M, Miller ZA, Borghesani V, Mizuiri D, Shwe W, Licata A, Ninomiya S, Lauricella M, Mandelli ML, Miller BL, Houde J, Gorno‐Tempini ML, Nagarajan SS. Distinct neurophysiology during nonword repetition in logopenic and non-fluent variants of primary progressive aphasia. Hum Brain Mapp 2023; 44:4833-4847. [PMID: 37516916 PMCID: PMC10472914 DOI: 10.1002/hbm.26408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/25/2023] [Accepted: 06/11/2023] [Indexed: 07/31/2023] Open
Abstract
Overlapping clinical presentations in primary progressive aphasia (PPA) variants present challenges for diagnosis and understanding pathophysiology, particularly in the early stages of the disease when behavioral (speech) symptoms are not clearly evident. Divergent atrophy patterns (temporoparietal degeneration in logopenic variant lvPPA, frontal degeneration in nonfluent variant nfvPPA) can partially account for differential speech production errors in the two groups in the later stages of the disease. While the existing dogma states that neurodegeneration is the root cause of compromised behavior and cortical activity in PPA, the extent to which neurophysiological signatures of speech dysfunction manifest independent of their divergent atrophy patterns remain unknown. We test the hypothesis that nonword deficits in lvPPA and nfvPPA arise from distinct patterns of neural oscillations that are unrelated to atrophy. We use a novel structure-function imaging approach integrating magnetoencephalographic imaging of neural oscillations during a non-word repetition task with voxel-based morphometry-derived measures of gray matter volume to isolate neural oscillation abnormalities independent of atrophy. We find reduced beta band neural activity in left temporal regions associated with the late stages of auditory encoding unique to patients with lvPPA and reduced high-gamma neural activity over left frontal regions associated with the early stages of motor preparation in patients with nfvPPA. Neither of these patterns of reduced cortical oscillations was explained by cortical atrophy in our statistical model. These findings highlight the importance of structure-function imaging in revealing neurophysiological sequelae in early stages of dementia when neither structural atrophy nor behavioral deficits are clinically distinct.
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Affiliation(s)
- Leighton B. N. Hinkley
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Megan Thompson
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Zachary A. Miller
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Danielle Mizuiri
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Wendy Shwe
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Abigail Licata
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Seigo Ninomiya
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael Lauricella
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Bruce L. Miller
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - John Houde
- Department of Otolaryngology – Head and Neck SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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13
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Ghirelli A, Tafuri B, Urso D, Milella G, De Blasi R, Nigro S, Logroscino G. Cortical signature of depressive symptoms in frontotemporal dementia: A surface-based analysis. Ann Clin Transl Neurol 2023; 10:1704-1713. [PMID: 37522381 PMCID: PMC10578898 DOI: 10.1002/acn3.51860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Depressive symptoms are frequently reported in patients affected by frontotemporal dementia (FTD). At structural MRI, cortical features of depressed FTD patients have been poorly described. Our objective was to investigate correlations between cortical measures and depression severity in FTD patients. METHODS Data were obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative (FTLDNI) database. We included 98 controls and 92 FTD patients, n = 38 behavioral variant FTD (bvFTD), n = 26 non-fluent variant Primary Progressive Aphasia (nfvPPA), and n = 28 semantic variant Primary Progressive Aphasia (svPPA). Patients underwent clinical and cognitive evaluations, as well as a 3D T1-weighted MRI on a 3 Tesla scanner (Siemens, Trio Tim system). Depression was evaluated by means of Geriatric Depression Scale (GDS). Surface-based analysis was performed on T1-weighted images to evaluate cortical thickness, a measure of gray matter integrity, and local gyrification index (lGI), a quantitative metric of cortical folding. RESULTS Patients affected by svPPA were more depressed than controls at NPI and depression severity at GDS was higher in svPPA and bvFTD. Severity of depression correlated with a decrease in lGI in left precentral and superior frontal gyrus, supramarginal and postcentral gyrus and right precentral, supramarginal, superior parietal and superior frontal gyri. Furthermore, depression severity correlated positively with cortical thickness in the left medial orbitofrontal cortex. DISCUSSION We found that lGI was associated with depressive symptoms over brain regions involved in the pathophysiology of major depressive disorder. This finding provides novel insights into the mechanisms underlying psychiatric symptoms in FTD.
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Affiliation(s)
- Alma Ghirelli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Neurosciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Giammarco Milella
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Roberto De Blasi
- Department of Diagnostic ImagingPia Fondazione di Culto e Religione “Card. G. Panico”LecceItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Institute of Nanotechnology (NANOTEC), National Research CouncilLecceItaly
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Diagnostic ImagingPia Fondazione di Culto e Religione “Card. G. Panico”LecceItaly
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Takagi S, Daimon S, Inoue K, Umeda M, Kobayashi Z. [A Case of Amyotrophic Lateral Sclerosis with Semantic Variant Primary Progressive Aphasia: A Study of Language Symptoms and Agraphia]. Brain Nerve 2023; 75:1155-1161. [PMID: 37849367 DOI: 10.11477/mf.1416202493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The patient was a 66-year-old man brought to the emergency room with impaired consciousness due to hypercarbonemia, managed on a respirator, and diagnosed with amyotrophic lateral sclerosis (ALS). MRI showed atrophy of the anterior and medial surfaces of the bilateral temporal lobes that was more severe in the right side. The patient had dysgraphia in both kana and kanji. Detailed examinations of the language function revealed impaired single-word comprehension, impaired naming, and surface dysgraphia, leading to the diagnosis of semantic variant primary progressive aphasia (svPPA). ALS patients with atrophy of the anterior temporal lobe and surface dysgraphia of kanji may have svPPA as a complication. (Received April 14, 2023; Accepted June 21, 2023; Published October 1, 2023).
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Affiliation(s)
- Saki Takagi
- Department of Rehabilitation, JA Toride Medical Center
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15
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Neophytou K, Wiley R, Litovsky C, Tsapkini K, Rapp B. The right hemisphere's capacity for language: evidence from primary progressive aphasia. Cereb Cortex 2023; 33:9971-9985. [PMID: 37522277 PMCID: PMC10502784 DOI: 10.1093/cercor/bhad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.
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Affiliation(s)
- Kyriaki Neophytou
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Robert Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Celia Litovsky
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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16
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Polito C, Conca F, Santi GC, Esposito V, Caminiti SP, Boccalini C, Berti V, Morinelli C, Mazzeo S, Marcone A, Iannaccone S, Bessi V, Sorbi S, Perani D, Cappa SF, Catricalà E. Comparing two picture naming tasks in primary progressive aphasia: Insights from behavioural and neural results. Cortex 2023; 166:1-18. [PMID: 37295234 DOI: 10.1016/j.cortex.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/29/2022] [Revised: 02/24/2023] [Accepted: 04/26/2023] [Indexed: 06/12/2023]
Abstract
Picture naming tests are widely used to evaluate language impairments in neurodegenerative diseases, especially in Primary Progressive Aphasia (PPA). The available tests differ for many factors affecting the performance, e.g. format of stimuli and their psycholinguistic properties. We aim to identify the most appropriate naming test to be used on PPA according to the clinical and research demands. We investigated the behavioural characteristics, i.e. proportion of correct responses and error type, and their neural correlates in two Italian naming tests, CaGi naming (CaGi) and naming subtest of the Screening for Aphasia in NeuroDegeneration battery (SAND), administered to 52 PPA patients who underwent an FDG-PET scan. We analysed the effectiveness of the tests in distinguishing PPA versus controls and among PPA variants, considering the psycholinguistic variables affecting performance. We explored the brain metabolic correlates of behavioural performance in the tests. SAND, differently from CaGi, has time limits for the response and its items are less frequent and acquired later. SAND and CaGi differed in terms of number of correct responses and error profile, suggesting a higher difficulty to name SAND items compared to CaGi. Semantic errors predominated in CaGi, while anomic and semantic errors were equally frequent in SAND. Both tests distinguished PPA from controls, but SAND outperformed CaGi in discriminating among PPA variants. FDG-PET imaging revealed a shared metabolic involvement of temporal areas associated with lexico-semantic processing, encompassing anterior fusiform, temporal pole, and extending to posterior fusiform in sv-PPA. Concluding, a picture naming test with response time limit and items which are less frequent and acquired later in life, as SAND, may be effective at highlighting subtle distinctions between PPA variants, improving the diagnosis. Conversely, a naming test without time limit for the response, as CaGi, may be useful for a better characterization of the nature of the naming impairment at the behavioural level, eliciting more naming errors than anomia, possibly helping in the development of rehabilitation protocols.
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Affiliation(s)
| | | | - Gaia C Santi
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, Pavia, Italy
| | | | - Silvia P Caminiti
- Vita-Salute San Raffaele University, 20132, Milan, Italy; In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, 20132, Milan, Italy
| | - Cecilia Boccalini
- Vita-Salute San Raffaele University, 20132, Milan, Italy; In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Valentina Berti
- Nuclear Medicine, Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Italy
| | - Carmen Morinelli
- SOD Neurologia 1, Dipartimento Neuromuscolo-Scheletrico e Degli Organi di Senso, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Salvatore Mazzeo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; NEUROFARBA, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alessandra Marcone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Valentina Bessi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SOD Neurologia 1, Dipartimento Neuromuscolo-Scheletrico e Degli Organi di Senso, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; NEUROFARBA, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SOD Neurologia 1, Dipartimento Neuromuscolo-Scheletrico e Degli Organi di Senso, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; NEUROFARBA, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, 20132, Milan, Italy; In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, 20132, Milan, Italy
| | - Stefano F Cappa
- IRCCS Mondino Foundation, Pavia, Italy; ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, Pavia, Italy.
| | - Eleonora Catricalà
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, Pavia, Italy
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17
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Clarke AJ, Manser D, Fleischer R, Fulham M, Ahmed RM. Pearls & Oy-sters: Huntington Disease Presenting as Primary Progressive Aphasia: A Case of Semantics. Neurology 2023; 101:414-417. [PMID: 37202171 PMCID: PMC10501099 DOI: 10.1212/wnl.0000000000207428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
We present a case of semantic variant primary progressive aphasia as the presenting feature in a patient with Huntington disease (HD). The patient initially developed progressive language impairment including impaired naming and object knowledge and single-word comprehension and then developed chorea and behavioral changes. An MRI of the brain showed left anterior temporal lobe and hippocampal atrophy. A neurologic FDG PET/CT showed reduced metabolism in the head of the left caudate nucleus. Huntingtin gene testing revealed an expansion of 39 CAG repeats in 1 allele. This case outlines the substantial overlap between the clinical presentation of HD and frontotemporal lobar degeneration syndromes and provides commentary on the investigation of these neurodegenerative diseases.
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Affiliation(s)
- Antonia J Clarke
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia.
| | - David Manser
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Ronald Fleischer
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Michael Fulham
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
| | - Rebekah M Ahmed
- From the Faculty of Medicine and Health (A.J.C., R.M.A.), University of Sydney; Department of Neurology (A.J.C., D.M., M.F., R.M.A.), Genetics Department (R.F.), and Department of Molecular Imaging (M.F.), Royal Prince Alfred Hospital; and Faculty of Engineering and Computer Science (M.F.), University of Sydney, Australia
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18
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Mandelli ML, Lorca‐Puls DL, Lukic S, Montembeault M, Gajardo‐Vidal A, Licata A, Scheffler A, Battistella G, Grasso SM, Bogley R, Ratnasiri BM, La Joie R, Mundada NS, Europa E, Rabinovici G, Miller BL, De Leon J, Henry ML, Miller Z, Gorno‐Tempini ML. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp 2023; 44:4390-4406. [PMID: 37306089 PMCID: PMC10318204 DOI: 10.1002/hbm.26388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/21/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Abstract
The logopenic variant of primary progressive aphasia (lvPPA) is a neurodegenerative syndrome characterized linguistically by gradual loss of repetition and naming skills resulting from left posterior temporal and inferior parietal atrophy. Here, we sought to identify which specific cortical loci are initially targeted by the disease (epicenters) and investigate whether atrophy spreads through predetermined networks. First, we used cross-sectional structural MRI data from individuals with lvPPA to define putative disease epicenters using a surface-based approach paired with an anatomically fine-grained parcellation of the cortical surface (i.e., HCP-MMP1.0 atlas). Second, we combined cross-sectional functional MRI data from healthy controls and longitudinal structural MRI data from individuals with lvPPA to derive the epicenter-seeded resting-state networks most relevant to lvPPA symptomatology and ascertain whether functional connectivity in these networks predicts longitudinal atrophy spread in lvPPA. Our results show that two partially distinct brain networks anchored to the left anterior angular and posterior superior temporal gyri epicenters were preferentially associated with sentence repetition and naming skills in lvPPA. Critically, the strength of connectivity within these two networks in the neurologically-intact brain significantly predicted longitudinal atrophy progression in lvPPA. Taken together, our findings indicate that atrophy progression in lvPPA, starting from inferior parietal and temporoparietal junction regions, predominantly follows at least two partially nonoverlapping pathways, which may influence the heterogeneity in clinical presentation and prognosis.
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Affiliation(s)
- Maria Luisa Mandelli
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Diego L. Lorca‐Puls
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Sección de Neurología, Departamento de Especialidades, Facultad de MedicinaUniversidad de ConcepciónConcepciónChile
| | - Sladjana Lukic
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Communication Sciences and DisordersAdelphi UniversityGarden CityNew YorkUSA
| | - Maxime Montembeault
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of PsychiatryDouglas Mental Health University Institute, McGill UniversityMontréalCanada
| | - Andrea Gajardo‐Vidal
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Faculty of Health SciencesUniversidad del DesarrolloConcepciónChile
| | - Abigail Licata
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Aaron Scheffler
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Giovanni Battistella
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of OtolaryngologyHead and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical SchoolBostonMassachusettsUSA
| | - Stephanie M. Grasso
- Department of Speech, Language, and Hearing SciencesUniversity of TexasAustinTexasUSA
| | - Rian Bogley
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Buddhika M. Ratnasiri
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Renaud La Joie
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Nidhi S. Mundada
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Eduardo Europa
- Department of Communicative Disorders and SciencesSan Jose State UniversitySan JoseCaliforniaUSA
| | - Gil Rabinovici
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jessica De Leon
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Maya L. Henry
- Department of Speech, Language, and Hearing SciencesUniversity of TexasAustinTexasUSA
| | - Zachary Miller
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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19
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Wang Z, Ficek BN, Webster KT, Herrmann O, Frangakis CE, Desmond JE, Onyike CU, Caffo B, Hillis AE, Tsapkini K. Specificity in Generalization Effects of Transcranial Direct Current Stimulation Over the Left Inferior Frontal Gyrus in Primary Progressive Aphasia. Neuromodulation 2023; 26:850-860. [PMID: 37287321 PMCID: PMC10250817 DOI: 10.1016/j.neurom.2022.09.004] [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: 05/11/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Generalization (or near-transfer) effects of an intervention to tasks not explicitly trained are the most desirable intervention outcomes. However, they are rarely reported and even more rarely explained. One hypothesis for generalization effects is that the tasks improved share the same brain function/computation with the intervention task. We tested this hypothesis in this study of transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus (IFG) that is claimed to be involved in selective semantic retrieval of information from the temporal lobes. MATERIALS AND METHODS In this study, we examined whether tDCS over the left IFG in a group of patients with primary progressive aphasia (PPA), paired with a lexical/semantic retrieval intervention (oral and written naming), may specifically improve semantic fluency, a nontrained near-transfer task that relies on selective semantic retrieval, in patients with PPA. RESULTS Semantic fluency improved significantly more in the active tDCS than in the sham tDCS condition immediately after and two weeks after treatment. This improvement was marginally significant two months after treatment. We also found that the active tDCS effect was specific to tasks that require this IFG computation (selective semantic retrieval) but not to other tasks that may require different computations of the frontal lobes. CONCLUSIONS We provided interventional evidence that the left IFG is critical for selective semantic retrieval, and tDCS over the left IFG may have a near-transfer effect on tasks that depend on the same computation, even if they are not specifically trained. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02606422.
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Affiliation(s)
- Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Bronte N Ficek
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Olivia Herrmann
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Constantine E Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Radiology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - John E Desmond
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA; Neuroscience Program, Johns Hopkins University, Baltimore, MD, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins Medicine, Baltimore, MD, USA.
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20
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Chandregowda A, Clark HM, Machulda MM, Pham NTT, Lowe VJ, Josephs KA, Whitwell JL. A Case of Atypical Alzheimer's Disease With Clinical Manifestation That Straddled the Boundary Between Primary Progressive Aphasia and Posterior Cortical Atrophy. Neurologist 2023; 28:195-197. [PMID: 35981305 PMCID: PMC9938085 DOI: 10.1097/nrl.0000000000000458] [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] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the context of Alzheimer's disease phenotypes, patients may present with symptoms and signs that do not exclusively fit into one of the existing phenotypic categories, which often delays timely diagnosis and initiation of services to optimize patient awareness and coping. CASE REPORT A 74-year-old woman presented with the complaint of progressive word-finding difficulty, raising our suspicion for primary progressive aphasia. Clinical evaluations, however, also revealed emerging cortical visual deficits consistent with posterior cortical atrophy. During evaluation 1 year later, Gerstmann syndrome was evident. Her in vivo neuroimaging was positive for beta-amyloid and tau biomarkers of Alzheimer's disease pathology. CONCLUSION In addition to contributing to the literature on the heterogeneity of the clinical manifestations of Alzheimer's disease, this report highlights that a breakdown in the visual-lexical interface can account for anomia in posterior cortical atrophy at least in some cases. Other relevant clinical insights pertinent to this case are discussed.
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Affiliation(s)
| | | | | | | | | | - Keith A Josephs
- Neurology (Behavioral Neurology; Movement Disorders), Mayo Clinic, Tampa, FL
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21
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Robinson CG, Duffy JR, Clark HA, Utianski RL, Machulda MM, Botha H, Singh NA, Thu NT, Ertekin-Taner N, Dickson DW, Lowe VJ, Whitwell JL, Josephs KA. Clinicopathological associations of hemispheric dominance in primary progressive apraxia of speech. Eur J Neurol 2023; 30:1209-1219. [PMID: 36869612 PMCID: PMC10410644 DOI: 10.1111/ene.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Primary progressive apraxia of speech (PPAOS) is associated with imaging abnormalities in the lateral premotor cortex (LPC) and supplementary motor area (SMA). It is not known whether greater involvement of these regions in either hemisphere is associated with demographics, presenting, and/or longitudinal features. METHODS In 51 prospectively recruited PPAOS patients who completed [18 F]-fluorodeoxyglucose (FDG) positron emission tomography (PET), we classified patients as left-dominant, right-dominant, or symmetric, based on visual assessment of the LPC and SMA on FDG-PET. SPM and statistical analyses of regional metabolic values were performed. Diagnosis of PPAOS was made if apraxia of speech was present and aphasia absent. Thirteen patients completed ioflupane-123I (dopamine transporter [DAT]) scans. We compared cross-sectional and longitudinal clinicopathological, genetic, and neuroimaging characteristics across the three groups, with area under the receiver-operating curve (AUROC) determined as a measure of effect size. RESULTS In all, 49% of the PPAOS patients were classified as left-dominant, 31% as right-dominant, and 20% as symmetric, which was supported by results from the SPM and regional analyses. There were no differences in baseline characteristics. Longitudinally, right-dominant PPAOS showed faster rates of progression of ideomotor apraxia (AUROC 0.79), behavioral disturbances (AUROC 0.84), including disinhibition symptoms (AUROC 0.82) and negative behaviors (AUROC 0.82), and parkinsonism (AUROC 0.75) compared to left-dominant PPAOS. Symmetric PPAOS showed faster rates of dysarthria progression compared to left-dominant (AUROC 0.89) and right-dominant PPAOS (AUROC 0.79). Five patients showed abnormal DAT uptake. Braak neurofibrillary tangle stage differed across groups (p = 0.01). CONCLUSIONS Patients with PPAOS and a right-dominant pattern of hypometabolism on FDG-PET have the fastest rates of decline of behavioral and motor features.
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Affiliation(s)
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | | | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN
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22
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Premi E, Dukart J, Mattioli I, Libri I, Pengo M, Gadola Y, Cotelli M, Manenti R, Binetti G, Gazzina S, Alberici A, Magoni M, Koch G, Gasparotti R, Padovani A, Borroni B. Unravelling neurotransmitters impairment in primary progressive aphasias. Hum Brain Mapp 2023; 44:2245-2253. [PMID: 36649260 PMCID: PMC10028634 DOI: 10.1002/hbm.26206] [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: 10/18/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Primary progressive aphasias (PPAs) are a group of neurodegenerative diseases mainly characterized by language impairment, and with variably presence of dysexecutive syndrome, behavioural disturbances and parkinsonism. Detailed knowledge of neurotransmitters impairment and its association with clinical features hold the potential to develop new tailored therapeutic approaches. In the present study, we applied JuSpace toolbox, which allowed for cross-modal correlation of magnetic resonance imaging (MRI)-based measures with nuclear imaging derived estimates covering various neurotransmitter systems including dopaminergic, serotonergic, noradrenergic, GABAergic and glutamatergic neurotransmission. We included 103 PPA patients and 80 age-matched healthy controls (HC). We tested if the spatial patterns of grey matter volume (GMV) alterations in PPA patients (relative to HC) are correlated with specific neurotransmitter systems. As compared to HC, voxel-based brain changes in PPA were significantly associated with spatial distribution of serotonin, dopamine, and glutamatergic pathways (p < .05, False Discovery Rate corrected-corrected). Disease severity was negatively correlated with the strength of GMV colocalization of D1 receptors (p = .035) and serotonin transporter (p = .020). Moreover, we observed a significant negative correlation between positive behavioural symptoms, as measured with Frontal Behavioural Inventory, and GMV colocalization of D1 receptors (p = .007) and serotonin transporter (p < .001). This pilot study suggests that JuSpace is a helpful tool to indirectly assess neurotransmitter deficits in neurodegenerative dementias and may provide novel insight into disease mechanisms and associated clinical features.
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Affiliation(s)
- Enrico Premi
- Stroke Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM‐7)Research CentreJülichJülichGermany
- Institute of Systems Neuroscience, Medical FacultyHeinrich Heine University DüsseldorfDüsseldorfGermany
| | - Irene Mattioli
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Marta Pengo
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Yasmine Gadola
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Maria Cotelli
- Neuropsychology UnitIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Rosa Manenti
- Neuropsychology UnitIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers LaboratoryIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Stefano Gazzina
- Neurophysiology Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Antonella Alberici
- Neurology Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Mauro Magoni
- Stroke Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Giacomo Koch
- Department of Neuroscience and RehabilitationUniversity of Ferrara and Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT)FerraraItaly
- Department of Clinical and Behavioural NeurologySanta Lucia Foundation IRCCSRomeItaly
| | | | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Neurology Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Neurology Unit, Department of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
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23
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Hupfeld KE, Zöllner HJ, Oeltzschner G, Hyatt HW, Herrmann O, Gallegos J, Hui SCN, Harris AD, Edden RAE, Tsapkini K. Brain total creatine differs between primary progressive aphasia (PPA) subtypes and correlates with disease severity. Neurobiol Aging 2023; 122:65-75. [PMID: 36508896 PMCID: PMC9839619 DOI: 10.1016/j.neurobiolaging.2022.11.006] [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: 07/12/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
Primary progressive aphasia (PPA) is comprised of three subtypes: logopenic (lvPPA), non-fluent (nfvPPA), and semantic (svPPA). We used magnetic resonance spectroscopy (MRS) to measure tissue-corrected metabolite levels in the left inferior frontal gyrus (IFG) and right sensorimotor cortex (SMC) from 61 PPA patients. We aimed to: (1) characterize subtype differences in metabolites; and (2) test for metabolite associations with symptom severity. tCr differed by subtype across the left IFG and right SMC. tCr levels were lowest in lvPPA and highest in svPPA. tCr levels predicted lvPPA versus svPPA diagnosis. Higher IFG tCr and lower Glx correlated with greater disease severity. As tCr is involved in brain energy metabolism, svPPA pathology might involve changes in specific cellular energy processes. Perturbations to cellular energy homeostasis in language areas may contribute to symptoms. Reduced cortical excitatory capacity (i.e. lower Glx) in language regions may also contribute to symptoms. Thus, tCr may be useful for differentiating between PPA subtypes, and both tCr and Glx might have utility in understanding PPA mechanisms and tracking progression.
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Affiliation(s)
- Kathleen E Hupfeld
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Helge J Zöllner
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Hayden W Hyatt
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olivia Herrmann
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Gallegos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steve C N Hui
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ashley D Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA.
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Licata AE, Zhao Y, Herrmann O, Hillis AE, Desmond J, Onyike C, Tsapkini K. Sex differences in effects of tDCS and language treatments on brain functional connectivity in primary progressive aphasia. Neuroimage Clin 2023; 37:103329. [PMID: 36701874 PMCID: PMC9883295 DOI: 10.1016/j.nicl.2023.103329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
Primary Progressive Aphasia (PPA) is a neurodegenerative disorder primarily affecting language functions. Neuromodulatory techniques (e.g., transcranial direct current stimulation, active-tDCS) and behavioral (speech-language) therapy have shown promising results in treating speech and language deficits in PPA patients. One mechanism of active-tDCS efficacy is through modulation of network functional connectivity (FC). It remains unknown how biological sex influences FC and active-tDCS or language treatment(s). In the current study, we compared sex differences, induced by active-tDCS and language therapy alone, in the default mode and language networks, acquired during resting-state fMRI in 36 PPA patients. Using a novel statistical method, the covariate-assisted-principal-regression (CAPs) technique, we found sex and age differences in FC changes following active-tDCS. In the default mode network (DMN): (1) men (in both conditions) showed greater FC in DMN than women. (2) men who received active-tDCS showed greater FC in the DMN than men who received language-treatment only. In the language network: (1) women who received active-tDCS showed significantly greater FC across the language network than women who received sham-tDCS. As age increases, regardless of sex and treatment condition, FC in language regions decreases. The current findings suggest active-tDCS treatment in PPA alters network-specific FC in a sex-dependent manner.
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Affiliation(s)
- Abigail E Licata
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Faculty of Psychology and Educational Sciences, University of Geneva, Geneva 1205, Switzerland
| | - Yi Zhao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Olivia Herrmann
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore MD 21287, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - John Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore MD 21287, USA.
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25
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Dial HR, Europa E, Grasso SM, Mandelli ML, Schaffer KM, Hubbard HI, Wauters LD, Wineholt L, Wilson SM, Gorno-Tempini ML, Henry ML. Baseline structural imaging correlates of treatment outcomes in semantic variant primary progressive aphasia. Cortex 2023; 158:158-175. [PMID: 36577212 PMCID: PMC9904210 DOI: 10.1016/j.cortex.2022.10.004] [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: 08/30/2021] [Revised: 02/25/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative disorder characterized by a loss of semantic knowledge in the context of anterior temporal lobe atrophy (left > right). Core features of svPPA include anomia and single-word comprehension impairment. Despite growing evidence supporting treatment for anomia in svPPA, there is a paucity of research investigating neural mechanisms supporting treatment-induced gains and generalization to untrained items. In the current study, we examined the relation between the structural integrity of brain parenchyma (tissue inclusive of gray and white matter) at pre-treatment and treatment outcomes for trained and untrained items in a group of 19 individuals with svPPA who completed lexical retrieval treatment. Two structural neuroimaging approaches were used: an exploratory, whole-brain, voxel-wise approach and an a priori region of interest (ROI) approach. Based on previous research, bilateral temporal (inferior, middle, and superior temporal gyri), parietal (supramarginal and angular gyri), frontal (inferior and middle frontal gyri) and medial temporal (hippocampus and parahippocampal gyri) ROIs were selected from the Automated Anatomical Labeling (AAL) atlas. Analyses revealed improved naming of trained items and generalization to untrained items following treatment, providing converging evidence that individuals with svPPA can benefit from treatment for anomia. Better post-treatment naming accuracy was associated with the structural integrity of inferior parietal cortex and the hippocampus. Specifically, improved naming of trained items was related to the left supramarginal (phonological processing) and angular gyri (phonological and semantic processing), and improved naming of trained and untrained items was related to the left hippocampus (episodic, context-based memory). Future research should examine treatment outcomes in relation to pre-treatment functional and structural connectivity as well as changes in network dynamics following speech-language intervention to further elucidate the neural mechanisms underlying treatment response in svPPA and related disorders.
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Affiliation(s)
- Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, 3871 Holman St, Houston, TX, USA; Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA.
| | - Eduardo Europa
- Connie L. Lurie College of Education, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Stephanie M Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Kristin M Schaffer
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - H Isabel Hubbard
- College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA
| | - Lisa D Wauters
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Lindsey Wineholt
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA; Department of Neurology, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0700, Austin, TX USA
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26
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Chokesuwattanaskul A, Marshall CR, van Harskamp N, Houlden H, Rohrer JD, Hardy CJ, Warren JD. Primary progressive aphasia: ReADing the clinical GRANularity. Pract Neurol 2022; 22:509-514. [PMID: 35710752 DOI: 10.1136/practneurol-2022-003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
Primary progressive aphasia remains a diagnostic challenge despite (or even because of) the increasing availability of ancillary tests and biomarkers. We present a 67-year-old man with apparently sporadic logopenic aphasia and positive Alzheimer biomarkers who was subsequently found also to have a pathogenic mutation in the progranulin gene. This was signalled by early atypical features (mild expressive agrammatism and behavioural change, rapid clinical deterioration) around the core logopenic aphasia syndrome. Each of the canonical progressive aphasia syndromes has a 'halo' of less typical variants that may herald alternative or additional pathologies. The accurate diagnosis of primary progressive aphasia depends on careful clinical analysis to direct investigations appropriately.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natasja van Harskamp
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Henry Houlden
- Department of Neurogenetics, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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27
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Younes K, Borghesani V, Montembeault M, Spina S, Mandelli ML, Welch AE, Weis E, Callahan P, Elahi FM, Hua AY, Perry DC, Karydas A, Geschwind D, Huang E, Grinberg LT, Kramer JH, Boxer AL, Rabinovici GD, Rosen HJ, Seeley WW, Miller ZA, Miller BL, Sturm VE, Rankin KP, Gorno-Tempini ML. Right temporal degeneration and socioemotional semantics: semantic behavioural variant frontotemporal dementia. Brain 2022; 145:4080-4096. [PMID: 35731122 PMCID: PMC10200288 DOI: 10.1093/brain/awac217] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 04/30/2021] [Revised: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
Focal anterior temporal lobe degeneration often preferentially affects the left or right hemisphere. While patients with left-predominant anterior temporal lobe atrophy show severe anomia and verbal semantic deficits and meet criteria for semantic variant primary progressive aphasia and semantic dementia, patients with early right anterior temporal lobe atrophy are more difficult to diagnose as their symptoms are less well understood. Focal right anterior temporal lobe atrophy is associated with prominent emotional and behavioural changes, and patients often meet, or go on to meet, criteria for behavioural variant frontotemporal dementia. Uncertainty around early symptoms and absence of an overarching clinico-anatomical framework continue to hinder proper diagnosis and care of patients with right anterior temporal lobe disease. Here, we examine a large, well-characterized, longitudinal cohort of patients with right anterior temporal lobe-predominant degeneration and propose new criteria and nosology. We identified individuals from our database with a clinical diagnosis of behavioural variant frontotemporal dementia or semantic variant primary progressive aphasia and a structural MRI (n = 478). On the basis of neuroimaging criteria, we defined three patient groups: right anterior temporal lobe-predominant atrophy with relative sparing of the frontal lobes (n = 46), frontal-predominant atrophy with relative sparing of the right anterior temporal lobe (n = 79) and left-predominant anterior temporal lobe-predominant atrophy with relative sparing of the frontal lobes (n = 75). We compared the clinical, neuropsychological, genetic and pathological profiles of these groups. In the right anterior temporal lobe-predominant group, the earliest symptoms were loss of empathy (27%), person-specific semantic impairment (23%) and complex compulsions and rigid thought process (18%). On testing, this group exhibited greater impairments in Emotional Theory of Mind, recognition of famous people (from names and faces) and facial affect naming (despite preserved face perception) than the frontal- and left-predominant anterior temporal lobe-predominant groups. The clinical symptoms in the first 3 years of the disease alone were highly sensitive (81%) and specific (84%) differentiating right anterior temporal lobe-predominant from frontal-predominant groups. Frontotemporal lobar degeneration-transactive response DNA binding protein (84%) was the most common pathology of the right anterior temporal lobe-predominant group. Right anterior temporal lobe-predominant degeneration is characterized by early loss of empathy and person-specific knowledge, deficits that are caused by progressive decline in semantic memory for concepts of socioemotional relevance. Guided by our results, we outline new diagnostic criteria and propose the name, 'semantic behavioural variant frontotemporal dementia', which highlights the underlying cognitive mechanism and the predominant symptomatology. These diagnostic criteria will facilitate early identification and care of patients with early, focal right anterior temporal lobe degeneration as well as in vivo prediction of frontotemporal lobar degeneration-transactive response DNA binding protein pathology.
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Affiliation(s)
- Kyan Younes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94304, USA
| | - Valentina Borghesani
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Elizabeth Weis
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Patrick Callahan
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Fanny M Elahi
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Alice Y Hua
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - David C Perry
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Daniel Geschwind
- Neurogenetics Program, Department of Neurology and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Eric Huang
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Virginia E Sturm
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Dyslexia Center, University of California, San Francisco, CA 94158, USA
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28
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Roytman M, Chiang GC, Gordon ML, Franceschi AM. Multimodality Imaging in Primary Progressive Aphasia. AJNR Am J Neuroradiol 2022; 43:1230-1243. [PMID: 36007947 PMCID: PMC9451618 DOI: 10.3174/ajnr.a7613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
Primary progressive aphasia is a clinically and neuropathologically heterogeneous group of progressive neurodegenerative disorders, characterized by language-predominant impairment and commonly associated with atrophy of the dominant language hemisphere. While this clinical entity has been recognized dating back to the 19th century, important advances have been made in defining our current understanding of primary progressive aphasia, with 3 recognized subtypes to date: logopenic variant, semantic variant, and nonfluent/agrammatic variant. Given the ongoing progress in our understanding of the neurobiology and genomics of these rare neurodegenerative conditions, accurate imaging diagnoses are of the utmost importance and carry implications for future therapeutic triaging. This review covers the diverse spectrum of primary progressive aphasia and its multimodal imaging features, including structural, functional, and molecular neuroimaging findings; it also highlights currently recognized diagnostic criteria, clinical presentations, histopathologic biomarkers, and treatment options of these 3 primary progressive aphasia subtypes.
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Affiliation(s)
- M Roytman
- From the Neuroradiology Division (M.R., G.C.C.), Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - G C Chiang
- From the Neuroradiology Division (M.R., G.C.C.), Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - M L Gordon
- Departments of Neurology and Psychiatry (M.L.G.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Litwin-Zucker Research Center, Feinstein Institutes for Medical Research, Manhasset, New York
| | - A M Franceschi
- Neuroradiology Division (A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
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29
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Tee BL, Lorinda Kwan-Chen LY, Chen TF, Yan CTY, Tsoh J, Lung-Tat Chan A, Wong A, Lo RY, Lu CL, Wang PN, Lee Y, Yang FG, Battistella G, Allen IE, Dronkers NF, Miller BL, Gorno-Tempini ML. Dysgraphia Phenotypes in Native Chinese Speakers With Primary Progressive Aphasia. Neurology 2022; 98:e2245-e2257. [PMID: 35410909 PMCID: PMC9162166 DOI: 10.1212/wnl.0000000000200350] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Most primary progressive aphasia (PPA) literature is based on English language users. Linguistic features that vary from English, such as logographic writing systems, are underinvestigated. The current study characterized the dysgraphia phenotypes of patients with PPA who write in Chinese and investigated their diagnostic utility in classifying PPA variants. METHODS This study recruited 40 participants with PPA and 20 cognitively normal participants from San Francisco, Hong Kong, and Taiwan. We measured dictation accuracy using the Chinese Language Assessment for PPA (CLAP) 60-character orthographic dictation test and examined the occurrence of various writing errors across the study groups. We also performed voxel-based morphometry analysis to identify the gray matter regions correlated with dictation accuracy and prevalence of writing errors. RESULTS All PPA groups produced significantly less accurate writing responses than the control group and no significant differences in dictation accuracy were noted among the PPA variants. With a cut score of 36 out of 60 in the CLAP orthographic dictation task, the test achieved sensitivity and specificity of 90% and 95% in identifying Chinese participants with PPA vs controls. In addition to a character frequency effect, dictation accuracy was affected by homophone density and the number of strokes in semantic variant PPA and logopenic variant PPA groups. Dictation accuracy was correlated with volumetric changes over left ventral temporal cortices, regions known to be critical for orthographic long-term memory. Individuals with semantic variant PPA frequently presented with phonologically plausible errors at lexical level, patients with logopenic variant PPA showed higher preponderance towards visual and stroke errors, and patients with nonfluent/agrammatic variant PPA commonly exhibited compound word and radical errors. The prevalence of phonologically plausible, visual, and compound word errors was negatively correlated with cortical volume over the bilateral temporal regions, left temporo-occipital area, and bilateral orbitofrontal gyri, respectively. DISCUSSION The findings demonstrate the potential role of the orthographic dictation task as a screening tool and PPA classification indicator in Chinese language users. Each PPA variant had specific Chinese dysgraphia phenotypes that vary from those previously reported in English-speaking patients with PPA, highlighting the importance of language diversity in PPA.
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Affiliation(s)
- Boon Lead Tee
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis.
| | - Li Ying Lorinda Kwan-Chen
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Ta-Fu Chen
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Connie T Y Yan
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Joshua Tsoh
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Andrew Lung-Tat Chan
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Adrian Wong
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Raymond Y Lo
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Chien Long Lu
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Pei-Ning Wang
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - YiChen Lee
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Fanpei G Yang
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Giovanni Battistella
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Isabel Elaine Allen
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Nina F Dronkers
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Bruce L Miller
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
| | - Maria Luisa Gorno-Tempini
- From the Memory and Aging Center (B.L.T., G.B., B.L.M., M.L.G.-T.), Department of Neurology, Dyslexia Center (B.L.T., G.B., M.L.G.-T.), Global Brain Health Institute (B.L.T., M.L.G.-T.), and Department of Epidemiology and Biostatistics (I.E.A.), University of California, San Francisco; Department of Neurology (B.L.T., R.Y.L.), Buddhist Tzu Chi General Hospital, Hualien, Taiwan R.O.C.; Department of Special Education and Counselling (L.Y.L.K.-C.), The Education University of Hong Kong; Department of Neurology (T.-F.C., Y.L.), National Taiwan University Hospital, Taipei, Taiwan R.O.C.; Department of Psychiatry (C.T.Y.Y., J.T.), ShaTin Hospital, Hong Kong; Department of Medicine (C.T.Y.Y., J.T., A.W.), Chinese University of Hong Kong; Department of Medicine (A.L.-T.C.), Queen Elizabeth Hospital, Hong Kong; Department of Neurology (C.L.L.), En Chu Kong Hospital, New Taipei City; Division of General Neurology, Department of Neurological Institute (P.-N.W.), Taipei Veterans General Hospital; School of Medicine (P.-N.W.) and Brain Research Center (P.-N.W.), National Yang-Ming Chiao-Tung University, Taipei, Taiwan R.O.C.; Department of Foreign Languages and Literature (F.G.Y.), National Tsing Hua University, HsinChu, Taiwan R.O.C.; Department of Radiology (F.G.Y.), Graduate School of Dentistry, Osaka University, Japan; Department of Psychology (N.F.D.), University of California, Berkeley; and Department of Neurology (N.F.D.), University of California, Davis
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Tsiouris S, Bougias C, Konitsiotis S, Papadopoulos A, Fotopoulos A. Early-Onset Frontotemporal Dementia-Related Semantic Variant of Primary Progressive Aphasia: Multimodal Evaluation With Brain Perfusion SPECT, SPECT/MRI Coregistration, and MRI Volumetry. Clin Nucl Med 2022; 47:260-264. [PMID: 34653052 DOI: 10.1097/rlu.0000000000003934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by cortical and subcortical atrophies, with early involvement of the hippocampus and amygdala. A 58-year-old man with clinical presentation of primary progressive aphasia-particularly its svPPA (semantic variant)-and bilateral asymmetric (left-predominant) anterior temporal lobe atrophy on MRI was referred for brain perfusion SPECT. This revealed bilateral hypoperfusion of the anterior temporal lobe (sustained by software-fused SPECT/MRI), pointing toward FTD rather than Alzheimer disease. Furthermore, voxel-based MRI volumetric analysis confirmed bilateral atrophy affecting the hippocampus and amygdala. Combining SPECT with MRI was supportive of the early-onset FTD-related svPPA diagnosis.
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Illán-Gala I, Montal V, Borrego-Écija S, Mandelli ML, Falgàs N, Welch AE, Pegueroles J, Santos-Santos M, Bejanin A, Alcolea D, Dols-Icardo O, Belbin O, Sánchez-Saudinós MB, Bargalló N, González-Ortiz S, Lladó A, Blesa R, Dickerson BC, Rosen HJ, Miller BL, Lleó A, Gorno-Tempini ML, Sánchez-Valle R, Fortea J. Cortical microstructure in primary progressive aphasia: a multicenter study. Alzheimers Res Ther 2022; 14:27. [PMID: 35139897 PMCID: PMC8830043 DOI: 10.1186/s13195-022-00974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cortical mean diffusivity is a novel imaging metric sensitive to early changes in neurodegenerative syndromes. Higher cortical mean diffusivity values reflect microstructural disorganization and have been proposed as a sensitive biomarker that might antedate macroscopic cortical changes. We aimed to test the hypothesis that cortical mean diffusivity is more sensitive than cortical thickness to detect cortical changes in primary progressive aphasia (PPA). METHODS In this multicenter, case-control study, we recruited 120 patients with PPA (52 non-fluent, 31 semantic, and 32 logopenic variants; and 5 GRN-related PPA) as well as 89 controls from three centers. The 3-Tesla MRI protocol included structural and diffusion-weighted sequences. Disease severity was assessed with the Clinical Dementia Rating scale. Cortical thickness and cortical mean diffusivity were computed using a surface-based approach. RESULTS The comparison between each PPA variant and controls revealed cortical mean diffusivity increases and cortical thinning in overlapping regions, reflecting the canonical loci of neurodegeneration of each variant. Importantly, cortical mean diffusivity increases also expanded to other PPA-related areas and correlated with disease severity in all PPA groups. Cortical mean diffusivity was also increased in patients with very mild PPA when only minimal cortical thinning was observed and showed a good correlation with measures of disease severity. CONCLUSIONS Cortical mean diffusivity shows promise as a sensitive biomarker for the study of the neurodegeneration-related microstructural changes in PPA.
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Affiliation(s)
- Ignacio Illán-Gala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Atlantic Fellow for Equity in Brain Health at the University of California San Francisco, San Francisco, CA, 94115, USA.
| | - Victor Montal
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Sergi Borrego-Écija
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Neus Falgàs
- Atlantic Fellow for Equity in Brain Health at the University of California San Francisco, San Francisco, CA, 94115, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Jordi Pegueroles
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Miguel Santos-Santos
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Alexandre Bejanin
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Oriol Dols-Icardo
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Olivia Belbin
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Mª Belén Sánchez-Saudinós
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Nuria Bargalló
- Radiology Department, Hospital Clinic Barcelona and Magnetic Resonance Image Core facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Albert Lladó
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, 94115, USA
| | - Raquel Sánchez-Valle
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036, Barcelona, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Barcelona Down Medical Center. Fundació Catalana de Síndrome de Down, Barcelona, Spain.
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Mamouli D, Stavrakaki S, Iakovou I, Parisis D, Karacostas D, Papanastasiou E, Ioannidis P. SPECT analysis and language profile in Greek speaking patients with subtypes of frontotemporal dementia. Hell J Nucl Med 2022; 25:43-56. [PMID: 35388804 DOI: 10.1967/s002449912436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We aimed to examine if single photon emission computed tomography (SPECT) can discriminate between variants of frontotemporal dementia (FTD). As a secondary investigation we identify and establish the linguistic differences between those variants. MATERIALS AND METHODS Nine patients with semantic variant primary progressive aphasia (svPPA), 8 with non-fluent variant primary progressive aphasia (nfvPPA) and 17 with behavioral variant of frontotemporal dementia (bvFTD) were compared on Addenbrooke's cognitive examination-revised (ACE-R), auditory comprehension, oral expression and verbal fluency. All patients were also compared with healthy controls. Patients were evaluated using technetium-99m-hexamethylproyleneamine oxime (99mTc-HMPAO) brain SPECT as a measure of regional cerebral flow. RESULTS Significant group differences between all patients and controls were found for ACE-R, auditory comprehension and oral expression. Semantic variant primary progressive aphasia patients performed higher in letter compared to category fluency with significant deficits in auditory comprehension and oral expression. Non-fluent variant primary progressive aphasia patients showed significant deficits in auditory comprehension but not oral expression while performed lightly worse in letter fluency compared to category. Behavioral variant of frontotemporal dementia patients showed deficits in auditory comprehension and oral expression and performed similar in category and letter fluency. Single photon emission computed tomography analysis revealed left frontotemporal hypoperfusion extending to the right frontotemporal region in svPPA patients. Non-fluent variant primary progressive aphasia patients presented left frontotemporal hypoperfusion with participation of the left parietal and right frontotemporal regions. Behavioral variant of frontotemporal dementia patients showed bilateral frontotemporal hypoperfusion compared to parietal and visual cortices. CONCLUSION Our findings suggest that SPECT may assist in the discrimination of the FTD variants. We also confirmed that bvFTD patients share similar language deficits with svPPA patients.
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Affiliation(s)
- Dimitra Mamouli
- 424 General Military Training Hospital, Thessaloniki, Greece.
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Lukic S, Borghesani V, Weis E, Welch A, Bogley R, Neuhaus J, Deleon J, Miller ZA, Kramer JH, Miller BL, Dronkers NF, Gorno-Tempini ML. Dissociating nouns and verbs in temporal and perisylvian networks: Evidence from neurodegenerative diseases. Cortex 2021; 142:47-61. [PMID: 34182153 PMCID: PMC8556704 DOI: 10.1016/j.cortex.2021.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 07/30/2020] [Revised: 02/27/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
Naming of nouns and verbs can be selectively impaired in neurological disorders, but the specificity of the neural and cognitive correlates of such dissociation remains unclear. Functional imaging and stroke research sought to identify cortical regions selectively recruited for nouns versus verbs, yet findings are inconsistent. The present study investigated this issue in neurodegenerative diseases known to selectively affect different brain networks, thus providing new critical evidence of network specificity. We examined naming performances on nouns and verbs in 146 patients with different neurodegenerative syndromes (Primary Progressive Aphasia - PPA, Alzheimer's disease - AD, and behavioral variant Frontotemporal Dementia - FTD) and 30 healthy adults. We then correlated naming scores with MRI-derived cortical thickness values as well as with performances in semantic and syntactic tasks, across all subjects. Results indicated that patients with the semantic variant PPA named significantly fewer nouns than verbs. Instead, nonfluent/agrammatic PPA patients named fewer verbs than nouns. Across all subjects, performance on nouns (adjusted for verbs) specifically correlated with cortical atrophy in left anterior temporal regions, and performance on verbs (adjusted for nouns) with atrophy in left inferior and middle frontal, inferior parietal and posterior temporal regions. Furthermore, lower lexical-semantic abilities correlated with deficits in naming both nouns and verbs, while lower syntactic abilities only correlated with naming verbs. Our results show that different neural and cognitive mechanisms underlie naming of specific grammatical categories in neurodegenerative diseases. Importantly, our findings showed that verb processing depends on a widespread perisylvian networks, suggesting that some regions might be involved in processing different types of action knowledge. These findings have important implications for early differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Sladjana Lukic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Valentina Borghesani
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elizabeth Weis
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ariane Welch
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - John Neuhaus
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica Deleon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Nina F Dronkers
- University of California, Berkeley, CA, USA; University of California, Davis, CA, USA
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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Paek EJ, Murray LL, Newman SD. Effects of concurrent action and object naming treatment on naming skills and functional brain activation patterns in primary progressive aphasia: An fMRI study with a case-series design. Brain Lang 2021; 218:104950. [PMID: 33836414 DOI: 10.1016/j.bandl.2021.104950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/18/2020] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
Individuals with primary progressive aphasia (PPA) exhibit differential impairment patterns in noun and verb naming, but it remains unclear whether anomia treatment results in similar improvements in noun and verb naming. Therefore, we examined the immediate and long-term (3-months post-treatment) behavioral and neural effects of an anomia treatment on object and action naming skills in PPA. A case-series design was utilized involving two individuals with PPA. Object and action words were trained concurrently and probed regularly using word lists matched on a number of lexical characteristics. One participant showed improvements in all word categories with different effect sizes whereas the other participant demonstrated improved naming only on trained object words. Treatment-induced fMRI changes were found in both hemispheres, with distinct patterns observed across participants. Further research is needed to better understand the effects of residual language and cognitive skills on behavioral and neurophysiological outcomes following anomia treatment for PPA.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States; Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, United States.
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Takaya M, Ishii K, Saigoh K, Shirakawa O. Longitudinal study of primary progressive aphasia in a patient with pathologically diagnosed Alzheimer's disease: a case report. J Med Case Rep 2021; 15:272. [PMID: 34034805 PMCID: PMC8152353 DOI: 10.1186/s13256-021-02867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Alzheimer's disease is a neurodegenerative disease involving the deposition of pathologic amyloid-β and tau protein in the cerebral cortex. Alzheimer's disease is commonly characterized by progressive impairment of recent memory. Primary progressive aphasia is also often observed in patients with Alzheimer's disease. Moreover, language-associated symptoms, such as primary progressive aphasia, are diverse and varied in Alzheimer's disease. However, nonfluent/agrammatic variant primary progressive aphasia is not generally considered a symptom of Alzheimer's disease. To date, there has been no longitudinal study of primary progressive aphasia in Japanese-speaking patients or in patients speaking other languages with pathologically diagnosed Alzheimer's disease. Here we present a longitudinal study of primary progressive aphasia in a Japanese patient pathologically diagnosed with Alzheimer's disease. CASE PRESENTATION A 75-year-old Japanese man, whose wife reported that his memory was impaired, also suffered from suspected aphasia. He was pathologically diagnosed with Alzheimer's disease using 11C-Pittsburgh compound-B positron emission tomography and 18F-THK5351 positron emission tomography. Based on clinical observation and the results of the Japanese standard language test of aphasia, he was also diagnosed with nonfluent/agrammatic variant primary progressive aphasia. During the subsequent 2 years, his cognitive impairment, aphasia, and behavioral and psychological symptoms of dementia progressed. Furthermore, progression of pathologic amyloid-β and tau protein deposition was revealed through 11C-Pittsburgh compound-B positron emission tomography and 18F-THK5351 positron emission tomography. Although the results of [123I] iodoamphetamine single-photon emission computed tomography suggested corticobasal degeneration, this was not observed on the [123I] FP-CIT single-photon emission computed tomography (SPECT) (DaTscan). A previous study had reported that Alzheimer's disease with a nonfluent/agrammatic variant primary progressive aphasia was accompanied by corticobasal degeneration; however, this was not true in our case. CONCLUSIONS This is possibly the first longitudinal study of nonfluent/agrammatic variant primary progressive aphasia in a Japanese-speaking patient with pathologically diagnosed Alzheimer's disease, but without corticobasal degeneration.
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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
| | - Kazumasa Saigoh
- Department of Neurology, Faculty of Medicine and Department of Clinical Genetics, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
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Joo JY, Kim HG, Lee KM, Ko SH, Rhee HY, Park KC, Lee JS. Parosmia in Right-lateralized Semantic Variant Primary Progressive Aphasia: A Case Report. Alzheimer Dis Assoc Disord 2021; 35:160-163. [PMID: 33443872 DOI: 10.1097/wad.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
Parosmia, defined as the distorted perception of an odor stimulus, has been reported to be associated with head trauma, upper respiratory tract infections, sinonasal diseases, and toxin/drug consumption. To date, little is known about parosmia in right-lateralized semantic variant primary progressive aphasia. A 60-year-old right-handed man presented with a 2-year history of parosmia and prosopagnosia. Brain magnetic resonance imaging demonstrated severe atrophy of the right anterior and mesial temporal lobe, particularly in the fusiform cortex and the regions known as the primary olfactory cortex. 18F-fluorodeoxyglucose position emission tomography showed asymmetric hypometabolism of the bilateral temporal lobes (right > left). We clinically diagnosed him with right-lateralized semantic variant primary progressive aphasia. As the right hemisphere is known to be more involved in the processing of pleasant odors than the left hemisphere, we speculate that the unique manifestation of parosmia observed in this patient might be associated with the lateralization of the olfactory system.
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Affiliation(s)
| | | | | | - Seok Hoon Ko
- Emergency Medicine, Kyung Hee University Hospital
| | - Hak Young Rhee
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
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Cho S, Nevler N, Ash S, Shellikeri S, Irwin DJ, Massimo L, Rascovsky K, Olm C, Grossman M, Liberman M. Automated analysis of lexical features in frontotemporal degeneration. Cortex 2021; 137:215-231. [PMID: 33640853 PMCID: PMC8044033 DOI: 10.1016/j.cortex.2021.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 02/26/2020] [Revised: 07/26/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022]
Abstract
We implemented an automated analysis of lexical aspects of semi-structured speech produced by healthy elderly controls (n = 37) and three patient groups with frontotemporal degeneration (FTD): behavioral variant FTD (n = 74), semantic variant primary progressive aphasia (svPPA, n = 42), and nonfluent/agrammatic PPA (naPPA, n = 22). Based on previous findings, we hypothesized that the three patient groups and controls would differ in the counts of part-of-speech (POS) categories and several lexical measures. With a natural language processing program, we automatically tagged POS categories of all words produced during a picture description task. We further counted the number of wh-words, and we rated nouns for abstractness, ambiguity, frequency, familiarity, and age of acquisition. We also computed the cross-entropy estimation, where low cross-entropy indicates high predictability, and lexical diversity for each description. We validated a subset of the POS data that were automatically tagged with the Google Universal POS scheme using gold-standard POS data tagged by a linguist, and we found that the POS categories from our automated methods were more than 90% accurate. For svPPA patients, we found fewer unique nouns than in naPPA and more pronouns and wh-words than in the other groups. We also found high abstractness, ambiguity, frequency, and familiarity for nouns and the lowest cross-entropy estimation among all groups. These measures were associated with cortical thinning in the left temporal lobe. In naPPA patients, we found increased speech errors and partial words compared to controls, and these impairments were associated with cortical thinning in the left middle frontal gyrus. bvFTD patients' adjective production was decreased compared to controls and was correlated with their apathy scores. Their adjective production was associated with cortical thinning in the dorsolateral frontal and orbitofrontal gyri. Our results demonstrate distinct language profiles in subgroups of FTD patients and validate our automated method of analyzing FTD patients' speech.
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Affiliation(s)
- Sunghye Cho
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA.
| | - Naomi Nevler
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Ash
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjana Shellikeri
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Massimo
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Olm
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology and Penn Image Computing and Science Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Liberman
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA
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Buciuc M, Whitwell JL, Kasanuki K, Graff-Radford J, Machulda MM, Duffy JR, Strand EA, Lowe VJ, Graff-Radford NR, Rush BK, Franczak MB, Flanagan ME, Baker MC, Rademakers R, Ross OA, Ghetti BF, Parisi JE, Raghunathan A, Reichard RR, Bigio EH, Dickson DW, Josephs KA. Lewy Body Disease is a Contributor to Logopenic Progressive Aphasia Phenotype. Ann Neurol 2021; 89:520-533. [PMID: 33274526 PMCID: PMC8040336 DOI: 10.1002/ana.25979] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe clinical features, [18 F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) metabolism and digital pathology in patients with logopenic progressive aphasia (LPA) and pathologic diagnosis of diffuse Lewy body disease (DLBD) and compare to patients with LPA with other pathologies, as well as patients with classical features of probable dementia with Lewy bodies (pDLB). METHODS This is a clinicopathologic case-control study of 45 patients, including 20 prospectively recruited patients with LPA among whom 6 were diagnosed with LPA-DLBD. We analyzed clinical features and compared FDG-PET metabolism in LPA-DLBD to an independent group of patients with clinical pDLB and regional α-synuclein burden on digital pathology to a second independent group of autopsied patients with DLBD pathology and antemortem pDLB (DLB-DLBD). RESULTS All patients with LPA-DLBD were men. Neurological, speech, and neuropsychological characteristics were similar across LPA-DLBD, LPA-Alzheimer's disease (LPA-AD), and LPA-frontotemporal lobar degeneration (LPA-FTLD). Genetic screening of AD, DLBD, and FTLD linked genes were negative with the exception of APOE ε4 allele present in 83% of LPA-DLBD patients. Seventy-five percent of the patients with LPA-DLBD showed a parietal-dominant pattern of hy pometabolism; LPA-FTLD - temporal-dominant pattern, whereas LPA-AD showed heterogeneous patterns of hypometabolism. LPA-DLBD had more asymmetrical hypometabolism affecting frontal lobes, with relatively spared occipital lobe in the nondominantly affected hemisphere, compared to pDLB. LPA-DLBD had minimal atrophy on gross brain examination, higher cortical Lewy body counts, and higher α-synuclein burden in the middle frontal and inferior parietal cortices compared to DLB-DLBD. INTERPRETATION Whereas AD is the most frequent underlying pathology of LPA, DLBD can also be present and may contribute to the LPA phenotype possibly due to α-synuclein-associated functional impairment of the dominant parietal lobe. ANN NEUROL 2021;89:520-533.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Beth K. Rush
- Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Margaret E. Flanagan
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Bernardino F. Ghetti
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Joseph E. Parisi
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aditya Raghunathan
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R. Ross Reichard
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eileen H. Bigio
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wisse LEM, Ungrady MB, Ittyerah R, Lim SA, Yushkevich PA, Wolk DA, Irwin DJ, Das SR, Grossman M. Cross-sectional and longitudinal medial temporal lobe subregional atrophy patterns in semantic variant primary progressive aphasia. Neurobiol Aging 2021; 98:231-241. [PMID: 33341654 PMCID: PMC8018475 DOI: 10.1016/j.neurobiolaging.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
T1-magnetic resonance imaging (MRI) studies report early atrophy in the left anterior temporal lobe, especially the perirhinal cortex, in semantic variant primary progressive aphasia (svPPA). Improved segmentation protocols using high-resolution T2-MRI have enabled fine-grained medial temporal lobe (MTL) subregional measurements, which may provide novel information on the atrophy pattern and disease progression in svPPA. We aimed to investigate the MTL subregional atrophy pattern cross-sectionally and longitudinally in patients with svPPA as compared with controls and patients with Alzheimer's disease (AD). MTL subregional volumes were obtained using the Automated Segmentation for Hippocampal Subfields software from high-resolution T2-MRIs in 15 svPPA, 37 AD, and 23 healthy controls. All MTL volumes were corrected for intracranial volume and parahippocampal cortices for slice number. Longitudinal atrophy rates of all subregions were obtained using an unbiased deformation-based morphometry pipeline in 6 svPPA patients, 9 controls, and 12 AD patients. Cross-sectionally, significant volume loss was observed in svPPA compared with controls in the left MTL, right cornu ammonis 1 (CA1), Brodmann area (BA)35, and BA36 (subdivisions of the perirhinal cortex). Compared with AD patients, svPPA patients had significantly smaller left CA1, BA35, and left and right BA36 volumes. Longitudinally, svPPA patients had significantly greater atrophy rates of left and right BA36 than controls but not relative to AD patients. Fine-grained analysis of MTL atrophy patterns provides information about the evolution of atrophy in svPPA. These results indicate that MTL subregional measures might be useful markers to track disease progression or for clinical trials in svPPA.
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Affiliation(s)
- Laura E M Wisse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Molly B Ungrady
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ranjit Ittyerah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sydney A Lim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
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Zhao Y, Ficek B, Webster K, Frangakis C, Caffo B, Hillis AE, Faria A, Tsapkini K. White Matter Integrity Predicts Electrical Stimulation (tDCS) and Language Therapy Effects in Primary Progressive Aphasia. Neurorehabil Neural Repair 2021; 35:44-57. [PMID: 33317422 PMCID: PMC7748290 DOI: 10.1177/1545968320971741] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/11/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS), in conjunction with language therapy, improves language therapy outcomes in primary progressive aphasia (PPA). However, no studies show whether white matter integrity predicts language therapy or tDCS effects in PPA. OBJECTIVE We aimed to determine whether white matter integrity, measured by diffusion tensor imaging (DTI), predicts written naming/spelling language therapy effects (letter accuracy on trained and untrained words) with and without tDCS over the left inferior frontal gyrus (IFG) in PPA. METHODS Thirty-nine participants with PPA were randomly assigned to tDCS or sham condition, coupled with language therapy for 15 daily sessions. White matter integrity was measured by mean diffusivity (MD) and fractional anisotropy (FA) in DTI scans before therapy. Written naming outcomes were evaluated before, immediately after, 2 weeks, and 2 months posttherapy. To assess tDCS treatment effect, we used a mixed-effects model with treatment evaluation and time interaction. We considered a forward model selection approach to identify brain regions/fasciculi of which white matter integrity can predict improvement in performance of word naming. RESULTS Both sham and tDCS groups significantly improved in trained items immediately after and at 2 months posttherapy. Improvement in the tDCS group was greater and generalized to untrained words. White matter integrity of ventral language pathways predicted tDCS effects in trained items whereas white matter integrity of dorsal language pathways predicted tDCS effects in untrained items. CONCLUSIONS White matter integrity influences both language therapy and tDCS effects. Thus, it holds promise as a biomarker for deciding which patients will benefit from language therapy and tDCS.
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Affiliation(s)
- Yi Zhao
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine
| | - Kimberly Webster
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Otolaryngology-Head and Neck Surgery
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
- Department of Radiology, Johns Hopkins School of Medicine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Cognitive Science, Johns Hopkins University
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Cognitive Science, Johns Hopkins University
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Popal H, Quimby M, Hochberg D, Dickerson BC, Collins JA. Altered functional connectivity of cortical networks in semantic variant Primary Progressive Aphasia. Neuroimage Clin 2020; 28:102494. [PMID: 33395985 PMCID: PMC7708956 DOI: 10.1016/j.nicl.2020.102494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/29/2020] [Revised: 10/01/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022]
Abstract
As their illness progresses, patients with the semantic variant of Primary Progressive Aphasia (svPPA) frequently exhibit peculiar behaviors indicative of altered visual attention or an increased interest in artistic endeavors. In the present study, we examined changes within and between large-scale functional brain networks that may explain this altered visual behavior. We first examined the connectivity of the visual association network, the dorsal attention network, and the default mode network in healthy young adults (n = 89) to understand the typical architecture of these networks in the healthy brain. We then compared the large-scale functional connectivity of these networks in a group of svPPA patients (n = 12) to a group of age-matched cognitively normal controls (n = 30). Our results showed that the between-network connectivity of the dorsal attention and visual association networks was elevated in svPPA patients relative to controls. We further showed that this heightened between-network connectivity was associated with a decrease in the within-network connectivity of the default mode network, possibly due to progressive degeneration of the anterior temporal lobes in svPPA. These results suggest that focal neurodegeneration can lead to the reorganization of large-scale cognitive networks beyond the primarily affected network(s), possibly contributing to cognitive or behavioral changes that are commonly present as part of the clinical phenotype of svPPA.
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Affiliation(s)
- Haroon Popal
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Megan Quimby
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daisy Hochberg
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jessica A Collins
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Borghesani V, Hinkley LBN, Ranasinghe KG, Thompson MMC, Shwe W, Mizuiri D, Lauricella M, Europa E, Honma S, Miller Z, Miller B, Vossel K, Henry MML, Houde JF, Gorno-Tempini ML, Nagarajan SS. Taking the sublexical route: brain dynamics of reading in the semantic variant of primary progressive aphasia. Brain 2020; 143:2545-2560. [PMID: 32789455 PMCID: PMC7447517 DOI: 10.1093/brain/awaa212] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 01/29/2023] Open
Abstract
Reading aloud requires mapping an orthographic form to a phonological one. The mapping process relies on sublexical statistical regularities (e.g. 'oo' to |uː|) or on learned lexical associations between a specific visual form and a series of sounds (e.g. yacht to/jɑt/). Computational, neuroimaging, and neuropsychological evidence suggest that sublexical, phonological and lexico-semantic processes rely on partially distinct neural substrates: a dorsal (occipito-parietal) and a ventral (occipito-temporal) route, respectively. Here, we investigated the spatiotemporal features of orthography-to-phonology mapping, capitalizing on the time resolution of magnetoencephalography and the unique clinical model offered by patients with semantic variant of primary progressive aphasia (svPPA). Behaviourally, patients with svPPA manifest marked lexico-semantic impairments including difficulties in reading words with exceptional orthographic to phonological correspondence (irregular words). Moreover, they present with focal neurodegeneration in the anterior temporal lobe, affecting primarily the ventral, occipito-temporal, lexical route. Therefore, this clinical population allows for testing of specific hypotheses on the neural implementation of the dual-route model for reading, such as whether damage to one route can be compensated by over-reliance on the other. To this end, we reconstructed and analysed time-resolved whole-brain activity in 12 svPPA patients and 12 healthy age-matched control subjects while reading irregular words (e.g. yacht) and pseudowords (e.g. pook). Consistent with previous findings that the dorsal route is involved in sublexical, phonological processes, in control participants we observed enhanced neural activity over dorsal occipito-parietal cortices for pseudowords, when compared to irregular words. This activation was manifested in the beta-band (12-30 Hz), ramping up slowly over 500 ms after stimulus onset and peaking at ∼800 ms, around response selection and production. Consistent with our prediction, svPPA patients did not exhibit this temporal pattern of neural activity observed in controls this contrast. Furthermore, a direct comparison of neural activity between patients and controls revealed a dorsal spatiotemporal cluster during irregular word reading. These findings suggest that the sublexical/phonological route is involved in processing both irregular and pseudowords in svPPA. Together these results provide further evidence supporting a dual-route model for reading aloud mediated by the interplay between lexico-semantic and sublexical/phonological neurocognitive systems. When the ventral route is damaged, as in the case of neurodegeneration affecting the anterior temporal lobe, partial compensation appears to be possible by over-recruitment of the slower, serial attention-dependent, dorsal one.
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Affiliation(s)
- Valentina Borghesani
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Leighton B N Hinkley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Megan M C Thompson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
- UC Berkeley-UC San Francisco Graduate Program in Bioengineering, University of California, San Francisco, USA
| | - Wendy Shwe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Michael Lauricella
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Eduardo Europa
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Susanna Honma
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Zachary Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
| | - Keith Vossel
- Department of Neurology, University of Minnesota, Minneapolis, USA
| | - Maya M L Henry
- Department of Communication Sciences and Disorders, University of Texas at Austin, USA
| | - John F Houde
- Department of Otolaryngology, University of California San Francisco, USA
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
- Department of Otolaryngology, University of California San Francisco, USA
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43
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Unal G, Ficek B, Webster K, Shahabuddin S, Truong D, Hampstead B, Bikson M, Tsapkini K. Impact of brain atrophy on tDCS and HD-tDCS current flow: a modeling study in three variants of primary progressive aphasia. Neurol Sci 2020; 41:1781-1789. [PMID: 32040791 PMCID: PMC7363529 DOI: 10.1007/s10072-019-04229-z] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND During transcranial direct current stimulation (tDCS), the amount and distribution of current that reaches the brain depends on individual anatomy. Many progressive neurodegenerative diseases are associated with cortical atrophy, but the importance of individual brain atrophy during tDCS in patients with progressive atrophy, including primary progressive aphasia (PPA), remains unclear. OBJECTIVE In the present study, we addressed the question whether brain anatomy in patients with distinct cortical atrophy patterns would impact brain current intensity and distribution during tDCS over the left IFG. METHOD We developed state-of-the-art, gyri-precise models of three subjects, each representing a variant of primary progressive aphasia: non-fluent variant PPA (nfvPPA), semantic variant PPA (svPPA), and logopenic variant PPA (lvPPA). We considered two exemplary montages over the left inferior frontal gyrus (IFG): a conventional pad montage (anode over F7, cathode over the right cheek) and a 4 × 1 high-definition tDCS montage. We further considered whether local anatomical features, specifically distance of the cortex to skull, can directly predict local electric field intensity. RESULTS We found that the differences in brain current flow across the three PPA variants fall within the distribution of anatomically typical adults. While clustering of electric fields was often around individual gyri or sulci, the minimal distance from the gyri/sulci to skull was not correlated with electric field intensity. CONCLUSION Limited to the conditions and assumptions considered here, this argues against a specific need to adjust the tDCS montage for these patients any more than might be considered useful in anatomically typical adults. Therefore, local atrophy does not, in isolation, reliably predict local electric field. Rather, our results are consistent with holistic head anatomy influencing brain current flow, with tDCS producing diffuse and individualized brain current flow patterns and HD-tDCS producing targeted brain current flow across individuals.
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Affiliation(s)
- Gozde Unal
- Department of Biomedical Engineering, The City College of New York, New York, NY, 10031, USA
| | - Bronte Ficek
- Department of Neurology, Cerebrovascular Division, Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps 488, Baltimore, MD, 21287, USA
| | - Kimberly Webster
- Department of Neurology, Cerebrovascular Division, Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps 488, Baltimore, MD, 21287, USA
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore, MD, 21287, USA
| | - Syed Shahabuddin
- Department of Biomedical Engineering, The City College of New York, New York, NY, 10031, USA
| | - Dennis Truong
- Department of Biomedical Engineering, The City College of New York, New York, NY, 10031, USA
| | - Benjamin Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, 10031, USA
| | - Kyrana Tsapkini
- Department of Neurology, Cerebrovascular Division, Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps 488, Baltimore, MD, 21287, USA.
- Department of Cognitive Science, Johns Hopkins Medicine, Baltimore, MD, 21218, USA.
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44
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Petroi D, Duffy JR, Borgert A, Strand EA, Machulda MM, Senjem ML, Jack CR, Josephs KA, Whitwell JL. Neuroanatomical correlates of phonologic errors in logopenic progressive aphasia. Brain Lang 2020; 204:104773. [PMID: 32114145 PMCID: PMC7219283 DOI: 10.1016/j.bandl.2020.104773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 01/10/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
While phonologic errors may be one of the salient features of the logopenic variant of primary progressive aphasia (lvPPA), sparse data are available on their neuroimaging correlates. The purpose of this study was to identify brain regions associated with different types of phonologic errors across several tasks for participants with lvPPA. Correlational analyses between phonologic errors across tasks most likely to elicit such errors and specific left hemisphere gray matter volume regions were conducted for 20 participants. Findings point to the inferior parietal lobe and supramarginal gyrus as being the most relevant correlates. Atrophy in these regions may increase the likelihood of making phonologic errors in lvPPA, particularly substitution error types. Our results provide support for neuroanatomical correlates of phonologic errors in the parietal region, which is consistent with previous findings of temporoparietal cortex involvement/atrophy in lvPPA.
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Affiliation(s)
- Diana Petroi
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, WI 54601, USA
| | - Edythe A Strand
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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45
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Nelson MJ, Moeller S, Basu A, Christopher L, Rogalski EJ, Greicius M, Weintraub S, Bonakdarpour B, Hurley RS, Mesulam MM. Taxonomic Interference Associated with Phonemic Paraphasias in Agrammatic Primary Progressive Aphasia. Cereb Cortex 2020; 30:2529-2541. [PMID: 31800048 PMCID: PMC7174997 DOI: 10.1093/cercor/bhz258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/14/2022] Open
Abstract
Phonemic paraphasias are thought to reflect phonological (post-semantic) deficits in language production. Here we present evidence that phonemic paraphasias in non-semantic primary progressive aphasia (PPA) may be associated with taxonomic interference. Agrammatic and logopenic PPA patients and control participants performed a word-to-picture visual search task where they matched a stimulus noun to 1 of 16 object pictures as their eye movements were recorded. Participants were subsequently asked to name the same items. We measured taxonomic interference (ratio of time spent viewing related vs. unrelated foils) during the search task for each item. Target items that elicited a phonemic paraphasia during object naming elicited increased taxonomic interference during the search task in agrammatic but not logopenic PPA patients. These results could reflect either very subtle sub-clinical semantic distortions of word representations or partial degradation of specific phonological word forms in agrammatic PPA during both word-to-picture matching (input stage) and picture naming (output stage). The mechanism for phonemic paraphasias in logopenic patients seems to be different and to be operative at the pre-articulatory stage of phonological retrieval. Glucose metabolic imaging suggests that degeneration in the left posterior frontal lobe and left temporo-parietal junction, respectively, might underlie these different patterns of phonemic paraphasia.
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Affiliation(s)
- M J Nelson
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurological Surgery, Feinberg School of Medicine , Northwestern University, Chicago, IL 60611, USA
- Department of Neurosurgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - S Moeller
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - A Basu
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - L Christopher
- Department of Neurology and Neurological Sciences, FIND Lab, Stanford University, Stanford, CA 94304, USA
| | - E J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - M Greicius
- Department of Neurology and Neurological Sciences, FIND Lab, Stanford University, Stanford, CA 94304, USA
| | - S Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurology, Feinberg School of Medicine , Northwestern University, Chicago, IL 60611, USA
| | - B Bonakdarpour
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - R S Hurley
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Psychology, Cleveland State University, Cleveland, OH 44115, USA
| | - M-M Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurology, Feinberg School of Medicine , Northwestern University, Chicago, IL 60611, USA
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46
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Bocchetta M, Iglesias Espinosa MDM, Lashley T, Warren JD, Rohrer JD. In vivo staging of frontotemporal lobar degeneration TDP-43 type C pathology. Alzheimers Res Ther 2020; 12:34. [PMID: 32220237 PMCID: PMC7102433 DOI: 10.1186/s13195-020-00600-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/13/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND TDP-43 type C is one of the pathological forms of frontotemporal lobar degeneration (FTLD) and mainly associated clinically with the semantic variant of primary progressive aphasia (svPPA). We aimed to define in vivo the sequential pattern of neuroanatomical involvement in a cohort of patients with FTLD-TDP type C pathology. METHODS We extracted the volumes of a set of cortical and subcortical regions from MRI scans of 19 patients with post mortem confirmed TDP-43 type C pathology (all with left hemisphere-predominant atrophy at baseline). In the initial development phase, we used w-scores computed from 81 cognitively normal controls to define a set of sequential stages of neuroanatomical involvement within the FTLD-TDP type C cohort where a w-score of < - 1.65 was considered abnormal. In a subsequent validation phase, we used 31 follow-up scans from 14 of the 19 patients in the same cohort to confirm the staging model. RESULTS Four sequential stages were identified in the initial development phase. Stage 1 was defined by atrophy in the left amygdala, medial temporal cortex, temporal pole, lateral temporal cortex and right medial temporal cortex; Stage 2 by atrophy in the left supratemporal cortex; Stage 3 by atrophy in the right anterior insula; and Stage 4 by atrophy in the right accumbens. In the validation phase, calculation of w-scores in the longitudinal scans confirmed the staging system, with all patients either staying in the same stage or progressing to a later stage at follow-up. CONCLUSION In vivo imaging is able to detect distinct stages of neuroanatomical involvement in FTLD-TDP type C pathology. Using an imaging-derived staging system allows a more refined stratification of patients with svPPA during life.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3BG, UK
| | | | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, WC1N 3BG, UK
| | - 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.
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Battistella G, Borghesani V, Henry M, Shwe W, Lauricella M, Miller Z, Deleon J, Miller BL, Dronkers N, Brambati SM, Seeley WW, Mandelli ML, Gorno-Tempini ML. Task-Free Functional Language Networks: Reproducibility and Clinical Application. J Neurosci 2020; 40:1311-1320. [PMID: 31852732 PMCID: PMC7002153 DOI: 10.1523/jneurosci.1485-19.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 01/17/2023] Open
Abstract
Intrinsic connectivity networks (ICNs) identified through task-free fMRI (tf-fMRI) offer the opportunity to investigate human brain circuits involved in language processes without requiring participants to perform challenging cognitive tasks. In this study, we assessed the ability of tf-fMRI to isolate reproducible networks critical for specific language functions and often damaged in primary progressive aphasia (PPA). First, we performed whole-brain seed-based correlation analyses on tf-fMRI data to identify ICNs anchored in regions known for articulatory, phonological, and semantic processes in healthy male and female controls (HCs). We then evaluated the reproducibility of these ICNs in an independent cohort of HCs, and recapitulated their functional relevance with a post hoc meta-analysis on task-based fMRI. Last, we investigated whether atrophy in these ICNs could inform the differential diagnosis of nonfluent/agrammatic, semantic, and logopenic PPA variants. The identified ICNs included a dorsal articulatory-phonological network involving inferior frontal and supramarginal regions; a ventral semantic network involving anterior middle temporal and angular gyri; a speech perception network involving superior temporal and sensorimotor regions; and a network between posterior inferior temporal and intraparietal regions likely linking visual, phonological, and attentional processes for written language. These ICNs were highly reproducible across independent groups and revealed areas consistent with those emerging from task-based meta-analysis. By comparing ICNs' spatial distribution in HCs with patients' atrophy patterns, we identified ICNs associated with each PPA variant. Our findings demonstrate the potential use of tf-fMRI to investigate the functional status of language networks in patients for whom activation studies can be methodologically challenging.SIGNIFICANCE STATEMENT We showed that a single, short, task-free fMRI acquisition is able to identify four reproducible and relatively segregated intrinsic left-dominant networks associated with articulatory, phonological, semantic, and multimodal orthography-to-phonology processes, in HCs. We also showed that these intrinsic networks relate to syndrome-specific atrophy patterns in primary progressive aphasia. Collectively, our results support the application of task-free fMRI in future research to study functionality of language circuits in patients for whom tasked-based activation studies might be methodologically challenging.
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Affiliation(s)
- Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158,
| | - Valentina Borghesani
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Maya Henry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
- Department of Communication Sciences and Disorders, University of Texas, Austin, Texas 78712
| | - Wendy Shwe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Michael Lauricella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Zachary Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Jessica Deleon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Nina Dronkers
- Department of Psychology, University of California, Berkeley, California 94720, and
| | - Simona M Brambati
- Département de Psychologie, Université de Montréal, Quebec H3T 1J4, Canada
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California 94158
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48
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Faria AV, Meyer A, Friedman R, Tippett DC, Hillis AE. Baseline MRI associates with later naming status in primary progressive aphasia. Brain Lang 2020; 201:104723. [PMID: 31864209 PMCID: PMC7282486 DOI: 10.1016/j.bandl.2019.104723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
Advanced imaging studies in neurodegenerative disease have yielded new insights into subtypes of disease, progression of disease in various brain regions, and changes in structural and functional connectivity between brain regions related to symptom progression. However, few studies have revealed imaging markers at baseline that correlate with rate or degree of decline in function. Here we tested the hypothesis that imaging features at baseline correlate with outcome of naming in primary progressive aphasia. We obtained longitudinal multimodal imaging in 15 individuals with primary progressive aphasia at the same time points as assessment of naming. We found that functional connectivity between particular brain regions (measured with resting state functional connectivity magnetic resonance imaging) is strongly associated with accuracy of naming 21 months later, independently of baseline severity of naming impairment. These data indicate that functional connectivity may carry information about later performance in naming, and is potentially useful for refining prognosis.
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Affiliation(s)
- Andreia V Faria
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Aaron Meyer
- Department of Neurology, Georgetown University School of Medicine, Washington, USA
| | - Rhonda Friedman
- Department of Neurology, Georgetown University School of Medicine, Washington, USA
| | - Donna C Tippett
- Department of Otolaryngology & Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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49
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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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50
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Beagle AJ, Zahir A, Borzello M, Kayser AS, Hsu M, Miller BL, Kramer JH, Chiong W. Amount and delay insensitivity during intertemporal choice in three neurodegenerative diseases reflects dorsomedial prefrontal atrophy. Cortex 2019; 124:54-65. [PMID: 31837518 DOI: 10.1016/j.cortex.2019.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/21/2019] [Revised: 07/28/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022]
Abstract
Patients with Alzheimer's disease and other dementias often make poor financial decisions, but it remains unclear whether this reflects specific failures in decision-making or more general deficits in episodic and working memory. We investigated how patients with Alzheimer's disease, behavioral variant frontotemporal dementia (bvFTD), and semantic variant primary progressive aphasia (svPPA) apply information in an intertemporal choice task between smaller intermediate and larger delayed rewards, with minimal memory demands. Multilevel modeling estimated subject-level sensitivities to three attributes of choice (the relative difference in reward magnitude, delay length, and absolute reward magnitudes) as well as baseline impulsivity. While baseline impulsivity in patients with Alzheimer's disease did not differ from controls, patients with bvFTD and svPPA were more impulsive than controls overall. Patients with Alzheimer's disease or bvFTD were less sensitive than controls to all three choice attributes, whereas patients with svPPA were less sensitive than controls to two attributes. Attenuated sensitivity to information presented during the choice was associated across all subjects with dorsomedial prefrontal atrophy for all three choice attributes. Given the minimal memory demands of our task, these findings suggest specific mechanisms underlying decision-making failures beyond episodic and working memory deficits in dementia.
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Affiliation(s)
- Alexander J Beagle
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ali Zahir
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Mia Borzello
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrew S Kayser
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Division of Neurology, VA Northern California Health Care System, Martinez, CA, USA
| | - Ming Hsu
- Helen Wills Neuroscience Institute and Haas School of Business, University of California, Berkeley, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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