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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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Lorca-Puls DL, Gajardo-Vidal A, Mandelli ML, Illán-Gala I, Ezzes Z, Wauters LD, Battistella G, Bogley R, Ratnasiri B, Licata AE, Battista P, García AM, Tee BL, Lukic S, Boxer AL, Rosen HJ, Seeley WW, Grinberg LT, Spina S, Miller BL, Miller ZA, Henry ML, Dronkers NF, Gorno-Tempini ML. Neural basis of speech and grammar symptoms in non-fluent variant primary progressive aphasia spectrum. Brain 2024; 147:607-626. [PMID: 37769652 PMCID: PMC10834255 DOI: 10.1093/brain/awad327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/14/2022] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS) and/or expressive agrammatism. In addition, many patients exhibit dysarthria and/or receptive agrammatism. This leads to substantial phenotypic variation within the speech-language domain across individuals and time, in terms of both the specific combination of symptoms as well as their severity. How to resolve such phenotypic heterogeneity in nfvPPA is a matter of debate. 'Splitting' views propose separate clinical entities: 'primary progressive apraxia of speech' when AoS occurs in the absence of expressive agrammatism, 'progressive agrammatic aphasia' (PAA) in the opposite case, and 'AOS + PAA' when mixed motor speech and language symptoms are clearly present. While therapeutic interventions typically vary depending on the predominant symptom (e.g. AoS versus expressive agrammatism), the existence of behavioural, anatomical and pathological overlap across these phenotypes argues against drawing such clear-cut boundaries. In the current study, we contribute to this debate by mapping behaviour to brain in a large, prospective cohort of well characterized patients with nfvPPA (n = 104). We sought to advance scientific understanding of nfvPPA and the neural basis of speech-language by uncovering where in the brain the degree of MRI-based atrophy is associated with inter-patient variability in the presence and severity of AoS, dysarthria, expressive agrammatism or receptive agrammatism. Our cross-sectional examination of brain-behaviour relationships revealed three main observations. First, we found that the neural correlates of AoS and expressive agrammatism in nfvPPA lie side by side in the left posterior inferior frontal lobe, explaining their behavioural dissociation/association in previous reports. Second, we identified a 'left-right' and 'ventral-dorsal' neuroanatomical distinction between AoS versus dysarthria, highlighting (i) that dysarthria, but not AoS, is significantly influenced by tissue loss in right-hemisphere motor-speech regions; and (ii) that, within the left hemisphere, dysarthria and AoS map onto dorsally versus ventrally located motor-speech regions, respectively. Third, we confirmed that, within the large-scale grammar network, left frontal tissue loss is preferentially involved in expressive agrammatism and left temporal tissue loss in receptive agrammatism. Our findings thus contribute to define the function and location of the epicentres within the large-scale neural networks vulnerable to neurodegenerative changes in nfvPPA. We propose that nfvPPA be redefined as an umbrella term subsuming a spectrum of speech and/or language phenotypes that are closely linked by the underlying neuroanatomy and neuropathology.
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Affiliation(s)
- Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, 4070105, Chile
| | - Andrea Gajardo-Vidal
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, 7590943, Chile
- Dirección de Investigación y Doctorados, Vicerrectoría de Investigación y Doctorados, Universidad del Desarrollo, Concepción, 4070001, Chile
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28029, Spain
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Lisa D Wauters
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA 02114, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Petronilla Battista
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Laboratory of Neuropsychology, Istituti Clinici Scientifici Maugeri IRCCS, Bari, 70124, Italy
| | - Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Buenos Aires, B1644BID, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, 9160000, Chile
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY 11530-0701, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, 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, SanFrancisco, CA 94158, USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
- Department of Neurology, Dell Medical School, University of Texas, Austin, TX 78712, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Department of Neurology, University of California, Davis, CA 95817, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
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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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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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Morrow C, Kamath V, Onyike C, Pantelyat A. A - 9 The Progressive Supranuclear Palsy Rating Scale Identifies Early Motor Symptoms in Primary Progressive Aphasia. Arch Clin Neuropsychol 2023; 38:1155-1158. [PMID: 37807128 DOI: 10.1093/arclin/acad067.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE This study examined cross-sectional differences in Progressive Supranuclear Palsy Rating Scale (PSPRS) scores among participants with behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA). We hypothesized that participants with nonfluent/agrammatic PPA (nfPPA) will show the highest (worst) PSPRS scores and greater gray matter atrophy in regions associated with progressive supranuclear palsy (PSP) pathology. METHOD Participants were enrolled in the ARTFL LEFFTDS Longitudinal Frontotemporal Lobar Degeneration consortium (ALLFTD). Analyses were limited to first visit data. Ten anatomic regions of interest were pre-selected for analysis based on previously identified neuroanatomic correlates of PSPRS performance. Differences in participant characteristics and clinical outcomes were compared using pairwise comparison of means. Linear multivariable regression adjusting for age and total intracranial volume was used to examine associations between regional gray matter volumes and diagnosis. The analyses were stratified by disease severity. RESULTS Participants with early-stage nfPPA had higher total PSPRS scores compared to those with bvFTD or semantic dementia (SD) and performed more poorly on domains of dysphagia, fine motor movements, falls, postural stability, dysarthria, saccadic eye movements, and motor rigidity. Participants with advanced-stage nfPPA showed greater atrophy in the left putamen, supplementary motor area, and precentral gyrus than those with bvFTD. CONCLUSION Our study highlights the phenotypic complexity of PPA and the utility of the PSPRS in capturing early motor symptoms in nfPPA. These data suggest that the PSPRS may facilitate early intervention in identifying and facilitating treatment of early motor symptoms, decreasing disability and improving quality of life in PPA.
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Mori K, Shigenobu K, Beck G, Uozumi R, Satake Y, Suzuki M, Kondo S, Gotoh S, Yonenobu Y, Kawai M, Suzuki Y, Saito Y, Morii E, Hasegawa M, Mochizuki H, Murayama S, Ikeda M. A heterozygous splicing variant IVS9-7A > T in intron 9 of the MAPT gene in a patient with right-temporal variant frontotemporal dementia with atypical 4 repeat tauopathy. Acta Neuropathol Commun 2023; 11:130. [PMID: 37563653 PMCID: PMC10413539 DOI: 10.1186/s40478-023-01629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
Right temporal variant frontotemporal dementia, also called right-predominant semantic dementia, often has an unclear position within the framework of the updated diagnostic criteria for behavioral variant frontotemporal dementia or primary progressive aphasia. Recent studies have suggested that this population may be clinically, neuropathologically, and genetically distinct from those with behavioral variant frontotemporal dementia or left-predominant typical semantic variant primary progressive aphasia. Here we describe a Japanese case of right temporal variant frontotemporal dementia with novel heterozygous MAPT mutation Adenine to Thymidine in intervening sequence (IVS) 9 at position -7 from 3' splicing site of intron 9/exon 10 boundary (MAPT IVS9-7A > T). Postmortem neuropathological analysis revealed a predominant accumulation of 4 repeat tau, especially in the temporal lobe, amygdala, and substantia nigra, but lacked astrocytic plaques or tufted astrocytes. Immunoelectron microscopy of the tau filaments extracted from the brain revealed a ribbon-like structure. Moreover, a cellular MAPT splicing assay confirmed that this novel variant promoted the inclusion of exon 10, resulting in the predominant production of 4 repeat tau. These data strongly suggest that the MAPT IVS9-7 A > T variant found in our case is a novel mutation that stimulates the inclusion of exon 10 through alternative splicing of MAPT transcript and causes predominant 4 repeat tauopathy which clinically presents as right temporal variant frontotemporal dementia.
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Affiliation(s)
- Kohji Mori
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan.
| | - Kazue Shigenobu
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan
- Department of Psychiatry, Asakayama General Hospital, Sakai, Japan
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Goichi Beck
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryota Uozumi
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan
| | - Yuto Satake
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan
| | - Maki Suzuki
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Shizuko Kondo
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan
| | - Shiho Gotoh
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan
| | - Yuki Yonenobu
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Makiko Kawai
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuki Suzuki
- Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yuko Saito
- Brain Bank for Aging Research (Neuropathology), Tokyo Metropolitan Institute of Geriatrics and Gerontology, Tokyo, Japan
| | - Eiichi Morii
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masato Hasegawa
- Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hideki Mochizuki
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shigeo Murayama
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
- Brain Bank for Aging Research (Neuropathology), Tokyo Metropolitan Institute of Geriatrics and Gerontology, Tokyo, Japan
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, Japan.
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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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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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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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10
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Ramanan S, Irish M, Patterson K, Rowe JB, Gorno-Tempini ML, Lambon Ralph MA. Understanding the multidimensional cognitive deficits of logopenic variant primary progressive aphasia. Brain 2022; 145:2955-2966. [PMID: 35857482 PMCID: PMC9473356 DOI: 10.1093/brain/awac208] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023] Open
Abstract
The logopenic variant of primary progressive aphasia is characterized by early deficits in language production and phonological short-term memory, attributed to left-lateralized temporoparietal, inferior parietal and posterior temporal neurodegeneration. Despite patients primarily complaining of language difficulties, emerging evidence points to performance deficits in non-linguistic domains. Temporoparietal cortex, and functional brain networks anchored to this region, are implicated as putative neural substrates of non-linguistic cognitive deficits in logopenic variant primary progressive aphasia, suggesting that degeneration of a shared set of brain regions may result in co-occurring linguistic and non-linguistic dysfunction early in the disease course. Here, we provide a Review aimed at broadening the understanding of logopenic variant primary progressive aphasia beyond the lens of an exclusive language disorder. By considering behavioural and neuroimaging research on non-linguistic dysfunction in logopenic variant primary progressive aphasia, we propose that a significant portion of multidimensional cognitive features can be explained by degeneration of temporal/inferior parietal cortices and connected regions. Drawing on insights from normative cognitive neuroscience, we propose that these regions underpin a combination of domain-general and domain-selective cognitive processes, whose disruption results in multifaceted cognitive deficits including aphasia. This account explains the common emergence of linguistic and non-linguistic cognitive difficulties in logopenic variant primary progressive aphasia, and predicts phenotypic diversification associated with progression of pathology in posterior neocortex.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre and School of Psychology, Sydney, Australia
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Cambridge University Centre for Frontotemporal Dementia, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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11
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García AM, Welch AE, Mandelli ML, Henry ML, Lukic S, Torres Prioris MJ, Deleon J, Ratnasiri BM, Lorca-Puls DL, Miller BL, Seeley W, Vogel AP, Gorno-Tempini ML. Automated Detection of Speech Timing Alterations in Autopsy-Confirmed Nonfluent/Agrammatic Variant Primary Progressive Aphasia. Neurology 2022; 99:e500-e511. [PMID: 35914945 PMCID: PMC9421598 DOI: 10.1212/wnl.0000000000200750] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Motor speech function, including speech timing, is a key domain for diagnosing nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard assessments use subjective, specialist-dependent evaluations, undermining reliability and scalability. Moreover, few studies have examined relevant anatomo-clinical alterations in patients with pathologically confirmed diagnoses. This study overcomes such caveats using automated speech timing analyses in a unique cohort of autopsy-proven cases. METHODS In a cross-sectional study, we administered an overt reading task and quantified articulation rate, mean syllable and pause duration, and syllable and pause duration variability. Neuroanatomical disruptions were assessed using cortical thickness and white matter (WM) atrophy analysis. RESULTS We evaluated 22 persons with nfvPPA (mean age: 67.3 years; 13 female patients) and confirmed underlying 4-repeat tauopathy, 15 persons with semantic variant primary progressive aphasia (svPPA; mean age: 66.5 years; 8 female patients), and 10 healthy controls (HCs; 70 years; 5 female patients). All 5 speech timing measures revealed alterations in persons with nfvPPA relative to both the HC and svPPA groups, controlling for dementia severity. The articulation rate robustly discriminated individuals with nfvPPA from HCs (area under the ROC curve [AUC] = 0.95), outperforming specialist-dependent perceptual measures of dysarthria and apraxia of speech severity. Patients with nfvPPA exhibited structural abnormalities in left precentral and middle frontal as well as bilateral superior frontal regions, including their underlying WM. The articulation rate correlated with atrophy of the left pars opercularis and supplementary/presupplementary motor areas. Secondary analyses showed that, controlling for dementia severity, all measures yielded greater deficits in patients with nfvPPA and corticobasal degeneration (nfvPPA-CBD, n = 12) than in those with progressive supranuclear palsy pathology (nfvPPA-PSP, n = 10). The articulation rate robustly discriminated between individuals in each subgroup (AUC = 0.82). More widespread cortical thinning was observed for the nfvPPA-CBD than the nfvPPA-PSP group across frontal regions. DISCUSSION Automated speech timing analyses can capture specific markers of nfvPPA while potentially discriminating between patients with different tauopathies. Thanks to its objectivity and scalability; this approach could support standard speech assessments. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that automated speech analysis can accurately differentiate patients with nonfluent PPA from normal controls and patients with semantic variant PPA.
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Affiliation(s)
- Adolfo M García
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Ariane E Welch
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maria Luisa Mandelli
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maya L Henry
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Sladjana Lukic
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - María José Torres Prioris
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Jessica Deleon
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Buddhika M Ratnasiri
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Diego L Lorca-Puls
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Bruce L Miller
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - William Seeley
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Adam P Vogel
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia
| | - Maria Luisa Gorno-Tempini
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology, University of California, San Francisco; Department of Communication Sciences and Disorders (M.L.H.), University of Texas at Austin; Department of Communication Sciences and Disorders (S.L.), Adelphi University, Garden City, NY; Cognitive Neurology and Aphasia Unit (M.J.T.P.), Centro de Investigaciones Médico-Sanitarias (M.J.T.P.), University of Malaga; Instituto de Investigación Biomédica de Málaga - IBIMA (M.J.T.P.), Malaga; Area of Psychobiology (M.J.T.P.), Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain; Sección Neurología (D.L.L.P.), Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Chile; Centre for Neuroscience of Speech (A.P.V.), Department of Audiology & Speech Pathology, The University of Melbourne; and Redenlab (A.P.V.), Melbourne, Australia.
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12
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Serpente M, Ghezzi L, Fenoglio C, Buccellato FR, Fumagalli GG, Rotondo E, Arcaro M, Arighi A, Galimberti D. miRNA Expression Is Increased in Serum from Patients with Semantic Variant Primary Progressive Aphasia. Int J Mol Sci 2022; 23:ijms23158487. [PMID: 35955622 PMCID: PMC9368911 DOI: 10.3390/ijms23158487] [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: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
Primary progressive aphasia (PPA) damages the parts of the brain that control speech and language. There are three clinical PPA variants: nonfluent/agrammatic (nfvPPA), logopenic (lvPPA) and semantic (svPPA). The pathophysiology underlying PPA variants is not fully understood, including the role of micro (mi)RNAs which were previously shown to play a role in several neurodegenerative diseases. Using a two-step analysis (array and validation through real-time PCR), we investigated the miRNA expression pattern in serum from 54 PPA patients and 18 controls. In the svPPA cohort, we observed a generalized upregulation of miRNAs with miR-106b-5p and miR-133a-3p reaching statistical significance (miR-106b-5p: 2.69 ± 0.89 mean ± SD vs. 1.18 ± 0.28, p < 0.0001; miR-133a-3p: 2.09 ± 0.10 vs. 0.74 ± 0.11 mean ± SD, p = 0.0002). Conversely, in lvPPA, the majority of miRNAs were downregulated. GO enrichment and KEGG pathway analyses revealed that target genes of both miRNAs are involved in pathways potentially relevant for the pathogenesis of neurodegenerative diseases. This is the first study that investigates the expression profile of circulating miRNAs in PPA variant patients. We identified a specific miRNA expression profile in svPPA that could differentiate this pathological condition from other PPA variants. Nevertheless, these preliminary results need to be confirmed in a larger independent cohort.
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Affiliation(s)
- Maria Serpente
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
- Correspondence: ; Tel.: +39-02-55033858; Fax: +39-02-550336580
| | - Laura Ghezzi
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Chiara Fenoglio
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy;
| | - Francesca R. Buccellato
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
- Department of Biomedical, Surgical and Dental Sciences, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
| | - Giorgio G. Fumagalli
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
| | - Emanuela Rotondo
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
| | - Marina Arcaro
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
| | - Andrea Arighi
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
| | - Daniela Galimberti
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.R.B.); (G.G.F.); (E.R.); (M.A.); (A.A.); (D.G.)
- Department of Biomedical, Surgical and Dental Sciences, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
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Campos DF, Rocca AR, Caixeta LF. Right Temporal Lobe Variant of Frontotemporal Dementia: Systematic Review. Alzheimer Dis Assoc Disord 2022; 36:272-279. [PMID: 35867973 DOI: 10.1097/wad.0000000000000511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/08/2021] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
Frontotemporal dementia corresponds to a heterogenous group of syndromes characterized by progressive changes in behavior and/or language. Approximately 30% of patients with primary progressive aphasia, semantic variant (semantic dementia), present with atrophy in the right cerebral hemisphere, in a rare clinical condition called right temporal variant of frontotemporal dementia (rtvFTD). The objective of the study is to present the main demographic, clinical, neuropsychological, neuroimaging, and pathologic characteristics of rtvFTD patients. A systematic review of the literature was carried out in the PubMed, LILACS, and SCIELO databases between January and March 2022. After the evaluation process, 41 articles were selected, published between 1993 and 2021. We found that rtvFTD presents with severe and progressive prosopagnosia (related to anterior temporal lobe injury) associated with behavioral symptoms-desinibition (51%), apathy (39%), obsessive-compulsive symptoms (37%), changes in eating habits (33%), and depression (28%), which is different from semantic dementia. The most common pathologic pattern is TDP-43, type C. This field of knowledge has few studies (mainly reports and case series) and heterogenous nomenclature, which is a limitation. A multinational longitudinal registry of people with rtvFTD, with standardized assessment and description of symptoms, is necessary to elucidate the characteristics of this entity.
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Affiliation(s)
- Danilo F Campos
- Center for Cognitive Neurology and Neuropsychiatry, Federal University of Goiás
| | - Andrey R Rocca
- Center for Cognitive Neurology and Neuropsychiatry, Federal University of Goiás
| | - Leonardo F Caixeta
- Center for Cognitive Neurology and Neuropsychiatry, Federal University of Goiás
- Department of Neurology, Federal University of Goiás School of Medicine, Goiânia, Goiás, Brazil
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14
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Kawles A, Nishihira Y, Feldman A, Gill N, Minogue G, Keszycki R, Coventry C, Spencer C, Lilek J, Ajroud K, Coppola G, Rademakers R, Rogalski E, Weintraub S, Zhang H, Flanagan ME, Bigio EH, Mesulam MM, Geula C, Mao Q, Gefen T. Cortical and subcortical pathological burden and neuronal loss in an autopsy series of FTLD-TDP-type C. Brain 2022; 145:1069-1078. [PMID: 34919645 PMCID: PMC9050539 DOI: 10.1093/brain/awab368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/07/2021] [Revised: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 10/31/2023] Open
Abstract
The TDP-43 type C pathological form of frontotemporal lobar degeneration is characterized by the presence of immunoreactive TDP-43 short and long dystrophic neurites, neuronal cytoplasmic inclusions, neuronal loss and gliosis and the absence of neuronal intranuclear inclusions. Frontotemporal lobar degeneration-TDP-type C cases are commonly associated with the semantic variant of primary progressive aphasia or behavioural variant frontotemporal dementia. Here, we provide detailed characterization of regional distributions of pathological TDP-43 and neuronal loss and gliosis in cortical and subcortical regions in 10 TDP-type C cases and investigate the relationship between inclusions and neuronal loss and gliosis. Specimens were obtained from the first 10 TDP-type C cases accessioned from the Northwestern Alzheimer's Disease Research Center (semantic variant of primary progressive aphasia, n = 7; behavioural variant frontotemporal dementia, n = 3). A total of 42 cortical (majority bilateral) and subcortical regions were immunostained with a phosphorylated TDP-43 antibody and/or stained with haematoxylin-eosin. Regions were evaluated for atrophy, and for long dystrophic neurites, short dystrophic neurites, neuronal cytoplasmic inclusions, and neuronal loss and gliosis using a semiquantitative 5-point scale. We calculated a 'neuron-to-inclusion' score (TDP-type C mean score - neuronal loss and gliosis mean score) for each region per case to assess the relationship between TDP-type C inclusions and neuronal loss and gliosis. Primary progressive aphasia cases demonstrated leftward asymmetry of cortical atrophy consistent with the aphasic phenotype. We also observed abundant inclusions and neurodegeneration in both cortical and subcortical regions, with certain subcortical regions emerging as particularly vulnerable to dystrophic neurites (e.g. amygdala, caudate and putamen). Interestingly, linear mixed models showed that regions with lowest TDP-type C pathology had high neuronal dropout, and conversely, regions with abundant pathology displayed relatively preserved neuronal densities (P < 0.05). This inverse relationship between the extent of TDP-positive inclusions and neuronal loss may reflect a process whereby inclusions disappear as their associated neurons are lost. Together, these findings offer insight into the putative substrates of neurodegeneration in unique dementia syndromes.
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Affiliation(s)
- Allegra Kawles
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Yasushi Nishihira
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alex Feldman
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nathan Gill
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Grace Minogue
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Rachel Keszycki
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Callen Spencer
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jaclyn Lilek
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kaouther Ajroud
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Giovanni Coppola
- Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Margaret E Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - M -Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Changiz Geula
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Cell and Developmental Biology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qinwen Mao
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Sikora J, Stein C, Ubellacker D, Walker A, Tippett DC. Longitudinal decline in spoken word recognition and object knowledge in primary progressive aphasia. Medicine (Baltimore) 2021; 100:e26163. [PMID: 34087875 PMCID: PMC8183769 DOI: 10.1097/md.0000000000026163] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/11/2021] [Indexed: 11/26/2022] Open
Abstract
The premise of this study is that spoken word recognition and object knowledge are impaired in semantic variant primary progressive aphasia (PPA) (svPPA) and are spared in logopenic variant (lvPPA) and nonfluent agrammatic primary progressive aphasia (nfaPPA) at disease onset. Over time, however, there may be heterogeneity in these abilities in lvPPA and nfaPPA. We hypothesized that individuals with svPPA would demonstrate poorer performance on baseline spoken word recognition and object knowledge than those with lvPPA and nfaPPA) as documented in the literature, but that rates of decline over time on spoken word recognition and object knowledge would be similar in all 3 PPA variants because these become less distinguishable with disease progression.The aim of this study was to investigate longitudinal patterns of decline in spoken word recognition and object knowledge across PPA variants.Ninety-five individuals with PPA completed the Semantic Word Picture Matching and Semantic Associates tests at baseline to establish expected performance in these areas. Thirty-five individuals completed follow-up testing.The distributions of trichotomized mean rates of decline in object knowledge were similar for lvPPA and svPPA (P = .05). There were weak negative correlations between symptom duration and baseline scores on Semantic Word Picture Matching (r[37] = -0.399, P = .01), and baseline scores on Semantic Associates (r[37] = -0.394, P = .01) in lvPPA.Degradation of spoken word recognition and object knowledge occurs over time in lvPPA. Further investigation of the receptive language deficits in PPA is warranted to characterize language changes that lessen the distinctions between PPA variants with disease progression.
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Affiliation(s)
| | | | | | | | - Donna C. Tippett
- Department of Neurology
- Department of Otolaryngology–Head and Neck Surgery
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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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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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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18
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Mesulam MM, Coventry C, Kuang A, Bigio EH, Mao Q, Flanagan ME, Gefen T, Sridhar J, Geula C, Zhang H, Weintraub S, Rogalski EJ. Memory Resilience in Alzheimer Disease With Primary Progressive Aphasia. Neurology 2021; 96:e916-e925. [PMID: 33441454 PMCID: PMC8105903 DOI: 10.1212/wnl.0000000000011397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether memory is preserved longitudinally in primary progressive aphasia (PPA) associated with Alzheimer disease (AD) and to identify potential factors that maintain memory despite underlying neurofibrillary degeneration of mediotemporal memory areas. METHODS Longitudinal memory assessment was done in 17 patients with PPA with autopsy or biomarker evidence of AD (PPA-AD) and 14 patients with amnestic dementia of the Alzheimer type with AD at autopsy (DAT-AD). RESULTS In PPA-AD, episodic memory, tested with nonverbal items, was preserved at the initial testing and showed no decline at retesting 2.35 ± 0.78 years later, at which time symptoms had been present for 6.26 ± 2.21 years. In contrast, language functions declined significantly during the same period. In DAT-AD, both verbal memory and language declined with equal severity. Although imaging showed asymmetric left-sided mediotemporal atrophy in PPA-AD, autopsy revealed bilateral hippocampo-entorhinal neurofibrillary degeneration at Braak stages V and VI. Compared to DAT-AD, however, the PPA-AD group had lower incidence of APOE ε4 and of mediotemporal TAR DNA-binding protein 43 (TDP-43) pathology. CONCLUSIONS Memory preservation in PPA is not just an incidental finding at onset but a core feature that persists for years despite the hippocampo-entorhinal AD neuropathology that is as severe as that of DAT-AD. Asymmetry of mediotemporal atrophy and a lesser impact of APOE ε4 and of TDP-43 on the integrity of memory circuitry may constitute some of the factors underlying this resilience. Our results also suggest that current controversies on memory in PPA-AD reflect inconsistencies in the diagnosis of logopenic PPA, the clinical variant most frequently associated with AD. CLINICALTRIALSGOV IDENTIFIER NCT00537004 and NCT03371706.
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Affiliation(s)
- M-Marsel Mesulam
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL.
| | - Christina Coventry
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Alan Kuang
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Eileen H Bigio
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Qinwen Mao
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Margaret E Flanagan
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Tamar Gefen
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Jaiashre Sridhar
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Changiz Geula
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Hui Zhang
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Sandra Weintraub
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Emily J Rogalski
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
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19
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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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20
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Ohm DT, Fought AJ, Martersteck A, Coventry C, Sridhar J, Gefen T, Weintraub S, Bigio E, Mesulam M, Rogalski E, Geula C. Accumulation of neurofibrillary tangles and activated microglia is associated with lower neuron densities in the aphasic variant of Alzheimer's disease. Brain Pathol 2021; 31:189-204. [PMID: 33010092 PMCID: PMC7855834 DOI: 10.1111/bpa.12902] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
The neurofibrillary tangles (NFT) and amyloid-ß plaques (AP) that comprise Alzheimer's disease (AD) neuropathology are associated with neurodegeneration and microglial activation. Activated microglia exist on a dynamic spectrum of morphologic subtypes that include resting, surveillant microglia capable of converting to activated, hypertrophic microglia closely linked to neuroinflammatory processes and AD neuropathology in amnestic AD. However, quantitative analyses of microglial subtypes and neurons are lacking in non-amnestic clinical AD variants, including primary progressive aphasia (PPA-AD). PPA-AD is a language disorder characterized by cortical atrophy and NFT densities concentrated to the language-dominant hemisphere. Here, a stereologic investigation of five PPA-AD participants determined the densities and distributions of neurons and microglial subtypes to examine how cellular changes relate to AD neuropathology and may contribute to cortical atrophy. Adjacent series of sections were immunostained for neurons (NeuN) and microglia (HLA-DR) from bilateral language and non-language regions where in vivo cortical atrophy and Thioflavin-S-positive APs and NFTs were previously quantified. NeuN-positive neurons and morphologic subtypes of HLA-DR-positive microglia (i.e., resting [ramified] microglia and activated [hypertrophic] microglia) were quantified using unbiased stereology. Relationships between neurons, microglia, AD neuropathology, and cortical atrophy were determined using linear mixed models. NFT densities were positively associated with hypertrophic microglia densities (P < 0.01) and inversely related to neuron densities (P = 0.01). Hypertrophic microglia densities were inversely related to densities of neurons (P < 0.01) and ramified microglia (P < 0.01). Ramified microglia densities were positively associated with neuron densities (P = 0.02) and inversely related to cortical atrophy (P = 0.03). Our findings provide converging evidence of divergent roles for microglial subtypes in patterns of neurodegeneration, which includes hypertrophic microglia likely driving a neuroinflammatory response more sensitive to NFTs than APs in PPA-AD. Moreover, the accumulation of both NFTs and activated hypertrophic microglia in association with low neuron densities suggest they may collectively contribute to focal neurodegeneration characteristic of PPA-AD.
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Affiliation(s)
- Daniel T. Ohm
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
| | - Angela J. Fought
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Adam Martersteck
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIL
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIL
| | - Eileen Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
- Department of PathologyNorthwestern University Feinberg School of MedicineChicagoIL
| | - M.‐Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIL
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIL
| | - Changiz Geula
- Mesulam Center for Cognitive Neurology and Alzheimer’s DiseaseNorthwestern University Feinberg School of MedicineChicagoIL
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21
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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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22
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Chapleau M, Bedetti C, Devenyi GA, Sheldon S, Rosen HJ, Miller BL, Gorno-Tempini ML, Chakravarty MM, Brambati SM. Deformation-based shape analysis of the hippocampus in the semantic variant of primary progressive aphasia and Alzheimer's disease. Neuroimage Clin 2020; 27:102305. [PMID: 32544853 PMCID: PMC7298722 DOI: 10.1016/j.nicl.2020.102305] [Citation(s) in RCA: 6] [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: 01/20/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Increasing evidence shows that the semantic variant of primary progressive aphasia (svPPA) is characterized by hippocampal atrophy. However, less is known about disease-related morphological hippocampal changes. The goal of the present study is to conduct a detailed characterization of the impact of svPPA on global hippocampus volume and morphology compared with control subjects and patients with Alzheimer's disease (AD). METHODS We measured hippocampal volume and deformation-based shape differences in 22 patients with svPPA compared with 99 patients with AD and 92 controls. Multiple Automatically Generated Templates Brain Segmentation Algorithm (MAGeT-Brain) was used on MRI images obtained at the diagnostic visit. RESULTS Comparable left and right hippocampal atrophy were observed in svPPA and AD. Deformation-based shape analysis showed a common pattern of morphological deformation in svPPA and AD compared with controls. More specifically, both svPPA and AD showed inward deformations in the dorsal surface of the hippocampus, from head to tail on the left side, and more limited to the anterior portion of the body in the right hemisphere. These results also pointed out that both diseases are characterized by a lateral displacement of the central part (body) of the hippocampus. DISCUSSION Our study provides critical new evidence of hippocampal morphological changes in svPPA, similar to those found in AD. These findings highlight the importance of considering morphological hippocampal changes as part of the anatomical profile of patients with svPPA.
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Affiliation(s)
- Marianne Chapleau
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Christophe Bedetti
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Gabriel A Devenyi
- Computational Brain Anatomy Lab, Cerebral Imaging Center, Douglas Mental Health University Institute, Quebec, Canada; Department of Psychiatry, McGill University, Quebec, Canada
| | - Signy Sheldon
- Department of Psychology, McGill University, Quebec, Canada
| | - Howie J Rosen
- Memory and Aging Center, University of California in San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California in San Francisco, CA, USA
| | | | - Mallar M Chakravarty
- Computational Brain Anatomy Lab, Cerebral Imaging Center, Douglas Mental Health University Institute, Quebec, Canada; Department of Psychiatry, McGill University, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Quebec, Canada
| | - Simona M Brambati
- Department of Psychology, University of Montreal, Quebec, Canada; Research Center of l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.
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23
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de Aguiar V, Zhao Y, Faria A, Ficek B, Webster KT, Wendt H, Wang Z, Hillis AE, Onyike CU, Frangakis C, Caffo B, Tsapkini K. Brain volumes as predictors of tDCS effects in primary progressive aphasia. Brain Lang 2020; 200:104707. [PMID: 31704518 PMCID: PMC7709910 DOI: 10.1016/j.bandl.2019.104707] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 12/13/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 05/28/2023]
Abstract
The current study aims to determine the brain areas critical for response to anodal transcranial direct current stimulation (tDCS) in PPA. Anodal tDCS and sham were administered over the left inferior frontal gyrus (IFG), combined with written naming/spelling therapy. Thirty people with PPA were included in this study, and assessed immediately, 2 weeks, and 2 months post-therapy. We identified anatomical areas whose volumes significantly predicted the additional tDCS effects. For trained words, the volumes of the left Angular Gyrus and left Posterior Cingulate Cortex predicted the additional tDCS gain. For untrained words, the volumes of the left Middle Frontal Gyrus, left Supramarginal Gyrus, and right Posterior Cingulate Cortex predicted the additional tDCS gain. These findings show that areas involved in language, attention and working memory contribute to the maintenance and generalization of stimulation effects. The findings highlight that tDCS possibly affects areas anatomically or functionally connected to stimulation targets.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center for Language and Cognition Groningen (CLCG), University of Groningen, Netherlands.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Haley Wendt
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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Abstract
INTRODUCTION This study tried to find out type of lobar features found in patients with progressive supranuclear palsy (PSP) and whether they differ from those of frontotemporal dementia (FTD) as both of these are tauopathies. METHODS We studied lobar functions of 45 patients with PSP. RESULTS Five (11.1%) patients had no lobar feature; 11 (24.4%) had PSP-like features like apathy, frontal release signs, impaired motor Luria written sequences, and fist-edge-palm test; and 29 (64.4%) patients had FTD-like lobar features like disinhibition, poor naming, and word finding difficulty. Among features resembling FTD, behavioural variant type occurred in 31.1%, primary progressive aphasia type occurred in 58.6%, 3.4% patients had semantic dementia type features, and 6.9% were unclassified. CONCLUSIONS Hence, patients with PSP with lobar features may fall in the middle of PSP-FTD spectrum with frontal lobe features typical of PSP (PSP-frontal like) and those with frontal lobe features resembling FTD (PSP-FTD complex) in between.
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Affiliation(s)
- Sunil Pradhan
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ruchika Tandon
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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25
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Bruffaerts R, Schaeverbeke J, De Weer AS, Nelissen N, Dries E, Van Bouwel K, Sieben A, Bergmans B, Swinnen C, Pijnenburg Y, Sunaert S, Vandenbulcke M, Vandenberghe R. Multivariate analysis reveals anatomical correlates of naming errors in primary progressive aphasia. Neurobiol Aging 2019; 88:71-82. [PMID: 31955981 DOI: 10.1016/j.neurobiolaging.2019.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 10/24/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 12/30/2022]
Abstract
Primary progressive aphasia (PPA) is an overarching term for a heterogeneous group of neurodegenerative diseases which affect language processing. Impaired picture naming has been linked to atrophy of the anterior temporal lobe in the semantic variant of PPA. Although atrophy of the anterior temporal lobe proposedly impairs picture naming by undermining access to semantic knowledge, picture naming also entails object recognition and lexical retrieval. Using multivariate analysis, we investigated whether cortical atrophy relates to different types of naming errors generated during picture naming in 43 PPA patients (13 semantic, 9 logopenic, 11 nonfluent, and 10 mixed variant). Omissions were associated with atrophy of the anterior temporal lobes. Semantic errors, for example, mistaking a rhinoceros for a hippopotamus, were associated with atrophy of the left mid and posterior fusiform cortex and the posterior middle and inferior temporal gyrus. Semantic errors and atrophy in these regions occurred in each PPA subtype, without major between-subtype differences. We propose that pathological changes to neural mechanisms associated with semantic errors occur across the PPA spectrum.
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Affiliation(s)
- Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurology Department, University Hospitals Leuven, Leuven, Belgium.
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - An-Sofie De Weer
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Natalie Nelissen
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Anne Sieben
- Neurology Department, University Hospital Ghent, Ghent, Belgium
| | - Bruno Bergmans
- Neurology Department, University Hospital Ghent, Ghent, Belgium; Neurology Department, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | | | - Yolande Pijnenburg
- Neurology Department, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Stefan Sunaert
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurology Department, University Hospitals Leuven, Leuven, Belgium
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26
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Utianski RL, Botha H, Martin PR, Schwarz CG, Duffy JR, Clark HM, Machulda MM, Butts AM, Lowe VJ, Jack CR, Senjem ML, Spychalla AJ, Whitwell JL, Josephs KA. Clinical and neuroimaging characteristics of clinically unclassifiable primary progressive aphasia. Brain Lang 2019; 197:104676. [PMID: 31419589 PMCID: PMC6726500 DOI: 10.1016/j.bandl.2019.104676] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/21/2018] [Revised: 07/01/2019] [Accepted: 08/04/2019] [Indexed: 05/12/2023]
Abstract
Many patients who meet core/root criteria for Primary Progressive Aphasia (PPA) are not classifiable as a recognized variant and are often excluded from neuroimaging studies. Here, we detail neurological, neuropsychological, speech and language assessments, and anatomic and molecular neuroimaging (MRI, PiB-PET, and FDG-PET) for fifteen (8 female) clinically unclassifiable PPA patients. Median age of onset was 64 years old with median 3 years disease duration at exam. Three patients were amyloid positive on PiB-PET. 14/15 patients had abnormal FDG-PETs with left predominant hypometabolism, affecting frontal, temporal, parietal, and even occipital lobes. Patients had mild to severe clinical presentations. Visualization of the FDG-PETs principal component analysis revealed patterns of hypometabolism similar to those seen in the PPA variants and suggests the brain regions affected in unclassifiable PPA patients are no different from those who are more easily classifiable. These findings may inform future modifications to the diagnostic criteria to improve diagnostic classification.
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Affiliation(s)
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Peter R Martin
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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27
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Bonakdarpour B, Hurley RS, Wang AR, Fereira HR, Basu A, Chatrathi A, Guillaume K, Rogalski EJ, Mesulam MM. Perturbations of language network connectivity in primary progressive aphasia. Cortex 2019; 121:468-480. [PMID: 31530376 DOI: 10.1016/j.cortex.2019.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/07/2019] [Revised: 05/21/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
Aphasias are caused by disruption in structural integrity and interconnectivity within a large-scale distributed language network. We investigated the distribution and behavioral consequences of altered functional connectivity in three variants of primary progressive aphasia (PPA). The goal was to clarify relationships among atrophy, resting connectivity, and the resulting behavioral changes in 73 PPA and 33 control participants. Three core regions of the left perisylvian language network: the inferior frontal gyrus (IFG), middle temporal gyrus (MTG), and anterior temporal lobe (ATL) were evaluated in agrammatic (PPA-G), logopenic (PPA-L), and semantic (PPA-S) PPA variants. All PPA groups showed decreased connectivity between IFG and MTG. The PPA-S group also showed additional loss of connectivity strength between ATL and the other language regions. Decreased connectivity between the IFG and MTG nodes in PPA-G remained significant even when controlled for the effect of atrophy. In the PPA group as a whole, IFG-MTG connectivity strength correlated with repetition and grammar scores, whereas MTG-ATL connectivity correlated with picture naming and single-word comprehension. There was no significant change in the connectivity of homologous regions in the right hemisphere. These results show that language impairments in PPA are associated with perturbations of functional connectivity within behaviorally concordant components of the language network. Altered connectivity in PPA may reflect not only the irreversible loss of cortical components indexed by atrophy, but also the dysfunction of remaining neurons.
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Affiliation(s)
- Borna Bonakdarpour
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Department of Neurology, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Robert S Hurley
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Department of Neurology, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Psychology, Cleveland State University, Cleveland, OH, USA
| | - Allan R Wang
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hernando R Fereira
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anisha Basu
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arjuna Chatrathi
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kyla Guillaume
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Marsel Mesulam
- Mesulam Center for Cognitive Neurology & Alzheimer Disease, USA; Department of Neurology, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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28
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Leyton CE, Landin-Romero R, Liang CT, Burrell JR, Kumfor F, Hodges JR, Piguet O. Correlates of anomia in non-semantic variants of primary progressive aphasia converge over time. Cortex 2019; 120:201-211. [PMID: 31325799 DOI: 10.1016/j.cortex.2019.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
To track neural correlates of naming performance with disease progression, we estimated key areas affected in nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) primary progressive aphasia variants over time and changes in naming correlates over time. Twenty-nine non-semantic PPA participants (17 nfvPPA and 12 lvPPA) were selected based upon current diagnostic criteria and PiB-PET status and conducted a confrontation-naming task and a structural MRI. Linear mixed-effect models implemented in FreeSurfer were used for tracking cortical thickness and epicenters of atrophy over time. Using averaged cortical thickness of epicenters and naming performance as variables of interest, two sets of multivariate analyses were conducted to compare atrophy progression and naming correlates across groups. While all PPA participants demonstrated naming deterioration and progressive cortical thinning in the left temporal lobe and the left inferior frontal gyrus, the lvPPA cohort showed greater naming deterioration and thinning in the left posterior inferior parietal cortex over time than it did the nfvPPA cohort. The multivariate analyses confirmed a widespread cortical thinning in lvPPA over time, but a more rapid thinning in the right superior frontal gyrus of nfvPPA participants. Impaired naming correlated with common cortical regions in both groups. These regions included the left anterior superior temporal gyrus and the posterior middle temporal gyrus, which was primarily affected in lvPPA. Non-semantic PPA variants initially present with separate epicenters of atrophy and different spatial-temporal patterns of neurodegeneration over time, but the common involvement in key cortical regions of the left temporal lobe accounts for naming deterioration in both groups.
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Affiliation(s)
- Cristian E Leyton
- The University of Sydney, Brain and Mind Centre, Faculty of Health Sciences, Sydney, NSW, Australia; Frontotemporal Disorders Unit, Department of Neurology Massachusetts, General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Ramon Landin-Romero
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Cheng Tao Liang
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - James R Burrell
- Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - Fiona Kumfor
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, School of Psychology, Sydney, NSW, Australia.
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29
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Giannini LAA, Xie SX, McMillan CT, Liang M, Williams A, Jester C, Rascovsky K, Wolk DA, Ash S, Lee EB, Trojanowski JQ, Grossman M, Irwin DJ. Divergent patterns of TDP-43 and tau pathologies in primary progressive aphasia. Ann Neurol 2019; 85:630-643. [PMID: 30851133 PMCID: PMC6538935 DOI: 10.1002/ana.25465] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 12/07/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To measure postmortem burden of frontotemporal lobar degeneration (FTLD) with TDP-43 (FTLD-TDP) or tau (FTLD-Tau) proteinopathy across hemispheres in primary progressive aphasia (PPA) using digital histopathology and to identify clinicopathological correlates of these distinct proteinopathies. METHODS In an autopsy cohort of PPA (FTLD-TDP = 13, FTLD-Tau = 14), we analyzed laterality and regional distribution of postmortem pathology, quantified using a validated digital histopathological approach, in available brain tissue from up to 8 cortical regions bilaterally. We related digital pathology to antemortem structural neuroimaging and specific clinical language features. RESULTS Postmortem cortical pathology was left-lateralized in both FTLD-TDP (beta = -0.15, standard error [SE] = 0.05, p = 0.007) and FTLD-Tau (beta = -0.09, SE = 0.04, p = 0.015), but the degree of lateralization decreased with greater overall dementia severity before death (beta = -8.18, SE = 3.22, p = 0.015). Among 5 core pathology regions sampled, we found greatest pathology in left orbitofrontal cortex (OFC) in FTLD-TDP, which was greater than in FTLD-Tau (F = 47.07, df = 1,17, p < 0.001), and in left midfrontal cortex (MFC) in FTLD-Tau, which was greater than in FTLD-TDP (F = 19.34, df = 1,16, p < 0.001). Postmortem pathology was inversely associated with antemortem magnetic resonance imaging cortical thickness (beta = -0.04, SE = 0.01, p = 0.007) in regions matching autopsy sampling. Irrespective of PPA syndromic variant, single-word comprehension impairment was associated with greater left OFC pathology (t = -3.72, df = 10.72, p = 0.004) and nonfluent speech with greater left MFC pathology (t = -3.62, df = 12.00, p = 0.004) among the 5 core pathology regions. INTERPRETATION In PPA, FTLD-TDP and FTLD-Tau have divergent anatomic distributions of left-lateralized postmortem pathology that relate to antemortem structural imaging and distinct language deficits. Although other brain regions may be implicated in neural networks supporting these complex language measures, our observations may eventually help to improve antemortem diagnosis of neuropathology in PPA. Ann Neurol 2019;85:630-643.
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Affiliation(s)
- Lucia A A Giannini
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mendy Liang
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Williams
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles Jester
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David A Wolk
- Alzheimer's Disease Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharon Ash
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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30
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Abstract
PURPOSE OF REVIEW Knowledge on primary progressive aphasia (PPA) has expanded rapidly in the past few decades. Clinical characteristics, neuroimaging correlates, and neuropathological features of PPA are better delineated. This facilitates scientific studies on the disease pathophysiology and allows speech and language therapy to be more precisely targeted. This review article begins with a summary of the current understanding of PPA and discusses how PPA can serve as a model to promote scientific discovery in neurodegenerative diseases. RECENT FINDINGS Studies on the different variants of PPA have demonstrated the high compatibility between clinical presentations and neuroimaging features, and in turn, enhances the understanding of speech and language neuroanatomy. In addition to the traditional approach of lesion-based or voxel-based mapping, scientists have also adopted functional connectivity and network topology approaches that permits a more multidimensional understanding of neuroanatomy. As a result, pharmacological and cognitive therapeutic strategies can now be better targeted towards specific pathological/molecular and cognitive subtypes. SUMMARY Recent scientific advancement in PPA potentiates it to be an optimal model for studying brain network vulnerability, neurodevelopment influences and the effects of nonpharmacological intervention in neurodegenerative diseases.
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Affiliation(s)
- Boon Lead Tee
- Global Brain Health Institute, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California at San Francisco, San Francisco, California, USA
- Dyslexia Center, University of California at San Francisco, San Francisco, California, USA
- Global Brain Health Institute, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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31
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Cho H, Kim HJ, Choi JY, Ryu YH, Lee MS, Na DL, Seo SW, Lyoo CH. 18F-flortaucipir uptake patterns in clinical subtypes of primary progressive aphasia. Neurobiol Aging 2018; 75:187-197. [PMID: 30594046 DOI: 10.1016/j.neurobiolaging.2018.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/06/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022]
Abstract
We analyzed 18F-flortaucipir uptake patterns and structural changes in patients with subtypes of primary progressive aphasia (PPA) using 18F-flortaucipir positron emission tomography and volumetric magnetic resonance imaging. We enrolled 34 consecutive patients with PPA (10 nonfluent/agrammatic PPA [nfvPPA], 18 semantic variant PPA [svPPA], and 6 logopenic variant PPA [lvPPA], as well as 20 healthy controls, and 20 patients with Alzheimer's disease. 18F-flortaucipir uptake was increased in the frontal cortex and underlying white matter, and subcortical nuclei in the 10 nfvPPA and 8 nfvPPA-amyloid-β (Aβ)- subgroup patients. In the svPPA patients (both the 13 svPPA-Aβ- and 5 svPPA-Aβ+), uptake generally increased in the widespread neocortex with left anterior temporal predominance. 18F-flortaucipir uptake patterns in the 6 lvPPA and the 5 lvPPA-Aβ+ subgroup patients were similar to those seen in the patients with Alzheimer's disease with mild predominance in the left lateral temporal cortex. Cortical thinning in each PPA subtype corresponded with increased 18F-flortaucipir uptake. 18F-flortaucipir uptake patterns and cortical atrophy were distinct and corresponded to areas related to the specific language functions that are impaired in each subtype of PPA.
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Affiliation(s)
- Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, Seoul, South Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myung Sik Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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32
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Bergeron D, Gorno-Tempini ML, Rabinovici GD, Santos-Santos MA, Seeley W, Miller BL, Pijnenburg Y, Keulen MA, Groot C, van Berckel BNM, van der Flier WM, Scheltens P, Rohrer JD, Warren JD, Schott JM, Fox NC, Sanchez-Valle R, Grau-Rivera O, Gelpi E, Seelaar H, Papma JM, van Swieten JC, Hodges JR, Leyton CE, Piguet O, Rogalski EJ, Mesulam MM, Koric L, Kristensen N, Pariente J, Dickerson B, Mackenzie IR, Hsiung GYR, Belliard S, Irwin DJ, Wolk DA, Grossman M, Jones M, Harris J, Mann D, Snowden JS, Chrem-Mendez P, Calandri IL, Amengual AA, Miguet-Alfonsi C, Magnin E, Magnani G, Santangelo R, Deramecourt V, Pasquier F, Mattsson N, Nilsson C, Hansson O, Keith J, Masellis M, Black SE, Matías-Guiu JA, Cabrera-Martin MN, Paquet C, Dumurgier J, Teichmann M, Sarazin M, Bottlaender M, Dubois B, Rowe CC, Villemagne VL, Vandenberghe R, Granadillo E, Teng E, Mendez M, Meyer PT, Frings L, Lleó A, Blesa R, Fortea J, Seo SW, Diehl-Schmid J, Grimmer T, Frederiksen KS, Sánchez-Juan P, Chételat G, Jansen W, Bouchard RW, Laforce RJ, Visser PJ, Ossenkoppele R. Prevalence of amyloid-β pathology in distinct variants of primary progressive aphasia. Ann Neurol 2018; 84:729-740. [PMID: 30255971 PMCID: PMC6354051 DOI: 10.1002/ana.25333] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [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: 11/22/2017] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the prevalence of amyloid positivity, defined by positron emission tomography (PET)/cerebrospinal fluid (CSF) biomarkers and/or neuropathological examination, in primary progressive aphasia (PPA) variants. METHODS We conducted a meta-analysis with individual participant data from 1,251 patients diagnosed with PPA (including logopenic [lvPPA, n = 443], nonfluent [nfvPPA, n = 333], semantic [svPPA, n = 401], and mixed/unclassifiable [n = 74] variants of PPA) from 36 centers, with a measure of amyloid-β pathology (CSF [n = 600], PET [n = 366], and/or autopsy [n = 378]) available. The estimated prevalence of amyloid positivity according to PPA variant, age, and apolipoprotein E (ApoE) ε4 status was determined using generalized estimating equation models. RESULTS Amyloid-β positivity was more prevalent in lvPPA (86%) than in nfvPPA (20%) or svPPA (16%; p < 0.001). Prevalence of amyloid-β positivity increased with age in nfvPPA (from 10% at age 50 years to 27% at age 80 years, p < 0.01) and svPPA (from 6% at age 50 years to 32% at age 80 years, p < 0.001), but not in lvPPA (p = 0.94). Across PPA variants, ApoE ε4 carriers were more often amyloid-β positive (58.0%) than noncarriers (35.0%, p < 0.001). Autopsy data revealed Alzheimer disease pathology as the most common pathologic diagnosis in lvPPA (76%), frontotemporal lobar degeneration-TDP-43 in svPPA (80%), and frontotemporal lobar degeneration-TDP-43/tau in nfvPPA (64%). INTERPRETATION This study shows that the current PPA classification system helps to predict underlying pathology across different cohorts and clinical settings, and suggests that age and ApoE genotype should be considered when interpreting amyloid-β biomarkers in PPA patients. Ann Neurol 2018;84:737-748.
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Affiliation(s)
- David Bergeron
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Miguel A Santos-Santos
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, Llobregat Hospital, Barcelona, Spain
- Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain
| | - William Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Yolande Pijnenburg
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - M Antoinette Keulen
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Colin Groot
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Oriol Grau-Rivera
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Ellen Gelpi
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harro Seelaar
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John C van Swieten
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John R Hodges
- Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Cristian E Leyton
- Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA
| | - Olivier Piguet
- Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Emily J Rogalski
- Neurological Sciences, Rush University, Chicago, IL
- Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL
| | - Marsel M Mesulam
- Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL
| | - Lejla Koric
- Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France
| | - Nora Kristensen
- Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France
| | - Jeéreémie Pariente
- University of Toulouse, INSERM, Toulouse Neuroimaging Center, Toulouse, France
| | - Bradford Dickerson
- Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA
| | - Ian R Mackenzie
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ging-Yuek R Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Belliard
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Irwin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA
| | - Matthew Jones
- Cerebral Function Unit, Greater Manchester Neurosciences Centre, Manchester, United Kingdom
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - Jennifer Harris
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - David Mann
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Julie S Snowden
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - Patricio Chrem-Mendez
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Ismael L Calandri
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Alejandra A Amengual
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Carole Miguet-Alfonsi
- Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France
| | - Eloi Magnin
- Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France
| | - Giuseppe Magnani
- Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy
| | - Roberto Santangelo
- Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy
| | | | - Florence Pasquier
- University of Lille Nord de France, INSERM U1171, DISTALZ, Lille, France
| | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Neuropsychiatric Clinic, Skåne University Hospital, Malmö, Sweden
| | - Julia Keith
- Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jordi A Matías-Guiu
- Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain
| | - María-Nieves Cabrera-Martin
- Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Claire Paquet
- Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France
- Department of Pathology, Lariboisière-Fernand-Widal Hospital, Paris, France
| | - Julien Dumurgier
- Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France
| | - Marc Teichmann
- Department of Neurology, National Reference Center for PPA and rare dementias, Pitié Salpêtriére Hospital, AP-HP, Paris, France
| | - Marie Sarazin
- Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France
- University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France
| | - Michel Bottlaender
- Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France
- University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France
| | - Bruno Dubois
- Center for Cognitive and Behavioral Diseases, Pitié Salpêtrière University Hospital, Paris, France
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rik Vandenberghe
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Elias Granadillo
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Edmond Teng
- Neurobehavior Service, Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Mario Mendez
- Neurobehavior Unit, West Los Angeles VA Medical Center, Los Angeles, CA
| | - Philipp T Meyer
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - Lars Frings
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Neurodegenerative Diseases, Madrid, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | | | - Gaël Chételat
- INSERM UMR-S U1237, University of Caen Normandy, Caen, France
| | - Willemijn Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Banner Alzheimer's Institute, Phoenix, AZ
| | - Rémi W Bouchard
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
| | - Robert Jr Laforce
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
- Clinique Interdisciplinaire de Mémoire de l'Enfant-Jésus, CHU de Québec, Université Laval, Québec, Canada
| | - Pieter Jelle Visser
- Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Hurley RS, Mesulam MM, Sridhar J, Rogalski EJ, Thompson CK. A nonverbal route to conceptual knowledge involving the right anterior temporal lobe. Neuropsychologia 2018; 117:92-101. [PMID: 29802865 DOI: 10.1016/j.neuropsychologia.2018.05.019] [Citation(s) in RCA: 11] [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: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/19/2022]
Abstract
The semantic variant of primary progressive aphasia (PPA-S) is diagnosed based on impaired single-word comprehension, but nonverbal impairments in face and object recognition can also be present, particularly in later disease stages. PPA-S is associated with focal atrophy in the left anterior temporal lobe (ATL), often accompanied by a lesser degree of atrophy in the right ATL. According to a dual-route account, the left ATL is critical for verbal access to conceptual knowledge while nonverbal access to conceptual knowledge depends upon the integrity of right ATL. Consistent with this view, single-word comprehension deficits in PPA-S have consistently been linked to the degree of atrophy in left ATL. In the current study we examined object processing and cortical thickness in 19 patients diagnosed with PPA-S, to evaluate the hypothesis that nonverbal object impairments would instead be determined by the amount of atrophy in the right ATL. All patients demonstrated inability to access conceptual knowledge on standardized tests with word stimuli: they were unable to match spoken words with their corresponding pictures on the Peabody Picture Vocabulary Test. Only a minority of patients, however, performed abnormally on an experimental thematic verification task, which requires judgments as to whether pairs of object pictures are thematically-associated, and does not rely on auditory or visual word input. The entire PPA-S group showed cortical thinning in left ATL, but atrophy in right ATL was more prominent in the subgroup with low verification scores. Thematic verification scores were correlated with cortical thickness in the right rather than left ATL, an asymmetric mapping which persisted when controlling for the degree of atrophy in the contralateral hemisphere. These results are consistent with a dual-route account of conceptual knowledge: breakdown of the verbal left hemispheric route produces an aphasic syndrome, which is only accompanied by visual object processing impairments when the nonverbal right hemispheric route is also compromised.
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Affiliation(s)
- Robert S Hurley
- Cognitive Neurology & Alzheimer's Disease Center, Northwestern University, Chicago, IL 60611, USA; Department of Neurology, Northwestern University, Chicago, IL 60611, USA; Department of Psychology, Cleveland State University, Cleveland, OH 44115, USA.
| | - M-Marsel Mesulam
- Cognitive Neurology & Alzheimer's Disease Center, Northwestern University, Chicago, IL 60611, USA; Department of Neurology, Northwestern University, Chicago, IL 60611, USA
| | - Jaiashre Sridhar
- Cognitive Neurology & Alzheimer's Disease Center, Northwestern University, Chicago, IL 60611, USA
| | - Emily J Rogalski
- Cognitive Neurology & Alzheimer's Disease Center, Northwestern University, Chicago, IL 60611, USA
| | - Cynthia K Thompson
- Cognitive Neurology & Alzheimer's Disease Center, Northwestern University, Chicago, IL 60611, USA; Department of Neurology, Northwestern University, Chicago, IL 60611, USA; Department of Communications Sciences and Disorders, Northwestern University, Chicago, IL 60611, USA
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Gefen T, Ahmadian SS, Mao Q, Kim G, Seckin M, Bonakdarpour B, Ramos EM, Coppola G, Rademakers R, Rogalski E, Rademaker A, Weintraub S, Mesulam MM, Geula C, Bigio EH. Combined Pathologies in FTLD-TDP Types A and C. J Neuropathol Exp Neurol 2018; 77:405-412. [PMID: 29584904 PMCID: PMC6019001 DOI: 10.1093/jnen/nly018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study investigated the presence of combined pathologies in a large cohort of autopsies that show a primary pathologic diagnosis of phosphorylated 43-kDa TAR DNA-binding protein (FTLD-TDP), the majority of which portrayed clinical phenotypes consistent with primary progressive aphasia or behavioral variant frontotemporal dementia (bvFTD). Thirty-eight cases with FTLD-TDP (30 type-A and 8 type-C) were identified to determine characteristic differences between cases with and without combined pathologies. Findings indicated that combined pathologies co-occur with FTLD-TDP type-A at a high frequency (50%)-greater than when compared to FTLD-TDP type-C cases (12.5%). Those with FTLD-TDP type-A and combined pathologies showed significantly longer lifespans (p < 0.05), and longer disease durations (p < 0.05), than those with only FTLD-TDP type-A. Cases with FTLD-TDP type-A and known genetic mutations tended not to show combined pathology. Those with the GRN mutation and FTLD-TDP type-A showed a significantly younger age of onset (p < 0.05) and younger age at death (p < 0.01) compared to noncarriers. In 1 bvFTD case, we highlight the rare presence of "triple" FTLD-TDP type-A, FTLD-tau, and Alzheimer pathology. The ante- and post-mortem features associated with combined pathologies in FTLD-related disorders are of useful consideration in the stratification of patients to drug trials, and in the development of therapeutic targets for FTLD.
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Affiliation(s)
- Tamar Gefen
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Psychiatry and Behavioral Sciences, University Feinberg School of Medicine, Chicago, Illinois
| | | | - Qinwen Mao
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Garam Kim
- Cognitive Neurology and Alzheimer’s Disease Center
| | | | | | - Eliana Marisa Ramos
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Psychiatry and Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Giovanni Coppola
- Department of Psychiatry and Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | | | - Alfred Rademaker
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Preventive Medicine, University Feinberg School of Medicine, Chicago, Illinois
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Psychiatry and Behavioral Sciences, University Feinberg School of Medicine, Chicago, Illinois
| | - M -Marsel Mesulam
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Changiz Geula
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Cellular and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eileen H Bigio
- Cognitive Neurology and Alzheimer’s Disease Center
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Josephs KA, Martin PR, Botha H, Schwarz CG, Duffy JR, Clark HM, Machulda MM, Graff-Radford J, Weigand SD, Senjem ML, Utianski RL, Drubach DA, Boeve BF, Jones DT, Knopman DS, Petersen RC, Jack CR, Lowe VJ, Whitwell JL. [ 18 F]AV-1451 tau-PET and primary progressive aphasia. Ann Neurol 2018; 83:599-611. [PMID: 29451323 PMCID: PMC5896771 DOI: 10.1002/ana.25183] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 11/17/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess [18 F]AV-1451 tau-PET (positron emission tomography) uptake patterns across the primary progressive aphasia (PPA) variants (logopenic, semantic, and agrammatic), examine regional uptake patterns of [18 F]AV-1451 independent of clinical diagnosis, and compare the diagnostic utility of [18 F]AV-1451, [18 F]-fluorodeoxygluclose (FDG)-PET and MRI (magnetic resonance imaging) to differentiate the PPA variants. METHODS We performed statistical parametric mapping of [18 F]AV-1451 across 40 PPA patients (logopenic-PPA = 14, semantic-PPA = 13, and agrammatic-PPA = 13) compared to 80 cognitively normal, Pittsburgh compound B-negative controls, age and gender matched 2:1. Principal component analysis of regional [18 F]AV-1451 tau-PET standard uptake value ratio was performed to understand underlying patterns of [18 F]AV-1451 uptake independent of clinical diagnosis. Penalized multinomial regression analyses were utilized to assess diagnostic utility. RESULTS Logopenic-PPA showed striking uptake throughout neocortex, particularly temporoparietal, compared to controls, semantic-PPA, and agrammatic-PPA. Semantic-PPA and agrammatic-PPA showed milder patterns of focal [18 F]AV-1451 uptake. Semantic-PPA showed elevated uptake (left>right) in anteromedial temporal lobes, compared to controls and agrammatic-PPA. Agrammatic-PPA showed elevated uptake (left>right) throughout prefrontal white matter and in subcortical gray matter structures, compared to controls and semantic-PPA. The principal component analysis of regional [18 F]AV-1451 indicated two primary dimensions, a severity dimension that distinguished logopenic-PPA from agrammatic-PPA and semantic-PPA, and a frontal versus temporal contrast that distinguishes agrammatic-PPA and semantic-PPA cases. Diagnostic utility of [18 F]AV-1451was superior to MRI and at least equal to FDG-PET. INTERPRETATION [18 F]AV-1451binding characteristics differ across the PPA variants and were excellent at distinguishing between the variants. [18 F]AV-1451binding characteristics were as good or better than other brain imaging modalities utilized in clinical practice, suggesting that [18 F]AV-1451 may have clinical diagnostic utility in PPA. Ann Neurol 2018 Ann Neurol 2018;83:599-611.
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Affiliation(s)
- Keith A. Josephs
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Peter R. Martin
- Department of Health Science Research (Biostatistics), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Hugo Botha
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Joseph R. Duffy
- Department of Neurology (Speech pathology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Heather M. Clark
- Department of Neurology (Speech pathology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mary M. Machulda
- Department of Psychiatry (Neuropsychology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jonathan Graff-Radford
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Stephen D. Weigand
- Department of Health Science Research (Biostatistics), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew L. Senjem
- Department of Information Technology, Mayo Clinic, Rochester, Minnesota, U.S.A
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Rene L. Utianski
- Department of Neurology (Speech pathology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel A. Drubach
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bradley F. Boeve
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David T. Jones
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David S. Knopman
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ronald C. Petersen
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Clifford R. Jack
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Val J. Lowe
- Department of Radiology (Nuclear Medicine), Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jennifer L. Whitwell
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, Minnesota, U.S.A
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Bocchetta M, Gordon E, Cardoso MJ, Modat M, Ourselin S, Warren JD, Rohrer JD. Thalamic atrophy in frontotemporal dementia - Not just a C9orf72 problem. Neuroimage Clin 2018; 18:675-681. [PMID: 29876259 PMCID: PMC5988457 DOI: 10.1016/j.nicl.2018.02.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/07/2018] [Accepted: 02/21/2018] [Indexed: 12/12/2022]
Abstract
Background Frontotemporal dementia (FTD) is a heterogeneous neurodegenerative disorder associated with frontal and temporal atrophy. Subcortical involvement has been described as well, with early thalamic atrophy most commonly associated with the C9orf72 expansion. However thalamic involvement has not been comprehensively investigated across the FTD spectrum. Methods We investigated thalamic volumes in a sample of 341 FTD patients (age: mean(standard deviation) 64.2(8.5) years; disease duration: 4.6(2.7) years) compared with 99 age-matched controls (age: 61.9(11.4) years). We performed a parcellation of T1 MRIs using an atlas propagation and label fusion approach to extract left and right thalamus volumes, which were corrected for total intracranial volumes. We assessed subgroups stratified by clinical diagnosis (141 behavioural variant FTD (bvFTD), 76 semantic dementia (SD), 103 progressive nonfluent aphasia (PNFA), 7 with associated motor neurone disease (FTD-MND) and 14 primary progressive aphasia not otherwise specified (PPA-NOS), genetic diagnosis (24 with MAPT, 24 with C9orf72, and 15 with GRN mutations), and pathological diagnosis (40 tauopathy, 61 TDP-43opathy, 3 FUSopathy). We assessed the diagnostic accuracy based on thalamic volume. Results Overall, FTD patients had smaller thalami than controls (8% difference in volume, p < 0.0005, ANCOVA). Stratifying by genetics, C9orf72 group had the smallest thalami (14% difference from controls, p < 0.0005). However, the thalami were also smaller than controls in the other genetic groups: GRN and MAPT groups showed a difference of 11% and 9% respectively (p < 0.0005). ROC analysis showed a relatively poor ability to separate C9orf72 from MAPT (AUC = 0.651, p = 0.073) and from GRN cases (AUC = 0.644, p = 0.133) using thalamic volume. All clinical subtypes had significantly smaller thalami than controls (p < 0.0005), with the FTD-MND group having the smallest (15%), followed by bvFTD (9%), PNFA (8%), PPA-NOS (7%), and lastly SD (5%). In the pathological groups, the TDP-43opathies had an 11% difference from controls, and tauopathies 9%, while the FUSopathies showed only 2% of difference from controls (p < 0.0005). GRN, PPA-NOS and SD were the subgroups showing the highest asymmetry in volumes. Conclusions The thalamus was most affected in C9orf72 genetically, TDP-43opathies pathologically and FTD-MND clinically. However, thalamic atrophy is a common feature across all FTD groups.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Elizabeth Gordon
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - M Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Marc Modat
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom.
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Paraskevas GP, Kasselimis D, Kourtidou E, Constantinides V, Bougea A, Potagas C, Evdokimidis I, Kapaki E. Cerebrospinal Fluid Biomarkers as a Diagnostic Tool of the Underlying Pathology of Primary Progressive Aphasia. J Alzheimers Dis 2018; 55:1453-1461. [PMID: 27858708 DOI: 10.3233/jad-160494] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary progressive aphasia (PPA) may present with three main clinical variants, namely nonfluent agrammatic (nfaPPA), semantic (sPPA), and logopenic (lPPA) subtypes. Frontotemporal lobar degenerations (FTLD) or Alzheimer's disease (AD) are the most common etiologies. OBJECTIVE To study the potential of cerebrospinal fluid (CSF) biomarkers for identifying the underlying pathology in patients with PPA. METHODS CSF levels of total tau protein (τT), amyloid-β peptide (Aβ42), and tau phosphorylated at threonine-181 (τP - 181) were measured by double sandwich, enzyme-linked immunosorbent assay (ELISA) in 43 patients with PPA, 26 patients with AD, and 17 healthy controls. RESULTS All patients could be classified as compatible with the AD or non-AD biomarker profile, either with the three biomarkers (90.7%) or their ratios, especially the τP - 181/Aβ42 ratio (9.3%). An AD-compatible biomarker profile was present in 39.5% of all PPA patients, specifically 22.2%, 35.7%, and 75% of nfaPPA, sPPA, and lPPA, respectively. In PPA patients with a non-AD profile (presumably FTLD), two different clusters could be identified according to the τP - 181/τT ratio, possibly corresponding to the two major FTLD pathologies (tau and TDP-43). CONCLUSION CSF biomarkers may be a valuable tool for the discrimination between PPA patients with AD and non-AD pathophysiology and possibly between FTLD patients with tau and TDP-43 pathology.
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Kim G, Vahedi S, Gefen T, Weintraub S, Bigio EH, Mesulam MM, Geula C. Asymmetric TDP pathology in primary progressive aphasia with right hemisphere language dominance. Neurology 2018; 90:e396-e403. [PMID: 29305438 PMCID: PMC5791793 DOI: 10.1212/wnl.0000000000004891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/31/2017] [Accepted: 10/12/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantitatively examine the regional densities and hemispheric distribution of the 43-kDa transactive response DNA-binding protein (TDP-43) inclusions, neurons, and activated microglia in a left-handed patient with right hemisphere language dominance and logopenic-variant primary progressive aphasia (PPA). METHODS Phosphorylated TDP-43 inclusions, neurons, and activated microglia were visualized with immunohistochemical and histologic methods. Markers were quantified bilaterally with unbiased stereology in language- and memory-related cortical regions. RESULTS Clinical MRI indicated cortical atrophy in the right hemisphere, mostly in the temporal lobe. Significantly higher densities of TDP-43 inclusions were present in right language-related temporal regions compared to the left or to other right hemisphere regions. The memory-related entorhinal cortex (ERC) and language regions without significant atrophy showed no asymmetry. Activated microglia displayed extensive asymmetry (R > L). A substantial density of neurons remained in all areas and showed no hemispheric asymmetry. However, perikaryal size was significantly smaller in the right hemisphere across all regions except the ERC. To demonstrate the specificity of this finding, sizes of residual neurons were measured in a right-handed case with PPA and were found to be smaller in the language-dominant left hemisphere. CONCLUSIONS The distribution of TDP-43 inclusions and microglial activation in right temporal language regions showed concordance with anatomic distribution of cortical atrophy and clinical presentation. The results revealed no direct relationship between density of TDP-43 inclusions and activated microglia. Reduced size of the remaining neurons is likely to contribute to cortical atrophy detected by MRI. These findings support the conclusion that there is no obligatory relationship between logopenic PPA and Alzheimer pathology.
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Affiliation(s)
- Garam Kim
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shahrooz Vahedi
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tamar Gefen
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sandra Weintraub
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen H Bigio
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marek-Marsel Mesulam
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Changiz Geula
- From the Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Joubert S, Vallet GT, Montembeault M, Boukadi M, Wilson MA, Laforce RJ, Rouleau I, Brambati SM. Comprehension of concrete and abstract words in semantic variant primary progressive aphasia and Alzheimer's disease: A behavioral and neuroimaging study. Brain Lang 2017; 170:93-102. [PMID: 28432988 DOI: 10.1016/j.bandl.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/16/2016] [Revised: 03/23/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the comprehension of concrete, abstract and abstract emotional words in semantic variant primary progressive aphasia (svPPA), Alzheimer's disease (AD), and healthy elderly adults (HE) Three groups of participants (9 svPPA, 12 AD, 11 HE) underwent a general neuropsychological assessment, a similarity judgment task, and structural brain MRI. The three types of words were processed similarly in the group of AD participants. In contrast, patients in the svPPA group were significantly more impaired at processing concrete words than abstract words, while comprehension of abstract emotional words was in between. VBM analyses showed that comprehension of concrete words relative to abstract words was significantly correlated with atrophy in the left anterior temporal lobe. These results support the view that concrete words are disproportionately impaired in svPPA, and that concrete and abstract words may rely upon partly dissociable brain regions.
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Affiliation(s)
- Sven Joubert
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QC, Canada.
| | - Guillaume T Vallet
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Maxime Montembeault
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Mariem Boukadi
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Maximiliano A Wilson
- Centre de recherche de l'Institut universitaire en santé mentale de Québec (CRIUSMQ), Canada; Département de réadaptation, Université Laval, Québec, QC, Canada
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada; Département des Sciences Neurologiques, Université Laval, QC, Canada
| | - Isabelle Rouleau
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Simona M Brambati
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
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Mandelli ML, Vilaplana E, Brown JA, Hubbard HI, Binney RJ, Attygalle S, Santos-Santos MA, Miller ZA, Pakvasa M, Henry ML, Rosen HJ, Henry RG, Rabinovici GD, Miller BL, Seeley WW, Gorno-Tempini ML. Healthy brain connectivity predicts atrophy progression in non-fluent variant of primary progressive aphasia. Brain 2016; 139:2778-2791. [PMID: 27497488 DOI: 10.1093/brain/aww195] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 02/12/2016] [Accepted: 06/02/2016] [Indexed: 11/12/2022] Open
Abstract
Neurodegeneration has been hypothesized to follow predetermined large-scale networks through the trans-synaptic spread of toxic proteins from a syndrome-specific epicentre. To date, no longitudinal neuroimaging study has tested this hypothesis in vivo in frontotemporal dementia spectrum disorders. The aim of this study was to demonstrate that longitudinal progression of atrophy in non-fluent/agrammatic variant primary progressive aphasia spreads over time from a syndrome-specific epicentre to additional regions, based on their connectivity to the epicentre in healthy control subjects. The syndrome-specific epicentre of the non-fluent/agrammatic variant of primary progressive aphasia was derived in a group of 10 mildly affected patients (clinical dementia rating equal to 0) using voxel-based morphometry. From this region, the inferior frontal gyrus (pars opercularis), we derived functional and structural connectivity maps in healthy controls (n = 30) using functional magnetic resonance imaging at rest and diffusion-weighted imaging tractography. Graph theory analysis was applied to derive functional network features. Atrophy progression was calculated using voxel-based morphometry longitudinal analysis on 34 non-fluent/agrammatic patients. Correlation analyses were performed to compare volume changes in patients with connectivity measures of the healthy functional and structural speech/language network. The default mode network was used as a control network. From the epicentre, the healthy functional connectivity network included the left supplementary motor area and the prefrontal, inferior parietal and temporal regions, which were connected through the aslant, superior longitudinal and arcuate fasciculi. Longitudinal grey and white matter changes were found in the left language-related regions and in the right inferior frontal gyrus. Functional connectivity strength in the healthy speech/language network, but not in the default network, correlated with longitudinal grey matter changes in the non-fluent/agrammatic variant of primary progressive aphasia. Graph theoretical analysis of the speech/language network showed that regions with shorter functional paths to the epicentre exhibited greater longitudinal atrophy. The network contained three modules, including a left inferior frontal gyrus/supplementary motor area, which was most strongly connected with the epicentre. The aslant tract was the white matter pathway connecting these two regions and showed the most significant correlation between fractional anisotropy and white matter longitudinal atrophy changes. This study showed that the pattern of longitudinal atrophy progression in the non-fluent/agrammatic variant of primary progressive aphasia relates to the strength of connectivity in pre-determined functional and structural large-scale speech production networks. These findings support the hypothesis that the spread of neurodegeneration occurs by following specific anatomical and functional neuronal network architectures.
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Affiliation(s)
- Maria Luisa Mandelli
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Eduard Vilaplana
- 2 Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau - Universitat Autonoma de Barcelona, Spain 3 Centro de Investigacion Biomedica en Red de Enfermedades Neurodegenerativas - CIBERNED, Spain
| | - Jesse A Brown
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - H Isabel Hubbard
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Richard J Binney
- 4 Department of Communication Sciences and Disorders, Temple University, Philadelphia, Pennsylvania, USA
| | - Suneth Attygalle
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Miguel A Santos-Santos
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Zachary A Miller
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Mikhail Pakvasa
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Maya L Henry
- 5 Department of Communication Sciences and Disorders, University of Texas, Austin, USA
| | - Howard J Rosen
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Roland G Henry
- 6 Department of Neurology, University of California San Francisco, CA, USA 7 Bioengineering Graduate Group, University of California Berkeley, San Francisco, CA, USA 8 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Bruce L Miller
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - William W Seeley
- 1 Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA 9 Department of Pathology, University of California San Francisco, CA, USA
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Migliaccio R, Boutet C, Valabregue R, Ferrieux S, Nogues M, Lehéricy S, Dormont D, Levy R, Dubois B, Teichmann M. The Brain Network of Naming: A Lesson from Primary Progressive Aphasia. PLoS One 2016; 11:e0148707. [PMID: 26901052 PMCID: PMC4764674 DOI: 10.1371/journal.pone.0148707] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/20/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Word finding depends on the processing of semantic and lexical information, and it involves an intermediate level for mapping semantic-to-lexical information which also subserves lexical-to-semantic mapping during word comprehension. However, the brain regions implementing these components are still controversial and have not been clarified via a comprehensive lesion model encompassing the whole range of language-related cortices. Primary progressive aphasia (PPA), for which anomia is thought to be the most common sign, provides such a model, but the exploration of cortical areas impacting naming in its three main variants and the underlying processing mechanisms is still lacking. METHODS We addressed this double issue, related to language structure and PPA, with thirty patients (11 semantic, 12 logopenic, 7 agrammatic variant) using a picture-naming task and voxel-based morphometry for anatomo-functional correlation. First, we analyzed correlations for each of the three variants to identify the regions impacting naming in PPA and to disentangle the core regions of word finding. We then combined the three variants and correlation analyses for naming (semantic-to-lexical mapping) and single-word comprehension (lexical-to-semantic mapping), predicting an overlap zone corresponding to a bidirectional lexical-semantic hub. RESULTS AND CONCLUSIONS Our results showed that superior portions of the left temporal pole and left posterior temporal cortices impact semantic and lexical naming mechanisms in semantic and logopenic PPA, respectively. In agrammatic PPA naming deficits were rare, and did not correlate with any cortical region. Combined analyses revealed a cortical overlap zone in superior/middle mid-temporal cortices, distinct from the two former regions, impacting bidirectional binding of lexical and semantic information. Altogether, our findings indicate that lexical/semantic word processing depends on an anterior-posterior axis within lateral-temporal cortices, including an anatomically intermediate hub dedicated to lexical-semantic integration. Within this axis our data reveal the underpinnings of anomia in the PPA variants, which is of relevance for both diagnosis and future therapy strategies.
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Affiliation(s)
- Raffaella Migliaccio
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Claire Boutet
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Romain Valabregue
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Sophie Ferrieux
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Nogues
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Didier Dormont
- Université Pierre et Marie Curie, INSERM, UMR-S 678, Paris, France
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Richard Levy
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Bruno Dubois
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Marc Teichmann
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
- * E-mail:
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Madhavan A, Schwarz CG, Duffy JR, Strand EA, Machulda MM, Drubach DA, Kantarci K, Przybelski SA, Reid RI, Senjem ML, Gunter JL, Apostolova LG, Lowe VJ, Petersen RC, Jack CR, Josephs KA, Whitwell JL. Characterizing White Matter Tract Degeneration in Syndromic Variants of Alzheimer's Disease: A Diffusion Tensor Imaging Study. J Alzheimers Dis 2016; 49:633-43. [PMID: 26484918 PMCID: PMC10038690 DOI: 10.3233/jad-150502] [Citation(s) in RCA: 21] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Different clinical syndromes can arise from Alzheimer's disease (AD) neuropathology, including dementia of the Alzheimer's type (DAT), logopenic primary progressive aphasia (lvPPA), and posterior cortical atrophy (PCA). OBJECTIVE To assess similarities and differences in patterns of white matter tract degeneration across these syndromic variants of AD. METHODS Sixty-four subjects (22 DAT, 24 lvPPA, and 18 PCA) that had diffusion tensor imaging and showed amyloid-β deposition on PET were assessed in this case-control study. A whole-brain voxel-based analysis was performed to assess differences in fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity across groups. RESULTS All three groups showed overlapping diffusion abnormalities in a network of tracts, including fornix, corpus callosum, posterior thalamic radiations, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and uncinate fasciculus. Subtle regional differences were also observed across groups, with DAT particularly associated with degeneration of fornix and cingulum, lvPPA with left inferior fronto-occipital fasciculus and uncinate fasciculus, and PCA with posterior thalamic radiations, superior longitudinal fasciculus, posterior cingulate, and splenium of the corpus callosum. CONCLUSION These findings show that while each AD phenotype is associated with degeneration of a specific structural network of white matter tracts, striking spatial overlap exists among the three network patterns that may be related to AD pathology.
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Affiliation(s)
- Ajay Madhavan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R. Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Edythe A. Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | - Daniel A. Drubach
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Scott A. Przybelski
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | - Robert I. Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey L. Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Liana G. Apostolova
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ronald C. Petersen
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | | | - Keith A. Josephs
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | - Jennifer L. Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Correspondence to: Jennifer L. Whitwell, PhD, Associate Professor of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. Tel.: +1 507 284 5576; Fax: +1 507 284 9778;
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Mack JE, Chandler SD, Meltzer-Asscher A, Rogalski E, Weintraub S, Mesulam MM, Thompson CK. What do pauses in narrative production reveal about the nature of word retrieval deficits in PPA? Neuropsychologia 2015; 77:211-22. [PMID: 26300385 PMCID: PMC4609629 DOI: 10.1016/j.neuropsychologia.2015.08.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 12/23/2014] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
Abstract
Naming and word-retrieval deficits, which are common characteristics of primary progressive aphasia (PPA), differentially affect production across word classes (e.g., nouns, verbs) in some patients. Individuals with the agrammatic variant (PPA-G) often show greater difficulty producing verbs whereas those with the semantic variant (PPA-S) show greater noun deficits and those with logopenic PPA (PPA-L) evince no clear-cut differences in production of the two word classes. To determine the source of these production patterns, the present study examined word-finding pauses as conditioned by lexical variables (i.e., word class, frequency, length) in narrative speech samples of individuals with PPA-S (n=12), PPA-G (n=12), PPA-L (n=11), and cognitively healthy controls (n=12). We also examined the relation between pause distribution and cortical atrophy (i.e., cortical thickness) in nine left hemisphere regions of interest (ROIs) linked to word production. Results showed higher overall pause rates for PPA compared to unimpaired controls; however, greater naming severity was not associated with increased pause rate. Across all groups, more pauses were produced before lower vs. higher frequency words, with no independent effects of word length after controlling for frequency. With regard to word class, the PPA-L group showed a higher rate of pauses prior to production of nouns compared to verbs, consistent with noun-retrieval deficits arising at the lemma level of word production. Those with PPA-G and PPA-S, like controls, produced similar pause rates across word classes; however, lexical simplification (i.e., production of higher-frequency and/or shorter words) was evident in the more-impaired word class: nouns for PPA-S and verbs for PPA-G. These patterns are consistent with conceptual and/or lemma-level impairments for PPA-S, predominantly affecting objects/nouns, and a lemma-level verb-retrieval deficit for PPA-G, with a concomitant impairment in phonological encoding and articulation affecting overall pause rates. The greater tendency to pause before nouns was correlated with atrophy in the left precentral gyrus, inferior frontal gyrus and inferior parietal lobule, whereas the greater tendency to pause before less frequent and longer words was associated with atrophy in left precentral and inferior parietal regions.
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Affiliation(s)
- Jennifer E Mack
- Department of Communication Sciences and Disorders, Northwestern University, United States.
| | - Sarah D Chandler
- Department of Communication Sciences and Disorders, Northwestern University, United States
| | - Aya Meltzer-Asscher
- Linguistics Department, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Emily Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Psychiatry and Behavioral Sciences, Northwestern University, United States; Department of Neurology, Northwestern University, United States
| | - M-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Neurology, Northwestern University, United States
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, United States; Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Neurology, Northwestern University, United States
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Botha H, Duffy JR, Whitwell JL, Strand EA, Machulda MM, Schwarz CG, Reid RI, Spychalla AJ, Senjem ML, Jones DT, Lowe V, Jack CR, Josephs KA. Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech. Cortex 2015; 69:220-36. [PMID: 26103600 PMCID: PMC4522343 DOI: 10.1016/j.cortex.2015.05.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [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: 12/22/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
The consensus criteria for the diagnosis and classification of primary progressive aphasia (PPA) have served as an important tool in studying this group of disorders. However, a large proportion of patients remain unclassifiable whilst others simultaneously meet criteria for multiple subtypes. We prospectively evaluated a large cohort of patients with degenerative aphasia and/or apraxia of speech using multidisciplinary clinical assessments and multimodal imaging. Blinded diagnoses were made using operational definitions with important differences compared to the consensus criteria. Of the 130 included patients, 40 were diagnosed with progressive apraxia of speech (PAOS), 12 with progressive agrammatic aphasia, 9 with semantic dementia, 52 with logopenic progressive aphasia, and 4 with progressive fluent aphasia, while 13 were unclassified. The PAOS and progressive fluent aphasia groups were least impaired. Performance on repetition and sentence comprehension was especially poor in the logopenic group. The semantic and progressive fluent aphasia groups had prominent anomia, but only semantic subjects had loss of word meaning and object knowledge. Distinct patterns of grey matter loss and white matter changes were found in all groups compared to controls. PAOS subjects had bilateral frontal grey matter loss, including the premotor and supplementary motor areas, and bilateral frontal white matter involvement. The agrammatic group had more widespread, predominantly left sided grey matter loss and white matter abnormalities. Semantic subjects had bitemporal grey matter loss and white matter changes, including the uncinate and inferior occipitofrontal fasciculi, whereas progressive fluent subjects only had left sided temporal involvement. Logopenic subjects had diffuse and bilateral grey matter loss and diffusion tensor abnormalities, maximal in the posterior temporal region. A diagnosis of logopenic aphasia was strongly associated with being amyloid positive (46/52 positive). Our findings support consideration of an alternative way of identifying and categorizing subtypes of degenerative speech and language disorders.
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Affiliation(s)
- Hugo Botha
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | | | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | | | - Robert I Reid
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA
| | - Val Lowe
- Department of Radiology (Nuclear Medicine), Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Radiology (Neuroradiology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology (Behavioural Neurology), Mayo Clinic, Rochester, MN, USA; Department of Neurology (Movement Disorders), Mayo Clinic, Rochester, MN, USA.
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45
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Bonakdarpour B, Beeson P, DeMarco A, Rapcsak S. Variability in blood oxygen level dependent (BOLD) signal in patients with stroke-induced and primary progressive aphasia. Neuroimage Clin 2015; 8:87-94. [PMID: 26106531 PMCID: PMC4473284 DOI: 10.1016/j.nicl.2015.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/27/2015] [Accepted: 03/18/2015] [Indexed: 12/04/2022]
Abstract
Although fMRI is increasingly used to assess language-related brain activation in patients with aphasia, few studies have examined the hemodynamic response function (HRF) in perilesional, and contralesional areas of the brain. In addition, the relationship between HRF abnormalities and other variables such as lesion size and severity of aphasia has not been explored. The objective of this study was to investigate changes in HRF signal during language-related neural activation in patients with stroke-induced aphasia (SA). We also examined the status of the HRF in patients with aphasia due to nonvascular etiology, namely, primary progressive aphasia (PPA). Five right handed SA patients, three PPA patients, and five healthy individuals participated in the study. Structural damage was quantified with T1-weighted MR images. Functional MR imaging was performed with long trial event-related design and an overt naming task to measure BOLD signal time to peak (TTP) and percent signal change (ΔS). In SA patients, the average HRF TTP was significantly delayed in the left hemisphere regions involved in naming compared to healthy participants and PPA patients. However, ΔS was not different in SA patients compared to the other two groups. Delay in HRF TTP in the left hemisphere naming network of SA patients was correlated with lesion size and showed a negative correlation with global language function. There were no significant differences in the HRF TTP and ΔS in the right hemisphere homologues of the naming network or in the left and the right occipital control regions across the three groups. In PPA patients, HRF had a normal pattern. Our results indicate that abnormal task-related HRF is primarily found in the left hemisphere language network of SA patients and raise the possibility that abnormal physiology superimposed on structural damage may contribute to the clinical deficit. Follow-up investigations in a larger sample of age-matched healthy individuals, SA, and PPA patients will be needed to further confirm and extend our findings.
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Affiliation(s)
- B. Bonakdarpour
- Cognitive Neurology and Alzheimer Disease Center, Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - P.M. Beeson
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - A.T. DeMarco
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - S.Z. Rapcsak
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
- Department of Neurology, University of Arizona, Tucson, USA
- Southern Arizona VA Health Care System, Tucson, AZ, USA
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Iaccarino L, Crespi C, Della Rosa PA, Catricalà E, Guidi L, Marcone A, Tagliavini F, Magnani G, Cappa SF, Perani D. The semantic variant of primary progressive aphasia: clinical and neuroimaging evidence in single subjects. PLoS One 2015; 10:e0120197. [PMID: 25756991 PMCID: PMC4354903 DOI: 10.1371/journal.pone.0120197] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/05/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM We present a clinical-neuroimaging study in a series of patients with a clinical diagnosis of semantic variant of primary progressive aphasia (svPPA), with the aim to provide clinical-functional correlations of the cognitive and behavioral manifestations at the single-subject level. METHODS We performed neuropsychological investigations, 18F-FDG-PET single-subject and group analysis, with an optimized SPM voxel-based approach, and correlation analyses. A measurement of white matter integrity by means of diffusion tensor imaging (DTI) was also available for a subgroup of patients. RESULTS Cognitive assessment confirmed the presence of typical semantic memory deficits in all patients, with a relative sparing of executive, attentional, visuo-constructional, and episodic memory domains. 18F-FDG-PET showed a consistent pattern of cerebral hypometabolism across all patients, which correlated with performance in semantic memory tasks. In addition, a majority of patients also presented with behavioral disturbances associated with metabolic dysfunction in limbic structures. In a subgroup of cases the DTI analysis showed FA abnormalities in the inferior longitudinal and uncinate fasciculi. DISCUSSION Each svPPA individual had functional derangement involving an extended, connected system within the left temporal lobe, a crucial part of the verbal semantic network, as well as an involvement of limbic structures. The latter was associated with behavioral manifestations and extended beyond the area of atrophy shown by CT scan. CONCLUSION Single-subject 18F-FDG-PET analysis can account for both cognitive and behavioral alterations in svPPA. This provides useful support to the clinical diagnosis.
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Affiliation(s)
- Leonardo Iaccarino
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Crespi
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- CERMAC, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Lucia Guidi
- Istituto Universitario degli Studi Superiori—IUSS, Pavia, Italy
| | - Alessandra Marcone
- Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy
| | | | | | - Stefano F. Cappa
- CERMAC, Vita-Salute San Raffaele University, Milan, Italy
- Istituto Universitario degli Studi Superiori—IUSS, Pavia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- CERMAC, Vita-Salute San Raffaele University, Milan, Italy
- Istituto di Bioimmagini e Fisiologia Molecolare C.N.R., Segrate, Italy
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
- * E-mail:
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47
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Whitwell JL, Duffy JR, Strand EA, Machulda MM, Senjem ML, Schwarz CG, Reid R, Baker MC, Perkerson RB, Lowe VJ, Rademakers R, Jack CR, Josephs KA. Clinical and neuroimaging biomarkers of amyloid-negative logopenic primary progressive aphasia. Brain Lang 2015; 142:45-53. [PMID: 25658633 PMCID: PMC4380294 DOI: 10.1016/j.bandl.2015.01.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 06/09/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 06/01/2023]
Abstract
Logopenic primary progressive aphasia (lvPPA) is a progressive language disorder characterized by anomia, difficulty repeating complex sentences, and phonological errors. The majority, although not all, lvPPA patients have underlying Alzheimer's disease. We aimed to determine whether clinical or neuroimaging features differ according to the deposition of Aβ on Pittsburgh-compound B PET in lvPPA. Clinical features, patterns of atrophy on MRI, hypometabolism on FDG-PET, and white matter tract degeneration were compared between six PiB-negative and 20 PiB-positive lvPPA patients. PiB-negative patients showed more asymmetric left-sided patterns of atrophy, hypometabolism and white matter tract degeneration, with greater left anteromedial temporal and medial prefrontal involvement, than PiB-positive patients. PiB-positive patients showed greater involvement of right temporoparietal and frontal lobes. There was very little evidence for clinical differences between the groups. Strikingly asymmetric neuroimaging findings with relatively preserved right hemisphere may provide clues that AD pathology is absent in lvPPA.
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Affiliation(s)
| | - Joseph R Duffy
- Department of Neurology (Division of Speech Pathology), Mayo Clinic, Rochester, MN, United States
| | - Edythe A Strand
- Department of Neurology (Division of Speech Pathology), Mayo Clinic, Rochester, MN, United States
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, United States
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | | | - Robert Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Ralph B Perkerson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Keith A Josephs
- Department of Neurology (Division of Behavioral Neurology), Mayo Clinic, Rochester, MN, United states
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48
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Mesulam MM, Rogalski EJ, Wieneke C, Hurley RS, Geula C, Bigio EH, Thompson CK, Weintraub S. Primary progressive aphasia and the evolving neurology of the language network. Nat Rev Neurol 2014; 10:554-69. [PMID: 25179257 PMCID: PMC4201050 DOI: 10.1038/nrneurol.2014.159] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [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] [Indexed: 12/12/2022]
Abstract
Primary progressive aphasia (PPA) is caused by selective neurodegeneration of the language-dominant cerebral hemisphere; a language deficit initially arises as the only consequential impairment and remains predominant throughout most of the course of the disease. Agrammatic, logopenic and semantic subtypes, each reflecting a characteristic pattern of language impairment and corresponding anatomical distribution of cortical atrophy, represent the most frequent presentations of PPA. Such associations between clinical features and the sites of atrophy have provided new insights into the neurology of fluency, grammar, word retrieval, and word comprehension, and have necessitated modification of concepts related to the functions of the anterior temporal lobe and Wernicke's area. The underlying neuropathology of PPA is, most commonly, frontotemporal lobar degeneration in the agrammatic and semantic forms, and Alzheimer disease (AD) pathology in the logopenic form; the AD pathology often displays atypical and asymmetrical anatomical features consistent with the aphasic phenotype. The PPA syndrome reflects complex interactions between disease-specific neuropathological features and patient-specific vulnerability. A better understanding of these interactions might help us to elucidate the biology of the language network and the principles of selective vulnerability in neurodegenerative diseases. We review these aspects of PPA, focusing on advances in our understanding of the clinical features and neuropathology of PPA and what they have taught us about the neural substrates of the language network.
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Affiliation(s)
- M-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
| | - Emily J Rogalski
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
| | - Robert S Hurley
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
| | - Changiz Geula
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
| | - Eileen H Bigio
- Department of Neuropathology, Northwestern University Feinberg School of Medicine, 710 North Fairbanks Court, Chicago, IL 60611, USA
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, 633 Clark Street, Evanston, IL 60208, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Centre, 320 East Superior Street, Searle Building, 11-450, Northwestern University, Chicago, IL 60611, USA
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49
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Wilson SM, Brandt TH, Henry ML, Babiak M, Ogar JM, Salli C, Wilson L, Peralta K, Miller BL, Gorno-Tempini ML. Inflectional morphology in primary progressive aphasia: an elicited production study. Brain Lang 2014; 136:58-68. [PMID: 25129631 PMCID: PMC4159758 DOI: 10.1016/j.bandl.2014.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 06/03/2023]
Abstract
Inflectional morphology lies at the intersection of phonology, syntax and the lexicon, three language domains that are differentially impacted in the three main variants of primary progressive aphasia (PPA). To characterize spared and impaired aspects of inflectional morphology in PPA, we elicited inflectional morphemes in 48 individuals with PPA and 13 healthy age-matched controls. We varied the factors of regularity, frequency, word class, and lexicality, and used voxel-based morphometry to identify brain regions where atrophy was predictive of deficits on particular conditions. All three PPA variants showed deficits in inflectional morphology, with the specific nature of the deficits dependent on the anatomical and linguistic features of each variant. Deficits in inflecting low-frequency irregular words were associated with semantic PPA, with lexical/semantic deficits, and with left temporal atrophy. Deficits in inflecting pseudowords were associated with non-fluent/agrammatic and logopenic variants, with phonological deficits, and with left frontal and parietal atrophy.
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Affiliation(s)
- Stephen M Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA; Department of Neurology, University of Arizona, USA; Department of Neurology, University of California, San Francisco, USA.
| | - Temre H Brandt
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Maya L Henry
- Department of Neurology, University of California, San Francisco, USA; Department of Communication Sciences and Disorders, University of Texas, Austin, USA
| | - Miranda Babiak
- Department of Neurology, University of California, San Francisco, USA
| | - Jennifer M Ogar
- Department of Neurology, University of California, San Francisco, USA
| | - Chelsey Salli
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Lisa Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Karen Peralta
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, USA
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50
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Silveri MC, Pravatà E, Brita AC, Improta E, Ciccarelli N, Rossi P, Colosimo C. Primary progressive aphasia: linguistic patterns and clinical variants. Brain Lang 2014; 135:57-65. [PMID: 24974082 DOI: 10.1016/j.bandl.2014.05.004] [Citation(s) in RCA: 7] [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: 08/05/2013] [Revised: 04/08/2014] [Accepted: 05/15/2014] [Indexed: 05/15/2023]
Abstract
We investigated whether primary progressive aphasias (PPA) reflect non-random degradation of linguistic dimensions that might be supported by different neural subsystems and to what extent this degradation contributes to the emergence of clinical entities: semantic (S), logopenic (L) and nonfluent (NF) aphasia; apraxia of speech was also considered if associated with language disorders (AOS/aph). Forty-two aphasic patients are reported. Two main definable patterns of linguistic deficits tended to emerge that corresponded with identifiable patterns of brain atrophy, and probably diseases: the S variant, which principally expresses the impact of a "deep" cognitive (semantic) disorder on language, and AOS/aph in which "peripheral" executive components play a significant role. By contrast, NF aphasia emerged as a heterogeneous variant due to disorganization of various dimensions within the linguistic domain, that assumes different patterns depending on the differential distribution of atrophy in the perisylvian regions.
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Affiliation(s)
| | | | - Anna Clelia Brita
- Medicine of the Ageing, Department of Geriatrics, Neuroscience and Orthopedics, Italy
| | - Erika Improta
- Medicine of the Ageing, Department of Geriatrics, Neuroscience and Orthopedics, Italy
| | - Nicoletta Ciccarelli
- Medicine of the Ageing, Department of Geriatrics, Neuroscience and Orthopedics, Italy
| | - Paola Rossi
- Medicine of the Ageing, Department of Geriatrics, Neuroscience and Orthopedics, Italy
| | - Cesare Colosimo
- Department of Neuroimaging, Catholic University, Roma, Italy
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