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Miyagawa T, Brushaber D, Syrjanen J, Kremers W, Fields J, Forsberg LK, Heuer HW, Knopman D, Kornak J, Boxer A, Rosen HJ, Boeve BF, Appleby B, Caso C, Bordelon Y, Coppola G, Bove J, Dever R, Brannelly P, Dheel C, Dickerson B, Dickinson S, Dominguez S, Domoto-Reilly K, Faber K, Ferrell J, Fishman A, Fong J, Foroud T, Gavrilova R, Gearhart D, Ghazanfari B, Ghoshal N, Goldman JS, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Haley D, Hsiung R, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Kaufer D, Kerwin D, Kraft R, Kramer J, Kukull W, Litvan I, Lucente D, Lungu C, Mackenzie I, Maldonado M, Manoochehri M, McGinnis S, McKinley E, Mendez MF, Miller B, Multani N, Onyike C, Padmanabhan J, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Roberson ED, Rogalski E, Sengdy P, Shaw L, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Wang P, Weintraub S, Wong B, Wszolek Z. Utility of the global CDR ® plus NACC FTLD rating and development of scoring rules: Data from the ARTFL/LEFFTDS Consortium. Alzheimers Dement 2020; 16:106-117. [PMID: 31914218 PMCID: PMC7202045 DOI: 10.1002/alz.12033] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We created global rating scoring rules for the CDR® plus NACC FTLD to detect and track early frontotemporal lobar degeneration (FTLD) and to conduct clinical trials in FTLD. METHODS The CDR plus NACC FTLD rating was applied to 970 sporadic and familial participants from the baseline visit of Advancing Research and Treatment in Frontotemporal Lobar Degeneration (ARTFL)/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS). Each of the eight domains of the CDR plus NACC FTLD was equally weighed in determining the global score. An interrater reliability study was completed for 40 participants. RESULTS The CDR plus NACC FTLD showed very good interrater reliability. It was especially useful in detecting clinical features of mild non-fluent/agrammatic variant primary progressive aphasia participants. DISCUSSION The global CDR plus NACC FTLD score could be an attractive outcome measure for clinical trials in symptomatic FTLD, and may be useful in natural history studies and clinical trials in FTLD spectrum disorders.
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Ramos EM, Dokuru DR, Van Berlo V, Wojta K, Wang Q, Huang AY, Deverasetty S, Qin Y, van Blitterswijk M, Jackson J, Appleby B, Bordelon Y, Brannelly P, Brushaber DE, Dickerson B, Dickinson S, Domoto-Reilly K, Faber K, Fields J, Fong J, Foroud T, Forsberg LK, Gavrilova R, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Heuer HW, Hsiung GYR, Huey E, Irwin D, Kantarci K, Karydas A, Kaufer D, Kerwin D, Knopman D, Kornak J, Kramer JH, Kremers W, Kukull W, Litvan I, Ljubenkov P, Lungu C, Mackenzie I, Mendez MF, Miller BL, Onyike C, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rankin KP, Rascovsky K, Roberson ED, Rogalski E, Shaw L, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Weintraub S, Wong B, Wszolek Z, Rademakers R, Boeve BF, Rosen HJ, Boxer AL, Coppola G. Genetic screening of a large series of North American sporadic and familial frontotemporal dementia cases. Alzheimers Dement 2020; 16:118-130. [PMID: 31914217 PMCID: PMC7199807 DOI: 10.1002/alz.12011] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/13/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Advancing Research and Treatment for Frontotemporal Lobar Degeneration (ARTFL) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS) consortia are two closely connected studies, involving multiple North American centers that evaluate both sporadic and familial frontotemporal dementia (FTD) participants and study longitudinal changes. METHODS We screened the major dementia-associated genes in 302 sporadic and 390 familial (symptomatic or at-risk) participants enrolled in these studies. RESULTS Among the sporadic patients, 16 (5.3%) carried chromosome 9 open reading frame 72 (C9orf72), microtubule-associated protein tau (MAPT), and progranulin (GRN) pathogenic variants, whereas in the familial series we identified 207 carriers from 146 families. Of interest, one patient was found to carry a homozygous C9orf72 expansion, while another carried both a C9orf72 expansion and a GRN pathogenic variant. We also identified likely pathogenic variants in the TAR DNA binding protein (TARDBP), presenilin 1 (PSEN1), and valosin containing protein (VCP) genes, and a subset of variants of unknown significance in other rare FTD genes. DISCUSSION Our study reports the genetic characterization of a large FTD series and supports an unbiased sequencing screen, irrespective of clinical presentation or family history.
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Heuer HW, Wang P, Rascovsky K, Wolf A, Appleby B, Bove J, Bordelon Y, Brannelly P, Brushaber DE, Caso C, Coppola G, Dickerson B, Dickinson S, Domoto-Reilly K, Faber K, Ferrall J, Fields J, Fishman A, Fong J, Foroud T, Forsberg LK, Gearhart D, Ghazanfari B, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Haley D, Hsiung GY, Huey E, Irwin D, Jones D, Kantarci K, Karydas A, Kaufer D, Kerwin D, Knopman D, Kornak J, Kramer JH, Kraft R, Kremers WK, Kukull W, Litvan I, Ljubenkov P, Mackenzie IR, Maldonado M, Manoochehri M, McGinnis S, McKinley E, Mendez MF, Miller BL, Onyike C, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Roberson ED, Rogalski E, Sengdy P, Shaw L, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boeve BF, Rosen HJ, Boxer AL. Comparison of sporadic and familial behavioral variant frontotemporal dementia (FTD) in a North American cohort. Alzheimers Dement 2020; 16:60-70. [PMID: 31914226 PMCID: PMC7192555 DOI: 10.1002/alz.12046] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Behavioral variant frontotemporal dementia (bvFTD) may present sporadically or due to an autosomal dominant mutation. Characterization of both forms will improve understanding of the generalizability of assessments and treatments. METHODS A total of 135 sporadic (s-bvFTD; mean age 63.3 years; 34% female) and 99 familial (f-bvFTD; mean age 59.9; 48% female) bvFTD participants were identified. f-bvFTD cases included 43 with known or presumed chromosome 9 open reading frame 72 (C9orf72) gene expansions, 28 with known or presumed microtubule-associated protein tau (MAPT) mutations, 14 with known progranulin (GRN) mutations, and 14 with a strong family history of FTD but no identified mutation. RESULTS Participants with f-bvFTD were younger and had earlier age at onset. s-bvFTD had higher total Neuropsychiatric Inventory Questionnaire (NPI-Q) scores due to more frequent endorsement of depression and irritability. DISCUSSION f-bvFTD and s-bvFTD cases are clinically similar, suggesting the generalizability of novel biomarkers, therapies, and clinical tools developed in either form to the other.
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Staffaroni AM, Cobigo Y, Goh SYM, Kornak J, Bajorek L, Chiang K, Appleby B, Bove J, Bordelon Y, Brannelly P, Brushaber D, Caso C, Coppola G, Dever R, Dheel C, Dickerson BC, Dickinson S, Dominguez S, Domoto-Reilly K, Faber K, Ferrall J, Fields JA, Fishman A, Fong J, Foroud T, Forsberg LK, Gavrilova R, Gearhart D, Ghazanfari B, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Haley D, Heuer HW, Hsiung GY, Huey ED, Irwin DJ, Jones DT, Jones L, Kantarci K, Karydas A, Kaufer DI, Kerwin DR, Knopman DS, Kraft R, Kramer JH, Kremers WK, Kukull WA, Litvan I, Ljubenkov PA, Lucente D, Lungu C, Mackenzie IR, Maldonado M, Manoochehri M, McGinnis SM, McKinley E, Mendez MF, Miller BL, Multani N, Onyike C, Padmanabhan J, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Rascovsky K, Roberson ED, Rogalski E, Sengdy P, Shaw LM, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Weintraub S, Wang P, Wong B, Wszolek Z, Boxer AL, Boeve BF, Rosen HJ. Individualized atrophy scores predict dementia onset in familial frontotemporal lobar degeneration. Alzheimers Dement 2020; 16:37-48. [PMID: 31272932 PMCID: PMC6938544 DOI: 10.1016/j.jalz.2019.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Some models of therapy for neurodegenerative diseases envision starting treatment before symptoms develop. Demonstrating that such treatments are effective requires accurate knowledge of when symptoms would have started without treatment. Familial frontotemporal lobar degeneration offers a unique opportunity to develop predictors of symptom onset. METHODS We created dementia risk scores in 268 familial frontotemporal lobar degeneration family members by entering covariate-adjusted standardized estimates of brain atrophy into a logistic regression to classify asymptomatic versus demented participants. The score's predictive value was tested in a separate group who were followed up longitudinally (stable vs. converted to dementia) using Cox proportional regressions with dementia risk score as the predictor. RESULTS Cross-validated logistic regression achieved good separation of asymptomatic versus demented (accuracy = 90%, SE = 0.06). Atrophy scores predicted conversion from asymptomatic or mildly/questionably symptomatic to dementia (HR = 1.51, 95% CI: [1.16,1.98]). DISCUSSION Individualized quantification of baseline brain atrophy is a promising predictor of progression in asymptomatic familial frontotemporal lobar degeneration mutation carriers.
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Mendez MF, Yerstein O, Jimenez EE. Vicarious Embarrassment or "Fremdscham": Overendorsement in Frontotemporal Dementia. J Neuropsychiatry Clin Neurosci 2020; 32:274-279. [PMID: 31687868 PMCID: PMC7198328 DOI: 10.1176/appi.neuropsych.19030053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The experience of embarrassment signals violations in social norms, and impairment in this social emotion may underlie much of the social dysfunction in behavioral variant frontotemporal dementia (bvFTD). The authors investigated whether impaired self-awareness of embarrassment may distinguish patients with bvFTD early in the course of disease from healthy control subjects (HCs). METHODS Self-reported embarrassment was examined among 18 patients with early bvFTD and 23 HCs by using the 36-item Embarrassability Scale, which includes items of situations eliciting embarrassment for oneself ("self-embarrassment") and embarrassment for others ("vicarious embarrassment"). The two study groups were also compared with the Social Norms Questionnaire (SNQ). The analyses included correlations of SNQ results (total score, violations or "break" errors, and overendorsement of social rules or "overadhere" errors) with Embarrassability Scale scores. RESULTS Patients with bvFTD did not differ from HCs on total or self-embarrassment scores but did have significantly higher vicarious embarrassment scores. Unlike in the HC group, reports of vicarious embarrassment did not differ from reports of self-embarrassment among patients in the bvFTD group. The Embarrassability Score further correlated with overadherence to norms on the SNQ. CONCLUSIONS In the presence of social dysfunction and emotional blunting, these findings suggest that patients with bvFTD rely on their own perspective for a rule-based application of social norms in reporting vicarious embarrassment. The assessment of reports of embarrassment for others may indicate an early and previously unrecognized clinical measure for detecting bvFTD.
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Staffaroni AM, Bajorek L, Casaletto KB, Cobigo Y, Goh SYM, Wolf A, Heuer HW, Elahi FM, Ljubenkov PA, Dever R, Kornak J, Appleby B, Bove J, Bordelon Y, Brannelly P, Brushaber D, Caso C, Coppola G, Dheel C, Dickerson BC, Dickinson S, Dominguez S, Domoto-Reilly K, Faber K, Ferrall J, Fields JA, Fishman A, Fong J, Foroud T, Forsberg LK, Gavrilova R, Gearhart D, Ghazanfari B, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Haley D, Hsiung GY, Huey ED, Irwin DJ, Jones DT, Jones L, Kantarci K, Karydas A, Kaufer DI, Kerwin DR, Knopman DS, Kraft R, Kremers WK, Kukull WA, Litvan I, Lucente D, Lungu C, Mackenzie IR, Maldonado M, Manoochehri M, McGinnis SM, McKinley E, Mendez MF, Miller BL, Multani N, Onyike C, Padmanabhan J, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Rascovsky K, Roberson ED, Rogalski E, Sengdy P, Shaw LM, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Weintraub S, Wang P, Wong B, Wszolek Z, Boxer AL, Boeve BF, Kramer JH, Rosen HJ. Assessment of executive function declines in presymptomatic and mildly symptomatic familial frontotemporal dementia: NIH-EXAMINER as a potential clinical trial endpoint. Alzheimers Dement 2020; 16:11-21. [PMID: 31914230 PMCID: PMC6842665 DOI: 10.1016/j.jalz.2019.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Identifying clinical measures that track disease in the earliest stages of frontotemporal lobar degeneration (FTLD) is important for clinical trials. Familial FTLD provides a unique paradigm to study early FTLD. Executive dysfunction is a clinically relevant hallmark of FTLD and may be a marker of disease progression. METHODS Ninety-three mutation carriers with no symptoms or minimal/questionable symptoms (MAPT, n = 31; GRN, n = 28; C9orf72, n = 34; Clinical Dementia Rating scale plus NACC FTLD Module < 1) and 78 noncarriers enrolled through Advancing Research and Treatment in Frontotemporal Lobar Degeneration/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects studies completed the Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (NIH-EXAMINER) and the UDS neuropsychological battery. Linear mixed-effects models were used to identify group differences in cognition at baseline and longitudinally. We examined associations between cognition, clinical functioning, and magnetic resonance imaging volumes. RESULTS NIH-EXAMINER scores detected baseline and differences in slopes between carriers and noncarriers, even in carriers with a baseline Clinical Dementia Rating scale plus NACC FTLD Module = 0. NIH-EXAMINER declines were associated with worsening clinical symptoms and brain volume loss. DISCUSSION The NIH-EXAMINER is sensitive to cognitive changes in presymptomatic familial FTLD and is a promising surrogate endpoint.
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Restrepo-Martínez M, Espinola-Nadurille M, Bayliss L, Díaz-Meneses I, Kerik NE, Mendez MF, Ramírez-Bermúdez J. FDG-PET in Cotard syndrome before and after treatment: can functional brain imaging support a two-factor hypothesis of nihilistic delusions? Cogn Neuropsychiatry 2019; 24:470-480. [PMID: 31597522 DOI: 10.1080/13546805.2019.1676710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Cotard syndrome is a neuropsychiatric entity recognised by the presence of nihilistic delusions. Although different models have been proposed for the development of monothematic delusions, including Cotard syndrome, functional neuroanatomical models are lacking.Methods: A case report of a 19-year old male with autoimmune encephalitis and Cotard syndrome, in whom Positron Emission Tomography (18F-FDG-PET) scans were performed before and after successful treatment with electroconvulsive therapy (ECT), is presented. Literature review on brain imaging is provided to discuss a functional neuroanatomical model of Cotard syndrome, in accordance with the two-factor theory of delusions.Results: The patient's 18F-FDG-PET showed marked insular and prefrontal metabolic abnormalities. Except for insular hypometabolism, metabolic abnormalities improved after ECT. Previously reported structural neuroimaging studies in Cotard syndrome showed a predominance of right hemisphere lesions, in which frontal lobes were more frequently involved, followed by parietal and temporal lesions. Functional neuroimaging studies reported abnormalities in frontoparietal circuits as well as midline structures included in the "default mode network".Conclusions: Abnormalities in the functioning of the insular cortex and the prefrontal cortex could be related to the development of nihilistic delusions when a two-factor theory of delusions is considered.
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Mendez MF. Bilingualism and Dementia: Cognitive Reserve to Linguistic Competency. J Alzheimers Dis 2019; 71:377-388. [DOI: 10.3233/jad-190397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jimenez EE, Liang LJF, Mendez MF. P2-511: NOT ALL DEMENTIA CAREGIVING IS THE SAME: BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA COMPARED TO YOUNG-ONSET ALZHEIMER'S DISEASE CAREGIVER BURDEN. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Riedel BC, Mendez MF, Desarzant R, Melrose RJ, Jimenez EE, Thompson PM. P3-424: SUBJECT SPECIFIC WHOLE-BRAIN TRACTOGRAPHY DIFFERENCES BETWEEN AMNESTIC AND NON-AMNESTIC EARLY-ONSET ALZHEIMER'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Meysami S, Raji CA, Merrill DA, Porter VR, Mendez MF. IC-P-092: MRI VOLUMETRIC QUANTIFICATION IN COGNITIVELY-IMPAIRED PERSONS WITH A PRIOR HISTORY OF TRAUMATIC BRAIN INJURY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mendez MF, Montserratt L, Liang LJF, Chavez D, Jimenez EE, Maurer JJ, Laffey M. P4-359: NEUROPSYCHOLOGICAL SIMILARITIES AND DIFFERENCES BETWEEN AMNESTIC ALZHEIMER'S DISEASE AND ITS NON-AMNESTIC VARIANTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parand L, Yerstein O, Desarzant R, Mendez MF. P1-292: UPDATES ON LIMB APRAXIA IN DEMENTIA. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mendez MF, Carr AR, Jimenez EE, Riedel BC, Thompson PM. O4-03-02: DIFFERENTIATING FRONTOTEMPORAL DEMENTIA FROM ALZHEIMER'S DISEASE ON MEASURES OF EMPATHY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Apostolova LG, Iaccarino L, Collins JA, Aisen PS, Borowski BJ, Eloyan A, Fagan AM, Foroud TM, Gatsonis C, Jack CR, Kramer JH, Koeppe RA, Saykin AJ, Toga AW, Vemuri P, Day GS, Graff-Radford NR, Honig LS, Jones DT, Masdeu JC, Mendez MF, Onyike CU, Rogalski EJ, Salloway S, Wolk DA, Wingo TS, Rabinovici GD, Dickerson BC, Carrillo MC. P1-349: ADVANCING CLINICAL AND BIOMARKER RESEARCH IN AD: THE LEAD STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mendez MF, Montserratt L, Chavez D, Jimenez EE. P3-456: LANGUAGE LOSS IN BILINGUAL PATIENTS WITH ALZHEIMER'S DISEASE: A PILOT STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mendez MF, Moheb N, Desarzant RE, Teng EH. The Progressive Acalculia Presentation of Parietal Variant Alzheimer's Disease. J Alzheimers Dis 2019; 63:941-948. [PMID: 29710718 DOI: 10.3233/jad-180024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many patients with early-onset Alzheimer's disease (EOAD; age of onset <65 years) have non-amnestic presentations involving language (logopenic primary progressive aphasia, lvPPA), visuospatial abilities (posterior cortical atrophy, PCA), and even asymmetric symptoms consistent with corticobasal syndrome (CBS). An inferior parietal lobule variant of EOAD commonly presents with progressive difficulty with calculations. METHODS We reviewed 276 EOAD patients for presentations with predominant acalculia. These patients were diagnosed with clinically probable Alzheimer's disease (AD) verified by positron emission tomography (PET) or cerebrospinal fluid amyloid-β or tau biomarkers. RESULTS We identified 18 (9M/9F) (6.5%) EOAD patients with progressive acalculia that did not meet most criteria for lvPPA, visual PCA, or CBS. Their ages of onset and presentation were 56.6 (5.0) and 59.4 (6.5), respectively. Their acalculia was consistent with a primary acalculia ("anarithmetia") not explained by language or visuospatial impairments. Many also had anomia (14/18), ideomotor apraxia (13/18), and the complete Gerstmann's syndrome (7/18). Visual analysis of their diverse magnetic resonance imaging disclosed biparietal atrophy, disproportionately worse on the left. CONCLUSIONS Primary acalculia may be the most common manifestation of an inferior parietal presentation of EOAD affecting the left intraparietal sulcus. This parietal variant also commonly involves progressive anomia, ideomotor apraxia, and other elements of Gerstmann's syndrome. The early recognition of patients with this variant, which is distinguishable from lvPPA, visual PCA, or CBS, would be facilitated by its recognition as a unique subtype of EOAD.
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Carr AR, Jimenez EE, Thompson PM, Mendez MF. Frontotemporal asymmetry in socioemotional behavior: A pilot study in frontotemporal dementia. Soc Neurosci 2019; 15:15-24. [PMID: 31064266 DOI: 10.1080/17470919.2019.1614478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical studies report abnormal socioemotional behavior in patients with right frontotemporal disease, but neuroimaging studies of socioemotional behavior usually show bilateral activations in normal subjects. This discrepancy suggests that impaired interhemispheric collaboration for socioemotional functions results from asymmetric frontotemporal disease. Behavioral variant frontotemporal dementia (bvFTD) can clarify the contribution of direction-independent frontotemporal asymmetry. In a two-part study, we evaluated bvFTD patients using socioemotional scales and magnetic and resonance imaging measures. Part A compared 18 patients on scales of social dysfunction and emotional intelligence with degree of asymmetry in frontal lobe volumes and analyzed differences between lower and higher asymmetry groups. Part B compared 24 patients on scales of social observation and emotional blunting with degree of asymmetry in frontotemporal cortical thickness using multiple linear regression. Both results showed that left or right hemispheric-specific contributions did not account for all socioemotional differences and that frontal lobe and frontotemporal differences in atrophy between the hemispheres accounted for significant variance in abnormalities in social and emotional behavior. These preliminary results indicate that the degree of frontal lobe and frontotemporal asymmetric involvement, regardless of direction or laterality, significantly contribute to socioemotional dysfunction and support the hypothesis that interhemispheric collaboration is important for complex socioemotional behavior.
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Laffey M, Darby AJ, Cline MG, Teng E, Mendez MF. The utility of clinical criteria in patients with chronic traumatic encephalopathy. NeuroRehabilitation 2019; 43:431-441. [PMID: 30412511 DOI: 10.3233/nre-182452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive traumatic brain injury (TBI) is associated with chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disorder characterized by Alzheimer-like changes in the brain. CTE has been defined through neuropathological findings among deceased athletes and others exposed to repetitive TBI, but to date there are no definitive clinical criteria for CTE. OBJECTIVE To evaluate the utility of currently proposed clinical criteria for CTE and suggest improvements. METHODS We describe two well-characterized patients referred for evaluation of CTE and apply the four major proposed criteria for CTE. These criteria were further assessed in a cohort of patients referred to a neurobehavior clinic with or without a history of TBI. RESULTS Without a CTE biomarker, the current criteria were of limited utility when applied to the two patient and the Neurobehavior cohort. Six items were extracted as potentially improving the clinical diagnosis of CTE: length of exposure to head impacts, a progressive course, specific psychiatric symptoms, frontal-executive dysfunction, parkinsonism and tremors, and targeted findings on neuroimaging. CONCLUSIONS The prevention and neurorehabilitation of CTE depends on clinical diagnosis, but, without a biomarker, the clinical diagnosis of CTE remains difficult. This report suggests that clinical criteria for CTE may be greatly improved with emphasis on several critical historical and clinical correlates of CTE.
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Moheb N, Charuworn K, Ashla MM, Desarzant R, Chavez D, Mendez MF. Repetitive Behaviors in Frontotemporal Dementia: Compulsions or Impulsions? J Neuropsychiatry Clin Neurosci 2019; 31:132-136. [PMID: 30537913 PMCID: PMC6535208 DOI: 10.1176/appi.neuropsych.18060148] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The presence of repetitive behaviors is one of the core criteria for behavioral variant frontotemporal dementia (bvFTD). Patients with bvFTD often have perseverative, stereotyped, or compulsive-ritualistic behavior as an early aspect of their disorder. It is unclear whether such behaviors are related to compulsions, as in obsessive-compulsive disorder (OCD), or are part of the impulse disorder spectrum. METHODS The authors investigated early (within 3 years) repetitive behaviors among 93 well-characterized patients who met International Consensus Criteria for clinically probable bvFTD and compared the results with the literature on OCD. The most common repetitive behaviors among 59 (63.4%) bvFTD patients were stereotypies of speech (35.5%), simple repetitive movements (15.2%-18.6%), hoarding and collecting (16.9%), and excessive or unnecessary trips to the bathroom (13.5%). RESULTS Only hoarding and collecting was significantly common in both bvFTD and OCD; otherwise, the bvFTD patients had very low frequencies of the common OCD behaviors of checking, cleaning, counting, and ordering. The repetitive behaviors in bvFTD were not associated with verbalized anxiety, obsessional ideation, or reports of relief after completing the act. In contrast, these behaviors were often triggered by environmental stimuli and could be temporarily prevented from completion without undue distress. Finally, among the bvFTD patients, the repetitive behaviors were always associated with impulsive or disinhibited behaviors, such as inappropriate verbal or physical behavior. CONCLUSIONS These findings suggest that the repetitive behaviors in bvFTD are repetitive impulsions, possibly from specific involvement of frontostriatal-anterior temporal pathology.
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Mendez MF, Chavez D, Akhlaghipour G. Bilingualism Delays Expression of Alzheimer's Clinical Syndrome. Dement Geriatr Cogn Disord 2019; 48:281-289. [PMID: 32045913 PMCID: PMC7195235 DOI: 10.1159/000505872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the effects of bilingualism on the emergence of Alzheimer's clinical syndrome. BACKGROUND Studies have proposed an increase in cognitive and neural reserve from the management and control of two languages, with a consequent delayed expression of dementia. METHODS In a clinic with a large immigrant population, we identified 253 patients with probable Alzheimer's disease (AD) with intermediate or high evidence of AD pathophysiological process. These patients were reviewed for demographic variables, native language (L1) other than English, ages of onset and presentation, Mini-Mental State Examination (MMSE), digit spans, word fluencies, naming, and memory. RESULTS Among these patients, 74 (29.2%) were bilinguals with various L1s (Farsi, Spanish, Chinese, Tagalog, Arabic, others). When compared to the 179 monolingual AD patients, those who were bilingual had significant delays in ages of onset and presentation of approximately 4 years (p = 0.003). These delays persisted despite bilinguals having worse MMSE scores on presentation. There were no significant group differences on other variables except for worse naming in English among bilinguals versus monolinguals. Caregiver/informants reported that 66 (89.2%) of the 74 bilingual AD patients had gradually regressed to the predominant use of their L1. CONCLUSIONS In line with published reports worldwide, we found that bilingualism delays the expression of Alzheimer's clinical syndrome. We also found frequent reversion to the first learned language. These findings suggest that, among bilinguals, the availability of an L1 "back-up" either facilitates compensation or masks emergence of the early symptoms of dementia.
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Boxer AL, Heuer HW, Wang P, Rascovsky K, Rosen HJ, Boeve BF, Grossman M, Coppola G, Dickerson BC, Bordelon YM, Kimiko DR, Faber K, Feldman HH, Fields JA, Fong J, Foroud TM, Ghoshal N, Graff-Radford NR, Robin Hsiung GY, Huey ED, Irwin D, Kantarci K, Kaufer D, Karydas AM, Kerwin DR, Knopman DS, Kornak J, Kramer JH, Kukull WA, Litvan I, Lungu C, Mackenzie IR, Mendez MF, Miller BL, Onyike CU, Pantelyat A, Rademakers R, Roberson ED, Sutherland M, Tartaglia MC, Toga AW, Weintraub S, Rogalski EJ, Wszolek Z. O2‐14‐06: DIFFERENCES BETWEEN SPORADIC AND FAMILIAL BEHAVIORAL VARIANT FTD IN ADVANCING RESEARCH AND TREATMENT FOR FTLD (ARTFL) CLINICAL RESEARCH CONSORTIUM. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heuer HW, Boxer AL, Rosen HJ, Boeve BF, Grossman M, Dickerson BC, Appleby B, Bordelon YM, Brushaber D, Kimiko DR, Faber K, Feldman HH, Fields JA, Fong J, Foroud TM, Ghoshal N, Graff-Radford NR, Robin Hsiung GY, Huey ED, Irwin DJ, Kantarci K, Kaufer D, Karydas AM, Kerwin DR, Knopman DS, Kornak J, Kramer JH, Kukull WA, Litvan I, Lungu C, Mackenzie IR, Mendez MF, Miller BL, Onyike CU, Pantelyat A, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Roberson ED, Sutherland M, Tartaglia C, Toga AW, Weintraub S, Wszolek Z. O2‐14‐02: THE CLINICAL SPECTRUM OF FRONTOTEMPORAL LOBAR DEGENERATION IN NORTH AMERICA: BASELINE CHARACTERISTICS OF THE FIRST 912 PARTICIPANTS FROM THE ADVANCING RESEARCH AND TREATMENT IN FTLD (ARTFL) CLINICAL RESEARCH CONSORTIUM. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chu SA, Flagan TM, Jiskoot LC, Seeley WW, Papma JM, Deng J, Rosen HJ, Boeve BF, Boxer AL, Heuer HW, Brushaber D, Grossman M, Coppola G, Dickerson BC, Bordelon YM, Dheel C, Faber K, Feldman HH, Fields JA, Fong J, Foroud TM, Forsberg LK, Gavrilova RH, Ghoshal N, Graff-Radford NR, Robin Hsiung GY, Huey ED, Irwin D, Kantarci K, Kaufer D, Karydas AM, Klein A, Knopman DS, Kornak J, Kramer JH, Kukull WA, Lapid MI, Laxineta S, Litvan I, Mackenzie IR, Mendez MF, Miller BL, Onyike CU, Pantelyat A, Potter M, Rademakers R, Roberson ED, Tartaglia MC, Tatton N, Toga AW, Vetor A, Weintraub S, Wong B, Wszolek Z, Swieten JC, Lee SE. P1‐433: GRAY MATTER DEFICITS IN SYMPTOMATIC AND PRESYMPTOMATIC
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MUTATION CARRIERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Carr AR, Mendez MF. Affective Empathy in Behavioral Variant Frontotemporal Dementia: A Meta-Analysis. Front Neurol 2018; 9:417. [PMID: 29946291 PMCID: PMC6005854 DOI: 10.3389/fneur.2018.00417] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Empathy deficits are a widely recognized symptom in the behavioral variant frontotemporal dementia (bvFTD), and although several reviews have examined cognitive empathy deficits, there are no meta-analytic studies on affective empathy deficits. Objective: Identify salience of affective empathy in bvFTD. Method: A thorough review of affective empathy found 139 possible studies, but only 10 studies included measures of affective empathy and met standardized criteria. Results: BvFTD patients demonstrated a modest impairment compared to controls across all tasks (d = 0.98). Empathic concern as measured by the interpersonal reactivity index was particularly effected (d = 1.12). Conclusions: This study provides evidence for an increased commitment to observing affective empathy in bvFTD and capturing its role in the disorder.
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