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Restrepo-Martínez M, Ramirez-Bermudez J, Chacon-Gonzalez J, Ruiz-Garcia R, Malik R, Finger E. Defining repetitive behaviours in frontotemporal dementia. Brain 2024; 147:1149-1165. [PMID: 38134315 DOI: 10.1093/brain/awad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Repetitive behaviours are common manifestations of frontotemporal dementia (FTD). Patients with FTD exhibit various types of repetitive behaviours with unique behavioural and cognitive substrates, including compulsivity, lack of impulse control, stereotypy and hoarding. Other sources of repetitive behaviours, such as restrictive interests and insistence on sameness, may also be seen in FTD. Although repetitive behaviours are highly prevalent and potentially discriminatory in this population, their expression varies widely between patients, and the field lacks consensus about the classification of these behaviours. Terms used to describe repetitive behaviours in FTD are highly heterogeneous and may lack precise definitions. This lack of harmonization of the definitions for distinct forms of repetitive behaviour limits the ability to differentiate between pathological behaviours and impedes understanding of their underlying mechanisms. This review examines established definitions of well-characterized repetitive behaviours in other neuropsychiatric disorders and proposes operational definitions applicable to patients with FTD. Building on extant models of repetitive behaviours in non-human and lesion work and models of social behavioural changes in FTD, we describe the potential neurocognitive bases for the emergence of different types of repetitive behaviours in FTD and their potential perpetuation by a predisposition towards habit formation. Finally, examples of distinct therapeutic approaches for different forms of repetitive behaviours are highlighted, along with future directions to accurately classify, measure and treat these symptoms when they impair quality of life.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Jacobo Chacon-Gonzalez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Ramiro Ruiz-Garcia
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Rubina Malik
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
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Liu MN, Hu LY, Tsai CF, Hong CJ, Chou YH, Chang CC, Yang KC, You ZH, Lau CI. Abnormalities of Hippocampal Subfield and Amygdalar Nuclei Volumes and Clinical Correlates in Behavioral Variant Frontotemporal Dementia with Obsessive-Compulsive Behavior-A Pilot Study. Brain Sci 2023; 13:1582. [PMID: 38002542 PMCID: PMC10669726 DOI: 10.3390/brainsci13111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The hippocampus (HP) and amygdala are essential structures in obsessive-compulsive behavior (OCB); however, the specific role of the HP in patients with behavioral variant frontotemporal dementia (bvFTD) and OCB remains unclear. (2) Objective: We investigated the alterations of hippocampal and amygdalar volumes in patients with bvFTD and OCB and assessed the correlations of clinical severity with hippocampal subfield and amygdalar nuclei volumes in bvFTD patients with OCB. (3) Materials and methods: Eight bvFTD patients with OCB were recruited and compared with eight age- and sex-matched healthy controls (HCs). Hippocampal subfield and amygdalar nuclei volumes were analyzed automatically using a 3T magnetic resonance image and FreeSurfer v7.1.1. All participants completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Neuropsychiatric Inventory (NPI), and Frontal Behavioral Inventory (FBI). (4) Results: We observed remarkable reductions in bilateral total hippocampal volumes. Compared with the HCs, reductions in the left hippocampal subfield volume over the cornu ammonis (CA)1 body, CA2/3 body, CA4 body, granule cell layer, and molecular layer of the dentate gyrus (GC-ML-DG) body, molecular layer of the HP body, and hippocampal tail were more obvious in patients with bvFTD and OCB. Right subfield volumes over the CA1 body and molecular layer of the HP body were more significantly reduced in bvFTD patients with OCB than in those in HCs. We observed no significant difference in amygdalar nuclei volume between the groups. Among patients with bvFTD and OCB, Y-BOCS score was negatively correlated with left CA2/3 body volume (τb = -0.729, p < 0.001); total NPI score was negatively correlated with left GC-ML-DG body (τb = -0.648, p = 0.001) and total bilateral hippocampal volumes (left, τb = -0.629, p = 0.002; right, τb = -0.455, p = 0.023); and FBI score was negatively correlated with the left molecular layer of the HP body (τb = -0.668, p = 0.001), CA4 body (τb = -0.610, p = 0.002), and hippocampal tail volumes (τb = -0.552, p < 0.006). Mediation analysis confirmed these subfield volumes as direct biomarkers for clinical severity, independent of medial and lateral orbitofrontal volumes. (5) Conclusions: Alterations in hippocampal subfield volumes appear to be crucial in the pathophysiology of OCB development in patients with bvFTD.
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Grants
- 102-2314-B-075 -082, 105-2314-B-075 -024 -MY2, 104-2314-B-075 -039, 111-2314-B-075 -015 Ministry of Science and Technology, Taiwan
- V108B-009, V112B-039, V110B-028, V111B-033 Taipei Veterans General Hospital, Taiwan
- RVHCY111024 Chiayi branch of Taichung Veterans General Hospital, Taiwan
- 2021SKHADR016 Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
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Affiliation(s)
- Mu-N Liu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chen-Jee Hong
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- Center for Quality Management, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Kai-Chun Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-N.L.); (C.-J.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Zi-Hong You
- Department of Nephrology, Chiayi Branch, Taichung Veterans General Hospital, Chiayi 60090, Taiwan
| | - Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Rd., Shilin Dist., Taipei 11101, Taiwan
- Department of Neurology, University Hospital, Taipai, Macao SAR, China
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, 17 Queen Square, University College London, London WC1N 3AZ, UK
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3
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Sokołowski A, Roy ARK, Goh SM, Hardy EG, Datta S, Cobigo Y, Brown JA, Spina S, Grinberg L, Kramer J, Rankin KP, Seeley WW, Sturm VE, Rosen HJ, Miller BL, Perry DC. Neuropsychiatric symptoms and imbalance of atrophy in behavioral variant frontotemporal dementia. Hum Brain Mapp 2023; 44:5013-5029. [PMID: 37471695 PMCID: PMC10502637 DOI: 10.1002/hbm.26428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
Behavioral variant frontotemporal dementia is characterized by heterogeneous frontal, insular, and anterior temporal atrophy patterns that vary along left-right and dorso-ventral axes. Little is known about how these structural imbalances impact clinical symptomatology. The goal of this study was to assess the frequency of frontotemporal asymmetry (right- or left-lateralization) and dorsality (ventral or dorsal predominance of atrophy) and to investigate their clinical correlates. Neuropsychiatric symptoms and structural images were analyzed for 250 patients with behavioral variant frontotemporal dementia. Frontotemporal atrophy was most often symmetric while left-lateralized (9%) and right-lateralized (17%) atrophy were present in a minority of patients. Atrophy was more often ventral (32%) than dorsal (3%) predominant. Patients with right-lateralized atrophy were characterized by higher severity of abnormal eating behavior and hallucinations compared to those with left-lateralized atrophy. Subsequent analyses clarified that eating behavior was associated with right atrophy to a greater extent than a lack of left atrophy, and hallucinations were driven mainly by right atrophy. Dorsality analyses showed that anxiety, euphoria, and disinhibition correlated with ventral-predominant atrophy. Agitation, irritability, and depression showed greater severity with a lack of regional atrophy, including in dorsal regions. Aberrant motor behavior and apathy were not explained by asymmetry or dorsality. This study provides additional insight into how anatomical heterogeneity influences the clinical presentation of patients with behavioral variant frontotemporal dementia. Behavioral symptoms can be associated not only with the presence or absence of focal atrophy, but also with right/left or dorsal/ventral imbalance of gray matter volume.
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Affiliation(s)
- Andrzej Sokołowski
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ashlin R. K. Roy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sheng‐Yang M. Goh
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Emily G. Hardy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Samir Datta
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jesse A. Brown
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lea Grinberg
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Virginia E. Sturm
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - David C. Perry
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Ohm DT, Rhodes E, Bahena A, Capp N, Lowe M, Sabatini P, Trotman W, Olm CA, Phillips J, Prabhakaran K, Rascovsky K, Massimo L, McMillan C, Gee J, Tisdall MD, Yushkevich PA, Lee EB, Grossman M, Irwin DJ. Neuroanatomical and cellular degeneration associated with a social disorder characterized by new ritualistic belief systems in a TDP-C patient vs. a Pick patient. Front Neurol 2023; 14:1245886. [PMID: 37900607 PMCID: PMC10600461 DOI: 10.3389/fneur.2023.1245886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 10/31/2023] Open
Abstract
Frontotemporal dementia (FTD) is a spectrum of clinically and pathologically heterogenous neurodegenerative dementias. Clinical and anatomical variants of FTD have been described and associated with underlying frontotemporal lobar degeneration (FTLD) pathology, including tauopathies (FTLD-tau) or TDP-43 proteinopathies (FTLD-TDP). FTD patients with predominant degeneration of anterior temporal cortices often develop a language disorder of semantic knowledge loss and/or a social disorder often characterized by compulsive rituals and belief systems corresponding to predominant left or right hemisphere involvement, respectively. The neural substrates of these complex social disorders remain unclear. Here, we present a comparative imaging and postmortem study of two patients, one with FTLD-TDP (subtype C) and one with FTLD-tau (subtype Pick disease), who both developed new rigid belief systems. The FTLD-TDP patient developed a complex set of values centered on positivity and associated with specific physical and behavioral features of pigs, while the FTLD-tau patient developed compulsive, goal-directed behaviors related to general themes of positivity and spirituality. Neuroimaging showed left-predominant temporal atrophy in the FTLD-TDP patient and right-predominant frontotemporal atrophy in the FTLD-tau patient. Consistent with antemortem cortical atrophy, histopathologic examinations revealed severe loss of neurons and myelin predominantly in the anterior temporal lobes of both patients, but the FTLD-tau patient showed more bilateral, dorsolateral involvement featuring greater pathology and loss of projection neurons and deep white matter. These findings highlight that the regions within and connected to anterior temporal lobes may have differential vulnerability to distinct FTLD proteinopathies and serve important roles in human belief systems.
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Affiliation(s)
- Daniel T. Ohm
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Emma Rhodes
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Alejandra Bahena
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Noah Capp
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - MaKayla Lowe
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Philip Sabatini
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Winifred Trotman
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher A. Olm
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Karthik Prabhakaran
- Penn Image Computing and Science Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Lauren Massimo
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Corey McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - James Gee
- Penn Image Computing and Science Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - M. Dylan Tisdall
- Center for Advanced Magnetic Resonance Imaging and Spectroscopy, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Paul A. Yushkevich
- Penn Image Computing and Science Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward B. Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - David J. Irwin
- Penn Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
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5
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Obsessive-compulsive symptoms associated with left temporal dysembryoplastic neuroepithelial tumor: A case report. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Tanguy D, Batrancourt B, Estudillo-Romero A, Baxter JSH, Le Ber I, Bouzigues A, Godefroy V, Funkiewiez A, Chamayou C, Volle E, Saracino D, Rametti-Lacroux A, Morandi X, Jannin P, Levy R, Migliaccio R. An ecological approach to identify distinct neural correlates of disinhibition in frontotemporal dementia. Neuroimage Clin 2022; 35:103079. [PMID: 35700600 PMCID: PMC9194654 DOI: 10.1016/j.nicl.2022.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
Disinhibition is a core symptom of many neurodegenerative diseases, particularly frontotemporal dementia, and is a major cause of stress for caregivers. While a distinction between behavioural and cognitive disinhibition is common, an operational definition of behavioural disinhibition is still missing. Furthermore, conventional assessment of behavioural disinhibition, based on questionnaires completed by the caregivers, often lacks ecological validity. Therefore, their neuroanatomical correlates are non-univocal. In the present work, we used an original behavioural approach in a semi-ecological situation to assess two specific dimensions of behavioural disinhibition: compulsivity and social disinhibition. First, we investigated disinhibition profile in patients compared to controls. Then, to validate our approach, compulsivity and social disinhibition scores were correlated with classic cognitive tests measuring disinhibition (Hayling Test) and social cognition (mini-Social cognition & Emotional Assessment). Finally, we disentangled the anatomical networks underlying these two subtypes of behavioural disinhibition, taking in account the grey (voxel-based morphometry) and white matter (diffusion tensor imaging tractography). We included 17 behavioural variant frontotemporal dementia patients and 18 healthy controls. We identified patients as more compulsive and socially disinhibited than controls. We found that behavioural metrics in the semi-ecological task were related to cognitive performance: compulsivity correlated with the Hayling test and both compulsivity and social disinhibition were associated with the emotion recognition test. Based on voxel-based morphometry and tractography, compulsivity correlated with atrophy in the bilateral orbitofrontal cortex, the right temporal region and subcortical structures, as well as with alterations of the bilateral cingulum and uncinate fasciculus, the right inferior longitudinal fasciculus and the right arcuate fasciculus. Thus, the network of regions related to compulsivity matched the "semantic appraisal" network. Social disinhibition was associated with bilateral frontal atrophy and impairments in the forceps minor, the bilateral cingulum and the left uncinate fasciculus, regions corresponding to the frontal component of the "salience" network. Summarizing, this study validates our semi-ecological approach, through the identification of two subtypes of behavioural disinhibition, and highlights different neural networks underlying compulsivity and social disinhibition. Taken together, these findings are promising for clinical practice by providing a better characterisation of inhibition disorders, promoting their detection and consequently a more adapted management of patients.
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Affiliation(s)
- Delphine Tanguy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - John S H Baxter
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Isabelle Le Ber
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Arabella Bouzigues
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Valérie Godefroy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Aurélie Funkiewiez
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Céline Chamayou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Emmanuelle Volle
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Dario Saracino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Armelle Rametti-Lacroux
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Xavier Morandi
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Pierre Jannin
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Richard Levy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Raffaella Migliaccio
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France.
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7
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Nelson A, Russell LL, Peakman G, Convery RS, Bouzigues A, Greaves CV, Bocchetta M, Cash DM, van Swieten JC, Jiskoot L, Moreno F, Sanchez-Valle R, Laforce R, Graff C, Masellis M, Tartaglia MC, Rowe JB, Borroni B, Finger E, Synofzik M, Galimberti D, Vandenberghe R, de Mendonça A, Butler CR, Gerhard A, Ducharme S, Le Ber I, Santana I, Pasquier F, Levin J, Otto M, Sorbi S, Rohrer JD, Almeida MR, Anderl‐Straub S, Andersson C, Antonell A, Archetti S, Arighi A, Balasa M, Barandiaran M, Bargalló N, Bartha R, Bender B, Benussi A, Bertoux M, Bertrand A, Bessi V, Black S, Bocchetta M, Borrego‐Ecija S, Bras J, Brice A, Bruffaerts R, Camuzat A, Cañada M, Cantoni V, Caroppo P, Cash D, Castelo‐Branco M, Colliot O, Cope T, Deramecourt V, Arriba M, Di Fede G, Díez A, Duro D, Fenoglio C, Ferrari C, Ferreira CB, Fox N, Freedman M, Fumagalli G, Funkiewiez A, Gabilondo A, Gasparotti R, Gauthier S, Gazzina S, Giaccone G, Gorostidi A, Greaves C, Guerreiro R, Heller C, Hoegen T, Indakoetxea B, Jelic V, Karnath H, Keren R, Kuchcinski G, Langheinrich T, Lebouvier T, Leitão MJ, Lladó A, Lombardi G, Loosli S, Maruta C, Mead S, Meeter L, Miltenberger G, Minkelen R, Mitchell S, Moore K, Nacmias B, Nelson A, Öijerstedt L, Olives J, Ourselin S, Padovani A, Panman J, Papma JM, Pijnenburg Y, Polito C, Premi E, Prioni S, Prix C, Rademakers R, Redaelli V, Rinaldi D, Rittman T, Rogaeva E, Rollin A, Rosa‐Neto P, Rossi G, Rossor M, Santiago B, Saracino D, Sayah S, Scarpini E, Schönecker S, Seelaar H, Semler E, Shafei R, Shoesmith C, Swift I, Tábuas‐Pereira M, Tainta M, Taipa R, Tang‐Wai D, Thomas DL, Thompson P, Thonberg H, Timberlake C, Tiraboschi P, Todd E, Van Damme P, Vandenbulcke M, Veldsman M, Verdelho A, Villanua J, Warren J, Wilke C, Wlasich E, Zetterberg H, Zulaica M. The CBI-R detects early behavioural impairment in genetic frontotemporal dementia. Ann Clin Transl Neurol 2022; 9:644-658. [PMID: 35950369 PMCID: PMC9082390 DOI: 10.1002/acn3.51544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Behavioural dysfunction is a key feature of genetic frontotemporal dementia (FTD) but validated clinical scales measuring behaviour are lacking at present. METHODS We assessed behaviour using the revised version of the Cambridge Behavioural Inventory (CBI-R) in 733 participants from the Genetic FTD Initiative study: 466 mutation carriers (195 C9orf72, 76 MAPT, 195 GRN) and 267 non-mutation carriers (controls). All mutation carriers were stratified according to their global CDR plus NACC FTLD score into three groups: asymptomatic (CDR = 0), prodromal (CDR = 0.5) and symptomatic (CDR = 1+). Mixed-effects models adjusted for age, education, sex and family clustering were used to compare between the groups. Neuroanatomical correlates of the individual domains were assessed within each genetic group. RESULTS CBI-R total scores were significantly higher in all CDR 1+ mutation carrier groups compared with controls [C9orf72 mean 70.5 (standard deviation 27.8), GRN 56.2 (33.5), MAPT 62.1 (36.9)] as well as their respective CDR 0.5 groups [C9orf72 13.5 (14.4), GRN 13.3 (13.5), MAPT 9.4 (10.4)] and CDR 0 groups [C9orf72 6.0 (7.9), GRN 3.6 (6.0), MAPT 8.5 (13.3)]. The C9orf72 and GRN 0.5 groups scored significantly higher than the controls. The greatest impairment was seen in the Motivation domain for the C9orf72 and GRN symptomatic groups, whilst in the symptomatic MAPTgroup, the highest-scoring domains were Stereotypic and Motor Behaviours and Memory and Orientation. Neural correlates of each CBI-R domain largely overlapped across the different mutation carrier groups. CONCLUSIONS The CBI-R detects early behavioural change in genetic FTD, suggesting that it could be a useful measure within future clinical trials.
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Affiliation(s)
- Annabel Nelson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Georgia Peakman
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Arabella Bouzigues
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | | | - Lize Jiskoot
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia Universitary Hospital, San Sebastian, Spain.,Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec, Canada
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Karolinska Institutet, Solna, Sweden.,Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE, Tübingen, Germany
| | - Daniela Galimberti
- Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy.,University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Neurology Service, University Hospitals Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK.,Department of Brain Sciences, Imperial College London, London, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, QC, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Département de Neurologie, Centre de référence des démences rares ou précoces, IM2A, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Reference Network for Rare Neurological Diseases (ERN-RND), European Union
| | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Florence Pasquier
- Univ Lille, Lille, France.,Inserm 1172, Lille, France.,CHU, CNR-MAJ, Labex Distalz, LiCEND Lille, Lille, France
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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Paranhos T, Lucas T, de Salles A, Moll J, de Oliveira-Souza R. A presumptive association between obsessive compulsions and asymmetric temporal lobe atrophy: a case report. J Med Case Rep 2022; 16:21. [PMID: 35045865 PMCID: PMC8772087 DOI: 10.1186/s13256-021-03228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While semantic dementia and behavioral variant frontotemporal dementia are classically related to this syndrome, the logopenic variant of primary progressive aphasia has been less commonly reported. This case report aims to give a pictorial description of a case in which a patient with asymmetric temporal lobe atrophy presented with the logopenic variant of primary progressive aphasia and complex rituals of cleanliness. Case presentation We report on the case of a 68-year-old, right-handed White woman with complex rituals and progressive speech impairment. The obsessive–compulsive rituals represented an exacerbation of lifelong preoccupations with cleanliness and orderliness that were praised by her relatives. Neuropsychological assessment revealed a striking impairment of language and memory, with relative sparing of tool-use praxis and visuospatial skills. Magnetic resonance imaging and 18fluorodeoxyglucose-positron emission tomography scans showed bilateral asymmetrical temporal lobe atrophy and hypometabolism. A year later, she was still able to entertain conversation for a short while, but her vocabulary and fluency had further declined. Praxis and visuospatial skills remained intact. She did not experience pathological elation, delusions, or hallucinations. The disease followed a relentless progression into a partial Klüver–Bucy syndrome, abulia, and terminal dementia. She died from acute myocardial infarction 8 years after the onset of aphasia. The symptoms and their temporal course supported a diagnosis of logopenic variant of primary progressive aphasia due to asymmetric temporal variant frontotemporal lobar degeneration. Conclusions This report gives a pictorial description of a temporal variant of frontotemporal dementia in a patient who presented with worsening of a lifelong obsessive–compulsive disorder and logopenic variant of primary progressive aphasia. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03228-z.
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Peet BT, Spina S, Mundada N, La Joie R. Neuroimaging in Frontotemporal Dementia: Heterogeneity and Relationships with Underlying Neuropathology. Neurotherapeutics 2021; 18:728-752. [PMID: 34389969 PMCID: PMC8423978 DOI: 10.1007/s13311-021-01101-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
Frontotemporal dementia encompasses a group of clinical syndromes defined pathologically by degeneration of the frontal and temporal lobes. Historically, these syndromes have been challenging to diagnose, with an average of about three years between the time of symptom onset and the initial evaluation and diagnosis. Research in the field of neuroimaging has revealed numerous biomarkers of the various frontotemporal dementia syndromes, which has provided clinicians with a method of narrowing the differential diagnosis and improving diagnostic accuracy. As such, neuroimaging is considered a core investigative tool in the evaluation of neurodegenerative disorders. Furthermore, patterns of neurodegeneration correlate with the underlying neuropathological substrates of the frontotemporal dementia syndromes, which can aid clinicians in determining the underlying etiology and improve prognostication. This review explores the advancements in neuroimaging and discusses the phenotypic and pathologic features of behavioral variant frontotemporal dementia, semantic variant primary progressive aphasia, and nonfluent variant primary progressive aphasia, as seen on structural magnetic resonance imaging and positron emission tomography.
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Affiliation(s)
- Bradley T Peet
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nidhi Mundada
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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10
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Peet BT, Castro-Suarez S, Miller BL. The Neuropsychiatric Features of Behavioral Variant Frontotemporal Dementia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:17-31. [PMID: 33433866 DOI: 10.1007/978-3-030-51140-1_2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is a syndrome defined by a set of core clinical criteria, which include disinhibition; apathy or inertia; loss of sympathy or empathy; perseverative, stereotyped, or compulsive/ritualistic behavior; and hyperorality. The clinical features of bvFTD overlap substantially with those of psychiatric disease, particularly major depressive disorder and bipolar affective disorder. The similarities between bvFTD and primary psychiatric disease results in a significant diagnostic challenge for clinicians. Understanding the neuropsychiatric aspects of bvFTD may assist in differentiating bvFTD from a primary psychiatric disorder.
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Affiliation(s)
- Bradley T Peet
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
| | - Sheila Castro-Suarez
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Atlantic Fellow for Equity in Brain Health at UCSF and clinical researcher Instituto Nacional de Ciencias Neurológicas (INCN), Lima, Peru
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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11
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Coraini A, Basciotta M. Frontotemporal dementia as underlying cause of newly altered mental status in a 59-year-old female: a case presentation and literature review. J Community Hosp Intern Med Perspect 2020; 10:446-451. [PMID: 33235680 PMCID: PMC7671745 DOI: 10.1080/20009666.2020.1787810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
59 y.o. female is evaluated for chronic behavioral abnormalities. We describe the diagnostic approach to cases of altered mental status. Before considering the different possible etiologies including, for example, metabolic, infectious, toxic, hypoxemic, endocrine, or iatrogenic ones, we underline the importance of assessing patient’s baseline functional status. Often, in particular in older patients’ population, dementia is the underlying culprit of mentation abnormalities. Through extensive history and with the help of neuroimaging studies, our patient was diagnosed with frontotemporal dementia.
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Affiliation(s)
- A Coraini
- Internal Medicine, North Shore Medical Center-Salem Hospital, Salem, MA, USA.,Neurology, MGH/BWH/Harvard Medical School
| | - M Basciotta
- Internal Medicine, North Shore Medical Center-Salem Hospital, Salem, MA, USA
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12
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Häkkinen S, Chu SA, Lee SE. Neuroimaging in genetic frontotemporal dementia and amyotrophic lateral sclerosis. Neurobiol Dis 2020; 145:105063. [PMID: 32890771 DOI: 10.1016/j.nbd.2020.105063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) have a strong clinical, genetic and pathological overlap. This review focuses on the current understanding of structural, functional and molecular neuroimaging signatures of genetic FTD and ALS. We overview quantitative neuroimaging studies on the most common genes associated with FTD (MAPT, GRN), ALS (SOD1), and both (C9orf72), and summarize visual observations of images reported in the rarer genes (CHMP2B, TARDBP, FUS, OPTN, VCP, UBQLN2, SQSTM1, TREM2, CHCHD10, TBK1).
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Affiliation(s)
- Suvi Häkkinen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie A Chu
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Suzee E Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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13
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Scarioni M, Gami-Patel P, Timar Y, Seelaar H, van Swieten JC, Rozemuller AJM, Dols A, Scarpini E, Galimberti D, Hoozemans JJM, Pijnenburg YAL, Dijkstra AA. Frontotemporal Dementia: Correlations Between Psychiatric Symptoms and Pathology. Ann Neurol 2020; 87:950-961. [PMID: 32281118 PMCID: PMC7318614 DOI: 10.1002/ana.25739] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The pathology of frontotemporal dementia, termed frontotemporal lobar degeneration (FTLD), is characterized by distinct molecular classes of aggregated proteins, the most common being TAR DNA-binding protein-43 (TDP-43), tau, and fused in sarcoma (FUS). With a few exceptions, it is currently not possible to predict the underlying pathology based on the clinical syndrome. In this study, we set out to investigate the relationship between pathological and clinical presentation at single symptom level, including neuropsychiatric features. METHODS The presence or absence of symptoms from the current clinical guidelines, together with neuropsychiatric features, such as hallucinations and delusions, were scored and compared across pathological groups in a cohort of 150 brain donors. RESULTS Our cohort consisted of 68.6% FTLD donors (35.3% TDP-43, 28% tau, and 5.3% FUS) and 31.3% non-FTLD donors with a clinical diagnosis of frontotemporal dementia and a different pathological substrate, such as Alzheimer's disease (23%). The presence of hyperorality points to FTLD rather than non-FTLD pathology (p < 0.001). Within the FTLD group, hallucinations in the initial years of the disease were related to TDP-43 pathology (p = 0.02), including but not limited to chromosome 9 open reading frame 72 (C9orf72) repeat expansion carriers. The presence of perseverative or compulsive behavior was more common in the TDP-B and TDP-C histotypes (p = 0.002). INTERPRETATION Our findings indicate that neuropsychiatric features are common in FTLD and form an important indicator of underlying pathology. In order to allow better inclusion of patients in targeted molecular trials, the routine evaluation of patients with frontotemporal dementia should include the presence and nature of neuropsychiatric symptoms. ANN NEUROL 2020;87:950-961.
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Affiliation(s)
- Marta Scarioni
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dino Ferrari Center, University of Milan, Milan, Italy
| | - Priya Gami-Patel
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yannick Timar
- Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands
| | - Harro Seelaar
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands.,Department of Old Age Psychiatry, GGZinGeest/Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dino Ferrari Center, University of Milan, Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dino Ferrari Center, University of Milan, Milan, Italy
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- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands
| | - Anke A Dijkstra
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
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14
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Mitchell E, Tavares TP, Palaniyappan L, Finger EC. Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations. Cortex 2019; 121:443-453. [PMID: 31715541 DOI: 10.1016/j.cortex.2019.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/25/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010). METHODS Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer. RESULTS Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding. DISCUSSION The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.
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Affiliation(s)
- Eric Mitchell
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Tamara P Tavares
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada; Parkwood Institute, St. Josephs Health Care, Canada.
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15
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Padmanabhan P, Martínez-Mármol R, Xia D, Götz J, Meunier FA. Frontotemporal dementia mutant Tau promotes aberrant Fyn nanoclustering in hippocampal dendritic spines. eLife 2019; 8:45040. [PMID: 31237563 PMCID: PMC6592683 DOI: 10.7554/elife.45040] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022] Open
Abstract
The Src kinase Fyn plays critical roles in memory formation and Alzheimer’s disease. Its targeting to neuronal dendrites is regulated by Tau via an unknown mechanism. As nanoclustering is essential for efficient signaling, we used single-molecule tracking to characterize the nanoscale distribution of Fyn in mouse hippocampal neurons, and manipulated the expression of Tau to test whether it controls Fyn nanoscale organization. We found that dendritic Fyn exhibits at least three distinct motion states, two of them associated with nanodomains. Fyn mobility decreases in dendrites during neuronal maturation, suggesting a dynamic synaptic reorganization. Removing Tau increases Fyn mobility in dendritic shafts, an effect that is rescued by re-expressing wildtype Tau. By contrast, expression of frontotemporal dementia P301L mutant Tau immobilizes Fyn in dendritic spines, affecting its motion state distribution and nanoclustering. Tau therefore controls the nanoscale organization of Fyn in dendrites, with the pathological Tau P301L mutation potentially contributing to synaptic dysfunction by promoting aberrant Fyn nanoclustering in spines.
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Affiliation(s)
- Pranesh Padmanabhan
- Clem Jones Centre for Ageing Dementia Research (CJCADR), Queensland Brain Institute (QBI), University of Queensland, Brisbane, Australia
| | - Ramón Martínez-Mármol
- Clem Jones Centre for Ageing Dementia Research (CJCADR), Queensland Brain Institute (QBI), University of Queensland, Brisbane, Australia
| | - Di Xia
- Clem Jones Centre for Ageing Dementia Research (CJCADR), Queensland Brain Institute (QBI), University of Queensland, Brisbane, Australia
| | - Jürgen Götz
- Clem Jones Centre for Ageing Dementia Research (CJCADR), Queensland Brain Institute (QBI), University of Queensland, Brisbane, Australia
| | - Frédéric A Meunier
- Clem Jones Centre for Ageing Dementia Research (CJCADR), Queensland Brain Institute (QBI), University of Queensland, Brisbane, Australia
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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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Affiliation(s)
- Negar Moheb
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
| | - Kanida Charuworn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Mark M. Ashla
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
| | - Randy Desarzant
- Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Diana Chavez
- Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Mario F. Mendez
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles; Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
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Abstract
Frontotemporal dementia (FTD) is a heterogeneous disorder with distinct clinical phenotypes associated with multiple neuropathologic entities. Presently, the term FTD encompasses clinical disorders that include changes in behavior, language, executive control, and often motor symptoms. The core FTD spectrum disorders include behavioral variant FTD, nonfluent/agrammatic variant primary progressive aphasia, and semantic variant PPA. Related FTD disorders include frontotemporal dementia with motor neuron disease, progressive supranuclear palsy syndrome, and corticobasal syndrome. In this article, the authors discuss the clinical presentation, diagnostic criteria, neuropathology, genetics, and treatments of these disorders.
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Affiliation(s)
- Nicholas T Olney
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA.
| | - Salvatore Spina
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA; UCSF School of Medicine, San Francisco, CA, USA
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Boutoleau-Bretonnière C, Bretonnière C, Evrard C, Rocher L, Mazzietti A, Koenig O, Vercelletto M, Derkinderen P, Thomas-Antérion C. Ugly aesthetic perception associated with emotional changes in experience of art by behavioural variant of frontotemporal dementia patients. Neuropsychologia 2016; 89:96-104. [PMID: 27265766 DOI: 10.1016/j.neuropsychologia.2016.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/22/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
The aesthetic experience through art is a window into the study of emotions. Patients with behavioural variant of frontotemporal dementia (bvFTD) have early alteration of emotional processing. A new appreciation of art has been reported in some of these patients. We designed a computerized task using 32 abstract paintings that allowed us to investigate the integrity of patients' emotions when viewing the artwork. We evaluated both conscious and explicit appraisal of emotions [aesthetic judgment (beautiful/ugly), emotional relevance (affected or not by the painting), emotional valence (pleasant/unpleasant), emotional reaction (adjective choice) and arousal] and unconscious processing. Fifteen bvFTD patients and 15 healthy controls were included. BvFTD patients reported that they were "little touched" by the paintings. Aesthetic judgment was very different between the two groups: the paintings were considered ugly (negative aesthetic bias) and unpleasant (negative emotional bias) more often by the patients than by controls. Valence and aesthetic judgments correlated in both groups. In addition, there was a positive bias in the implicit task and for explicit emotional responses. Patients frequently chose the word "sad" and rarely expressed themselves with such adjectives as "happy". Our results suggest that bvFTD patients can give an aesthetic judgment, but present abstraction difficulties, as spectators, resulting from impairments in the cognitive processes involved. They also have difficulties in terms of emotional processes with the loss of the ability to feel the emotion per se (i.e., to feel an emotion faced with art) linked to behaviour assessment. This cognitive approach allows us to better understand which spectators are bvFTD patients and to show interactions between emotions and behavioural disorders.
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Affiliation(s)
- Claire Boutoleau-Bretonnière
- CHU Nantes, Centre Mémoire Ressource et Recherche (CMRR), Département de Neurologie, France; Inserm CIC 04, Nantes, France; Laboratoire d'études des mécanismes cognitifs, EA 3082, Université Lyon 2, Bron F-69500, France.
| | | | - Christelle Evrard
- CHU Nantes, Centre Mémoire Ressource et Recherche (CMRR), Département de Neurologie, France; Inserm CIC 04, Nantes, France; Laboratoire de Psychologie des Pays de la Loire, UPRES EA 4638, France
| | - Laetitia Rocher
- CHU Nantes, Centre Mémoire Ressource et Recherche (CMRR), Département de Neurologie, France; Inserm CIC 04, Nantes, France
| | - Audric Mazzietti
- Laboratoire d'études des mécanismes cognitifs, EA 3082, Université Lyon 2, Bron F-69500, France; Distance Learning University (Unidistance), Switzerland
| | - Olivier Koenig
- Laboratoire d'études des mécanismes cognitifs, EA 3082, Université Lyon 2, Bron F-69500, France
| | - Martine Vercelletto
- CHU Nantes, Centre Mémoire Ressource et Recherche (CMRR), Département de Neurologie, France; Inserm CIC 04, Nantes, France
| | - Pascal Derkinderen
- CHU Nantes, Centre Mémoire Ressource et Recherche (CMRR), Département de Neurologie, France; Inserm CIC 04, Nantes, France; Inserm, UMR 913, Nantes, France
| | - Catherine Thomas-Antérion
- Laboratoire d'études des mécanismes cognitifs, EA 3082, Université Lyon 2, Bron F-69500, France; Plein ciel, 75, Rue Bataille, 69008 Lyon, France
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Cai Y, An SSA, Kim S. Mutations in presenilin 2 and its implications in Alzheimer's disease and other dementia-associated disorders. Clin Interv Aging 2015; 10:1163-72. [PMID: 26203236 PMCID: PMC4507455 DOI: 10.2147/cia.s85808] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia. Mutations in the genes encoding presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid precursor protein have been identified as the main genetic causes of familial AD. To date, more than 200 mutations have been described worldwide in PSEN1, which is highly homologous with PSEN2, while mutations in PSEN2 have been rarely reported. We performed a systematic review of studies describing the mutations identified in PSEN2. Most PSEN2 mutations were detected in European and in African populations. Only two were found in Korean populations. Interestingly, PSEN2 mutations appeared not only in AD patients but also in patients with other disorders, including frontotemporal dementia, dementia with Lewy bodies, breast cancer, dilated cardiomyopathy, and Parkinson's disease with dementia. Here, we have summarized the PSEN2 mutations and the potential implications of these mutations in dementia-associated disorders.
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Affiliation(s)
- Yan Cai
- Department of Bionano Technology, Gachon Medical Research Institute, Gachon University, Seongnam-si, Gyeonggi-do, South Korea
| | - Seong Soo A An
- Department of Bionano Technology, Gachon Medical Research Institute, Gachon University, Seongnam-si, Gyeonggi-do, South Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Caixeta L, Vieira RT, Paes F, Carta MG, Nardi AE, Arias-Carrión O, Rocha NBF, Budde H, Machado S. Comparative study of subcortical atrophy in patients with frontotemporal dementia and dementia with extrapyramidal signs. Clin Pract Epidemiol Ment Health 2015; 11:125-9. [PMID: 25870648 PMCID: PMC4391205 DOI: 10.2174/1745017901511010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
Abstract
Objectives :
To investigate the severity of subcortical atrophy in frontotemporal dementia (FTD) without extrapyramidal symptoms (EPS) and dementia with EPS. In addition, we aim to verify if there is correlation between demographic and clinical characteristics and subcortical atrophy in the groups. Methodology : The sample was composed of 21 patients with dementia and EPS as well as 19 patients with FTD without EPS. A linear assessment was conducted in order to identify the degree of subcortical atrophy (i.e., bifrontal index - BFI) using MRI. Moreover, the Mini-Mental State Examination (MMSE), Pfeffer Functional Activities Questionnaire (FAQ) and the Clinical Dementia Rating (CDR) were used to investigate clinical aspects. Results : It was verified that patients with dementia and EPS was older than the patients with FTD (p=0.01). The severity of cognitive deficits was associated with BFI, as well as the dementia severity in the EPS group. Conclusion : FTD group presented mean BFI scores above the cutoff for normal elderly population, indicating the presence of subcortical atrophy in this group. Mean BFI was higher (although not statistically significant) in FTD group than in dementia with EPS, which can suggest at least that subcortical pathology in FTD may be as important as in the dementia with EPS group. Subcortical atrophy is a good biological marker for cognitive deterioration in FTD and in dementia with EPS.
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Affiliation(s)
- Leonardo Caixeta
- Neuropsychiatry, School of Medicine, Federal University of Goiás (UFG). Dementia Outpatient Unit, Hospital das Clínicas-UFG, Brazil
| | - Renata Teles Vieira
- Behavioral and Cognitive Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Goiânia (GO), Brazil
| | - Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Mauro Giovanni Carta
- Department of Public Health, Clinic and Molecular Medicine - University of Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea Gonzalez, Secretaria de Salud, México, DF, México
| | - Nuno B F Rocha
- Polytechnic Institute of Porto, School of Allied Health Sciences, Portugal
| | - Henning Budde
- Medical School Hamburg, Faculty of Human Sciences, Department of Pedagogy, Germany; Reykjavik University, School of Science and Engineering, Department of Sport Science, Iceland
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil ; Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, RJ, Brazil
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21
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Brain activation of the defensive and appetitive survival systems in obsessive compulsive disorder. Brain Imaging Behav 2014; 9:255-63. [DOI: 10.1007/s11682-014-9303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Abstract
Behavioral variant frontotemporal dementia and semantic dementia have been associated with striatal degeneration, but few studies have delineated striatal subregion volumes in vivo or related them to the clinical phenotype. We traced caudate, putamen, and nucleus accumbens on magnetic resonance images to quantify volumes of these structures in behavioral variant frontotemporal dementia, semantic dementia, Alzheimer disease, and healthy controls (n=12 per group). We further related these striatal volumes to clinical deficits and neuropathologic findings in a subset of patients. Behavioral variant frontotemporal dementia and semantic dementia showed significant overall striatal atrophy compared with controls. Moreover, behavioral variant frontotemporal dementia showed panstriatal degeneration, whereas semantic dementia featured a more focal pattern involving putamen and accumbens. Right-sided striatal atrophy, especially in the putamen, correlated with the overall behavioral symptom severity and with specific behavioral domains. At autopsy, patients with behavioral variant frontotemporal dementia and semantic dementia showed striking and severe tau or TAR DNA-binding protein of 43 kDa pathology, especially in ventral parts of the striatum. These results demonstrate that ventral striatum degeneration is a prominent shared feature in behavioral variant frontotemporal dementia and semantic dementia and may contribute to the social-emotional deficits common to both disorders.
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23
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Shin JS, Kim MS, Kim NS, Kim GH, Seo SW, Kim EJ, Heilman KM, Na DL. Excessive TV watching in patients with frontotemporal dementia. Neurocase 2013; 19:489-96. [PMID: 22827619 DOI: 10.1080/13554794.2012.701638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The "environmental dependency syndrome" refers to a loss of personal autonomy such that a person's environment almost entirely controls their actions. The goal of this study is to learn if patients with frontotemporal degeneration (FTD) exhibit prolonged TV watching, a behavior which may be a symptom of environmental dependency. We recruited 40 patients with FTD and 48 patients with Alzheimer's disease (AD), and asked these participants' caregivers about TV watching behaviors including total viewing time and channel/show preference, along with other behaviors indicative of environmental dependency. Compared to AD patients, FTD patients watched TV for a longer time. In addition, the patients who watched more TV showed more signs of environmental dependency. Increased TV watching may be a sign of environmental dependency, however further research is needed to explore other hypotheses.
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Affiliation(s)
- Ji Soo Shin
- a Department of Neurology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , South Korea
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24
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Serotonergic function and treatment of behavioral and psychological symptoms of frontotemporal dementia. Am J Geriatr Psychiatry 2012; 20:789-97. [PMID: 21878805 DOI: 10.1097/jgp.0b013e31823033f3] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The purposes of this study were first, to evaluate the effectiveness of citalopram in treating behavioral disturbances in frontotemporal dementia (FTD) subjects and second, to determine whether an association exists between serotonergic function, as determined by a neuroendocrine challenge, and treatment response. DESIGN Single-dose citalopram (30 mg per os) challenge followed by a 6-week open-label study. SETTING Outpatients referred to memory clinics. PARTICIPANTS Fifteen patients suffering from FTD with severe behavioral and psychological symptoms of dementia. INTERVENTION Following citalopram challenge, all patients were treated with citalopram titrated to a target dose of 40 mg once daily. MEASUREMENTS Behavioral disturbances, using the Neuropsychiatric Inventory (NPI) (primary outcome) and Frontal Behavioural Inventory (secondary outcome), were assessed. Change in prolactin concentration following citalopram challenge was used as an index of central serotonergic response. RESULTS Citalopram treatment was effective in treating behavioral symptoms, with significant decreases in NPI total score (F[2, 28] = 6.644, p = 0.004), disinhibition (F[2, 28] = 4.030, p = 0.029), irritability (F[2, 28] = 7.497, p = 0.003) and depression (F[2, 28] = 3.467, p = 0.045) scores over the 6 weeks. Significant improvement in Frontal Behavioural Inventory scores suggested that citalopram was also effective in the treatment ofbehaviors specific to FTD. A lower change score in concentration of prolactin was significantly positively correlated with greater improvement in the total NPI score from baseline to endpoint (r = 0.687, p = 0.005). A blunted response to a citalopram challenge, implying a dysfunctional serotonergic system, predicted a more positive treatment outcome. CONCLUSIONS The results suggest that despite the endogenous serotonin deficiency of FTD, citalopram treatment may be effective in targeting the behavioral disturbances characteristic of FTD.
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Polak AR, van der Paardt JW, Figee M, Vulink N, de Koning P, Olff M, Denys D. Compulsive carnival song whistling following cardiac arrest: a case study. BMC Psychiatry 2012; 12:75. [PMID: 22759699 PMCID: PMC3545985 DOI: 10.1186/1471-244x-12-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments. CASE PRESENTATION A 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling. DISCUSSION This case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.
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Affiliation(s)
- A Rosaura Polak
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands.
| | - Jasper W van der Paardt
- Emergency psychiatric hospital, Arkin Mental Health Care, 1e Constantijn Huygensstraat, 38, Amsterdam, 1054 BR, the Netherlands
| | - Martijn Figee
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Nienke Vulink
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Pelle de Koning
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Miranda Olff
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands,Arq Psychotrauma Expert Group, Nienoord 5, Diemen, 1112 XE, the Netherlands
| | - Damiaan Denys
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands,The Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, 1105 BA, the Netherlands
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26
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Schott GD. Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease. Brain 2012; 135:1947-63. [DOI: 10.1093/brain/awr314] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perry DC, Whitwell JL, Boeve BF, Pankratz VS, Knopman DS, Petersen RC, Jack CR, Josephs KA. Voxel-based morphometry in patients with obsessive-compulsive behaviors in behavioral variant frontotemporal dementia. Eur J Neurol 2012; 19:911-7. [PMID: 22284815 DOI: 10.1111/j.1468-1331.2011.03656.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Obsessions and compulsive (OC) behaviors are a frequent feature of behavioral variant frontotemporal dementia (bvFTD), but their structural correlates have not been definitively established. METHODS Patients with bvFTD presenting to the Mayo Clinic Alzheimer's Disease Research Center were recruited. Each patient's caregiver was given the Yale-Brown Obsessive-Compulsive scale (YBOCS) to document the type and presence of OC behaviors and to rate their severity. All subjects underwent standardized magnetic resonance imaging (MRI) that was evaluated using voxel-based morphometry (VBM). Seventeen patients with bvFTD were recruited, and 11 were included in the study and compared with 11 age- and gender-matched controls. Six were excluded for lack of MRI at the time of survey or a pre-existing neurodegenerative condition. RESULTS Nine of the 11 reported OC behaviors, with the most frequent compulsions being checking, hoarding, ordering/arranging, repeating rituals, and cleaning. In the VBM analysis, total YBOCS score correlated with gray matter loss in the bilateral globus pallidus, left putamen, and in the lateral temporal lobe, particularly the left middle and inferior temporal gyri (P < 0.001 uncorrected for multiple comparisons). CONCLUSIONS Obsessive-compulsive behaviors were frequent among these patients. The correlation with basal ganglia atrophy may point to involvement of frontal subcortical neuronal networks. Left lateral temporal lobe volume loss probably reflects the number of MAPT mutation patients included but also provides additional data implicating temporal lobe involvement in OC behaviors.
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Affiliation(s)
- D C Perry
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Slachevsky A, Muñoz-Neira C, Nuñez-Huasaf J, Stern TA, Blesius CR, Atri A. Late-onset cinephilia and compulsive behaviors: harbingers of frontotemporal dementia. Prim Care Companion CNS Disord 2011; 13:10f01115. [PMID: 21977365 DOI: 10.4088/pcc.10f01115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Andrea Slachevsky
- Department of Neurological Sciences and Program of Molecular and Clinical Pharmacology, ICBM, Faculty of Medicine, University of Chile, and Cognitive Neurology and Dementia Unit, Hospital del Salvador, Santiago, Chile
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Mateen FJ, Josephs KA. The clinical spectrum of stereotypies in frontotemporal lobar degeneration. Mov Disord 2009; 24:1237-40. [DOI: 10.1002/mds.22555] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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30
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Boggio PS, Fregni F, Valasek C, Ellwood S, Chi R, Gallate J, Pascual-Leone A, Snyder A. Temporal lobe cortical electrical stimulation during the encoding and retrieval phase reduces false memories. PLoS One 2009; 4:e4959. [PMID: 19319182 PMCID: PMC2655647 DOI: 10.1371/journal.pone.0004959] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 02/26/2009] [Indexed: 11/18/2022] Open
Abstract
A recent study found that false memories were reduced by 36% when low frequency repetitive transcranial magnetic stimulation (rTMS) was applied to the left anterior temporal lobe after the encoding (study) phase. Here we were interested in the consequences on a false memory task of brain stimulation throughout the encoding and retrieval task phases. We used transcranial direct current stimulation (tDCS) because it has been shown to be a useful tool to enhance cognition. Specifically, we examined whether tDCS can induce changes in a task assessing false memories. Based on our preliminary results, three conditions of stimulation were chosen: anodal left/cathodal right anterior temporal lobe (ATL) stimulation ("bilateral stimulation"); anodal left ATL stimulation (with a large contralateral cathodal electrode--referred as "unilateral stimulation") and sham stimulation. Our results showed that false memories were reduced significantly after the two active conditions (unilateral and bilateral stimulation) as compared with sham stimulation. There were no significant changes in veridical memories. Our findings show that false memories are reduced by 73% when anodal tDCS is applied to the anterior temporal lobes throughout the encoding and retrieval stages, suggesting a possible strategy for improving certain aspects of learning.
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Affiliation(s)
- Paulo S. Boggio
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
- * E-mail: (PSB); (FF)
| | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (PSB); (FF)
| | - Claudia Valasek
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - Sophie Ellwood
- Centre for the Mind, University of Sydney, Sydney, Australia
| | - Richard Chi
- Centre for the Mind, University of Sydney, Sydney, Australia
| | - Jason Gallate
- Centre for the Mind, University of Sydney, Sydney, Australia
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Allan Snyder
- Centre for the Mind, University of Sydney, Sydney, Australia
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Riedijk SR, Duivenvoorden HJ, Van Oostrom I, Rosso SM, Van Swieten J, Niermeijer MF, Tibben A. Frontotemporal dementia (FTD) patients living at home and their spousal caregivers compared with institutionalized FTD patients and their spousal caregivers. DEMENTIA 2009. [DOI: 10.1177/1471301208099045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with frontotemporal dementia (FTD) need complete care in the final stages of the disease. Some informal caregivers continue the in-home care whereas others institutionalize. This study identifies differences between in-home FTD patients and their caregivers (FTDH) and institutionalized FTD patients (FTDN) and their caregivers. Twelve in-home and 24 institutionalized FTD patients in the final stages of the disease, and their spousal caregivers, were observed. Neuropsychiatric function disorders, dementia duration and severity, burden, mental and physical health, quality of the current and premorbid relationship and caregiver motivation were analysed. The majority of FTDH patients had dementia of shorter duration and showed residual independence. In FTDH patients, neuropsychiatric symptoms were more often present whereas apathy and disinhibition were more intense in FTDN patients. FTDH caregivers felt more emotionally burdened but had better mental health. Caregiver motivations were similarly present in FTDH and FTDN caregivers, while the love-motivated caregivers had worse physical and mental health. Our data suggest that all FTD caregivers could benefit from psychological support. Motivation for caregiving has intervention potential.
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Affiliation(s)
| | | | | | | | | | | | - Aad Tibben
- Leiden University Medical Centre, Leiden, The Netherlands
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Huey ED, Armstrong N, Momeni P, Grafman J. Challenges and new opportunities in the investigation of new drug therapies to treat frontotemporal dementia. Expert Opin Ther Targets 2009; 12:1367-76. [PMID: 18851693 DOI: 10.1517/14728222.12.11.1367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frontotemporal dementia spectrum disorders are a set of neurodegenerative disorders affecting the frontal and anterior temporal lobes. They are often fatal, and currently no medications have been shown to slow their progression. Recent developments in understanding these disorders may aid in developing treatments. OBJECTIVE To discuss the development of drug therapies for frontotemporal dementia spectrum disorders, both those under current investigation and those that could be targets for future investigation. METHODS This review is divided into four sections: First, a brief review of frontotemporal dementia spectrum disorders; second, a discussion of the challenges in the development of drug therapies third, a review of the current clinical trials; and finally a discussion of some recent discoveries, which have sparked new areas of investigation. CONCLUSIONS Hopefully, advances in understanding of frontotemporal dementia spectrum disorders and clinical trial design will aid the development of new treatments.
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Affiliation(s)
- Edward D Huey
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Cognitive Neuroscience Section, Building 10, Room 7D43, MSC 1440, Bethesda, MD 20892-1440, USA.
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Gallate J, Chi R, Ellwood S, Snyder A. Reducing false memories by magnetic pulse stimulation. Neurosci Lett 2008; 449:151-4. [PMID: 19022348 DOI: 10.1016/j.neulet.2008.11.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/21/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
False memories are ubiquitous and often to our detriment. Yet, certain pathologies, including anterior temporal lobe dementia and autism, can lead to literal recall and thus greater resistance to false memories. This inspired us to reduce false memories by temporarily inhibiting the left anterior temporal lobe, using low frequency magnetic pulse stimulation. This site has been implicated in semantic memory and conceptual labelling. After active stimulation, participants in the sham/TMS group had 36% fewer false memories than they had with sham stimulation, and intact veridical memory. This is comparable to the improvement that people with autism and semantic dementia show over "normal" individuals. This finding suggests a potential method for reducing certain types of false memories.
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Affiliation(s)
- Jason Gallate
- Centre for the Mind, University of Sydney, Sydney, NSW 2006, Australia
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van den Heuvel OA, Remijnse PL, Mataix-Cols D, Vrenken H, Groenewegen HJ, Uylings HBM, van Balkom AJLM, Veltman DJ. The major symptom dimensions of obsessive-compulsive disorder are mediated by partially distinct neural systems. Brain 2008; 132:853-68. [PMID: 18952675 DOI: 10.1093/brain/awn267] [Citation(s) in RCA: 318] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder characterized by multiple, temporally stable symptom dimensions. Preliminary functional neuroimaging studies suggest that these symptom dimensions may have distinct neural substrates. Whole-brain voxel-based morphometry was used to examine the common and distinct neuroanatomical (structural) substrates of the major symptom dimensions of OCD. First, we compared 55 medication-free patients with OCD and 50 age-matched healthy control subjects. Multiple regression analyses were then used to examine the relationship between global and regional grey matter (GM) and white matter (WM) volumes and symptom dimension scores within the patient group. OCD patients showed decreased GM volume in left lateral orbitofrontal (BA47), left inferior frontal (BA44/45), left dorsolateral prefrontal (BA9) and right medial prefrontal (BA10) cortices and decreased bilateral prefrontal WM volume. Scores on the 'symmetry/ordering' dimension were negatively correlated with 'global' GM and WM volumes. Scores on the 'contamination/washing' dimension were negatively correlated with 'regional' GM volume in bilateral caudate nucleus and WM volume in right parietal region. Scores on the 'harm/checking' dimension were negatively correlated with regional GM and WM volume in bilateral temporal lobes. Scores on the 'symmetry/ordering' dimension were negatively correlated with regional GM volume in right motor cortex, left insula and left parietal cortex and positively correlated with bilateral temporal GM and WM volume. The results remained significant after controlling for age, sex, educational level, overall illness severity, global WM and GM volumes and excluding patients with comorbid depression. The reported symptom dimension-specific GM and WM alterations support the hypothesis that OCD is an etiologically heterogeneous disorder, with both overlapping and distinct neural correlates across symptom dimensions. These results have clear implications for the current neuroanatomical model of OCD and call for a substantial revision of such model which takes into account the heterogeneity of the disorder.
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Affiliation(s)
- Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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van Swieten JC, Heutink P. Mutations in progranulin (GRN) within the spectrum of clinical and pathological phenotypes of frontotemporal dementia. Lancet Neurol 2008; 7:965-74. [PMID: 18771956 DOI: 10.1016/s1474-4422(08)70194-7] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) is predominantly a presenile disorder that is characterised by behavioural changes and cognitive impairment, particularly in language and executive functions, and is associated with neurodegeneration in the frontal or temporal cortices, or both. Research into FTD has made many advances over the past 20 years that have important implications for clinical practice. Different clinical variants (ie, behavioural, aphasic, and motor neuron disease variants) are now recognised as part of the clinical spectrum of FTD. Neuropathologically, the disease can be divided into two main pathological subtypes: frontotemporal lobar degeneration (FTLD) with neuronal and glial tau inclusions (FTLD-tau); and FTLD with neuronal inclusions that are positive for ubiquitin (FTLD-U). 20-30% of cases of FTD follow an autosomal dominant pattern of inheritance, and half of which are caused by defects in MAPT, CHMP2B, and VCP. RECENT DEVELOPMENTS Mutations in the gene that encodes progranulin (GRN) on chromosome 17q21-22 have been identified in patients with hereditary FTD who have tau-negative, ubiquitin-positive inclusions. The recognition of the clinical phenotype associated with more than 50 different mutations in GRN has expanded the clinical knowledge of FTD to include presentations that resemble Alzheimer's disease, Lewy body disease, and corticobasal syndrome, with a variable age at onset (35-89 years) within families. Another recent breakthrough is the identification of the TAR DNA-binding protein (TARDBP; also known as TDP-43) as the main constituent of FTLD-U with mutations in GRN and with mutations in VCP, as well as in FTLD with amyotrophic lateral sclerosis. WHERE NEXT?: To develop therapeutic strategies to prevent FTD or delay its progression we must understand whether the loss of progranulin leads to the accumulation of TARDBP. In this Rapid Review, we focus on the clinical and pathological phenotypes associated with mutations in GRN, and distinguish those from other forms of hereditary FTD. In addition, we discuss the potential association of mutations in GRN on the pathophysiology of FTD with the accumulation of TARDBP.
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Affiliation(s)
- John C van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.
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Topiramate may modulate alcohol abuse but not other compulsive behaviors in frontotemporal dementia: case report. Cogn Behav Neurol 2008; 21:104-6. [PMID: 18541987 DOI: 10.1097/wnn.0b013e31816bdf73] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frontotemporal dementia (FTD) is an insidious presenile neurodegenerative disorder presenting with personality changes, compulsive behaviors, psychosis, apathetic, aberrant, and elated mood and behavior. No psychopharmacologic strategy has proven to be efficacious in the treatment of FTD yet. This is a case report of FTD in a 53-year-old male engineer whose alcohol abuse, but not other compulsive behaviors, responded to topiramate. Alcohol exerts reinforcing effects on cortico-mesolimbic dopamine pathways through the disinhibition of the inhibitory effects of gamma-amino-butyric acid-A neurons in the ventral tegmental area. Topiramate is a sulfamate-substituted fructopyranose derivative that may antagonize the reinforcing effects associated with the abuse liability of alcohol by modulation of cortico-mesolimbic dopamine function. On the basis of the mechanism of action of topiramate, we discuss the possible specificity of action of topiramate to control abusive drinking, but not to treat other clinical symptoms of FTD.
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Abstract
This article describes the spectrum of recurrent thoughts and behaviors that can result from frontotemporal dementia (FTD) and its variants. Although repetitive behaviors can result from a range of brain disorders, FTD is the most common neurologic cause of new-onset recurrent thoughts and behaviors in middle or late life. Patients with FTD can manifest typical or bizarre compulsions, hoarding, verbal and motor stereotypies and complex tics; self-injurious acts, perseverations; and fixed, obsessional thoughts. The frequency and variability of these repetitive behaviors suggest a common disturbance of orbitofrontal-basal ganglia circuits involved in response inhibition. The amelioration of these recurrent events with the administration of serotonin selective reuptake inhibitors further suggests a serotonergic deficit.
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A model for management of behavioral symptoms in frontotemporal lobar degeneration. Alzheimer Dis Assoc Disord 2008; 21:S64-9. [PMID: 18090427 DOI: 10.1097/wad.0b013e31815bf774] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Frontotemporal lobar degeneration is a neurologic condition that manifests profound behavioral, personality, and language symptoms. These changes, often unique to each person, may include social misconduct, eating disturbances, apathy, emotional blunting, childlike behavior, habits and rituals, executive dysfunction, and marked difficulty with speech and language. These symptoms occur as the result of cell loss in discrete areas of the brain, the frontal and/or anterior temporal lobes. Little is known about effective management of the behavioral symptoms that result from this disease. The purpose of this paper is to describe a model that could be used in the assessment and potential management of frontotemporal lobar degeneration behavioral symptoms. Suggestions for interventions are given for some of the more common FTD behaviors. The impact of behavioral symptoms on the family caregiver is discussed along with strategies for supportive services and recommendations for future study.
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Matsui T, Saxena S, Kawabe J, Matsunaga H, Kohagura K, Higashiyama S, Kiriike N. Secondary obsessive-compulsive disorder related to diaschisis after pontine infarction, successfully treated with paroxetine. Psychiatry Clin Neurosci 2007; 61:186-9. [PMID: 17362437 DOI: 10.1111/j.1440-1819.2007.01635.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes a case of secondary obsessive-compulsive disorder related to diaschisis after pontine infarction. A 71-year-old male developed obsessive images, after a pontine infarction. A brain magnetic resonance imaging scan showed a low intensity area in the right pons on T1-weighted image, while brain single photon emission computed tomography showed low cerebral blood flow in the temporal lobe as well as the pons. In this case, infarction in the pons appeared to cause dysfunction in the temporal lobe via the neural projection network, an example of so-called 'diaschisis'. This case suggests that brainstem infarction and decreased temporal lobe perfusion can lead to secondary obsessive-compulsive disorder.
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Affiliation(s)
- Tokuzo Matsui
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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40
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory. Dement Geriatr Cogn Disord 2007; 23:35-41. [PMID: 17077631 DOI: 10.1159/000096681] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/AIMS To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. RESULTS A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. CONCLUSION The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.
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Affiliation(s)
- Sytse U Zuidema
- Department of Nursing Home Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Salmon E. A review of the literature on neuroimaging of serotoninergic function in Alzheimer's disease and related disorders. J Neural Transm (Vienna) 2007; 114:1179-85. [PMID: 17308980 DOI: 10.1007/s00702-007-0636-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 01/18/2007] [Indexed: 10/23/2022]
Abstract
Behavioural and psychological disorders are frequent not only in frontotemporal dementia (FTD), but also in Alzheimer's disease (AD), and many of them are related to serotoninergic dysfunction. In vitro biochemical measurements on brain samples show both pre- and post-synaptic impaired brain serotoninergic function in degenerative dementia, sometimes related to hyperactivity or aggressive behaviour. To date, few studies have explored in vivo 5HT2A and 5HT1A brain receptors in AD and FTD. They suggest that brain cells are lost in the associative cortices (5HT2A) and hippocampus (5HT1A) of AD patients, and in the medial prefrontal and orbitofrontal cortices of FTD subjects (5HT2A). Apart from reflecting a loss of local neurons, the meaning of the decrease in 5HT receptors is not yet clear and larger populations are required to establish relationships with clinical symptoms such as dementia severity and search for possible consequences for patients' behavioural and affective status.
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Affiliation(s)
- E Salmon
- Cyclotron Research Centre, University of Liège, Liège, Belgium.
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42
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Riedijk SR, De Vugt ME, Duivenvoorden HJ, Niermeijer MF, Van Swieten JC, Verhey FRJ, Tibben A. Caregiver burden, health-related quality of life and coping in dementia caregivers: a comparison of frontotemporal dementia and Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 22:405-12. [PMID: 16966830 DOI: 10.1159/000095750] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2006] [Indexed: 11/19/2022] Open
Abstract
Frontotemporal dementia (FTD) is the second most prevalent dementia after Alzheimer's disease (AD). We compared 29 FTD and 90 AD caregivers with respect to burden, health-related quality of life (HQoL) and coping. FTD caregivers were more burdened than AD caregivers, and caregivers of patients who were demented for shorter duration had lower HQoL. We furthermore compared the 29 FTD caregivers with 34 caregivers of institutionalized FTD patients to understand their specific caregiver issues. Caregivers of FTD patients institutionalized after shorter dementia duration were most burdened and affected in their HQoL. Overall, passive coping strategies were associated with increased burden and decreased HQoL. We recommend that FTD caregivers be offered more support than AD caregivers. Furthermore, we suggest that interventions target passive coping strategies.
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Affiliation(s)
- S R Riedijk
- Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands.
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43
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de Vugt ME, Riedijk SR, Aalten P, Tibben A, van Swieten JC, Verhey FRJ. Impact of behavioural problems on spousal caregivers: a comparison between Alzheimer's disease and frontotemporal dementia. Dement Geriatr Cogn Disord 2006; 22:35-41. [PMID: 16679763 DOI: 10.1159/000093102] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioural changes are a key factor in distinguishing frontotemporal dementia (FTD) from Alzheimer's disease (AD), however, little is known about the impact of these changes on caregivers. The aim of this study was to compare caregivers' distress related to behavioural symptoms of AD and FTD. METHODS 47 spouse caregivers of consecutively referred patients with AD and 27 spouse caregivers of patients with FTD participated in this study. Behavioural disturbances in the patient and caregivers' emotional reactions were measured with the Neuropsychiatric Inventory. RESULTS Patients with FTD had significantly higher levels of agitation, apathy, disinhibition and aberrant motor behaviour than did patients with AD. High distress scores were found for disinhibition, depression and apathy in caregivers of FTD patients whereas caregivers of AD patients reported patient apathy, depression and anxiety as being severely distressing. Higher mean distress scores were found for disinhibition in the FTD group. Furthermore, caregivers of FTD patients reported higher levels of general burden, and felt less competent than AD caregivers. CONCLUSIONS Caregivers of FTD patients were overall more distressed by the behaviour of their partners than were the caregivers of AD patients. Findings from this study underscore the importance of differentiating between diagnostic groups and specific behavioural domains when focusing on caregiver reactions to problem behaviour.
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Affiliation(s)
- Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
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44
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Caixeta L, Mansur LL. [Semantic dementia: clinical and neuroimaging evaluation. Case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 63:348-51. [PMID: 16100990 DOI: 10.1590/s0004-282x2005000200030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Semantic dementia is a clinical syndrome in the spectrum of frontotemporal lobar degeneration group. We report on a 63 years old man who presented with memory disorder of semantic nature for visual and mainly verbal material when he was 57 years old. Mild behavior impairment was present and related to exaggerated responses to algic stimuli and repetitive behavior. Structural and functional neuroimaging methods disclosed asymmetric bitemporal damage, mainly on the left. Differential diagnosis should be considered with Alzheimer's disease, another subtypes of the frontotemporal lobar degeneration group and any other syndrome that presents with a fluent aphasic progressive disorder.
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Affiliation(s)
- Leonardo Caixeta
- Grupo de Neurologia Cognitiva e do Comportamento (GNCC) do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brasil.
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Seeley WW, Bauer AM, Miller BL, Gorno-Tempini ML, Kramer JH, Weiner M, Rosen HJ. The natural history of temporal variant frontotemporal dementia. Neurology 2006; 64:1384-90. [PMID: 15851728 PMCID: PMC2376750 DOI: 10.1212/01.wnl.0000158425.46019.5c] [Citation(s) in RCA: 242] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The temporal variant of frontotemporal dementia (tvFTD) features asymmetric anterior temporal/amygdala degeneration as well as ventromedial frontal, insular, and inferoposterior temporal involvement. Left temporal atrophy has been linked to loss of semantic knowledge, whereas behavioral symptoms dominate the right temporal variant. OBJECTIVE To investigate the first symptoms and the timing of subsequent symptoms in patients with left versus right tvFTD. METHODS Twenty-six patients with tvFTD were identified. Six had right > left temporal atrophy (right temporal lobe variant [RTLV]) and were matched with six having comparable left > right temporal atrophy (left temporal lobe variant [LTLV]). Clinical records were reviewed to generate individualized symptom chronologies. RESULTS In all patients, first symptoms involved semantics (4/6 LTLV, 1/6 RTLV), behavior (4/6 RTLV, 1/6 LTLV), or both (1 LTLV, 1 RTLV). Semantic loss began with anomia, word-finding difficulties, and repetitive speech, whereas the early behavioral syndrome was characterized by emotional distance, irritability, and disruption of physiologic drives (sleep, appetite, libido). After an average of 3 years, patients developed whichever of the two initial syndromes--semantic or behavioral--that they lacked at onset. A third stage, 5 to 7 years from onset, saw the emergence of disinhibition, compulsions, impaired face recognition, altered food preference, and weight gain. Compulsions in LTLV were directed toward visual, nonverbal stimuli, whereas patients with RTLV were drawn to games with words and symbols. CONCLUSIONS The temporal variant of frontotemporal dementia follows a characteristic cognitive and behavioral progression that suggests early spread from one anterior temporal lobe to the other. Later symptoms implicate ventromedial frontal, insular, and inferoposterior temporal regions, but their precise anatomic correlates await confirmation.
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Affiliation(s)
- W W Seeley
- Department of Neurology, University of California at San Francisco, San Francisco, CA 94143-1207, USA.
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46
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Whitwell JL, Jack CR. Comparisons between Alzheimer disease, frontotemporal lobar degeneration, and normal aging with brain mapping. Top Magn Reson Imaging 2005; 16:409-25. [PMID: 17088691 DOI: 10.1097/01.rmr.0000245457.98029.e1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD) are both common degenerative dementias in the under 65 age group. Although clinical criteria have been defined for both diseases, there is considerable overlap in clinical features, and hence, diagnosis still can be very difficult particularly in the early stages of the disease. As a result, there has been increasing interest in using magnetic resonance imaging to better characterize these diseases and to aid in diagnosis. Voxel-based morphometry (VBM) is an automated technique that assesses patterns of regional gray matter atrophy on magnetic resonance imaging between 2 groups of subjects. It is unbiased in that it looks throughout the whole brain and does not require any a priori assumptions concerning which structures to assess, giving it a significant advantage over traditional region of interest-based methods. Voxel-based morphometry has been widely used to assess patterns of regional atrophy in subjects with AD and FTLD. These studies have demonstrated specific patterns of regional loss in both diseases, compared the 2 diseases to look for differences that could be diagnostically useful, and have correlated regions of gray matter loss to cognitive and behavioral deficits in these subjects. This article will review the findings of these studies and discuss the role of VBM in these neurodegenerative diseases.
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Liebson E, Rauch P, Graff S, Folstein M. Early-onset dementia: diagnostic considerations and implications for families. Harv Rev Psychiatry 2005; 13:102-11. [PMID: 16020024 DOI: 10.1080/10673220590956492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Elizabeth Liebson
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
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48
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Mourik JC, Rosso SM, Niermeijer MF, Duivenvoorden HJ, Van Swieten JC, Tibben A. Frontotemporal dementia: behavioral symptoms and caregiver distress. Dement Geriatr Cogn Disord 2005; 18:299-306. [PMID: 15305107 DOI: 10.1159/000080123] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To discern behavioral problems that co-occur in frontotemporal dementia (FTD) patients, and to investigate the relation between behavioral clusters and the burden for caregivers. PATIENTS AND METHODS Baseline data of 63 FTD patients and their respective caregivers were used to detect the behavioral clusters in the Neuropsychiatric Inventory (NPI) and the accompanying distress evoked in caregivers. To detect the clusters in behavior of the FTD patients, we performed multidimensional scaling (procedure: PROXSCAL). Multiple regression analysis was used to determine the association between behavior of patients and the distress experienced by caregivers. RESULTS This was the first study that found behavioral clusters for FTD. Two behavioral clusters were found: agitation/psychosis (comprising delusions, hallucinations, irritability and agitation) and mood (made up of anxiety and depression). The remaining NPI domains (euphoria, disinhibition, aberrant motor behavior and apathy were found to be autonomous. After controlling for relevant confounding factors, caregiver distress was strongest related to agitation/psychosis, followed by mood. Disinhibition and aberrant motor behavior were mildly related to caregiver distress. Euphoria and apathy were not significantly related to distress. Caregivers of patients living at home were more distressed by the behavioral problems of the FTD patients than caregivers of hospitalized patients. DISCUSSION The high prevalence of psychopathology in FTD patients and the associated caregiver distress was confirmed in this study. Clustering behavioral symptoms allows investigation of the relationship between structural or functional cerebral deficits and neuropsychiatric symptoms.
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Affiliation(s)
- J C Mourik
- Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
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49
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Mendez MF. Dementia as a window to the neurology of art. Med Hypotheses 2005; 63:1-7. [PMID: 15193339 DOI: 10.1016/j.mehy.2004.03.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 03/01/2004] [Indexed: 11/24/2022]
Abstract
Art is an expression of neurological function and how it organizes and interprets perception. Recent reports of changes in art performance among patients with frontotemporal dementia have provided an unexpected window to the neurology of art. They confirm that visual art is predominantly in the right hemisphere and suggest a neuroanatomical schema for artistic creativity. The right parietal region is critical for the visuospatial prerequisites of art, and the right temporal lobe integrates and interprets these percepts. The right temporal lobe appears necessary for extracting and exaggerating the essential features of an artistic composition. In contrast, the left parietal region and the left temporal lobe have inhibitory effects on artistic expression through attention to visuospatial detail and semantic labeling, respectively. Frontal-executive functions are also required for artistic expression, particularly right dorsolateral frontal initiation of a network for novelty-seeking behavior. Further study of art in dementia can profitably evaluate this proposed schema for the mechanisms of art in the brain.
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Affiliation(s)
- Mario F Mendez
- Focal-type Dementias Clinic, University of California-Los Angeles, Los Angeles, CA 90073, USA.
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