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Common genetic variation is associated with longitudinal decline and network features in behavioral variant frontotemporal degeneration. Neurobiol Aging 2021; 108:16-23. [PMID: 34474300 PMCID: PMC8616801 DOI: 10.1016/j.neurobiolaging.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 01/28/2023]
Abstract
The T allele in rs1768208 located in or near the myelin oligodendrocyte basic protein gene (MOBP) is a risk factor for frontotemporal degeneration pathology. We evaluated the hypothesis that the presence of a T allele in rs1768208 will be associated with rate of cognitive decline in behavioral variant frontotemporal degeneration (bvFTD) related to compromised frontal networks. We studied 81 individuals clinically diagnosed with bvFTD who were genotyped for rs1768208 and coded using a dominant model reflecting the presence (i.e., MOBP +) or absence (MOBP -) of the T risk allele. Linear mixed-effects models assessed the association of genotype on neuropsychological performance over time. Regression analyses examined differences in network structure by MOBP genotype. We found a genotype by time interaction for declining cognitive performance, whereby MOBP + individuals demonstrated faster rates of decline in executive function. The presence of a MOBP risk allele was associated with degradation of white matter network features in the frontal lobe. These findings suggest that individual genetic variation may contribute to heterogeneity in clinical progression.
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Murley AG, Rouse MA, Coyle-Gilchrist ITS, Jones PS, Li W, Wiggins J, Lansdall C, Vázquez Rodríguez P, Wilcox A, Patterson K, Rowe JB. Predicting loss of independence and mortality in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:737-744. [PMID: 33563798 PMCID: PMC8223632 DOI: 10.1136/jnnp-2020-324903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that in syndromes associated with frontotemporal lobar degeneration, behavioural impairment predicts loss of functional independence and motor clinical features predict mortality, irrespective of diagnostic group. METHODS We used a transdiagnostic approach to survival in an epidemiological cohort in the UK, testing the association between clinical features, independence and survival in patients with clinical diagnoses of behavioural variant frontotemporal dementia (bvFTD n=64), non-fluent variant primary progressive aphasia (nfvPPA n=36), semantic variant primary progressive aphasia (svPPA n=25), progressive supranuclear palsy (PSP n=101) and corticobasal syndrome (CBS n=68). A principal components analysis identified six dimensions of clinical features. Using Cox proportional hazards and logistic regression, we identified the association between each of these dimensions and both functionally independent survival (time from clinical assessment to care home admission) and absolute survival (time to death). Analyses adjusted for the covariates of age, gender and diagnostic group. Secondary analysis excluded specific diagnostic groups. RESULTS Behavioural disturbance, including impulsivity and apathy, was associated with reduced functionally independent survival (OR 2.46, p<0.001), even if patients with bvFTD were removed from the analysis. Motor impairments were associated with reduced absolute survival, even if patients with PSP and CBS were removed from the analysis. CONCLUSION Our results can assist individualised prognostication and planning of disease-modifying trials, and they support a transdiagnostic approach to symptomatic treatment trials in patients with clinical syndromes associated with frontotemporal lobar degeneration.
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Affiliation(s)
- Alexander G Murley
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew A Rouse
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ian T S Coyle-Gilchrist
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P Simon Jones
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Tookey SA, Greaves CV, Rohrer JD, Stott J. Specific support needs and experiences of carers of people with frontotemporal dementia: A systematic review. DEMENTIA 2021; 20:3032-3054. [PMID: 34111957 DOI: 10.1177/14713012211022982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) is one of the most common types of dementia in persons younger than 65 years of age. Diagnosis is often delayed due to slow, gradual decline and misinterpretation of 'non-typical' dementia symptoms. Informal carers of people with FTD experience greater levels of overall burden than carers of people with other forms of dementia. The aim of this systematic review was to describe the subjective experience of being an informal carer of a person with FTD and to identify the specific needs, coping strategies and helpful support resources of this carer population. METHODS Four electronic databases were used to search for published literature presenting experiences of carers of people with FTD between January 2003 and July 2019. Search strategy followed PRISMA guidelines. Findings were analysed using framework analysis, employing five stages of analysis to develop a coding index and thematic framework that included key aspects of the carer experience, which were grouped into themes and presented in a narrative format. RESULTS 1213 articles were identified in total. Twelve studies were included in the final synthesis of the review. Six themes were identified: 'Challenging road to and receipt of diagnosis', 'relationship change and loss', 'challenging experiences in caring', 'positive experiences and resilience', 'coping' and 'support needs'. DISCUSSION Findings highlight an increased need for carers of people with FTD to receive support during the pre-diagnostic stage, including support to manage symptoms. Further research should explore relationship changes and loss amongst carers to inform approaches for carer support. In conclusion, the lack of knowledge and unique needs of carers highlight the importance of public awareness campaigns and healthcare professional education to support carers with FTD symptom impact.
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Affiliation(s)
- Sara A Tookey
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, UCL, Queen Square Institute of Neurology, 4919UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL, Queen Square Institute of Neurology, 4919UCL, London, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London, London, UK; ADAPT Lab, UCL, London, UK
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Giannini LAA, Peterson C, Ohm D, Xie SX, McMillan CT, Raskovsky K, Massimo L, Suh E, Van Deerlin VM, Wolk DA, Trojanowski JQ, Lee EB, Grossman M, Irwin DJ. Frontotemporal lobar degeneration proteinopathies have disparate microscopic patterns of white and grey matter pathology. Acta Neuropathol Commun 2021; 9:30. [PMID: 33622418 PMCID: PMC7901087 DOI: 10.1186/s40478-021-01129-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 01/10/2023] Open
Abstract
Frontotemporal lobar degeneration proteinopathies with tau inclusions (FTLD-Tau) or TDP-43 inclusions (FTLD-TDP) are associated with clinically similar phenotypes. However, these disparate proteinopathies likely differ in cellular severity and regional distribution of inclusions in white matter (WM) and adjacent grey matter (GM), which have been understudied. We performed a neuropathological study of subcortical WM and adjacent GM in a large autopsy cohort (n = 92; FTLD-Tau = 37, FTLD-TDP = 55) using a validated digital image approach. The antemortem clinical phenotype was behavioral-variant frontotemporal dementia (bvFTD) in 23 patients with FTLD-Tau and 42 with FTLD-TDP, and primary progressive aphasia (PPA) in 14 patients with FTLD-Tau and 13 with FTLD-TDP. We used linear mixed-effects models to: (1) compare WM pathology burden between proteinopathies; (2) investigate the relationship between WM pathology burden and WM degeneration using luxol fast blue (LFB) myelin staining; (3) study regional patterns of pathology burden in clinico-pathological groups. WM pathology burden was greater in FTLD-Tau compared to FTLD-TDP across regions (beta = 4.21, SE = 0.34, p < 0.001), and correlated with the degree of WM degeneration in both FTLD-Tau (beta = 0.32, SE = 0.10, p = 0.002) and FTLD-TDP (beta = 0.40, SE = 0.08, p < 0.001). WM degeneration was greater in FTLD-Tau than FTLD-TDP particularly in middle-frontal and anterior cingulate regions (p < 0.05). Distinct regional patterns of WM and GM inclusions characterized FTLD-Tau and FTLD-TDP proteinopathies, and associated in part with clinical phenotype. In FTLD-Tau, WM pathology was particularly severe in the dorsolateral frontal cortex in nonfluent-variant PPA, and GM pathology in dorsolateral and paralimbic frontal regions with some variation across tauopathies. Differently, FTLD-TDP had little WM regional variability, but showed severe GM pathology burden in ventromedial prefrontal regions in both bvFTD and PPA. To conclude, FTLD-Tau and FTLD-TDP proteinopathies have distinct severity and regional distribution of WM and GM pathology, which may impact their clinical presentation, with overall greater severity of WM pathology as a distinguishing feature of tauopathies.
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Affiliation(s)
- Lucia A A Giannini
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
- Department of Neurology, Alzheimer Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claire Peterson
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Daniel Ohm
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Corey T McMillan
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Katya Raskovsky
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Lauren Massimo
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - EunRah Suh
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David A Wolk
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA.
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El-Wahsh S, Finger EC, Piguet O, Mok V, Rohrer JD, Kiernan MC, Ahmed RM. Predictors of survival in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-324349. [PMID: 33441385 DOI: 10.1136/jnnp-2020-324349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
After decades of research, large-scale clinical trials in patients diagnosed with frontotemporal lobar degeneration (FTLD) are now underway across multiple centres worldwide. As such, refining the determinants of survival in FTLD represents a timely and important challenge. Specifically, disease outcome measures need greater clarity of definition to enable accurate tracking of therapeutic interventions in both clinical and research settings. Multiple factors potentially determine survival, including the clinical phenotype at presentation; radiological patterns of atrophy including markers on both structural and functional imaging; metabolic factors including eating behaviour and lipid metabolism; biomarkers including both serum and cerebrospinal fluid markers of underlying pathology; as well as genetic factors, including both dominantly inherited genes, but also genetic modifiers. The present review synthesises the effect of these factors on disease survival across the syndromes of frontotemporal dementia, with comparison to amyotrophic lateral sclerosis, progressive supranuclear palsy and corticobasal syndrome. A pathway is presented that outlines the utility of these varied survival factors for future clinical trials and drug development. Given the complexity of the FTLD spectrum, it seems unlikely that any single factor may predict overall survival in individual patients, further suggesting that a precision medicine approach will need to be developed in predicting disease survival in FTLD, to enhance drug target development and future clinical trial methodologies.
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Affiliation(s)
- Shadi El-Wahsh
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth C Finger
- Department of Clinicial Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Choudhury P, Scharf EL, Paolini MA, Graff-Radford J, Alden EC, Machulda MM, Jones DT, Fields JA, Murray ME, Graff-Radford NR, Constantopoulos E, Reichard RR, Knopman DS, Duffy JR, Dickson DW, Parisi JE, Josephs KA, Petersen RC, Boeve BF. Pick's disease: clinicopathologic characterization of 21 cases. J Neurol 2020; 267:2697-2704. [PMID: 32440921 DOI: 10.1007/s00415-020-09927-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pick's disease (PiD) is a unique subtype of frontotemporal lobar degeneration characterized pathologically by aggregates of 3-Repeat tau. Few studies have examined the clinical variability and disease progression in PiD. We describe the clinical features, neuropsychological profiles and coexistent pathologies in 21 cases of autopsy-confirmed PiD. METHODS This study was a retrospective analysis of patients with Pick's disease evaluated at Mayo Clinic, Rochester or Jacksonville (1995-2018), and identified through an existing database. RESULTS Twenty-one cases with sufficient clinical data were identified. Behavioral variant FTD (bvFTD; 12/21) was the most common phenotype, followed by primary progressive aphasia (PPA; 7/21), corticobasal syndrome (CBS; 1/21) and amnestic dementia (1/21). Median age at disease onset was 54 years, with PPA cases (median = 52 years) presenting earlier than bvFTD (median = 59). Median disease duration (onset-death) overall was 10 years and did not differ significantly between bvFTD (median = 9.5 years) and PPA (median = 13). Age at death was not significantly different in PPA (median = 66) compared to bvFTD (median = 68.5). A third of the cases (n = 7/21) demonstrated pure PiD pathology, while the remainder showed co-existent other pathologies including Alzheimer's type (n = 6), cerebral amyloid angiopathy (n = 3), combined Alzheimer's and amyloid angiopathy (n = 4), and Lewy body disease (n = 1). CONCLUSIONS Our study shows that bvFTD and PPA are the most common clinical phenotypes associated with PiD, although rare presentations such as CBS were also seen. Coexisting non-Pick's pathology was also present in many cases. Our study highlights the clinical and pathologic heterogeneity in PiD.
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Affiliation(s)
- Parichita Choudhury
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Eugene L Scharf
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Michael A Paolini
- Department of Molecular and Cellular Medicine, Texas A&M, College Station, TX, USA
| | | | - Eva C Alden
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Eleni Constantopoulos
- Department of Laboratory Medicine and Pathology (Neuropathology), Mayo Clinic, Rochester, MN, USA
| | - Ross R Reichard
- Department of Laboratory Medicine and Pathology (Neuropathology), Mayo Clinic, Rochester, MN, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Laboratory Medicine and Pathology (Neuropathology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Caswell C, McMillan CT, Xie SX, Van Deerlin VM, Suh E, Lee EB, Trojanowski JQ, Lee VMY, Irwin DJ, Grossman M, Massimo LM. Genetic predictors of survival in behavioral variant frontotemporal degeneration. Neurology 2019; 93:e1707-e1714. [PMID: 31537715 DOI: 10.1212/wnl.0000000000008387] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine autosomal dominant genetic predictors of survival in individuals with behavioral variant frontotemporal degeneration (bvFTD). METHODS A retrospective chart review of 174 cases with a clinical phenotype of bvFTD but no associated elementary neurologic features was performed, with diagnosis either autopsy-confirmed (n = 57) or supported by CSF evidence of non-Alzheimer pathology (n = 117). Genetic analysis of the 3 most common genes with pathogenic autosomal dominant mutations associated with frontotemporal degeneration was performed in all patients, which identified cases with C9orf72 expansion (n = 28), progranulin (GRN) mutation (n = 12), and microtubule-associated protein tau (MAPT) mutation (n = 10). Cox proportional hazards regressions were used to test for associations between survival and mutation status, sex, age at symptom onset, and education. RESULTS Across all patients with bvFTD, the presence of a disease-associated pathogenic mutation was associated with shortened survival (hazard ratio [HR] 2.164, 95% confidence interval [CI] 1.391, 3.368). In separate models, a GRN mutation (HR 2.423, 95% CI 1.237, 4.744), MAPT mutation (HR 8.056, 95% CI 2.938, 22.092), and C9orf72 expansion (HR 1.832, 95% CI 1.034, 3.244) were each individually associated with shorter survival relative to sporadic bvFTD. A mutation on the MAPT gene results in an earlier age at onset than a C9orf72 expansion or mutation on the GRN gene (p = 0.016). CONCLUSIONS Our findings suggest that autosomal dominantly inherited mutations, modulated by age at symptom onset, associate with shorter survival among patients with bvFTD. We suggest that clinical trials and clinical management should consider mutation status and age at onset when evaluating disease progression.
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Affiliation(s)
- Carrie Caswell
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Corey T McMillan
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sharon X Xie
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Vivianna M Van Deerlin
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - EunRan Suh
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Edward B Lee
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John Q Trojanowski
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Virginia M-Y Lee
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David J Irwin
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren M Massimo
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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8
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Abstract
PURPOSE OF REVIEW This article summarizes the clinical and anatomic features of the three named variants of primary progressive aphasia (PPA): semantic variant PPA, nonfluent/agrammatic variant PPA, and logopenic variant PPA. Three stroke aphasia syndromes that resemble the PPA variants (Broca aphasia, Wernicke aphasia, and conduction aphasia) are also presented. RECENT FINDINGS Semantic variant PPA and Wernicke aphasia are characterized by fluent speech with naming and comprehension difficulty; these syndromes are associated with disease in different portions of the left temporal lobe. Patients with nonfluent/agrammatic variant PPA or Broca aphasia have nonfluent speech with grammatical difficulty; these syndromes are associated with disease centered in the left inferior frontal lobe. Patients with logopenic variant PPA or conduction aphasia have difficulty with repetition and word finding in conversational speech; these syndromes are associated with disease in the left inferior parietal lobe. While PPA and stroke aphasias resemble one another, this article also presents their distinguishing features. SUMMARY Primary progressive and stroke aphasia syndromes interrupt the left perisylvian language network, resulting in identifiable aphasic syndromes.
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9
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Massimo L, Xie SX, Rennert L, Fick DM, Halpin A, Placek K, Williams A, Rascovsky K, Irwin DJ, Grossman M, McMillan CT. Occupational attainment influences longitudinal decline in behavioral variant frontotemporal degeneration. Brain Imaging Behav 2019. [PMID: 29542053 DOI: 10.1007/s11682-018-9852-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To evaluate whether occupational attainment influences the trajectory of longitudinal cognitive decline in behavioral variant frontotemporal degeneration (bvFTD). Single-center, retrospective, longitudinal study. Sixty-three patients meeting consensus criteria for bvFTD underwent evaluation at the University of Pennsylvania Frontotemporal Degeneration Center. All patients were studied longitudinally on letter-guided fluency, category-naming fluency and Boston Naming Test (BNT). Occupational attainment was defined categorically by assigning each individual's occupation to a professional or non-professional category. Linear mixed-effects models evaluated the interaction of neuropsychological performance change with occupational status. Regression analyses were used to relate longitudinal decline in executive function to baseline MRI grey matter atrophy. Higher occupational status was associated with a more severe slope of cognitive decline on letter-guided fluency and category-naming fluency, but not BNT. Faster rates of longitudinal decline on letter-guided and category-naming fluency were associated with more severe baseline grey matter atrophy in right dorsolateral and inferior frontal regions. Our longitudinal findings suggest that bvFTD individuals with higher lifetime cognitive experience demonstrate more rapid decline on measures of executive function. This finding converges with cross-sectional evidence suggesting that lifetime cognitive experiences contribute to heterogeneity in clinical progression in bvFTD.
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Affiliation(s)
- Lauren Massimo
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA.
- The Pennsylvania State University, College of Nursing, University Park, PA, USA.
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lior Rennert
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna M Fick
- The Pennsylvania State University, College of Nursing, University Park, PA, USA
| | - Amy Halpin
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - Katerina Placek
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - Andrew Williams
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - Katya Rascovsky
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
| | - Corey T McMillan
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 West Gates, Philadelphia, PA, 19104, USA
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10
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Rennert L, Xie SX. Bias induced by ignoring double truncation inherent in autopsy-confirmed survival studies of neurodegenerative diseases. Stat Med 2019; 38:3599-3613. [PMID: 31062392 DOI: 10.1002/sim.8185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 11/10/2022]
Abstract
Neurodegenerative diseases require an autopsy for confirmation of diagnosis. When death is the event of interest, studies based on autopsy-confirmed diagnoses result in right truncated survival times because individuals who live past the end of study date do not receive a pathological diagnosis and are therefore not included in the sample. Furthermore, many studies of neurodegenerative diseases recruit subjects only after the onset of the disease, which may result in left truncated survival times. Therefore, double truncation, the simultaneous presence of left and right truncation, is inherent in many autopsy-confirmed survival studies of neurodegenerative diseases. The main focus of this paper is to inform about the inherent double truncation in these studies and demonstrate how to properly estimate and compare survival distribution functions in this setting. We do so by conducting a case study of subjects with autopsy-confirmed Alzheimer's disease and frontotemporal lobar degeneration. This case study is supported by extensive simulation studies, which provide several new contributions to the literature on survival distribution estimation in the context of double truncation.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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11
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Lansdall CJ, Coyle-Gilchrist ITS, Vázquez Rodríguez P, Wilcox A, Wehmann E, Robbins TW, Rowe JB. Prognostic importance of apathy in syndromes associated with frontotemporal lobar degeneration. Neurology 2019; 92:e1547-e1557. [PMID: 30842292 PMCID: PMC6448451 DOI: 10.1212/wnl.0000000000007249] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To determine the influence of apathy, impulsivity, and behavioral change on survival in patients with frontotemporal dementia, progressive supranuclear palsy, and corticobasal syndrome. Methods We assessed 124 patients from the epidemiologic PiPPIN (Pick's Disease and Progressive Supranuclear Palsy, Prevalence and Incidence) study. Patients underwent detailed baseline cognitive and behavioral assessment focusing on apathy, impulsivity, and behavioral change. Logistic regression identified predictors of death within 2.5 years from assessment, including age, sex, diagnosis, cognition, and 8 neurobehavioral profiles derived from a principal component analysis of neuropsychological and behavioral measures. Results An apathetic neurobehavioral profile predicted death (Wald statistic = 8.119, p = 0.004, Exp(B) = 2.912, confidence interval = >1 [1.396–6.075]) and was elevated in all patient groups. This profile represented apathy, weighted strongly to carer reports from the Apathy Evaluation Scale, Neuropsychiatric Inventory, and Cambridge Behavioral Inventory. Age at assessment, sex, and global cognitive impairment were not significant predictors. Differences in mortality risk across diagnostic groups were accounted for by their neuropsychiatric and behavioral features. Conclusions The relationship between apathy and survival highlights the need to develop more effective and targeted measurement tools to improve its recognition and facilitate treatment. The prognostic importance of apathy suggests that neurobehavioral features might be useful to predict survival and stratify patients for interventional trials. Effective symptomatic interventions targeting the neurobiology of apathy might ultimately also improve prognosis.
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Affiliation(s)
- Claire J Lansdall
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK.
| | - Ian T S Coyle-Gilchrist
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Patricia Vázquez Rodríguez
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Alicia Wilcox
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Eileen Wehmann
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Trevor W Robbins
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - James B Rowe
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
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12
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Rasmussen H, Hellzen O, Stordal E, Enmarker I. Family caregivers experiences of the pre-diagnostic stage in frontotemporal dementia. Geriatr Nurs 2018; 40:246-251. [PMID: 30424902 DOI: 10.1016/j.gerinurse.2018.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 12/17/2022]
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disease with symptoms that differs from other dementias. Commonly early symptoms in FTD are changes in personality and behavior, which can be interpreted as psychiatric disease. The delay in FTD diagnosis contributes to the burden of family caregivers. Therefore, it is important to have more knowledge about the pre-diagnostic stage. In this qualitative interview study, we explored fourteen family caregiver's experiences of the pre-diagnostic stage of frontotemporal dementia (FTD). Our findings suggest that the family caregivers experienced the pre-diagnostic stage of FTD as changes in the interpersonal relationship with their loved one. These changes were often subtle and difficult for family caregivers to explain to others. The findings from our study illuminate the importance of medical staff paying attention when a next of kin is concerned about subtle changes in a loved one. The findings also illuminate that awareness of FTD should be raised.
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Affiliation(s)
- Hege Rasmussen
- Clinic for Mental Health and Substance Abuse, Nord-Trndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway.
| | - Ove Hellzen
- Department of Nursing Scienses, Mid Sweden University, Sundsvall, Sweden
| | - Eystein Stordal
- Clinic for Mental Health and Substance Abuse, Nord-Trndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway
| | - Ingela Enmarker
- Faculty of Health and Occupational Studies, University of Gvle, Sweden
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13
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Abstract
Primary progressive aphasia (PPA) refers to a disorder of declining language associated with neurodegenerative diseases such as frontotemporal degeneration and Alzheimer disease. Variants of PPA are important to recognize from a medical perspective because these syndromes are clinical markers suggesting specific underlying pathology. In this review, I discuss linguistic aspects of PPA syndromes that may prove informative for parsing our language mechanism and identifying the neural representation of fundamental elements of language. I focus on the representation of word meaning in a discussion of semantic variant PPA, grammatical comprehension and expression in a discussion of nonfluent/agrammatic variant PPA, the supporting role of short-term memory in a discussion of logopenic variant PPA, and components of language associated with discourse in a discussion of behavioral variant frontotemporal dementia. PPA provides a novel perspective that uniquely addresses facets of language and its disorders while complementing traditional aphasia syndromes that follow stroke.
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Affiliation(s)
- Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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14
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Kansal K, Mareddy M, Sloane KL, Minc AA, Rabins PV, McGready JB, Onyike CU. Survival in Frontotemporal Dementia Phenotypes: A Meta-Analysis. Dement Geriatr Cogn Disord 2016; 41:109-22. [PMID: 26854827 DOI: 10.1159/000443205] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Survival in frontotemporal dementia (FTD) is not well understood. We conducted a mixed effects meta-analysis of survival in FTD to examine phenotype differences and contributory factors. METHODS The PubMed, Medline, EMBASE, CINAHL, PsycINFO and Cochrane databases were searched for studies describing survival or natural history of behavioral variant FTD (bvFTD), progressive non-fluent aphasia (PNFA), semantic dementia (SD), FTD with amyotrophic lateral sclerosis (FTD-ALS), progressive supranuclear palsy and corticobasal degeneration. There were no language restrictions. RESULTS We included 27 studies (2,462 subjects). Aggregate mean and median survival were derived for each phenotype and, for comparison, Alzheimer's disease (AD) (using data from the selected studies). Survival was shortest in FTD-ALS (2.5 years). Mean survival was longest in bvFTD and PNFA (8 years) and median survival in SD (12 years). AD was comparable in survival to all except FTD-ALS. Age and sex did not affect survival; the education effect was equivocal. Heterogeneity in FTD survival was largely, but not wholly, explained by phenotypes. CONCLUSIONS Survival differs for FTD phenotypes but, except for FTD-ALS, compares well to AD survival. Elucidating the potential causes of within-phenotype heterogeneity in survival (such as complicating features and comorbidities) may open up opportunities for tailored interventions.
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Affiliation(s)
- Kalyani Kansal
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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15
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Abstract
Today, frontotemporal dementia (FTD) remains one of the most common forms of early-onset dementia, that is, before the age of 65, thus posing several diagnostic challenges to clinicians since symptoms are often mistaken for psychiatric or neurological diseases causing a delay in correct diagnosis, and the majority of patients with FTD present with symptoms at ages between 50 and 60. Genetic components are established risk factors for FTD, but the influence of lifestyle, comorbidity, and environmental factors on the risk of FTD is still unclear. Approximately 40% of individuals with FTD have a family history of dementia but less than 10% have a clear autosomal dominant pattern of inheritance. Lack of insight is often an early clue to FTD. A tailored treatment option at an early phase can mitigate suffering and improve patients' and caregivers' quality of life.
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Affiliation(s)
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| | - Zeina Chemali
- Department of Neurology and Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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16
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Massimo L, Zee J, Xie SX, McMillan CT, Rascovsky K, Irwin DJ, Kolanowski A, Grossman M. Occupational attainment influences survival in autopsy-confirmed frontotemporal degeneration. Neurology 2015; 84:2070-5. [PMID: 25904687 DOI: 10.1212/wnl.0000000000001595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/11/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the influence of occupational attainment and education on survival in autopsy-confirmed cases of frontotemporal lobar degeneration (FTLD) and Alzheimer disease (AD). METHODS We performed a retrospective chart review of 83 demographically matched, autopsy-confirmed FTLD (n = 34) and AD (n = 49) cases. Each patient's primary occupation was classified and ranked. Level of education was recorded in years. Survival was defined as time from symptom onset until death. Linear regression was used to test for associations among occupational attainment, education, and patient survival. RESULTS Median survival was 81 months for FTLD and 95 months for AD. Years of education and occupational attainment were similar for both groups. We found that higher occupational attainment was associated with longer survival in FTLD but not AD. CONCLUSIONS Our findings suggest that higher occupational attainment is associated with longer survival in autopsy-confirmed FTLD. The identification of protective factors associated with FTLD survival has important implications for estimates of prognosis and longitudinal studies such as treatment trials.
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Affiliation(s)
- Lauren Massimo
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA.
| | - Jarcy Zee
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Sharon X Xie
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Corey T McMillan
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Katya Rascovsky
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - David J Irwin
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Ann Kolanowski
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Murray Grossman
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
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17
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Abstract
BACKGROUND Primary progressive aphasia (PPA) is a progressive disorder of language that is increasingly recognised as an important presentation of a specific spectrum of neurodegenerative conditions. AIMS In an era of etiologically specific treatments for neurodegenerative conditions, it is crucial to establish the histopathologic basis for PPA. In this review, I discuss biomarkers for identifying the pathology underlying PPA. MAIN CONTRIBUTION Clinical syndromes suggest a probabilistic association between a specific PPA variant and an underlying pathology, but there are also many exceptions. A considerable body of work with biomarkers is now emerging as an important addition to clinical diagnosis. I review genetic, neuroimaging and biofluid studies that can help determine the pathologic basis for PPA. CONCLUSIONS Together with careful clinical examination, there is great promise that supplemental biomarker assessments will lead to accurate diagnosis of the pathology associated with PPA during life and serve as the basis for clinical trials in this spectrum of disease.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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18
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Irwin DJ, McMillan CT, Suh E, Powers J, Rascovsky K, Wood EM, Toledo JB, Arnold SE, Lee VMY, Van Deerlin VM, Trojanowski JQ, Grossman M. Myelin oligodendrocyte basic protein and prognosis in behavioral-variant frontotemporal dementia. Neurology 2014; 83:502-9. [PMID: 24994843 DOI: 10.1212/wnl.0000000000000668] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the prognostic utility of tauopathy-associated single nucleotide polymorphisms (SNPs) in sporadic behavioral-variant frontotemporal dementia (bvFTD). METHODS Eighty-one patients with sporadic bvFTD were genotyped for tauopathy-associated SNPs at rs8070723 (microtubule-associated protein tau [MAPT]) and rs1768208 (myelin-associated oligodendrocyte basic protein [MOBP]). We performed a retrospective case-control study comparing age at onset and disease duration between carriers of ≥1 polymorphism allele and noncarriers for these SNPs. Subanalyses were performed for autopsied subgroups with tauopathy (n = 20) and TDP-43 proteinopathy (n = 12). To identify a potential biological basis for disease duration, neuroimaging measures of white matter integrity were evaluated (n = 37). RESULTS Carriers of risk allele (T) in rs1768208 (i.e., MOBP RA+) had a shorter median disease duration (TC/TT = 5.5 years, CC = 9.5 years; p = 0.02). This was also found in the subset of cases with autopsy-confirmed tauopathies (p = 0.04) but not with TDP-43 proteinopathies (p > 0.1). By comparison, polymorphisms at rs8070723 (MAPT) had no effect on disease duration (p > 0.1), although carriers of protective allele (G) in rs8070723 had a younger median age at onset (AG/GG = 54.5 years, AA = 58 years; p < 0.01). MOBP RA+ patients had increased radial diffusivity in the superior corona radiata and midbrain, and reduced fractional anisotropy in the superior corona radiata as well as superior and inferior longitudinal fasciculi compared with noncarriers (p < 0.01). CONCLUSIONS The rs1768208 risk polymorphism in MOBP may have prognostic value in bvFTD. MOBP RA+ patients have more severe white matter degeneration in bvFTD that may contribute to shorter disease duration. Future studies are needed to help confirm these findings.
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Affiliation(s)
- David J Irwin
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia.
| | - Corey T McMillan
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - EunRan Suh
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - John Powers
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Katya Rascovsky
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Elisabeth M Wood
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Jon B Toledo
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Steven E Arnold
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Virginia M-Y Lee
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Vivianna M Van Deerlin
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - John Q Trojanowski
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Penn Frontotemporal Degeneration Center, Department of Neurology (D.J.I., C.T.M., J.P., K.R., E.M.W., M.G.); Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, Alzheimer's Disease Core Center (D.J.I., C.T.M., E.S., E.M.W., J.B.T., S.E.A., V.M.-Y.L., V.M.V.D., J.Q.T., M.G.); Penn Memory Center, Department of Neurology (S.E.A.); and Brain-Behavior Laboratory, Departments of Psychiatry, Perelman School of Medicine (S.E.A.), University of Pennsylvania, Philadelphia
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19
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Borroni B, Benussi A, Cosseddu M, Archetti S, Padovani A. Cerebrospinal fluid tau levels predict prognosis in non-inherited frontotemporal dementia. NEURODEGENER DIS 2013; 13:224-9. [PMID: 24029600 DOI: 10.1159/000353280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The course of frontotemporal dementia (FTD) is heterogeneous and no predictors of survival are currently available. Cerebrospinal fluid (CSF) tau dosage has been demonstrated to be useful in predicting outcome over time in a number of neurological disorders. OBJECTIVE To assess CSF tau levels in FTD and to evaluate their prognostic value. METHODS Seventy-seven FTD patients with no mutations in known causative genes were consecutively enrolled, and CSF tau and phospho-tau levels analysed. Each patient was reassessed over time, and survival (i.e. death/bedridden and otherwise) was evaluated. The survival analysis was carried out by Cox proportional hazards regression models. RESULTS Patients with high CSF tau levels (≥400 pg/ml) had shorter survival than those with low CSF tau levels [hazard ratio (HR) = 3.406; 95% CI: 1.151-10.077; Wald χ(2) = 4.902; d.f. = 1; p = 0.027]. The association between tau levels and survival probability was confirmed after adjusting for age, gender, clinical phenotype and FTD clinical dementia rating at enrolment (HR = 3.769; 95% CI: 1.143-12.433; Wald χ(2) = 4.748; d.f. = 1; p = 0.029). Neither demographic or clinical characteristics nor CSF phospho-tau levels or apolipoprotein E genotype were significantly associated with prognosis. CONCLUSIONS This study argues that CSF tau levels may be considered in FTD to predict patients' outcome. Establishing in vivo prognostic biomarkers is mandatory to define homogeneous groups for inclusion in future clinical trials and to monitor the effectiveness of future therapeutic approaches.
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Affiliation(s)
- Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
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20
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Massimo L, Evans LK, Benner P. Caring for loved ones with frontotemporal degeneration: the lived experiences of spouses. Geriatr Nurs 2013; 34:302-6. [PMID: 23726759 DOI: 10.1016/j.gerinurse.2013.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 12/12/2022]
Abstract
There is an abundant literature about the experience of caregiving for a spouse living with Alzheimer's disease (AD), but there are very few qualitative studies about caregiving for persons living with Frontotemporal Degeneration (FTD). FTD causes a change in personality and affected persons may lose the ability to adhere to social norms. Thus, the emotional loss caregivers experience is often confounded by anger in response to embarrassing and socially inappropriate behaviors. In this paper, we offer a glimpse of this lived experience through the voices of two spouses whom we interviewed, each with experience caring for persons living with FTD. We suggest that FTD caregivers experience a loss of emotional attachment to their spouse because of their partner's behavioral symptoms. This loss gives rise to feelings of isolation and anger as caregivers assume new roles and reimagine their future. The findings from these interviews illuminate the need for more research and greater attention and support for FTD caregivers early in the disease trajectory.
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Affiliation(s)
- Lauren Massimo
- School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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21
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Abstract
Frontotemporal dementia, a heterogeneous neurodegenerative disorder, is a common cause of young onset dementia (i.e. dementia developing in midlife or earlier). The estimated point prevalence is 15-22/100,000, and incidence 2.7-4.1/100,000. Some 25% are late-life onset cases. Population studies show nearly equal distribution by gender, which contrasts with myriad clinical and neuropathology reports. FTD is frequently familial and hereditary; five genetic loci for causal mutations have been identified, all showing 100% penetrance. Non-genetic risk factors are yet to be identified. FTD shows poor life expectancy but with survival comparable to that of Alzheimer's disease. Recent progress includes the formulation of up-to-date diagnostic criteria for the behavioural and language variants, and the development of new and urgently needed instruments for monitoring and staging the illness. There is still need for descriptive population studies to fill gaps in our knowledge about minority groups and developing regions. More pressing, however, is the need for reliable physiological markers for disease. There is a present imperative to develop a translational science to form the conduit for transferring neurobiological discoveries and insights from bench to bedside.
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Affiliation(s)
- Chiadi U. Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Janine Diehl-Schmid
- Center for Cognitive Disorders, Department of Psychiatry at Technische Universität München, München DE, Germany
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22
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Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (naPPA) is a young-onset neurodegenerative disorder characterised by poor grammatical comprehension and expression and a disorder of speech sound production. In an era of disease-modifying treatments, the identification of naPPA might be an important step in establishing a specific cause of neurodegenerative disease. However, difficulties in defining the characteristic language deficits and heterogeneity in the anatomical distribution of disease in naPPA have led to controversy. Findings from imaging studies have linked an impairment of this uniquely human language capacity with disruption of large-scale neural networks centred in left inferior frontal and anterior superior temporal regions. Accordingly, the pathological burden of disease in naPPA is anatomically focused in these regions. Most cases of naPPA are associated with the spectrum of pathological changes found in frontotemporal lobar degeneration involving the microtubule-associated protein tau. Knowledge of these unique clinical-pathological associations should advance care for patients with this important class of neurodegenerative diseases while supplementing our knowledge of human cognitive neuroscience.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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23
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Onyike CU. What is the life expectancy in frontotemporal lobar degeneration? Neuroepidemiology 2011; 37:166-7. [PMID: 22056969 DOI: 10.1159/000333347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Chiadi U Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, Baltimore, MD 21205, USA.
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24
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Nunnemann S, Last D, Schuster T, Förstl H, Kurz A, Diehl-Schmid J. Survival in a German population with frontotemporal lobar degeneration. Neuroepidemiology 2011; 37:160-5. [PMID: 22056939 DOI: 10.1159/000331485] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 08/03/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The present study aimed at analysing survival of patients with behavioural-variant frontotemporal dementia (bvFTD), semantic dementia (SD) and progressive non-fluent aphasia (PNFA). Furthermore, the objective of the study was to identify prognostic factors associated with survival and to examine causes of death. METHODS Interviews were performed with the proxies of 124 patients with frontotemporal lobar degeneration (FTLD). RESULTS Survival from the onset of first symptoms was significantly longer in SD than in bvFTD (10.5 years). Median survival in PNFA was 12.6 years. Age at onset, gender, education and severity of dementia at diagnosis did not significantly influence survival. We did not identify any phenocopy cases. The most frequent cause of death as reported by caregivers was respiratory system disorder. CONCLUSION This study adds to the growing literature on survival in patients with FTLD and provides insights into the causes of death.
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Affiliation(s)
- Sabine Nunnemann
- Department of Psychiatry, Technische Universität München, München, Germany
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25
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Estimating the number of persons with frontotemporal lobar degeneration in the US population. J Mol Neurosci 2011; 45:330-5. [PMID: 21584654 DOI: 10.1007/s12031-011-9538-y] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/28/2011] [Indexed: 12/12/2022]
Abstract
There are many challenges for determining the prevalence and incidence of frontotemporal lobar degenerations (FTLD). Consequently, the number of cases of behavioral variant frontotemporal dementia (bvFTD) or primary progressive aphasia (PPA) in the USA is unknown. Our objective was to derive a consensus estimate of bvFTD and PPA prevalence and thereby to estimate the total number of these syndromes in the USA. We identified five prevalence and three incidence studies of FTLD based on passive surveillance and seven studies of survival in FTLD. Data from these studies were used to estimate the number of cases of PPA or bvFTD in the USA. Because prevalence and incidence estimates outside of the 45-64-year age range were either not available or widely divergent, we used data from clinical and pathological series to estimate the proportion of FTLD cases aged <45 or >64 years. The prevalence estimates in the age categories of 45-64 years old have ranged from 15 to 22 per 100,000 person-years in studies where both bvFTD and PPA were identified. The incidence estimates for the same age group ranged from 2.7 to 4.1 per 100,000 person-years. Using a survival rate of 6 to 9 years from onset and rates from the incidence studies, a calculated prevalence estimate (prevalence = incidence × duration) was similar to the previously reported prevalence rates. We estimated that 10% of cases were less than age 45 years and 30% were 65 years and older. We estimate that there are approximately 20,000 to 30,000 cases of the cognitive syndromes of FTLD in the USA. The main threat to the accuracy of the estimates is the difficulty in diagnosing the clinical syndromes that comprise the FTLD group of disorders.
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26
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Borroni B, Grassi M, Archetti S, Papetti A, Del Bo R, Bonvicini C, Comi GP, Gennarelli M, Bellelli G, Di Luca M, Padovani A. Genetic background predicts poor prognosis in frontotemporal lobar degeneration. NEURODEGENER DIS 2011; 8:289-95. [PMID: 21311163 DOI: 10.1159/000322790] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/15/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ruling out predictors of survival in frontotemporal lobar degeneration (FTLD) is a clinical challenge for defining disease outcomes and monitoring therapeutic interventions. Little is known about determinants of survival in FTLD. OBJECTIVE The aim of the present study was to identify whether genetic determinants are key, not only as risk factors but as predictors of survival in FTLD. METHODS Ninety-seven FTLD patients were considered in the present study. A clinical evaluation and a standardized assessment were carried out. Each patient underwent blood sampling for genetic testing, and mutations within the progranulin (PGRN) gene, microtubule-associated protein tau (MAPT) haplotype, apolipoprotein E (APOE) genotype and 4 vascular endothelial growth factor (VEGF) polymorphisms were evaluated. Discrete-time survival models were applied. RESULTS Monogenic FTLD due to PGRN mutations [odds ratio (OR) = 3.62, 95% confidence interval (CI) = 1.12-11.7; p = 0.032], and MAPT *H2 haplotype (OR = 3.23, 95% CI = 1.08-9.69; p = 0.036) were associated with an increased hazard risk of poor outcome. Conversely, APOE genotype, and VEGF polymorphisms were not associated with survival risk in the FTLD sample. CONCLUSIONS Genetic background is not only crucial in disease pathogenesis, but it also modulates disease course. Genetic factors influencing prognosis should be taken into account to include homogeneous groups in future clinical trials and to monitor efficacy of future interventions.
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Affiliation(s)
- B Borroni
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy. bborroni @ inwind.it
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27
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Mendez MF. The Frontotemporal Dementia Syndromes. PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRY 2010:348-359. [DOI: 10.1002/9780470669600.ch57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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28
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Abstract
Primary progressive aphasia (PPA) is a disorder of declining language that is a frequent presentation of neurodegenerative diseases such as frontotemporal lobar degeneration. Three variants of PPA are recognized: progressive nonfluent aphasia, semantic dementia, and logopenic progressive aphasia. In an era of etiology-specific treatments for neurodegenerative conditions, determining the histopathological basis of PPA is crucial. Clinicopathological correlations in PPA emphasize the contributory role of dementia with Pick bodies and other tauopathies, TDP-43 proteinopathies, and Alzheimer disease. These data suggest an association between a specific PPA variant and an underlying pathology, although many cases of PPA are associated with an unexpected pathology. Neuroimaging and biofluid biomarkers are now emerging as important adjuncts to clinical diagnosis. There is great hope that the addition of biomarker assessments to careful clinical examination will enable accurate diagnosis of the pathology associated with PPA during a patient's life, and that such findings will serve as the basis for clinical trials in this spectrum of disease.
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Affiliation(s)
- Murray Grossman
- Department of Neurology, 2 Gibson, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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29
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Avants BB, Cook PA, Ungar L, Gee JC, Grossman M. Dementia induces correlated reductions in white matter integrity and cortical thickness: a multivariate neuroimaging study with sparse canonical correlation analysis. Neuroimage 2010; 50:1004-16. [PMID: 20083207 DOI: 10.1016/j.neuroimage.2010.01.041] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 01/06/2010] [Accepted: 01/12/2010] [Indexed: 12/12/2022] Open
Abstract
We use a new, unsupervised multivariate imaging and analysis strategy to identify related patterns of reduced white matter integrity, measured with the fractional anisotropy (FA) derived from diffusion tensor imaging (DTI), and decreases in cortical thickness, measured by high resolution T1-weighted imaging, in Alzheimer's disease (AD) and frontotemporal dementia (FTD). This process is based on a novel computational model derived from sparse canonical correlation analysis (SCCA) that allows us to automatically identify mutually predictive, distributed neuroanatomical regions from different imaging modalities. We apply the SCCA model to a dataset that includes 23 control subjects that are demographically matched to 49 subjects with autopsy or CSF-biomarker-diagnosed AD (n=24) and FTD (n=25) with both DTI and T1-weighted structural imaging. SCCA shows that the FTD-related frontal and temporal degeneration pattern is correlated across modalities with permutation corrected p<0.0005. In AD, we find significant association between cortical thinning and reduction in white matter integrity within a distributed parietal and temporal network (p<0.0005). Furthermore, we show that-within SCCA identified regions-significant differences exist between FTD and AD cortical-connective degeneration patterns. We validate these distinct, multimodal imaging patterns by showing unique relationships with cognitive measures in AD and FTD. We conclude that SCCA is a potentially valuable approach in image analysis that can be applied productively to distinguishing between neurodegenerative conditions.
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Affiliation(s)
- Brian B Avants
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104-6389, USA.
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30
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Borroni B, Grassi M, Agosti C, Premi E, Alberici A, Paghera B, Lucchini S, Luca MD, Perani D, Padovani A. Survival in Frontotemporal Lobar Degeneration and Related Disorders: Latent Class Predictors and Brain Functional Correlates. Rejuvenation Res 2009; 12:33-44. [DOI: 10.1089/rej.2008.0812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- B. Borroni
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - M. Grassi
- Department of Health Sciences, Section of Medical Statistics & Epidemiology, University of Pavia, Pavia, Italy
| | - C. Agosti
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - E. Premi
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - A. Alberici
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - B. Paghera
- Nuclear Medicine Unit, Brescia Hospital, Brescia, Italy
| | - S. Lucchini
- Nuclear Medicine Unit, Brescia Hospital, Brescia, Italy
| | - M. Di Luca
- Centre of Excellence for Neurodegenerative Disorders and Department of Pharmacological Sciences, University of Milan, Milan, Italy
| | - D. Perani
- Vita-Salute San Raffaele University, IRCCS San Raffaele, National Institute of Neuroscience (INN) and IBFM-CNR, Milan, Italy
| | - A. Padovani
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
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31
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Bian H, Grossman M. Frontotemporal lobar degeneration: recent progress in antemortem diagnosis. Acta Neuropathol 2007; 114:23-9. [PMID: 17541785 DOI: 10.1007/s00401-007-0235-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/05/2007] [Accepted: 05/08/2007] [Indexed: 12/12/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) is a neurodegenerative disorder characterized by changes in behaviour and language dysfunction. Two broad pathological subdivisions of FTLD are recognized in a recent classification scheme based on biochemical features: tau-positive pathology due to the accumulation of various forms of the microtubule-associated protein tau, such as FTLD with Pick bodies and corticobasal degeneration; and tau-negative pathology such as frontotemporal lobar degeneration with ubiquitin/TDP-43-immunoreactive inclusions. Etiologically based treatments aim to target the mechanisms underlying the accumulation of these abnormal proteins in these conditions. It is essential for us to develop biomarkers that support the accurate diagnosis of the specific diseases causing FTLD. These biomarkers also can be useful in assessing efficacy during treatment trials. This review summarizes the epidemiologic, clinical, neuropsychological, imaging and cerebrospinal fluid (CSF) biomarker features that can help identify these pathologically defined conditions during life.
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Affiliation(s)
- Hong Bian
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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