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Godefroy V, Batrancourt B, Charron S, Bouzigues A, Sezer I, Bendetowicz D, Carle G, Rametti-Lacroux A, Bombois S, Cognat E, Migliaccio R, Levy R. Disentangling Clinical Profiles of Apathy in Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis 2022; 90:639-654. [PMID: 36155506 PMCID: PMC9697059 DOI: 10.3233/jad-220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Apathy is highly frequent in behavioral variant frontotemporal dementia (bvFTD). It is presumed to involve different pathophysiological mechanisms and neuroanatomical regions. OBJECTIVE We explored the hypothesis that subgroups showing distinct profiles of apathy and distinct patterns of atrophy within frontal lobes could be disentangled in bvFTD. METHODS Using data-driven clustering applied to 20 bvFTD patients, we isolated subgroups according to their profiles on the three subscales of the Dimensional Apathy Scale (DAS). We explored their apathy profiles and atrophy patterns. Apathy profiles were characterized through both subjective measures of apathy by questionnaires and measures including objective behavioral metrics. Atrophy patterns were obtained by voxel-based morphometry, contrasting each bvFTD subgroup with healthy controls (N = 16). RESULTS By clustering based on DAS dimensions, we disentangled three subgroups of bvFTD patients, with distinct apathy profiles and atrophy patterns. One subgroup, which presented the smallest pattern of atrophy (including orbitofrontal cortex) with a right asymmetry, was characterized by high self-reported emotional and initiation apathy and by a self-initiation deficit reversible by external guidance. In other subgroups showing more diffuse bilateral atrophies extending to lateral prefrontal cortex, apathy was not reversible by external guidance and more difficulty to focus on goal-management was observed, especially in the subgroup with the largest atrophy and highest levels of executive apathy. CONCLUSION Distinct clinical profiles of apathy, corresponding to distinct anatomical subtypes of bvFTD, were identified. These findings have implications for clinicians in a perspective of precision medicine as they could contribute to personalize treatments of apathy.
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Affiliation(s)
- Valérie Godefroy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Bénédicte Batrancourt
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Sylvain Charron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Arabella Bouzigues
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Idil Sezer
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - David Bendetowicz
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.,Department of Neurology, IM2A, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Behavioural Neuropsychiatry Unit, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - Guilhem Carle
- Behavioural Neuropsychiatry Unit, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - Armelle Rametti-Lacroux
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphanie Bombois
- Department of Neurology, IM2A, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Emmanuel Cognat
- UMRS 1144, INSERM, F-5010, Université de Paris, Paris, France.,Centre de Neurologie Cognitive, Hôpital Lariboisière Fernand-Widal, APHP Nord, Paris, France
| | - Raffaella Migliaccio
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.,Department of Neurology, IM2A, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Behavioural Neuropsychiatry Unit, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - Richard Levy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.,Department of Neurology, IM2A, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Behavioural Neuropsychiatry Unit, AP-HP, Hôpital de la Salpêtrière, Paris, France
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Mazoué A, Gaultier A, Rocher L, Deruet AL, Vercelletto M, Boutoleau-Bretonnière C. Does a rabbit have feathers or fur? Development of a 42-item semantic memory test (SMT-42). J Clin Exp Neuropsychol 2022; 44:514-531. [DOI: 10.1080/13803395.2022.2133088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Aurélien Mazoué
- Département de Neurologie, Centre Mémoire Ressource et Recherche (CMRR), CHU de Nantes, Nantes, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Laëtitia Rocher
- Département de Neurologie, Centre Mémoire Ressource et Recherche (CMRR), CHU de Nantes, Nantes, France
| | - Anne-Laure Deruet
- Département de Neurologie, Centre Mémoire Ressource et Recherche (CMRR), CHU de Nantes, Nantes, France
| | - Martine Vercelletto
- Département de Neurologie, Centre Mémoire Ressource et Recherche (CMRR), CHU de Nantes, Nantes, France
- Inserm CIC 04, CHU de Nantes, Nantes, France
| | - Claire Boutoleau-Bretonnière
- Département de Neurologie, Centre Mémoire Ressource et Recherche (CMRR), CHU de Nantes, Nantes, France
- Inserm CIC 04, CHU de Nantes, Nantes, France
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Peltier C, Lejeune FX, Jorgensen LGT, Rametti-Lacroux A, Tanguy D, Godefroy V, Bendetowicz D, Carle G, Cognat E, Bombois S, Migliaccio R, Levy R, Marin F, Batrancourt B. A temporal classification method based on behavior time series data in patients with behavioral variant of frontotemporal dementia and apathy. J Neurosci Methods 2022; 376:109625. [PMID: 35653896 DOI: 10.1016/j.jneumeth.2022.109625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Caroline Peltier
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Centre des Sciences du Goût et de l'Alimentation (CSGA), ChemoSens Platform, AgroSup Dijon, CNRS, INRAE, University of Bourgogne Franche-Comté, PROBE Research Infrastructure, Dijon, France
| | - François-Xavier Lejeune
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Lars G T Jorgensen
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, 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
| | - Delphine Tanguy
- 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
| | - David Bendetowicz
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Guilhem Carle
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Emmanuel Cognat
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphanie Bombois
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, 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, Hôpital de la Pitié Salpêtrière, Department of Neurology, Center of excellence of neurodegenerative disease (CoEN), Institute of Memory and Alzheimer's Disease (IM2A), F-75013 Paris, 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, Hôpital de la Pitié Salpêtrière, Department of Neurology, Center of excellence of neurodegenerative disease (CoEN), Institute of Memory and Alzheimer's Disease (IM2A), F-75013 Paris, France
| | - Frédéric Marin
- Centre of Excellence for Human and Animal Movement Biomechanics (CoEMoB), Laboratoire de BioMécanique et BioIngénierie (UMR CNRS 7338), Université de Technologie de Compiègne (UTC), Alliance Sorbonne Université, 60200 Compiègne, France
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.
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Functional connectivity correlates of reduced goal-directed behaviors in behavioural variant frontotemporal dementia. Brain Struct Funct 2022; 227:2971-2989. [PMID: 35751676 DOI: 10.1007/s00429-022-02519-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
We explored the resting state functional connectivity correlates of apathy assessed as a multidimensional construct, using behavioral metrics, in behavioral variant frontotemporal dementia (bvFTD). We recorded the behavior of 20 bvFTD patients and 16 healthy controls in a close-to-real-life situation including a free phase (FP-in which actions were self-initiated) and a guided phase (GP-in which initiation of actions was facilitated by external guidance). We investigated the activity time and walking episode features as quantifiers of apathy. We used the means ((FP + GP)/2) and the differences (FP-GP) calculated for these metrics as well as measures by questionnaires to extract apathy dimensions by factor analysis. We assessed two types of fMRI-based resting state connectivity measures (local activity and seed-based connectivity) and explored their relationship with extracted apathy dimensions. Apathy in bvFTD was associated with lower time spent in activity combined with walking episodes of higher frequency, lower acceleration and higher duration. Using these behavioral metrics and apathy measures by questionnaires, we disentangled two dimensions: the global reduction of goal-directed behaviors and the specific deficit of self-initiation. Global apathy was associated with lower resting state activity within prefrontal cortex and lower connectivity of salience network hubs while the decrease in self-initiation was related to increased connectivity of parietal default-mode network hubs. Through a novel dimensional approach, we dissociated the functional connectivity correlates of global apathy and self-initiation deficit. We discussed in particular the role of the modified connectivity of lateral parietal cortex in the volitional process.
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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Godefroy V, Levy R, Bouzigues A, Rametti-Lacroux A, Migliaccio R, Batrancourt B. ECOCAPTURE@HOME: Protocol for the Remote Assessment of Apathy and Its Everyday-Life Consequences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157824. [PMID: 34360133 PMCID: PMC8345445 DOI: 10.3390/ijerph18157824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
Apathy, a common neuropsychiatric symptom associated with dementia, has a strong impact on patients’ and caregivers’ quality of life. However, it is still poorly understood and hard to define. The main objective of the ECOCAPTURE programme is to define a behavioural signature of apathy using an ecological approach. Within this program, ECOCAPTURE@HOME is an observational study which aims to validate a method based on new technologies for the remote monitoring of apathy in real life. For this study, we plan to recruit 60 couples: 20 patient-caregiver dyads in which patients suffer from behavioral variant Fronto-Temporal Dementia, 20 patient-caregiver dyads in which patients suffer from Alzheimer Disease and 20 healthy control couples. These dyads will be followed for 28 consecutive days via multi-sensor bracelets collecting passive data (acceleration, electrodermal activity, blood volume pulse). Active data will also be collected by questionnaires on a smartphone application. Using a pool of metrics extracted from these passive and active data, we will validate a measurement model for three behavioural markers of apathy (i.e., daytime activity, quality of sleep, and emotional arousal). The final purpose is to facilitate the follow-up and precise diagnosis of apathy, towards a personalised treatment of this condition within everyday life.
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Affiliation(s)
- Valérie Godefroy
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
- Correspondence: ; Tel.: +33-06-09-86-29-47
| | - Richard Levy
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
- Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France
- Unité de Neuropsychiatrie Comportementale, Département de Neurologie, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France
| | - Arabella Bouzigues
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
| | - Armelle Rametti-Lacroux
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
| | - Raffaella Migliaccio
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
- Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France; (R.L.); (A.B.); (A.R.-L.); (R.M.); (B.B.)
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Shim YS, Shin HE. Analysis of Neuropsychiatric Symptoms in Patients with Alzheimer's Disease Using Quantitative EEG and sLORETA. NEURODEGENER DIS 2020; 20:12-19. [PMID: 32610338 DOI: 10.1159/000508130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The electrocortical activities associated with the neuropsychiatric symptoms (NPSs) of Alzheimer's disease (AD) were investigated using frequency-domain electroencephalography (EEG) spectral source analysis, and the potential electrocortical indices identified. MATERIALS AND METHODS Scalp EEG data were obtained from 51 patients with AD to investigate the presence of four NPS subdomains, hyperactivity, psychosis, affective symptoms, and apathy. EEG power spectra and the standardized low-resolution brain electromagnetic tomography (sLORETA)-localized EEG cortical sources were compared between the groups with and without the four NPS subdomains in eight frequency bands: 1-4, 4-8, 8-10, 10-12, 12-18, 18-20, 20-30, and 30-45 Hz. RESULTS The power spectral analysis of EEG data showed that AD patients with psychosis had lower values at the α2-band in most areas. In patients with apathy, the θ-to-β power ratio showed a greater activity over the frontal and central regions. The cortical source analysis using sLORETA revealed that patients with psychosis showed decreased values in the α2-band and patients with apathy showed higher δ-values, especially in the right frontal and temporal regions. CONCLUSION The results of the present study showed that both classical EEG spectral and EEG source analysis could differentiate patients with and without NPSs, especially psychosis and apathy subdomains. Spectral and sLORETA analyses provided information helpful for a better characterization in patients with NPSs.
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Affiliation(s)
- Yong S Shim
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea,
| | - Hae-Eun Shin
- Department of Neurology, The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Republic of Korea
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van Engelen MPE, Gossink FT, de Vijlder LS, Meursing JR, Scheltens P, Dols A, Pijnenburg YA. End Stage Clinical Features and Cause of Death of Behavioral Variant Frontotemporal Dementia and Young-Onset Alzheimer's Disease. J Alzheimers Dis 2020; 77:1169-1180. [PMID: 32925036 PMCID: PMC7683069 DOI: 10.3233/jad-200337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Limited literature exists regarding the clinical features of end stage behavioral variant frontotemporal dementia (bvFTD). This data is indispensable to inform and prepare family members as well as professional caregivers for the expected disease course and to anticipate with drug-based and non-pharmacological treatment strategies. OBJECTIVE The aim of the present study was to describe end stage bvFTD in a broad explorative manner and to subsequently evaluate similarities and dissimilarities with the end stage of the most prevalent form of young-onset dementia, Alzheimer's disease (yoAD). METHODS We analyzed medical files on patients, using a mixed model of qualitative and quantitative approaches. Included were previously deceased patients with probable bvFTD and probable yoAD. End stage was defined as the last 6 months prior to death. Primary outcome measures comprised somatic, neurological, and psychiatric symptoms and the secondary outcome measure was cause of death. RESULTS Out of 89 patients, a total of 30 patients were included (bvFTD; n = 12, yoAD; n = 18). Overall, the end stages of bvFTD and yoAD were characterized by a broad spectrum of clinical symptoms including severe autonomic dysfunction and an increased muscle tone. Patients with bvFTD displayed more mutism compared with yoAD while compulsiveness was only present in bvFTD. CONCLUSION Our study describes the full clinical spectrum of end stage bvFTD and yoAD. In this study, symptoms extend far beyond the initial behavioral and cognitive features. By taking both somatic, psychiatric, and neurological features into account, family members and professional caregivers may anticipate (non) pharmacological treatment.
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Affiliation(s)
- Marie-Paule E. van Engelen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Flora T. Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Lieke S. de Vijlder
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Jan R.A. Meursing
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Batrancourt B, Lecouturier K, Ferrand-Verdejo J, Guillemot V, Azuar C, Bendetowicz D, Migliaccio R, Rametti-Lacroux A, Dubois B, Levy R. Exploration Deficits Under Ecological Conditions as a Marker of Apathy in Frontotemporal Dementia. Front Neurol 2019; 10:941. [PMID: 31551908 PMCID: PMC6736613 DOI: 10.3389/fneur.2019.00941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/14/2019] [Indexed: 11/13/2022] Open
Abstract
Apathy is one of the six clinical criteria for the behavioral variant of frontotemporal dementia (bvFTD), and it is almost universal in this disease. Although its consequences in everyday life are debilitating, its underlying mechanisms are poorly known, its assessment is biased by subjectivity and its care management is very limited. In this context, we have developed "ECOCAPTURE," a method aimed at providing quantifiable and objective signature(s) of apathy in order to assess it and identify its precise underlying mechanisms. ECOCAPTURE consists of the observation and recording of the patient's behavior when the participant is being submitted to a multiple-phase scenario reproducing a brief real-life situation. It is performed in a functional exploration platform transformed into a fully furnished waiting room equipped with a video and sensor-based data acquisition system. This multimodal method allowed video-based behavior analyses according to predefined behavioral categories (exploration behavior, sustained activities or inactivity) and actigraphy analyses from a 3D accelerometer. The data obtained were also correlated with behavioral/cognitive tests and scales assessing global cognitive efficiency, apathy, cognitive disinhibition, frontal syndrome, depression and anxiety. Here, bvFTD patients (n = 14) were compared to healthy participants (n = 14) during the very first minutes of the scenario, when the participants discovered the room and were encouraged to explore it. We showed that, in the context of facing a new environment, healthy participants first explored it and then engaged in sustained activities. By contrast, bvFTD patients were mostly inactive and eventually explored this new place, but in a more irregular and less efficient mode than normal subjects. This exploration deficit was correlated with apathy, disinhibition and cognitive and behavioral dysexecutive syndromes. These findings led us to discuss the presumed underlying mechanisms responsible for the exploration deficit (an inability to self-initiate actions, to integrate reward valuation and to inhibit involuntary behavior). Altogether, these results pave the way for simple and objective assessment of behavioral changes that represents a critical step for the evaluation of disease progression and efficacy of treatment in bvFTD.
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Affiliation(s)
- Bénédicte Batrancourt
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France
| | - Karen Lecouturier
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France
| | - Johan Ferrand-Verdejo
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France
| | - Vincent Guillemot
- Institut Pasteur, Centre de Bioinformatique, Biostatistique et Biologie Intégrative (C3BI), Paris, France
| | - Carole Azuar
- AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Institut de la Mèmoire et de la Maladie d'Alzheimer (IM2A), Paris, France
| | - David Bendetowicz
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Institut de la Mèmoire et de la Maladie d'Alzheimer (IM2A), Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Behavioral Neuropsychiatry Unit, Paris, France
| | - Raffaella Migliaccio
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Institut de la Mèmoire et de la Maladie d'Alzheimer (IM2A), Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Behavioral Neuropsychiatry Unit, Paris, France
| | - Armelle Rametti-Lacroux
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France
| | - Bruno Dubois
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Institut de la Mèmoire et de la Maladie d'Alzheimer (IM2A), Paris, France
| | - Richard Levy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Institut de la Mèmoire et de la Maladie d'Alzheimer (IM2A), Paris, France.,AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie, Behavioral Neuropsychiatry Unit, Paris, France
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10
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Nardone R, Sebastianelli L, Versace V, Saltuari L, Lochner P, Frey V, Golaszewski S, Brigo F, Trinka E, Höller Y. Usefulness of EEG Techniques in Distinguishing Frontotemporal Dementia from Alzheimer's Disease and Other Dementias. DISEASE MARKERS 2018; 2018:6581490. [PMID: 30254710 PMCID: PMC6140274 DOI: 10.1155/2018/6581490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022]
Abstract
The clinical distinction of frontotemporal dementia (FTD) and Alzheimer's disease (AD) may be difficult. In this narrative review we summarize and discuss the most relevant electroencephalography (EEG) studies which have been applied to demented patients with the aim of distinguishing the various types of cognitive impairment. EEG studies revealed that patients at an early stage of FTD or AD displayed different patterns in the cortical localization of oscillatory activity across different frequency bands and in functional connectivity. Both classical EEG spectral analysis and EEG topography analysis are able to differentiate the different dementias at group level. The combination of standardized low-resolution brain electromagnetic tomography (sLORETA) and power parameters seems to improve the sensitivity, but spectral and connectivity biomarkers able to differentiate single patients have not yet been identified. The promising EEG findings should be replicated in larger studies, but could represent an additional useful, noninvasive, and reproducible diagnostic tool for clinical practice.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Vanessa Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
- University for Medical Informatics and Health Technology (UMIT), Hall in Tirol, Austria
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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11
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Schroeter ML, Pawelke S, Bisenius S, Kynast J, Schuemberg K, Polyakova M, Anderl-Straub S, Danek A, Fassbender K, Jahn H, Jessen F, Kornhuber J, Lauer M, Prudlo J, Schneider A, Uttner I, Thöne-Otto A, Otto M, Diehl-Schmid J. A Modified Reading the Mind in the Eyes Test Predicts Behavioral Variant Frontotemporal Dementia Better Than Executive Function Tests. Front Aging Neurosci 2018; 10:11. [PMID: 29441012 PMCID: PMC5797534 DOI: 10.3389/fnagi.2018.00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/10/2018] [Indexed: 01/27/2023] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is characterized by deep alterations in behavior and personality. Although revised diagnostic criteria agree for executive dysfunction as most characteristic, impairments in social cognition are also suggested. The study aimed at identifying those neuropsychological and behavioral parameters best discriminating between bvFTD and healthy controls. Eighty six patients were diagnosed with possible or probable bvFTD according to Rascovsky et al. (2011) and compared with 43 healthy age-matched controls. Neuropsychological performance was assessed with a modified Reading the Mind in the Eyes Test (RMET), Stroop task, Trail Making Test (TMT), Hamasch-Five-Point Test (H5PT), and semantic and phonemic verbal fluency tasks. Behavior was assessed with the Apathy Evaluation Scale, Frontal Systems Behavioral Scale, and Bayer Activities of Daily Living Scale. Each test's discriminatory power was investigated by Receiver Operating Characteristic curves calculating the area under the curve (AUC). bvFTD patients performed significantly worse than healthy controls in all neuropsychological tests. Discriminatory power (AUC) was highest in behavioral questionnaires, high in verbal fluency tasks and the RMET, and lower in executive function tests such as the Stroop task, TMT and H5PT. As fluency tasks depend on several cognitive functions, not only executive functions, results suggest that the RMET discriminated better between bvFTD and control subjects than other executive tests. Social cognition should be incorporated into diagnostic criteria for bvFTD in the future, such as in the International Classification of Diseases (ICD)-11, as already suggested in the Diagnostic and Statistical Manual for Mental Disorders (DSM)-5.
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Affiliation(s)
- Matthias L Schroeter
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sarah Pawelke
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sandrine Bisenius
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jana Kynast
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Katharina Schuemberg
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryna Polyakova
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Adrian Danek
- Department of Neurology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Bonn, The German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Lauer
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Anja Schneider
- Department of Psychiatry and Psychotherapy, University of Bonn, The German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Angelika Thöne-Otto
- Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
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12
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Piguet O, Kumfor F, Hodges J. Diagnosing, monitoring and managing behavioural variant frontotemporal dementia. Med J Aust 2017; 207:303-308. [DOI: 10.5694/mja16.01458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/30/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Olivier Piguet
- Brain and Mind Centre, University of Sydney, Sydney, NSW
- School of Psychology, University of Sydney, Sydney, NSW
| | - Fiona Kumfor
- Brain and Mind Centre, University of Sydney, Sydney, NSW
- School of Psychology, University of Sydney, Sydney, NSW
| | - John Hodges
- Brain and Mind Centre, University of Sydney, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
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13
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Gossink FT, Dols A, Krudop WA, Sikkes SA, Kerssens CJ, Prins ND, Scheltens P, Stek ML, Pijnenburg YAL. Formal Psychiatric Disorders are not Overrepresented in Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis 2016; 51:1249-56. [PMID: 26967225 DOI: 10.3233/jad-151198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While psychiatric misdiagnosis is well-known in behavioral variant frontotemporal dementia (bvFTD), a systematic evaluation of standardized criteria for psychiatric disorders in bvFTD is still missing. Our aim was to define frequency and character of DSM-IV psychiatric disorders among patients with probable and definite bvFTD compared to possible bvFTD, other neurodegenerative diseases, and psychiatric diagnoses, using MINI-International Neuropsychiatric Interview. We additionally compared psychiatric prodromes between these groups. Subjects were participants of the late-onset frontal lobe (LOF) study, a longitudinal multicenter study. In each patient, after baseline diagnostic procedure, a neurologist and geriatric psychiatrist made a joint clinical diagnosis. Independently, a structured diagnostic interview according to DSM-IV and ICD-10 criteria (MINI-Plus) was performed by a trained professional blinded to clinical diagnosis. Out of 91 patients, 23 with probable and definite bvFTD, 3 with possible bvFTD, 25 with a non bvFTD neurodegenerative disease, and 40 with a clinical psychiatric diagnosis were included. Overall frequency of formal current and past psychiatric disorders in probable and definite bvFTD (21.7% current, 8.7% past) did not differ from other neurodegenerative diseases (12.0% current, 16.0% past) or possible bvFTD (66.7% current, 66.7% past), but was less than in patients with a clinical psychiatric diagnosis (57.5% current, 62.5% past; p < 0.01). In probable and definite bvFTD unipolar mood disorders were most common. Formally diagnosed psychiatric disorders are not overrepresented in probable bvFTD, suggesting that psychiatric misdiagnosis in bvFTD can be reduced by strictly applying diagnostic criteria. In suspected bvFTD close collaboration between neurologists and psychiatrists will advance diagnostics and subsequent treatment.
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Affiliation(s)
- Flora T Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Welmoed A Krudop
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sietske A Sikkes
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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14
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Abstract
Patients with different types of dementia may exhibit pathological eating habits, including food fads, hyperphagia, or even ingestion of inanimate objects. Several findings reveal that such eating alterations are more common in patients with frontotemporal dementia (FTD) than other types of dementia. Moreover, eating alterations may differ between the two variants of the disease, namely the behavioral variant and semantic dementia (SD). In this review, we summarized evidences regarding four areas: eating and body weight alterations in FTD, the most common assessment methods, anatomical correlates of eating disorders, and finally, proposed underlying mechanisms. An increasing understanding of the factors that contribute to eating abnormalities may allow first, a better comprehension of the clinical features of the disease and second, shed light on the mechanism underlying eating behaviors in the normal population.
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Affiliation(s)
| | - Vincenzo Silani
- b Department of Neurology and Laboratory of Neuroscience , IRCCS Istituto Auxologico Italiano, Dino Ferrari Centre , Milan , Italy.,c Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy
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15
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Yu M, Gouw AA, Hillebrand A, Tijms BM, Stam CJ, van Straaten ECW, Pijnenburg YAL. Different functional connectivity and network topology in behavioral variant of frontotemporal dementia and Alzheimer's disease: an EEG study. Neurobiol Aging 2016; 42:150-62. [PMID: 27143432 DOI: 10.1016/j.neurobiolaging.2016.03.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
Abstract
We investigated whether the functional connectivity and network topology in 69 Alzheimer's disease (AD), 48 behavioral variant of frontotemporal dementia (bvFTD) patients, and 64 individuals with subjective cognitive decline are different using resting-state electroencephalography recordings. Functional connectivity between all pairs of electroencephalography channels was assessed using the phase lag index (PLI). We subsequently calculated PLI-weighted networks, from which minimum spanning trees (MSTs) were constructed. Finally, we investigated the hierarchical clustering organization of the MSTs. Functional connectivity analysis showed frequency-dependent results: in the delta band, bvFTD showed highest whole-brain PLI; in the theta band, the whole-brain PLI in AD was higher than that in bvFTD; in the alpha band, AD showed lower whole-brain PLI compared with bvFTD and subjective cognitive decline. The MST results indicate that frontal networks appear to be selectively involved in bvFTD against the background of preserved global efficiency, whereas parietal and occipital loss of network organization in AD is accompanied by global efficiency loss. Our findings suggest different pathophysiological mechanisms in these 2 separate neurodegenerative disorders.
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Affiliation(s)
- Meichen Yu
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, the Netherlands.
| | - Alida A Gouw
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, the Netherlands; Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Betty M Tijms
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Cornelis Jan Stam
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Elisabeth C W van Straaten
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
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16
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Lee GJ, Lu PH, Mather MJ, Shapira J, Jimenez E, Leow AD, Thompson PM, Mendez MF. Neuroanatomical correlates of emotional blunting in behavioral variant frontotemporal dementia and early-onset Alzheimer's disease. J Alzheimers Dis 2015; 41:793-800. [PMID: 24685626 DOI: 10.3233/jad-132219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emotional blunting is a characteristic feature of behavioral variant frontotemporal dementia (bvFTD) and can help discriminate between patients with bvFTD and other forms of younger-onset dementia. OBJECTIVE We compared the presence of emotional blunting symptoms in patients with bvFTD and early-onset Alzheimer's disease (AD), and investigated the neuroanatomical associations between emotional blunting and regional brain volume. METHODS Twenty-five individuals with bvFTD (n = 11) and early-onset AD (n = 14) underwent magnetic resonance imaging (MRI) and were rated on symptoms of emotional blunting using the Scale for Emotional Blunting (SEB). The two groups were compared on SEB ratings and MRI-derived brain volume using tensor-based morphometry. Voxel-wise linear regression was performed to determine neuroanatomical correlates of SEB scores. RESULTS The bvFTD group had significantly higher SEB scores compared to the AD group. On MRI, bvFTD patients had smaller bilateral frontal lobe volume compared to AD patients, while AD patients had smaller bilateral temporal and left parietal volume than bvFTD patients. In bvFTD, SEB ratings were strongly correlated with right anterior temporal volume, while the association between SEB and the right orbitofrontal cortex was non-significant. CONCLUSIONS Symptoms of emotional blunting were more prevalent in bvFTD than early-onset AD patients. These symptoms were particularly associated with right-sided atrophy, with significant involvement of the right anterior temporal region. Based on these findings, the SEB appears to measure symptoms of emotional blunting that are localized to the right anterior temporal lobe.
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Affiliation(s)
- Grace J Lee
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Po H Lu
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michelle J Mather
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Jill Shapira
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Alex D Leow
- Departments of Psychiatry and Bioengineering, University of Illinois, Chicago, IL, USA
| | - Paul M Thompson
- Laboratory of NeuroImaging, Institute for Neuroimaging and Informatics, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
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17
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Boutoleau-Bretonnière C, Evrard C, Hardouin JB, Rocher L, Charriau T, Etcharry-Bouyx F, Auriacombe S, Richard-Mornas A, Lebert F, Pasquier F, Sauvaget A, Bulteau S, Vercelletto M, Derkinderen P, Bretonnière C, Thomas-Antérion C. DAPHNE: A New Tool for the Assessment of the Behavioral Variant of Frontotemporal Dementia. Dement Geriatr Cogn Dis Extra 2015; 5:503-16. [PMID: 26955383 PMCID: PMC4777961 DOI: 10.1159/000440859] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The diagnosis of behavioral variant of frontotemporal dementia (bvFTD) relies primarily on clinical features and remains challenging. The specificity of the recently revised criteria can be disappointing, justifying development of new clinical tools. OBJECTIVE We produced a behavioral inventory named DAPHNE. This scale (adapted from Rascovsky's criteria) explores six domains: disinhibition, apathy, perseverations, hyperorality, personal neglect and loss of empathy. It is composed of ten items (five answer categories). The aim was (1) to assess the validity and reliability of DAPHNE and (2) to evaluate its contribution in differentiating patients. METHODS Two scores were computed: DAPHNE-6 (screening) from the six domains and DAPHNE-40 (diagnosis) from the ten items. Reliability and reproducibility were assessed. External validity was studied with the Frontal Behavioral Inventory (FBI) and the Frontotemporal Behavioral Scale (FBS). Finally, the diagnostic performance of DAPHNE was compared to revised criteria, FBI and FBS. RESULTS DAPHNE was administered to the caregivers of 89 patients, 36 with bvFTD, 22 with Alzheimer's disease, 15 with progressive supranuclear palsy and 16 with bipolar disorder. Reliability and reproducibility were excellent, as was external validity. DAPHNE-6 allowed bvFTD diagnosis (score ≥4) with a sensitivity of 92%, while DAPHNE-40 (score ≥15) had a specificity of 92%. CONCLUSION We demonstrate excellent psychometric features for DAPHNE. This quick tool could help for both diagnosing and screening bvFTD.
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Affiliation(s)
- Claire Boutoleau-Bretonnière
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM CIC 04, Université de Nantes, France
- Laboratoire d'Etudes des Mécanismes Cognitifs, EA 3082, Université Lyon 2, Bron, Lyon, France
| | - Christelle Evrard
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM CIC 04, Université de Nantes, France
| | - Jean Benoît Hardouin
- EA 4275, Biostatistics, Pharmacoepidemiology and Human Sciences Research Team, Université de Nantes, France
- CHU Nantes, Département de Méthodologie et Biostatistiques, Université de Nantes, Nantes, France
| | - Laëtitia Rocher
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM CIC 04, Université de Nantes, France
| | - Tiphaine Charriau
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM CIC 04, Université de Nantes, France
| | | | - Sophie Auriacombe
- Centre Mémoire Ressource et Recherche, Département de Neurologie, CHU Bordeaux, Bordeaux, Lyon, France
| | | | - Florence Lebert
- Centre Mémoire Ressource et Recherche, Département de Neurologie, CHU Lille, Lille, Lyon, France
| | - Florence Pasquier
- Centre Mémoire Ressource et Recherche, Département de Neurologie, CHU Lille, Lille, Lyon, France
| | - Anne Sauvaget
- CAPPA Jacques Prévert Unité ECT-TMS-Liaison, UIC 18 ‘Addictions Comportementales et Troubles de l'Humeur Complexes', Service d'Addictologie et Psychiatrie de Liaison, CHU Nantes, Université de Nantes, Nantes, France
| | - Samuel Bulteau
- CAPPA Jacques Prévert Unité ECT-TMS-Liaison, UIC 18 ‘Addictions Comportementales et Troubles de l'Humeur Complexes', Service d'Addictologie et Psychiatrie de Liaison, CHU Nantes, Université de Nantes, Nantes, France
| | - Martine Vercelletto
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM CIC 04, Université de Nantes, France
| | - Pascal Derkinderen
- CHU Nantes, Centre Mémoire Ressource et Recherche, Département de Neurologie, Université de Nantes, France
- INSERM, UMR 913, Université de Nantes, Nantes, France
| | - Cédric Bretonnière
- EA3826, Thérapeutiques Cliniques et Expérimentales des Infections, UFR Médecine, Université de Nantes, Nantes, France
| | - Catherine Thomas-Antérion
- Laboratoire d'Etudes des Mécanismes Cognitifs, EA 3082, Université Lyon 2, Bron, Lyon, France
- Plein-Ciel, Lyon, France
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18
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Role of semiquantitative assessment of regional binding potential in 123I-FP-CIT SPECT for the differentiation of frontotemporal dementia, dementia with Lewy bodies, and Alzheimer's dementia. Clin Nucl Med 2015; 40:e27-33. [PMID: 25140560 DOI: 10.1097/rlu.0000000000000554] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION I-FP-CIT SPECT is increasingly used to differentiate between Alzheimer's dementia (AD) and dementia with Lewy bodies (DLB). The role of I-FP-CIT SPECT in frontotemporal dementia (FTD) is rather unclear, albeit nigrostriatal involvement may occur. The aim of this study was to evaluate its role in the differentiation of FTD, DLB, and AD. METHODS We analyzed 34 patients with clinical diagnosis of FTD (n = 13), DLB (n = 12), and AD (n = 9) undergoing combined F-FDG PET and I-FP-CIT SPECT. We performed a semiquantitative region of interest-based analysis to determine the binding potential values in caudate nucleus, putamen, and whole striatum including the caudate/putamen binding potential ratio and asymmetry indices. The receiver operating characteristic analyses and multinomial logistic regression were conducted to assess discrimination accuracy. RESULTS The putaminal binding potential separated DLB from AD with high accuracy (area under the receiver operating characteristic curve [AUC], 0.94). It also discriminated FTD from DLB with high accuracy (AUC, 0.92), whereas differentiation between FTD and AD was less accurate (AUC, 0.74). The binding potential ratio also provided high accuracy for differentiation of FTD and DLB (AUC, 0.91). Combination of these 2 parameters yielded slightly higher results for differentiation of FTD and DLB (AUC, 0.97). In a group including all patients, accuracy remained very high for DLB (AUC, 0.95), whereas values for FTD (AUC, 0.81) and AD (AUC, 0.80) were lower. CONCLUSIONS Semiquantitative assessment of striatal dopamine transporter availability can differentiate between FTD and DLB as well as DLB and AD with high accuracy, whereas discrimination between AD and FTD is limited.
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Pagonabarraga J, Kulisevsky J, Strafella AP, Krack P. Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. Lancet Neurol 2015; 14:518-31. [PMID: 25895932 DOI: 10.1016/s1474-4422(15)00019-8] [Citation(s) in RCA: 296] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 02/06/2023]
Abstract
Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers. Differentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain
| | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit, E.J. Safra Parkinson Disease Program, Toronto Western Hospital and Research Institute, UHN, ON, Canada; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, ON, Canada
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France; INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France.
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Wu L, Wu L, Chen Y, Zhou J. A promising method to distinguish vascular dementia from Alzheimer's disease with standardized low-resolution brain electromagnetic tomography and quantitative EEG. Clin EEG Neurosci 2014; 45:152-7. [PMID: 24214287 DOI: 10.1177/1550059413496779] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In clinical settings, it is difficult to distinguish Alzheimer's disease (AD) from vascular dementia (VD). The present study summarizes a clinical method to distinguish VD and AD at the early stage of the diseases. This study evaluated the possibility of differentiating 25 VD, 25 AD, and 25 healthy individuals (control, CN) by means of power spectral analysis and standardized low-resolution brain electromagnetic tomography (sLORETA) within alpha 1, alpha 2, beta 1, beta 2, delta, and theta frequency bands. Electroencephalogram (EEG) spectral analysis and sLORETA indicated that higher diffuse delta/theta and lower central/ posterior fast frequency bands were present in AD compared with CN. VD showed diffuse increased theta power compared with CN and lower delta than AD. AD also presented diffuse higher theta on spectral analysis and decreased alpha 2 and beta 1 values in central/temporal regions by sLORETA. Mini Mental State Examination (MMSE) scores were significantly associated with frontal alpha 1 sLORETA solutions (r = 0.91616, P < .001) and relative power (r = 0.87322, P < .01) in AD, but no correlations were found in VD. In conclusion, EEG spectral and sLORETA together could be a tool to distinguish the different EEG rhythmic activities in AD and VD.
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Affiliation(s)
- Lei Wu
- Department of Neurology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Lei Wu
- Department of Neurology, General Hospital of PLA, Beijing, China
| | - Ying Chen
- Department of Neurology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Jiong Zhou
- Department of Neurology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
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Apathy and emotion-based decision-making in amnesic mild cognitive impairment and Alzheimer's disease. Behav Neurol 2014; 2014:231469. [PMID: 25049450 PMCID: PMC4090525 DOI: 10.1155/2014/231469] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Apathy and reduced emotion-based decision-making are two behavioral modifications independently described in Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI). Objectives. The aims of this study were to investigate decision-making based on emotional feedback processing in AD and aMCI and to study the impact of reduced decision-making performances on apathy. Methods. We recruited 20 patients with AD, 20 participants with aMCI, and 20 healthy controls. All participants completed the Lille apathy rating scale (LARS) and the Iowa gambling task (IGT). Results. Both aMCI and AD participants had reduced performances on the IGT and were more apathetic compared to controls without any difference between aMCI and AD groups. For the entire sample, LARS initiation dimension was related to IGT disadvantageous decision-making profile. Conclusions. We provide the first study showing that both aMCI and AD individuals make less profitable decisions than controls, whereas aMCI and AD did not differ. Disadvantageous decision-making profile on the IGT was associated with higher level of apathy on the action initiation dimension. The role of an abnormal IGT performance as a risk factor for the development of apathy needs to be investigated in other clinical populations and in normal aging.
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Effect of diagnostic criteria on prevalence of frontotemporal dementia in the elderly. Alzheimers Dement 2014; 11:425-33. [DOI: 10.1016/j.jalz.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 02/24/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
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Kas A, Lavault S, Habert MO, Arnulf I. Feeling unreal: a functional imaging study in patients with Kleine-Levin syndrome. ACTA ACUST UNITED AC 2014; 137:2077-87. [PMID: 24785943 DOI: 10.1093/brain/awu112] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Kleine-Levin syndrome is characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, apathy, derealization and behavioural disturbances. Between episodes, patients have normal sleep, mood and behaviour. Functional imaging studies performed in small series of patients with Kleine-Levin syndrome with visual or semi-quantitative, uncontrolled analysis yielded equivocal brain changes. Using whole brain voxel-based group analysis, we compared brain perfusion scintigraphy during and between episodes in consecutive patients with Kleine-Levin syndrome versus healthy control subjects and correlated perfusion changes with disease severity and symptoms, focusing on less studied but disabling symptoms, such as apathy and derealization. During asymptomatic periods, 41 patients (mean age of 22.3 ± 8.1 years, 56.1% male) and 15 age- and sex-matched healthy control subjects underwent single-photon emission computed tomography scanning with technetium-99m ethyl cysteinate dimer. Eleven patients repeated the test during a symptomatic period. Compared with controls, patients during asymptomatic periods had persistent hypoperfusion in the hypothalamus, the thalamus (mainly the right posterior part), the caudate nucleus, and cortical associative areas, including the anterior cingulate, (Brodmann area 25), the orbito-frontal (Brodmann area 11) and the right superior temporal cortices (Brodmann area 22), extending to the insula (P < 0.001 in all area). Two additional hypoperfused areas emerged during symptomatic periods (P < 0.001), located in the right dorsomedial prefrontal cortex (Brodmann area 8) and the right parieto-temporal junction (Brodmann areas 22 and 39). These two areas were more affected between episodes, when the mean episode duration was longer (r = -0.53; P < 0.001). The score for the Depersonalization/Derealization Inventory during symptomatic periods strongly correlated with the hypoperfusion of the right (r = -0.74, P < 0.001) and left (r = -0.59, P < 0.005) parieto-temporal junctions. No hyperperfusion was found. Because the parieto-temporal junction (including the angular gyrus) is involved in cross-modal association between somatosensory (body knowledge), auditory and visual information, the robust hypoperfusions and correlations observed in this area may underlie the striking derealization reported by patients during episodes. Defects in the dorsomedial prefrontal cortex may cause apathy. Persistent hypoperfusion in the diencephalic and associative cortical area during asymptomatic periods is a marker of the disease, suggestive of a scenario wherein patients compensate for these deficient circuitries.
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Affiliation(s)
- Aurelie Kas
- 1 Nuclear Medicine Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France2 Sorbonne University, UPMC Univ Paris 06, Laboratoire d'Imagerie Fonctionnelle, INSERM UMR S 678, Paris, France
| | - Sophie Lavault
- 3 Sorbonne University, UPMC Univ Paris 06, Brain Research Institute (CRICM), Inserm UMR-S975, CNRS UMR7225, Paris, France4 Clinical investigation Centre Paris Est (CIC-9304), Paris, France5 Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Marie-Odile Habert
- 1 Nuclear Medicine Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France2 Sorbonne University, UPMC Univ Paris 06, Laboratoire d'Imagerie Fonctionnelle, INSERM UMR S 678, Paris, France
| | - Isabelle Arnulf
- 3 Sorbonne University, UPMC Univ Paris 06, Brain Research Institute (CRICM), Inserm UMR-S975, CNRS UMR7225, Paris, France4 Clinical investigation Centre Paris Est (CIC-9304), Paris, France5 Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié-Salpêtrière University Hospital, APHP, Paris, France
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Lagarde J, Valabrègue R, Corvol JC, Pineau F, Le Ber I, Vidailhet M, Dubois B, Levy R. Are frontal cognitive and atrophy patterns different in PSP and bvFTD? A comparative neuropsychological and VBM study. PLoS One 2013; 8:e80353. [PMID: 24278277 PMCID: PMC3835584 DOI: 10.1371/journal.pone.0080353] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and frontotemporal lobar degeneration (FTD) are two clinicohistological entities that share a severe prefrontal syndrome. To what extent do the cognitive syndrome and the location of the underlying brain atrophy unify or segregate these entities? Here, we examined the clinical and radiological patterns of frontal involvement and the neural bases of the cognitive dysfunctions observed in the Richardson form of PSP and the behavioral variant of FTD (bvFTD). The cognitive profile and grey and white matter volume of PSP (n = 19) and bvFTD (n = 16) patients and control participants (n = 18) were compared using a standard battery of neuropsychological tests and voxel-based morphometry (VBM), respectively. Analyses of correlations between neuropsychological and morphometric data were additionally performed. The severity and qualitative pattern of cognitive dysfunction was globally similar between the two patient groups. Grey matter volume was decreased in widespread frontal areas and in the temporal uncus in bvFTD, while it was decreased in the frontal and temporal lobes as well as in the thalamus in PSP. We also found an unexpected involvement of the frontal rectal gyrus in PSP patients compared to controls. Correlation analyses yielded different results in the two groups, with no area showing significant correlations in PSP patients, while several frontal and some temporal areas did so in bvFTD patients. In spite of minor neuropsychological and morphological differences, this study shows that the patterns of cognitive dysfunction and atrophy are very similar in PSP and bvFTD. However, executive dysfunction in these diseases may stem from partially divergent cortical and subcortical neural circuits.
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Affiliation(s)
- Julien Lagarde
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
| | - Romain Valabrègue
- Centre de NeuroImagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
| | - Jean-Christophe Corvol
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- INSERM, Centre d'Investigation Clinique, CIC-9503, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Fanny Pineau
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, Centre d'Investigation Clinique, CIC-9503, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Isabelle Le Ber
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- National reference center on rare dementias, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
| | - Bruno Dubois
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- National reference center on rare dementias, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Richard Levy
- Department of Neurology, AP-HP, Hôpital Saint-Antoine, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- * E-mail:
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Tan KS, Libon DJ, Rascovsky K, Grossman M, Xie SX. Differential longitudinal decline on the Mini-Mental State Examination in frontotemporal lobar degeneration and Alzheimer disease. Alzheimer Dis Assoc Disord 2013; 27:310-5. [PMID: 23314064 PMCID: PMC3648632 DOI: 10.1097/wad.0b013e31827bdc6f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine how phenotype affects longitudinal decline on the Mini-Mental State Examination (MMSE) in patients with frontotemporal lobar degeneration (FTLD) and Alzheimer disease (AD). BACKGROUND The MMSE is the most commonly administered assessment for dementia severity; however, the effects of phenotype on longitudinal MMSE performance in FTLD and AD have not been extensively studied. METHODS Data from 185 patients diagnosed with AD (n=106) and 3 FTLD (n=79) phenotypes [behavioral variant frontotemporal dementia (bvFTD), nonfluent agrammatic variant of primary progressive aphasia (nfaPPA), and semantic variant PPA (svPPA)] were collected for up to 52 months since initial evaluation. RESULTS Differential rates of decline were noted in that MMSE scores declined more precipitously for AD and svPPA compared with bvFTD and nfaPPA patients (P=0.001). The absolute 4-year MMSE decline given median baseline MMSE for bvFTD [14.67; 95% confidence interval (CI), 14.63-14.71] and nfaPPA (11.02; 95% CI, 10.98-11.06) were lower than svPPA (22.32; 95% CI, 22.29-22.34) or AD (22.24; 95% CI, 22.22-22.26). CONCLUSIONS These data suggest that within-group AD and FTLD phenotypes present distinct patterns of longitudinal decline on the MMSE. MMSE may not be adequately sensitive to track disease progression in some phenotypes of FTLD.
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Affiliation(s)
- Kay-See Tan
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
| | - David J. Libon
- Department of Neurology, Drexel University College of Medicine, University of Pennsylvania
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Sharon X. Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
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Premi E, Garibotto V, Gazzina S, Grassi M, Cosseddu M, Paghera B, Turla M, Padovani A, Borroni B. Beyond cognitive reserve: Behavioural reserve hypothesis in Frontotemporal Dementia. Behav Brain Res 2013; 245:58-62. [DOI: 10.1016/j.bbr.2013.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/19/2013] [Accepted: 01/25/2013] [Indexed: 11/15/2022]
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Lippe S, Gonin-Flambois C, Jambaqué I. The neuropsychology of the Klüver-Bucy syndrome in children. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:1285-8. [PMID: 23622339 DOI: 10.1016/b978-0-444-52910-7.00051-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Klüver-Bucy syndrome (KBS) is characterized by a number of peculiar behavioral symptoms. The syndrome was first observed in 1939 by Heinrich Klüver and Paul Bucy in the rhesus monkey following removal of the greater portion of the monkey's temporal lobes and rhinencephalon. The animal showed (a) visual agnosia (inability to recognize objects without general loss of visual discrimination), (b) excessive oral tendency (oral exploration of objects), (c) hypermetamorphosis (excessive visual attentiveness), (d) placidity with loss of normal fear and anger responses, (e) altered sexual behavior manifesting mainly as marked and indiscriminate hypersexuality, and (f) changes in eating behavior. In humans, KBS can be complete or incomplete. It occurs as a consequence of neurological disorders that essentially cause destruction or dysfunction of bilateral mesial temporal lobe structures (i.e., Pick disease, Alzheimer disease, cerebral trauma, cerebrovascular accidents, temporal lobe epilepsy, herpetic encephalopathy, heat stroke). As for epilepsy, complete and incomplete KBS are well documented in temporal lobe epilepsy, temporal lobectomy, and partial status epilepticus. KBS can occur at any age. Children seem to show similar symptoms to adults, although some differences in the manifestations of symptoms may be related to the fact that children have not yet learned certain behaviors.
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Affiliation(s)
- S Lippe
- Centre Hospitalier Universitaire Sainte-Justine Research Center and Psychology Department, University of Montreal, Montreal, Canada.
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Using the revised diagnostic criteria for frontotemporal dementia in India: evidence of an advanced and florid disease. PLoS One 2013; 8:e60999. [PMID: 23596513 PMCID: PMC3626587 DOI: 10.1371/journal.pone.0060999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The International Consortium (FTDC) that revised the diagnostic criteria for behavioural variant frontotemporal dementia (bvFTD) did not have an Asian representation. Whether the revised criteria are equally useful in the early detection of Asian bvFTD patients therefore remains largely unexplored. Earlier studies have indicated differences in clinical manifestations in Indian and other Asian bvFTD patients when compared to western groups. There is an urgent need for clarification, given the projected exponential rise in dementia in these countries and the imminent clinical trials on bvFTD. OBJECTIVE To assess how Indian bvFTD patients fulfil the FTDC criteria, hypothesizing that our patients might present differently early in the illness. METHOD In a hospital-based retrospective observational study, we assessed 48 probable bvFTD patients, diagnosed according to the FTDC criteria, for the speed with which these criteria were fulfilled, the frequency of individual symptoms and their order of appearance during the illness. RESULTS Most of our patients presented with moderate to severe dementia, in spite of having relatively short onset to diagnosis times. Patients on average took 1.4 years from onset to meet the FTDC criteria, with 90% of them presenting with four or more symptoms at diagnosis. Disinhibition was the commonest symptom and the first symptom in most patients. CONCLUSION With most patients presenting with advanced and florid disease, the FTDC criteria have little additional impact in early identification of bvFTD in India. Modifying the criteria further could allow detection of Indian patients early enough for their inclusion in future clinical trials.
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Premi E, Garibotto V, Alberici A, Paghera B, Giubbini R, Padovani A, Borroni B. Nature versus nurture in frontotemporal lobar degeneration: the interaction of genetic background and education on brain damage. Dement Geriatr Cogn Disord 2013; 33:372-8. [PMID: 22797130 DOI: 10.1159/000339366] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is a progressive neurodegenerative disorder with a strong genetic background. It has been reported that modifiable factors, i.e. education (E), might act as proxies for reserve capacity. OBJECTIVE To evaluate the impact of genetic background (positive family history, FH) on reserve mechanisms, by measuring regional cerebral blood flow (rCBF) correlates in FTLD patients. METHODS 145 FTLD patients were recruited and underwent clinical, neuropsychological, behavioral assessment, and SPECT study. The main effect of E and FH on rCBF was evaluated. To test the potential interaction between the E and rCBF in FTLD patients with or without positive FH, a difference of slope analysis in the two groups was calculated. All the analyses were controlled for disease severity (Clinical Dementia Rating Scale, FTD-CDR). RESULTS A main effect of education (E+ < E-) in frontal regions was reported, and high genetic loading (FH+ < FH-) was associated with a greater bilateral temporoparietal hypoperfusion. Evaluating the relationship between E and rCBF, a greater hypoperfusion of cingulate region in FH+ as compared to FH- was observed. DISCUSSION Reserve mechanisms are available also in presence of an unfavorable genetic status. However, these compensatory mechanisms are modulated by the interaction with genetic factors.
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Affiliation(s)
- E Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Italy
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Piguet O, Hodges JR. Behavioural-variant frontotemporal dementia: an update. Dement Neuropsychol 2013; 7:10-18. [PMID: 29213814 PMCID: PMC5619539 DOI: 10.1590/s1980-57642013dn70100003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/28/2013] [Indexed: 12/12/2022] Open
Abstract
Behavioural-variant frontotemporal dementia (bvFTD) is characterised by insidious changes in personality and interpersonal conduct that reflect progressive disintegration of the neural circuits involved in social cognition, emotion regulation, motivation and decision making. The underlying pathology is heterogeneous and classified according to the presence of intraneuronal inclusions of tau, TDP-43 or occasionally FUS. Biomarkers to detect these histopathological changes in life are increasingly important with the development of disease-modifying drugs. Gene mutations have been found which collectively account for around 10-20% of cases including a novel hexanucleotide repeat on chromosome 9 (C9orf72). The recently reviewed International Consensus Criteria for bvFTD propose three levels of diagnostic certainly: possible, probable and definite. Detailed history taking from family members to elicit behavioural features underpins the diagnostic process with support from neuropsychological testing designed to detect impairment in decision-making, emotion processing and social cognition. Brain imaging is important for increasing the level of diagnosis certainty. Carer education and support remain of paramount importance.
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Affiliation(s)
- Olivier Piguet
- Neuroscience Research Australia, Barker St, Randwick NSW
2031, Australia. School of Medical Sciences, the University of New South Wales,
Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, the
University of New South Wales, Sydney, Australia
| | - John R. Hodges
- Neuroscience Research Australia, Barker St, Randwick NSW
2031, Australia. School of Medical Sciences, the University of New South Wales,
Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, the
University of New South Wales, Sydney, Australia
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Apathy: A pathology of goal-directed behaviour. A new concept of the clinic and pathophysiology of apathy. Rev Neurol (Paris) 2012; 168:585-97. [DOI: 10.1016/j.neurol.2012.05.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 12/21/2022]
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Raaphorst J, Beeldman E, De Visser M, De Haan RJ, Schmand B. A systematic review of behavioural changes in motor neuron disease. ACTA ACUST UNITED AC 2012; 13:493-501. [PMID: 22424127 DOI: 10.3109/17482968.2012.656652] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Motor neuron disease (MND) and the behavioural variant of frontotemporal dementia (bvFTD) are thought to be part of a disease spectrum. There is uncertainty about the frequency and characteristics of behavioural changes in MND, and similarly, about a relation between bvFTD and the site of onset of MND. Our aim was to perform a systematic review of the publications on behavioural changes in MND. An extensive search for articles on behavioural changes in MND patients was performed. First, cohort studies of MND patients were reviewed to summarize the prevalence of bvFTD and mild behavioural changes. Secondly, data on bvFTD symptoms (mostly from case reports) of individual MND-bvFTD patients were used to analyse characteristics and pooled prevalences of bvFTD symptoms. In addition, site of onset, survival and demographic variables of MND-bvFTD patients were analysed. Results showed that in cohorts, 8.1% (95% CI 5.6 - 11.5%) of MND patients had bvFTD. In 170 individual patients with MND-bvFTD, perseveration (40%), apathy (29%) and disinhibition (26%) were the most frequently reported behavioural changes; 43% had memory disturbances and bulbar onset was found in 48%. In conclusion, 8% of MND patients have bvFTD, with perseveration being reported most frequently. MND-bvFTD is often accompanied by memory disturbances and is related to bulbar onset.
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Affiliation(s)
- Joost Raaphorst
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Caso F, Cursi M, Magnani G, Fanelli G, Falautano M, Comi G, Leocani L, Minicucci F. Quantitative EEG and LORETA: valuable tools in discerning FTD from AD? Neurobiol Aging 2012; 33:2343-56. [PMID: 22244088 DOI: 10.1016/j.neurobiolaging.2011.12.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 11/18/2011] [Accepted: 12/05/2011] [Indexed: 11/30/2022]
Abstract
Drawing a clinical distinction between frontotemporal dementia (FTD) and Alzheimer's disease (AD) is tricky, particularly at the early stages of disease. This study evaluates the possibility in differentiating 39 FTD, 39 AD, and 39 controls (CTR) by means of power spectral analysis and standardized low resolution brain electromagnetic tomography (sLORETA) within delta, theta, alpha 1 and 2, beta 1, 2, and 3 frequency bands. Both analyses revealed in AD patients, relative to CTR, higher expression of diffuse delta/theta and lower central/posterior fast frequency (from alpha1 to beta2) bands. FTD patients showed diffuse increased theta power compared with CTR and lower delta relative to AD patients. Compared with FTD, AD patients showed diffuse higher theta power at spectral analysis and, at sLORETA, decreased alpha2 and beta1 values in central/temporal regions. Spectral analysis and sLORETA provided complementary information that might help characterizing different patterns of electroencephalogram (EEG) oscillatory activity in AD and FTD. Nevertheless, this differentiation was possible only at the group level because single patients could not be discerned with sufficient accuracy.
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Affiliation(s)
- Francesca Caso
- Department of Neurology, Institute of Experimental Neurology-INSPE, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.
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Chow TW, Links KA, Masterman DL, Mendez MF, Vinters HV. A case of semantic variant primary progressive aphasia with severe insular atrophy. Neurocase 2011; 18:450-6. [PMID: 22150361 PMCID: PMC3500405 DOI: 10.1080/13554794.2011.627343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Insular degeneration has been linked to symptoms of frontotemporal dementia (FTD). Presented in this case is a patient exhibiting semantic variant primary progressive aphasia, behavioral disturbance. Upon autopsy, he was found to have severe insular atrophy. In addition, selective serotonin reuptake inhibitors were ineffective in reducing symptoms of obsessive-compulsive behaviors or emotional blunting. This case suggests that Seeley et al.'s (2007 , Alzheimer Disease & Associated Disorders, 21, S50) hypothesis that von Economo neurons and fork cell-rich brain regions, particularly in the insula, are targeted in additional subtypes of FTD beyond the behavioral variant.
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Affiliation(s)
- T W Chow
- Baycrest Rotman Research Institute, Brain Health Complex, Toronto, ON, Canada.
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Abstract
Over the past ten years, dopaminergic imaging has become increasingly part of the assessment and diagnosis of dementia. There are numerous PET and SPECT ligands available that target different steps in the process of neurotransmission. Abnormalities in dopaminergic imaging measures are consistent features of dementia with Lewy bodies (DLB) and other parkinsonian syndromes, and can be used to facilitate diagnosis, particularly in distinguishing between DLB and Alzheimer's disease. This review summarizes present knowledge in this area and the implications for current and future clinical practice.
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Jicha GA, Nelson PT. Management of frontotemporal dementia: targeting symptom management in such a heterogeneous disease requires a wide range of therapeutic options. Neurodegener Dis Manag 2011; 1:141-156. [PMID: 21927623 PMCID: PMC3172080 DOI: 10.2217/nmt.11.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
There are no US FDA-approved therapies for the management of frontotemporal dementia (FTD). Evidence-based medicine that would support a FDA indication for the treatment of FTD requires large-scale, randomized, double-blind, placebo-controlled trials that do not currently exist. Progress in obtaining approval and therapeutic indications for FTD has been severely hampered by the heterogeneity of clinical and pathological phenotypes seen in various FTD disease states. These issues are often misinterpreted by clinicians, caregivers and patients suggesting that potential treatment options are nonexistent for this devastating disease. This article discusses these issues in the context of recent studies and publications investigating therapeutic options in FTD, and further suggests a rationale for individualized therapy in FTD. Targeting the myriad of symptoms seen in FTD requires recognition of such symptoms that may play primary or secondary roles in the spectrum of deficits that lead to functional disability in FTD, and the availability of a wide range of therapeutic options that may be helpful in alleviating such symptomatology. Fortunately, agents targeting the many cognitive, behavioral, psychiatric and motor symptoms that can be seen in FTD are readily available, having been previously developed and approved for symptomatic benefit in other disease states. In contrast to the widespread belief that beneficial treatments are not available for FTD today, our therapeutic armament is stocked with pharmacological tools that may improve quality of life for those suffering from this devastating and incurable class of degenerative diseases.
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Affiliation(s)
- Gregory A Jicha
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neuropathology, University of Kentucky College of Medicine, Lexington, KY, USA
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Piguet O, Hornberger M, Mioshi E, Hodges JR. Behavioural-variant frontotemporal dementia: diagnosis, clinical staging, and management. Lancet Neurol 2010; 10:162-72. [PMID: 21147039 DOI: 10.1016/s1474-4422(10)70299-4] [Citation(s) in RCA: 336] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with behavioural-variant frontotemporal dementia (bvFTD) present with insidious changes in personality and interpersonal conduct that indicate progressive disintegration of the neural circuits involved in social cognition, emotion regulation, motivation, and decision making. The underlying pathological changes are heterogeneous and are characterised by various intraneuronal inclusions. Biomarkers to detect these histopathological changes in life are becoming increasingly important with the development of disease-modifying drugs. Gene mutations have been found that collectively account for around 10-20% of cases. Recently, criteria proposed for bvFTD define three levels of diagnostic certainty: possible, probable, and definite. Detailed history taking from family members to elicit behavioural features underpins the diagnostic process, with support from neuropsychological testing designed to detect impairment in decision making, emotion processing, and social cognition. Brain imaging is important for increasing the level of diagnostic certainty. A recently developed staging instrument shows much promise for monitoring patients and evaluating therapies, which at present are aimed at symptom amelioration. Carer education and support remain of paramount importance.
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Affiliation(s)
- Olivier Piguet
- Neuroscience Research Australia, Randwick, NSW, Australia
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Apathy: A Common Psychiatric Syndrome in the Elderly. J Am Med Dir Assoc 2009; 10:381-93. [DOI: 10.1016/j.jamda.2009.03.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/26/2009] [Accepted: 03/03/2009] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To compare the time taken to establish a clinical diagnosis of Frontotemporal dementia (FTD) relative to a diagnosis of early onset Alzheimer's dementia (AD). METHODS The data came from 89 patients under the age of 65 years, 52 of whom met the Manchester-Lund criteria for Frontotemporal dementia; 20 of these came from Lund University Hospital in Sweden. The other 32 patients with FTD along with 37 subjects who fulfilled the ICD-10 criteria for early onset Alzheimer's disease were recruited from four memory clinics and two neurology departments in Norway. RESULTS For FTD patients in Norway it took 59.2 months (SD 36.1) from the onset of illness until a clinical FTD diagnosis was made. The corresponding time period for FTD patients in Sweden is 49.5 months (SD 24.5) and for AD patients in Norway 39.1 months (SD 19.9). The time from the first visit to a medical doctor until a diagnosis was made for the FTD patients in Norway was 34.5 months (SD 22.6), for the Swedish FTD patients 23.1 months (SD 22.4) and for the AD patients 25.9 months (SD 13.1). In all, 71% of FTD patients and 30% of AD patients initially received a non-dementia diagnosis. CONCLUSION More knowledge about early presenting cognitive and behavioural signs of FTD is needed in both primary and secondary health care to reduce the time period needed to establish a clinical diagnosis of FTD.
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Mendez MF, Licht EA, Shapira JS. Changes in dietary or eating behavior in frontotemporal dementia versus Alzheimer's disease. Am J Alzheimers Dis Other Demen 2008; 23:280-5. [PMID: 18198236 PMCID: PMC10846021 DOI: 10.1177/1533317507313140] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Changes in dietary or eating behavior are common in dementia and may help distinguish between different dementing illnesses. OBJECTIVE To evaluate and characterize differences in dietary and eating behavior among patients with early frontotemporal dementia (FTD) versus Alzheimer's disease (AD). METHODS This study administered the Food-Related Problems Questionnaire (FRPQ) to caregivers of 16 patients with FTD and 16 comparable patients with AD. The FRPQ was evaluated at initial presentation when patients presented for a diagnostic evaluation. RESULTS Compared with the AD patients, the FTD patients had significantly more changes on the FRPQ. Subscale analysis indicated that the FTD patients showed impairment of observed satiety, improper taking of food, and inappropriate responses when food was not available. CONCLUSIONS The use of food-related questionnaires, such as the FRPQ, can help distinguish FTD patients, early in their course, from those with AD and can further characterize the altered dietary and eating behavior.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, University of California, Los Angeles, CA, USA.
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Boutoleau-Bretonnière C, Vercelletto M, Volteau C, Renou P, Lamy E. Zarit burden inventory and activities of daily living in the behavioral variant of frontotemporal dementia. Dement Geriatr Cogn Disord 2008; 25:272-7. [PMID: 18285675 DOI: 10.1159/000117394] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Activities of daily living (ADL) and caregiver burden are known to have a major impact on the decision to institutionalize patients with Alzheimer's disease (AD), yet little research has been done on these aspects in patients with frontotemporal dementia (FTD). AIM To compare ADL and caregiver burden in FTD and in early-onset AD. METHODS We compared 26 FTD and 28 AD patients with respect to the Neuropsychiatric Inventory (NPI), Mini Mental State Examination, Mattis Dementia Rating Scale (MDRS), Disability Assessment for Dementia (DAD) and Zarit Burden Inventory (ZBI). RESULTS Demographic variables for FTD and AD were similar. FTD patients obtained a significantly higher NPI behavioral score than AD patients (median, 39.5 vs. 11; p < 0.0001). However, the two groups did not differ in their total DAD score. No correlations were observed between DAD and cognitive status (MDRS) or between DAD and behavioral impairment (NPI). The ZBI was higher in FTD than in AD patients (median, 40 vs. 18.5; p = 0.0004) and was correlated with the NPI in both groups. CONCLUSION Functional disability was similar in FTD and AD patients. Nevertheless, the caregiver burden was higher in FTD than in AD, a result that has important implications for caregiver help.
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Pijnenburg YAL, Strijers RLM, Made YV, van der Flier WM, Scheltens P, Stam CJ. Investigation of resting-state EEG functional connectivity in frontotemporal lobar degeneration. Clin Neurophysiol 2008; 119:1732-1738. [PMID: 18490193 DOI: 10.1016/j.clinph.2008.02.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 02/18/2008] [Accepted: 02/22/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the presence of EEG abnormalities in frontotemporal lobar degeneration (FTLD) in comparison with Alzheimer's disease (AD) and non-demented individuals with subjective memory complaints (SMC), using an elaborated visual EEG rating scale; furthermore, to investigate whether assessment of resting-state functional connectivity of the EEG is superior to visual evaluation in distinguishing between FTLD, AD and non-demented controls. METHODS EEGs of 15 patients with FTLD, 20 with AD and 23 individuals with SMC were visually compared using the Grand Total EEG (GTE) score. The synchronization likelihood (SL) as a measure of functional connectivity between different EEG channels was calculated for the 0.5-4Hz, 4-8Hz, 8-10Hz, 10-13Hz, 13-30Hz and 30-45Hz frequency bands. Patients had mild to moderate dementia. RESULTS In AD, as expected, the GTE revealed significant differences from FTLD and SMC, indicating more EEG slowing and loss of reactivity. Patients with FTLD, however, could not be discriminated from individuals with SMC by the GTE score. Analysis of resting-state functional connectivity showed decreased SL in AD compared to both FTLD and SMC in the lower and higher alpha frequency band and decreased SL in AD compared to SMC in the beta frequency band, whereas no differences between FTLD and AD or SMC were found. CONCLUSIONS In patients with mild to moderate FTLD both the visually rated EEG and EEG measures of resting-state functional connectivity are normal. SIGNIFICANCE Although widespread neuronal degeneration takes place in frontotemporal lobar degeneration, this is not reflected in the EEG during the mild to moderate stages of the disease. An abnormal EEG in a mildly demented subject favours a diagnosis of AD.
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Affiliation(s)
- Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Rob L M Strijers
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Yolande Vd Made
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Pijnenburg YAL, Mulder JL, van Swieten JC, Uitdehaag BMJ, Stevens M, Scheltens P, Jonker C. Diagnostic accuracy of consensus diagnostic criteria for frontotemporal dementia in a memory clinic population. Dement Geriatr Cogn Disord 2008; 25:157-64. [PMID: 18176077 DOI: 10.1159/000112852] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2007] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS The goal of the present study was to evaluate the diagnostic accuracy of the core diagnostic criteria for frontotemporal dementia (FTD) [Neary D, et al: Neurology 1998;51:1546-1554] within a memory clinic population. METHODS The 5 core diagnostic criteria for FTD were operationalised in an informant-based written questionnaire. For a diagnosis of FTD the total clinical picture was weighted with findings on additional investigations and possible exclusion criteria, with follow-up of at least 1 year. RESULTS The operationalised core criteria for FTD had a sensitivity of 79% (95% CI = 57-92) and a specificity of 90% (95% CI = 85-94). CONCLUSION The core diagnostic criteria for FTD applied in a caregiver questionnaire have good diagnostic accuracy among subjects without advanced dementia attending a memory clinic. This stresses the importance of the informant-based history in the differential diagnosis of dementia.
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Rankin KP, Santos-Modesitt W, Kramer JH, Pavlic D, Beckman V, Miller BL. Spontaneous social behaviors discriminate behavioral dementias from psychiatric disorders and other dementias. J Clin Psychiatry 2008; 69:60-73. [PMID: 18312039 PMCID: PMC2735556 DOI: 10.4088/jcp.v69n0109] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Changes in social behavior are often the first symptoms of neurodegenerative disease. Patients with frontotemporal lobar degeneration (FTLD) often go undiagnosed, or are misclassified as psychiatric patients, because in the absence of cognitive deficits, nonexperts fail to recognize these social changes as dementia symptoms. The object of this study was to improve screening for behavioral dementias in primary care and mental health settings by quantifying spontaneous social behaviors specific to FTLD. METHOD In a university hospital dementia clinic, examiners blind to subject diagnosis performed 1 hour of cognitive testing, then completed the Interpersonal Measure of Psychopathy, an 18-item checklist of observed inappropriate behaviors. Patients then underwent a multidisciplinary evaluation to derive a neurodegenerative or psychiatric diagnosis. Data were collected from 288 subjects: 45 Alzheimer's disease (National Institute of Neurologic and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association research criteria); 40 frontotemporal dementia, 21 semantic dementia, and 13 progressive nonfluent aphasia (Neary research criteria); 14 corticobasal degeneration and 21 progressive supranuclear palsy (Litvan research criteria); 37 dementia with Lewy bodies (McKeith research criteria); 16 vascular dementia (Ischemic Vascular Disease research criteria); 29 mixed vascular and Alzheimer's disease (Alzheimer's Disease Diagnostic and Treatment Centers criteria); and 35 primary psychiatric disorder (DSM-IV) patients and 17 normal older controls. The study was conducted from March 2002 to January 2005. RESULTS Statistical item analyses demonstrated specific patterns of social behavior that differentiated both frontotemporal dementia and semantic dementia patients from (1) nondementing older adults, (2) nondementing individuals with psychiatric conditions, (3) individuals with cerebrovascular disease, and (4) individuals with other neurodegenerative disorders. Semantic dementia patients verbally and physically interrupted evaluations, spoke perseveratively and tangentially, and resisted clinician redirection. Frontotemporal dementia patients were apathetic or disinhibited and were unconcerned about meeting clinician expectations. CONCLUSION Specific, abnormal, interpersonal behaviors can alert nonexperts to the need for specialized dementia referral.
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Affiliation(s)
| | | | - Joel H. Kramer
- Department of Neurology, University of California San Francisco
| | - Danijela Pavlic
- Department of Neurology, University of California San Francisco
| | | | - Bruce L. Miller
- Department of Neurology, University of California San Francisco
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Demenze frontotemporali. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Diehl-Schmid J, Schūlte-Overberg J, Hartmann J, Förstl H, Kurz A, Häussermann P. Extrapyramidal signs, primitive reflexes and incontinence in fronto-temporal dementia. Eur J Neurol 2007; 14:860-4. [PMID: 17662005 DOI: 10.1111/j.1468-1331.2007.01773.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
According to the diagnostic consensus criteria [1] akinesia, rigidity and tremor as well as primitive reflexes and incontinence support the diagnosis of fronto-temporal dementia (FTD). However, the prevalence of extrapyramidal signs (EPMS), primitive reflexes and incontinence in FTD has not yet been systematically studied. In the present study, thirty-one patients with mild or moderate FTD without previous or present antipsychotic medication underwent a detailed neurological exam including the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). The average total score on the motor subscale of the UPDRS was 14.0 points. Akinesia and Parkinsonian gait or posture were found frequently but were mild in most instances. Rigidity was found in 36% of the patients. Resting tremor was a rare symptom. The only primitive reflex that occurred was a positive palmomental that was found in 7% of the patients. Urinary incontinence was present in 26%. The results have to be confirmed with larger or pooled patient samples from different ascertainment scenarios. If the results of the present study can be replicated, a revision of the consensus criteria from 1998 might be considered.
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Affiliation(s)
- J Diehl-Schmid
- Department of Psychiatry, Technische Universität München, München, Germany.
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Sedaghat F, Gotzamani-Psarrakou A, Dedousi E, Arnaoutoglou M, Psarrakos K, Baloyannis I, Dimitriadis AS, Baloyannis SJ. Evaluation of Dopaminergic Function in Frontotemporal Dementia Using 123I-FP-CIT Single Photon Emission Computed Tomography. NEURODEGENER DIS 2007; 4:382-5. [PMID: 17622781 DOI: 10.1159/000105159] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 10/26/2006] [Indexed: 12/20/2022] Open
Abstract
Extrapyramidal symptoms are observed in frontotemporal dementia (FTD). (123)I-FP-CIT (DaT scan) single photon emission computed tomography (SPECT) can detect loss of presynaptic dopamine transporters in the striatum. We aimed to evaluate the dopaminergic status of the striatum in patients with FTD using DaT scan. Seven patients (age range 65-76 years), who fulfilled the Neary criteria and in whom the diagnosis of FTD was confirmed by hexamethylpropyleneamine oxime SPECT, were included in the study. The severity of the extrapyramidal symptoms was evaluated by the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). SPECT using (123)I-FP-CIT was done. A (region - occipital)/occipital ratio was calculated for the striatum, putamen and caudate nucleus. The results were compared with those of the 7 age-matched normal controls. The uptake of the radiotracer in the right and left striatum was reduced to 62% (p = 0.000) and 68% (p = 0.000), respectively, compared to controls. The motor UPDRS score of the patients with FTD showed a negative correlation to the uptake of the radiotracer. The presynaptic dopamine transporter in FTD is impaired, related to the severity of the extrapyramidal symptoms. Since an effective treatment for FTD is still to be established, there is a need for evaluating the efficacy of dopaminergic drugs.
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Affiliation(s)
- Fereshteh Sedaghat
- Department of Nuclear Medicine, AHEPA University Hospital, Ellispondou 49, Kalamaria 55132, GR-54636 Thessaloniki, Greece.
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Dujardin K. Apathie et pathologies neuro-dégénératives : physiopathologie, évaluation diagnostique et traitement. Rev Neurol (Paris) 2007; 163:513-21. [PMID: 17571020 DOI: 10.1016/s0035-3787(07)90458-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Apathy is usually defined as a lack of motivation leading to reduced interest and participation in various activities. From a pathophysiological viewpoint, the most common cause of apathy is dysfunction of the frontal lobes, following either direct lesion of the frontal cortex or damage to regions tightly connected to the latter (such as the basal ganglia). The frontal-subcortical circuits often seem to be involved. Apathy is a common behavioral consequence of neurodegenerative disorders (Alzheimer's disease, parkinsonian syndromes, fronto-temporal dementia). The methods for detecting apathy and assessing its severity are various, the main difficulty being to disentangle apathy and depression. The treatment of apathy per se remains anecdotal and, to date, little research into the efficacy of medication therapy has been performed.
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Affiliation(s)
- K Dujardin
- Faculté de Médecine, Université du Droit et de la Santé de Lille, Institut Fédératif de Recherche (IFR 114, Neurosciences), Cedex.
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Ruby P, Schmidt C, Hogge M, D'Argembeau A, Collette F, Salmon E. Social Mind Representation: Where Does It Fail in Frontotemporal Dementia? J Cogn Neurosci 2007; 19:671-83. [PMID: 17381257 DOI: 10.1162/jocn.2007.19.4.671] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
We aimed at investigating social disability and its cerebral correlates in frontotemporal dementia (FTD). To do so, we contrasted answers of patients with early-stage FTD and of their relatives on personality trait judgment and on behavior prediction in social and emotional situations. Such contrasts were compared to control contrasts calculated with answers of matched controls tested with their relatives. In addition, brain metabolism was measured in patients with positron emission tomography and the [18F]fluorodeoxyglucose method. Patients turned out to be as accurate as controls in describing their relative's personality, but they failed to predict their relative's behavior in social and emotional circumstances. Concerning the self, patients were impaired both in current personality assessment and in prediction of their own behavior. Those two self-evaluation measures did not correlate. Only patients' anosognosia for social behavioral disability was found to be related to decreased metabolic activity in the left temporal pole. Such results suggest that anosognosia for social disability in FTD originates in impaired processing of emotional autobiographical information, leading to a self-representation that does not match current behavior. Moreover, we propose that perspective-taking disability participates in anosognosia, preventing patients from correcting their inaccurate self-representation based on their relative's perspective.
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