1
|
Benussi A, Libri I, Premi E, Alberici A, Cantoni V, Gadola Y, Rivolta J, Pengo M, Gazzina S, Calhoun VD, Gasparotti R, Zetterberg H, Ashton NJ, Blennow K, Padovani A, Borroni B. Differences and similarities between familial and sporadic frontotemporal dementia: An Italian single-center cohort study. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12326. [PMID: 35898667 PMCID: PMC9310192 DOI: 10.1002/trc2.12326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/11/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Introduction The possibility to generalize our understandings on treatments and assessments to both familial frontotemporal dementia (f-FTD) and sporadic FTD (s-FTD) is a fundamental perspective for the near future, considering the constant advancement in potential disease-modifying therapies that target particular genetic forms of FTD. We aimed to investigate differences in clinical features, cerebrospinal fluid (CSF), and blood-based biomarkers between f-FTD and s-FTD. Methods In this longitudinal cohort study, we evaluated a consecutive sample of symptomatic FTD patients, classified as f-FTD and s-FTD according to Goldman scores (GS). All patients underwent clinical, behavioral, and neuropsychiatric symptom assessment, CSF biomarkers and serum neurofilament light (NfL) analysis, and brain atrophy evaluation with magnetic resonance imaging. Results Of 570 patients with FTD, 123 were classified as f-FTD, and 447 as s-FTD. In the f-FTD group, 95 had a pathogenic FTD mutation while 28 were classified as GS = 1 or 2; of the s-FTD group, 133 were classified as GS = 3 and 314 with GS = 4. f-FTD and s-FTD cases showed comparable demographic features, except for younger age at disease onset, age at diagnosis, and higher years of education in the f-FTD group (all P < .05). f-FTD showed worse behavioral disturbances as measured with Frontal Behavioral Inventory (FBI) negative behaviors (14.0 ± 7.6 vs. 11.6 ± 7.4, P = .002), and positive behaviors (20.0 ± 11.0 vs. 17.4 ± 11.8, P = .031). Serum NfL concentrations were higher in patients with f-FTD (70.9 ± 37.9 pg/mL) compared to s-FTD patients (37.3 ± 24.2 pg/mL, P < .001), and f-FTD showed greater brain atrophy in the frontal and temporal regions and basal ganglia. Patients with f-FTD had significantly shorter survival than those with s-FTD (P = .004). Discussion f-FTD and s-FTD are very similar clinical entities, but with different biological mechanisms, and different rates of progression. The parallel characterization of both f-FTD and s-FTD will improve our understanding of the disease, and aid in designing future clinical trials for both genetic and sporadic forms of FTD. Highlights Do clinical features and biomarkers differ between patients with familial frontotemporal dementia (f-FTD) and sporadic FTD (s-FTD)?In this cohort study of 570 patients with FTD, f-FTD and s-FTD share similar demographic features, but with younger age at disease onset and diagnosis in the f-FTD group.f-FTD showed higher serum neurofilament light concentrations, greater brain damage, and shorter survival, compared to s-FTD.f-FTD and s-FTD are very similar clinical entities, but with different cognitive reserve mechanisms and different rates of progression.
Collapse
Affiliation(s)
- Alberto Benussi
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Neurology UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Ilenia Libri
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Enrico Premi
- Stroke UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Antonella Alberici
- Neurology UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Valentina Cantoni
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Yasmine Gadola
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Jasmine Rivolta
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Marta Pengo
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Stefano Gazzina
- Neurophysiology UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Vince D. Calhoun
- The Mind Research NetworkDepartment of Electrical and Computer EngineeringUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | | | - Henrik Zetterberg
- Institute of Neuroscience and PhysiologyDepartment of Psychiatry and NeurochemistryThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- UK Dementia Research Institute at UCLLondonUK
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyLondonUK
- Hong Kong Center for Neurodegenerative DiseasesHong KongChina
| | - Nicholas J. Ashton
- Institute of Neuroscience and PhysiologyDepartment of Psychiatry and NeurochemistryThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgMölndalSweden
- King's College LondonInstitute of PsychiatryPsychology & NeuroscienceMaurice Wohl Clinical Neuroscience InstituteLondonUK
- NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS FoundationLondonUK
| | - Kaj Blennow
- Institute of Neuroscience and PhysiologyDepartment of Psychiatry and NeurochemistryThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Alessandro Padovani
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Neurology UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| | - Barbara Borroni
- Neurology UnitDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Neurology UnitDepartment of Neurological and Vision SciencesASST Spedali CiviliBresciaItaly
| |
Collapse
|
2
|
El-Wahsh S, Finger EC, Piguet O, Mok V, Rohrer JD, Kiernan MC, Ahmed RM. Predictors of survival in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-324349. [PMID: 33441385 DOI: 10.1136/jnnp-2020-324349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
After decades of research, large-scale clinical trials in patients diagnosed with frontotemporal lobar degeneration (FTLD) are now underway across multiple centres worldwide. As such, refining the determinants of survival in FTLD represents a timely and important challenge. Specifically, disease outcome measures need greater clarity of definition to enable accurate tracking of therapeutic interventions in both clinical and research settings. Multiple factors potentially determine survival, including the clinical phenotype at presentation; radiological patterns of atrophy including markers on both structural and functional imaging; metabolic factors including eating behaviour and lipid metabolism; biomarkers including both serum and cerebrospinal fluid markers of underlying pathology; as well as genetic factors, including both dominantly inherited genes, but also genetic modifiers. The present review synthesises the effect of these factors on disease survival across the syndromes of frontotemporal dementia, with comparison to amyotrophic lateral sclerosis, progressive supranuclear palsy and corticobasal syndrome. A pathway is presented that outlines the utility of these varied survival factors for future clinical trials and drug development. Given the complexity of the FTLD spectrum, it seems unlikely that any single factor may predict overall survival in individual patients, further suggesting that a precision medicine approach will need to be developed in predicting disease survival in FTLD, to enhance drug target development and future clinical trial methodologies.
Collapse
Affiliation(s)
- Shadi El-Wahsh
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth C Finger
- Department of Clinicial Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Benussi A, Dell'Era V, Cantoni V, Cotelli MS, Cosseddu M, Spallazzi M, Micheli A, Turrone R, Alberici A, Borroni B. TMS for staging and predicting functional decline in frontotemporal dementia. Brain Stimul 2019; 13:386-392. [PMID: 31787557 DOI: 10.1016/j.brs.2019.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/31/2019] [Accepted: 11/17/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate if transcranial magnetic stimulation (TMS) measures correlate with disease severity and predict functional decline in frontotemporal dementia (FTD) phenotypes. METHODS Paired-pulse TMS was used to investigate the activity of different intracortical circuits in 171 FTD patients (122 bvFTD, 31 avPPA, 18 svPPA) and 74 healthy controls. Pearson's correlations were used to analyze the association between TMS measures and disease severity, while multiple regression analysis was used to identify the best clinical or neurophysiological measure to predict functional decline at 12 months. RESULTS We observed significant strong correlations between TMS measures [short interval intracortical inhibition-facilitation (SICI-ICF) and long interval intracortical inhibition (LICI)], and disease severity (evaluated with the FTLD-CDR) (all r > 0.5, p < 0.005). SICI-ICF, short interval intracortical facilitation (SICF) and LICI were also significant predictors of functional decline, evaluated as the change in FTLD-CDR scores at 12 months (all p < 0.005), while at the stepwise multiple regression analysis, SICI was the best predictor of disease progression, accounting for 72.5% of the variation in FTLD-CDR scores at 12 months (adjusted R2 = 0.72, p < 0.001). CONCLUSIONS The present study has shown that the dysfunction of inhibitory and facilitatory intracortical circuits, evaluated with TMS, correlates with disease severity and progression, accurately predicting functional decline at 12 months, better than any other investigated marker.
Collapse
Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valentina Dell'Era
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valentina Cantoni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | | | - Maura Cosseddu
- Neurology Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Marco Spallazzi
- Department of Medicine and Surgery, Section of Neurology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | | | | | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| |
Collapse
|
4
|
Agarwal S, Ahmed RM, D'Mello M, Foxe D, Kaizik C, Kiernan MC, Halliday GM, Piguet O, Hodges JR. Predictors of survival and progression in behavioural variant frontotemporal dementia. Eur J Neurol 2019; 26:774-779. [PMID: 30565360 DOI: 10.1111/ene.13887] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Predicting the course of behavioural variant frontotemporal dementia (bvFTD) remains a major clinical challenge. This study aimed to identify factors that predict survival and clinical progression in bvFTD. METHODS Consecutive patients with clinically probable bvFTD were prospectively followed up over an 8-year period. Baseline neuropsychological variables, presence of a known pathogenic frontotemporal dementia gene mutation and a systematic visual magnetic resonance imaging assessment at baseline were examined as candidate predictors using multivariate modelling. RESULTS After screening 121 cases, the study cohort consisted of 75 patients with probable bvFTD, with a mean age of 60.8 ± 8.5 years, followed up for a mean duration of 7.2 ± 3.5 years from symptom onset. Median survival time from disease onset was 10.8 years and median survival, prior to transition to nursing home, was 8.9 years. A total of 25 of the 75 patients died during the study follow-up period. Survival without dependence was predicted by shorter disease duration at presentation (hazard ratio, 0.49, P = 0.001), greater atrophy in the anterior cingulate cortex (hazard ratio, 1.75, P = 0.047), older age (hazard ratio, 1.07, P = 0.026) and a higher burden of behavioural symptoms (hazard ratio, 1.04, P = 0.015). In terms of disease progression, presence of a known pathogenic frontotemporal dementia mutation (β = 0.46, P < 0.001) was the strongest predictor of progression. Deficits in letter fluency (β = -0.43, P = 0.017) and greater atrophy in the motor cortex (β = 0.51, P = 0.03) were also associated with faster progression. CONCLUSIONS This study provides novel clinical predictors of survival and progression in bvFTD. Our findings are likely to have an impact on prognostication and care planning in this difficult disease.
Collapse
Affiliation(s)
- S Agarwal
- Neurology Unit, Addenbrooke's Hospital, Cambridge, UK.,Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales
| | - R M Ahmed
- Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales
| | - M D'Mello
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales
| | - D Foxe
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales.,Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, New South Wales, Australia
| | - C Kaizik
- Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, New South Wales, Australia
| | - M C Kiernan
- Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales
| | - G M Halliday
- Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, New South Wales, Australia
| | - O Piguet
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales.,Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, New South Wales, Australia
| | - J R Hodges
- Central Clinical School and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales
| |
Collapse
|
5
|
Cupidi C, Frangipane F, Gallo M, Clodomiro A, Colao R, Bernardi L, Anfossi M, Conidi ME, Vasso F, Curcio SAM, Mirabelli M, Smirne N, Torchia G, Muraca MG, Puccio G, Di Lorenzo R, Zampieri S, Romanello M, Dardis A, Maletta RG, Bruni AC. Role of Niemann-Pick Type C Disease Mutations in Dementia. J Alzheimers Dis 2018; 55:1249-1259. [PMID: 27792009 DOI: 10.3233/jad-160214] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several neurological and systemic diseases can cause dementia, beyond Alzheimer's disease. Rare genetic causes are often responsible for dementia with atypical features. Recently, mutations causative for Niemann-Pick type C disease (NPC) have also been implicated in neurodegenerative diseases. NPC is an autosomal recessive lipid storage disorder caused by mutations in NPC1 and NPC2 genes. In adults, clinical presentation mimicking other neurodegenerative diseases makes diagnosis difficult. Recent evidence suggests that heterozygous mutations in NPC genes may take on etiological significance. OBJECTIVE To investigate the presence of NPC1 and NPC2 mutations in adults affected by neurodegenerative dementia plus. METHODS We performed a genetic screening on 50 patients using a wide clinical and biochemical approach to characterize the phenotype of mutated patients. RESULTS Sequencing analysis revealed four different and known heterozygous mutations in NPC1 and NPC2 genes. Patient 1 carried the p. F284LfsX26 in NPC1 and was affected by progressive supranuclear palsy-like syndrome. The remaining three patients showed a corticobasal syndrome and harbored the c.441+1G>A variant of NPC2 (patient 2), the missense p.N222 S mutation associated with the c.1947+8G>C variant in the splice region of intron 12 in NPC1 (patient 3), and the p.V30M mutation in NPC2 (patient 4), respectively. Filipin staining was abnormal in patients 1 and 2. mRNA analysis revealed an altered splicing of the NPC2 gene in patient 2. CONCLUSIONS Heterozygous mutations of NPC1 and NPC2 genes could contribute to dementia plus, at least in a subset of patients. We highlight the occurrence of NPC1 and NPC2 heterozygous variants in dementia-plus as pathological event.
Collapse
Affiliation(s)
- Chiara Cupidi
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Maura Gallo
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Rosanna Colao
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | - Livia Bernardi
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | - Maria Anfossi
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Franca Vasso
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Maria Mirabelli
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | - Nicoletta Smirne
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | - Giusi Torchia
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Gianfranco Puccio
- Regional Neurogenetic Centre (CRN), ASP Catanzaro, Lamezia Terme, Italy
| | | | - Stefania Zampieri
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Milena Romanello
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Andrea Dardis
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | | |
Collapse
|
6
|
Cosseddu M, Benussi A, Gazzina S, Turrone R, Archetti S, Bonomi E, Biasiotto G, Zanella I, Ferrari R, Cotelli MS, Alberici A, Padovani A, Borroni B. Mendelian forms of disease and age at onset affect survival in frontotemporal dementia. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:87-92. [DOI: 10.1080/21678421.2017.1384020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maura Cosseddu
- Neurology Unit, Spedali Civili Hospital, Brescia, Italy,
| | - Alberto Benussi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Stefano Gazzina
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Rosanna Turrone
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Silvana Archetti
- Biotechnology Laboratory and Department of Diagnostics, Civic Hospital of Brescia, Brescia, Italy,
| | - Elisa Bonomi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Giorgio Biasiotto
- Biotechnology Laboratory and Department of Diagnostics, Civic Hospital of Brescia, Brescia, Italy,
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy,
| | - Isabella Zanella
- Biotechnology Laboratory and Department of Diagnostics, Civic Hospital of Brescia, Brescia, Italy,
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy,
| | - Raffaele Ferrari
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK, and
| | | | - Antonella Alberici
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| | - Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
| |
Collapse
|
7
|
Lee JS, Jung NY, Jang YK, Kim HJ, Seo SW, Lee J, Kim YJ, Lee JH, Kim BC, Park KW, Yoon SJ, Jeong JH, Kim SY, Kim SH, Kim EJ, Park KC, Knopman DS, Na DL. Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy. J Clin Neurol 2017; 13:234-242. [PMID: 28748674 PMCID: PMC5532319 DOI: 10.3988/jcn.2017.13.3.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Only a few studies have investigated the relationship between different subtypes and disease progression or prognosis in patients with behavioral variant frontotemporal dementia (bvFTD). Since a localized injury often produces more focal signs than a diffuse injury, we hypothesized that the clinical characteristics differ between patients with bvFTD who show diffuse frontal lobe atrophy (D-type) on axial magnetic resonance imaging (MRI) scans versus those with focal or circumscribed frontal lobe atrophy (F-type). Methods In total, 94 MRI scans (74 scans from bvFTD and 20 scans from age-matched normal controls) were classified into 35 D- and 39 F-type bvFTD cases based on an axial MRI visual rating scale. We compared baseline clinical characteristics, progression in motor and cognitive symptoms, and survival times between D- and F-types. Survival analyses were performed for 62 of the 74 patients. Results While D-type performed better on neuropsychological tests than F-type at baseline, D-type had higher baseline scores on the Unified Parkinson's Disease Rating Scale (UPDRS) Part III. Evaluations of motor progression showed that the disease duration with motor symptoms was shorter in D-type than F-type. Moreover, the survival time was shorter in D-type (6.9 years) than F-type (9.4 years). Cox regression analyses revealed that a high UPDRS Part III score at baseline contributed to an increased risk of mortality, regardless of the pattern of atrophy. Conclusions The prognosis is worse for D-type than for those with F-type. Shorter survival in D-type may be associated with the earlier appearance of motor symptoms.
Collapse
Affiliation(s)
- Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Na Yeon Jung
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Young Kyoung Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Juyoun Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jee H Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Key Chung Park
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea.
| |
Collapse
|
8
|
Massimo L, Zee J, Xie SX, McMillan CT, Rascovsky K, Irwin DJ, Kolanowski A, Grossman M. Occupational attainment influences survival in autopsy-confirmed frontotemporal degeneration. Neurology 2015; 84:2070-5. [PMID: 25904687 DOI: 10.1212/wnl.0000000000001595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/11/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the influence of occupational attainment and education on survival in autopsy-confirmed cases of frontotemporal lobar degeneration (FTLD) and Alzheimer disease (AD). METHODS We performed a retrospective chart review of 83 demographically matched, autopsy-confirmed FTLD (n = 34) and AD (n = 49) cases. Each patient's primary occupation was classified and ranked. Level of education was recorded in years. Survival was defined as time from symptom onset until death. Linear regression was used to test for associations among occupational attainment, education, and patient survival. RESULTS Median survival was 81 months for FTLD and 95 months for AD. Years of education and occupational attainment were similar for both groups. We found that higher occupational attainment was associated with longer survival in FTLD but not AD. CONCLUSIONS Our findings suggest that higher occupational attainment is associated with longer survival in autopsy-confirmed FTLD. The identification of protective factors associated with FTLD survival has important implications for estimates of prognosis and longitudinal studies such as treatment trials.
Collapse
Affiliation(s)
- Lauren Massimo
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA.
| | - Jarcy Zee
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Sharon X Xie
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Corey T McMillan
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Katya Rascovsky
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - David J Irwin
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Ann Kolanowski
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| | - Murray Grossman
- From the Frontotemporal Degeneration Center, Department of Neurology (L.M., C.T.M., K.R., D.J.I., M.G.), and Department of Biostatistics and Epidemiology (J.Z., S.X.X.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and The Pennsylvania State University (L.M., A.K.), College of Nursing, University Park, PA
| |
Collapse
|
9
|
Borroni B, Benussi A, Cosseddu M, Archetti S, Padovani A. Cerebrospinal fluid tau levels predict prognosis in non-inherited frontotemporal dementia. NEURODEGENER DIS 2013; 13:224-9. [PMID: 24029600 DOI: 10.1159/000353280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The course of frontotemporal dementia (FTD) is heterogeneous and no predictors of survival are currently available. Cerebrospinal fluid (CSF) tau dosage has been demonstrated to be useful in predicting outcome over time in a number of neurological disorders. OBJECTIVE To assess CSF tau levels in FTD and to evaluate their prognostic value. METHODS Seventy-seven FTD patients with no mutations in known causative genes were consecutively enrolled, and CSF tau and phospho-tau levels analysed. Each patient was reassessed over time, and survival (i.e. death/bedridden and otherwise) was evaluated. The survival analysis was carried out by Cox proportional hazards regression models. RESULTS Patients with high CSF tau levels (≥400 pg/ml) had shorter survival than those with low CSF tau levels [hazard ratio (HR) = 3.406; 95% CI: 1.151-10.077; Wald χ(2) = 4.902; d.f. = 1; p = 0.027]. The association between tau levels and survival probability was confirmed after adjusting for age, gender, clinical phenotype and FTD clinical dementia rating at enrolment (HR = 3.769; 95% CI: 1.143-12.433; Wald χ(2) = 4.748; d.f. = 1; p = 0.029). Neither demographic or clinical characteristics nor CSF phospho-tau levels or apolipoprotein E genotype were significantly associated with prognosis. CONCLUSIONS This study argues that CSF tau levels may be considered in FTD to predict patients' outcome. Establishing in vivo prognostic biomarkers is mandatory to define homogeneous groups for inclusion in future clinical trials and to monitor the effectiveness of future therapeutic approaches.
Collapse
Affiliation(s)
- Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | | | | | | | | |
Collapse
|
10
|
Premi E, Gazzina S, Bozzali M, Archetti S, Alberici A, Cercignani M, Bianchetti A, Gasparotti R, Turla M, Caltagirone C, Padovani A, Borroni B. Cognitive reserve in granulin-related frontotemporal dementia: from preclinical to clinical stages. PLoS One 2013; 8:e74762. [PMID: 24040338 PMCID: PMC3767639 DOI: 10.1371/journal.pone.0074762] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/02/2013] [Indexed: 12/03/2022] Open
Abstract
Objective Consistent with the cognitive reserve hypothesis, higher education and occupation attainments may help persons with neurodegenerative dementias to better withstand neuropathology before developing cognitive impairment. We tested here the cognitive reserve hypothesis in patients with frontotemporal dementia (FTD), with or without pathogenetic granulin mutations (GRN+ and GRN-), and in presymptomatic GRN mutation carriers (aGRN+). Methods Education and occupation attainments were assessed and combined to define Reserve Index (RI) in 32 FTD patients, i.e. 12 GRN+ and 20 GRN-, and in 17 aGRN+. Changes in functional connectivity were estimated by resting state fMRI, focusing on the salience network (SN), executive network (EN) and bilateral frontoparietal networks (FPNs). Cognitive status was measured by FTD-modified Clinical Dementia Rating Scale. Results In FTD patients higher level of premorbid cognitive reserve was associated with reduced connectivity within the SN and the EN. EN was more involved in FTD patients without GRN mutations, while SN was more affected in GRN pathology. In aGRN+, cognitive reserve was associated with reduced SN. Conclusions This study suggests that cognitive reserve modulates functional connectivity in patients with FTD, even in monogenic disease. In GRN inherited FTD, cognitive reserve mechanisms operate even in presymptomatic to clinical stages.
Collapse
Affiliation(s)
- Enrico Premi
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Stefano Gazzina
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Antonella Alberici
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Mara Cercignani
- Brighton and Sussex Medical School, Clinical Imaging Centre, University of Sussex, Brighton, United Kingdom
| | | | | | | | - Carlo Caltagirone
- Department of Neuroscience, University of Rome “Tor Vergata”, Rome, Italy
| | - Alessandro Padovani
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
- * E-mail:
| |
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- E Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Italy
| | | | | | | | | | | | | |
Collapse
|
12
|
Granulin mutation drives brain damage and reorganization from preclinical to symptomatic FTLD. Neurobiol Aging 2012; 33:2506-20. [DOI: 10.1016/j.neurobiolaging.2011.10.031] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 10/23/2011] [Accepted: 10/25/2011] [Indexed: 11/18/2022]
|
13
|
Maloney B, Lahiri DK. Structural and functional characterization of H2 haplotype MAPT promoter: unique neurospecific domains and a hypoxia-inducible element would enhance rationally targeted tauopathy research for Alzheimer's disease. Gene 2012; 501:63-78. [PMID: 22310385 DOI: 10.1016/j.gene.2012.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/29/2022]
Abstract
Alzheimer's disease (AD) is the leading cause of dementia in the elderly. Extraneuronal plaque comprising mostly the amyloid β peptide and intraneuronal tangles of hyperphosphorylated microtubule-associated τ protein (τ, gene MAPT) are typical of AD. Misfolded τ is also implicated in Parkinson's disease and frontotemporal dementia. We aim to understand the regulation of the human MAPT promoter by mapping its functional domains. We subcloned a 4868 base pair (bp) fragment from human BAC RPCI-11 100C5. Sequence analysis revealed an H2 haplotype MAPT promoter, 5'-UTR, and intronal fragment. Database analysis of the fragment showed 50%-75% homology with mouse and >90% with rhesus monkey. Comparison with human H1 sequences revealed differences that crossed predicted transcription factor sites. DNA-protein interaction studies by electrophoretic mobility shift assay suggested hypoxia response and an active specificity protein 1 (SP1) site in the 5'-untranslated region. Transfection of a series of MAPT promoter deletions revealed unique functional domains. The distal-most had different activities in neuronal vs. non-neuronal cells. We have cloned, sequenced, and functionally characterized a 4868bp fragment of the human MAPT 5'-flanking region, including the core promoter region (-302/+4), neurospecific domains (-4364/-1992 and +293/+504, relative to +1 TSS), and a hypoxia-inducible element (+60/+84). Our work extended functional analysis of the MAPT sequence further upstream, and explores cell-type specificity of MAPT promoter activity. Finally, we provided direct comparison of likely transcription factor binding sites, which are useful to understand differences between H1/H2 pathogenic associations.
Collapse
Affiliation(s)
- Bryan Maloney
- Laboratory of Molecular Neurogenetics, Department of Psychiatry, Institute of Psychiatric Research Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | |
Collapse
|