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Tuovinen T, Häkli J, Rytty R, Krüger J, Korhonen V, Järvelä M, Helakari H, Kananen J, Nikkinen J, Veijola J, Remes AM, Kiviniemi V. The relative brain signal variability increases in the behavioral variant of frontotemporal dementia and Alzheimer's disease but not in schizophrenia. J Cereb Blood Flow Metab 2024:271678X241262583. [PMID: 38897598 DOI: 10.1177/0271678x241262583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Overlapping symptoms between Alzheimer's disease (AD), behavioral variant of frontotemporal dementia (bvFTD), and schizophrenia (SZ) can lead to misdiagnosis and delays in appropriate treatment, especially in cases of early-onset dementia. To determine the potential of brain signal variability as a diagnostic tool, we assessed the coefficient of variation of the BOLD signal (CVBOLD) in 234 participants spanning bvFTD (n = 53), AD (n = 17), SZ (n = 23), and controls (n = 141). All underwent functional and structural MRI scans. Data unveiled a notable increase in CVBOLD in bvFTD patients across both datasets (local and international, p < 0.05), revealing an association with clinical scores (CDR and MMSE, r = 0.46 and r = -0.48, p < 0.0001). While SZ and control group demonstrated no significant differences, a comparative analysis between AD and bvFTD patients spotlighted elevated CVBOLD in the frontopolar cortices for the latter (p < 0.05). Furthermore, CVBOLD not only presented excellent diagnostic accuracy for bvFTD (AUC 0.78-0.95) but also showcased longitudinal repeatability. During a one-year follow-up, the CVBOLD levels increased by an average of 35% in the bvFTD group, compared to a 2% increase in the control group (p < 0.05). Our findings suggest that CVBOLD holds promise as a biomarker for bvFTD, offering potential for monitoring disease progression and differentiating bvFTD from AD and SZ.
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Affiliation(s)
- Timo Tuovinen
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Jani Häkli
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Riikka Rytty
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Neurology, Hyvinkää Hospital, The Wellbeing Services County of Central Uusimaa, Hyvinkää, Finland
| | - Johanna Krüger
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Neurology, Neurocenter, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Vesa Korhonen
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Matti Järvelä
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Heta Helakari
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Janne Kananen
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Clinical Neurophysiology, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Juha Nikkinen
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Department of Oncology and Radiotherapy, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Juha Veijola
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Research Unit of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Vesa Kiviniemi
- Oulu Functional NeuroImaging, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
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Manera AL, Dadar M, Ducharme S, Collins DL. VentRa: distinguishing frontotemporal dementia from psychiatric disorders. Brain Commun 2024; 6:fcae069. [PMID: 38510209 PMCID: PMC10953623 DOI: 10.1093/braincomms/fcae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
The volume of the lateral ventricles is a reliable and sensitive indicator of brain atrophy and disease progression in behavioural variant frontotemporal dementia. In this study, we validate our previously developed automated tool using ventricular features (known as VentRa) for the classification of behavioural variant frontotemporal dementia versus a mixed cohort of neurodegenerative, vascular and psychiatric disorders from a clinically representative independent dataset. Lateral ventricles were segmented for 1110 subjects-14 behavioural variant frontotemporal dementia, 30 other frontotemporal dementia, 70 Lewy body disease, 898 Alzheimer's disease, 62 vascular brain injury and 36 primary psychiatric disorder from the publicly accessible National Alzheimer's Coordinating Center dataset to assess the performance of VentRa. Using ventricular features to discriminate behavioural variant frontotemporal dementia subjects from primary psychiatric disorders, VentRa achieved an accuracy rate of 84%, a sensitivity rate of 71% and a specificity rate of 89%. VentRa was able to identify behavioural variant frontotemporal dementia from a mixed age-matched cohort (i.e. other frontotemporal dementia, Lewy body disease, Alzheimer's disease, vascular brain injury and primary psychiatric disorders) and to correctly classify other disorders as 'not compatible with behavioral variant frontotemporal dementia' with a specificity rate of 83%. The specificity rates against each of the other individual cohorts were 80% for other frontotemporal dementia, 83% for Lewy body disease, 83% for Alzheimer's disease, 84% for vascular brain injury and 89% for primary psychiatric disorders. VentRa is a robust and generalizable tool with potential usefulness for improving the diagnostic certainty of behavioural variant frontotemporal dementia, particularly for the differential diagnosis with primary psychiatric disorders.
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Affiliation(s)
- Ana L Manera
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Mahsa Dadar
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Psychiatry, Douglas Mental Health University Health Centre, McGill University, Montreal, QC H4H 1R3, Canada
| | - Simon Ducharme
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Psychiatry, Douglas Mental Health University Health Centre, McGill University, Montreal, QC H4H 1R3, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
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Pressman PS, Molden J, Wortzel HS, Plys E, Woodcock JH, Filley CM, Arciniegas DB. Psychiatric Screening Measures in Behavioral Variant Frontotemporal Dementia. J Neuropsychiatry Clin Neurosci 2023; 36:160-165. [PMID: 37981780 DOI: 10.1176/appi.neuropsych.20230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Behavioral variant frontotemporal dementia (bvFTD) is sometimes misdiagnosed as a primary psychiatric disorder, such as major depressive disorder, bipolar disorder, an anxiety disorder, autism spectrum disorder (ASD), or attention-deficit hyperactivity disorder (ADHD). Nonspecialists often use screening measures for primary psychiatric disorders in early assessments of persons with bvFTD. The investigators aimed to evaluate the manifestations of bvFTD in surveys intended to screen for primary psychiatric disorders. METHODS Patients with bvFTD (N=27) presenting to an academic neurobehavior specialty clinic and their caregivers were provided questionnaire packets including the Mood Disorder Questionnaire (MDQ), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 scale (GAD-7), the Adult ADHD Self-Report Scale, version 1.1, the Ritvo Autism and Asperger Diagnostic Scale, and the Neuropsychiatric Inventory Questionnaire. Established cutoff scores suggesting the presence of a primary psychiatric disorder were used to define a "positive" response. Individual questions from each screening questionnaire were examined for a more granular characterization of bvFTD. RESULTS Overall, 15% of bvFTD patients screened positive for bipolar disorder, 54% screened positive for ADHD, and 89% screened positive for ASD. Hyperactivity or hypersensitivity symptoms were infrequently endorsed. In addition, 57% of respondents screened positive for depressive symptoms on the PHQ-9, and 43% screened positive for anxiety symptoms on the GAD-7. CONCLUSIONS The use of cutoff scores on screening measures for primary psychiatric disorders resulted in potentially problematic positive screens of primary psychiatric disorders among persons with bvFTD. Identifying specific questions that distinguish between bvFTD and primary psychiatric disorders requires further study.
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Affiliation(s)
- Peter S Pressman
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Joie Molden
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Hal S Wortzel
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Evan Plys
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Jonathan H Woodcock
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Christopher M Filley
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - David B Arciniegas
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
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Yliranta A, Karjalainen VL, Nuorva J, Ahmasalo R, Jehkonen M. Apraxia testing to distinguish early Alzheimer's disease from psychiatric causes of cognitive impairment. Clin Neuropsychol 2023; 37:1629-1650. [PMID: 36829305 DOI: 10.1080/13854046.2023.2181223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
Objective: Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly interpreted as symptoms of dementia; thus, more reliable diagnostic approaches are needed. The present work defines the discriminant accuracy of the Dementia Apraxia Test (DATE) between psychiatric conditions and early-onset Alzheimer's disease (AD) on its own and in combination with memory tests. Method: The consecutive sample included 50-70-year-old patients referred to dementia investigations for recent cognitive and/or affective symptoms. The DATE was administered and scored as a blinded measurement, and a receiver operating curve analysis was used to define the optimal diagnostic cut-off score. Results: A total of 24 patients were diagnosed with probable AD (mean age 61 ± 4) and 23 with a psychiatric condition (mean age 57 ± 4). The AD patients showed remarkable limb apraxia, but the psychiatric patients mainly performed at a healthy level on the DATE. The test showed a total discriminant accuracy of 87% for a total sum cut-off of 47 (sensitivity 79% and specificity 96%). The limb subscale alone reached an accuracy of 91% for a cut-off of 20 (sensitivity 83% and specificity 100%). All memory tests were diagnostically less accurate, while the combination of the limb praxis subscale and a verbal episodic memory test suggested a correct diagnosis in all but one patient. Conclusions: Apraxia testing may improve the accuracy of differentiation between AD and psychiatric aetiologies. Its potential in severe and chronic psychiatric conditions should be examined in the future.
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Affiliation(s)
- Aino Yliranta
- Faculty of Social Sciences, Tampere University
- Neurology Clinic, Lapland Central Hospital
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de Boer SCM, Gossink F, Krudop W, Vijverberg E, Schouws S, Reus LM, Pijnenburg YAL, Dols A. Diagnostic Instability Over Time in the Late-Onset Frontal Lobe Syndrome: When Can We Say it's FTD? Am J Geriatr Psychiatry 2023; 31:679-690. [PMID: 37028983 DOI: 10.1016/j.jagp.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Distinguishing sporadic behavioral variant of frontotemporal dementia (bvFTD) from late-onset primary psychiatric disorders (PPD) remains challenging with the lack of robust biomarkers. An early bvFTD misdiagnosis in PPD cases and vice-versa is common. Little is known about diagnostic (in)stability over longer period of time. We investigated diagnostic instability in a neuropsychiatric cohort up to 8 years after baseline visit and identified which clinical hallmarks contribute to diagnostic instability. DESIGN Diagnoses of participants of the late-onset frontal lobe (LOF) study were collected from the baseline visit (T0) and the 2-year follow-up visit (T2). Clinical outcomes were retrieved 5-8 years after baseline visit (Tfinal). Endpoint diagnoses were categorized into bvFTD, PPD and other neurological disorders (OND). We calculated the total amount of participants that switched diagnosis between T0-T2 and T2-Tfinal. Clinical records of participants that switched diagnosis were assessed. RESULTS Of the 137 patients that were included in the study, the final diagnoses at Tfinal were bvFTD 24.1% (n = 33), PPD 39.4% (n = 54), OND 33.6% (n = 46) and unknown 2.9% (n = 4). Between T0 and T2, a total of 29 (21.2%) patients switched diagnosis. Between T2 and Tfinal, 8 (5.8%) patients switched diagnosis. Prolonged follow-up identified few cases with diagnostic instability. Major contributors to diagnostic instability where a nonconverting diagnosis of possible bvFTD and a probable bvFTD diagnosis based on informant-based history and an abnormal FDG-PET scan whilst having a normal MRI. CONCLUSION Considering these lessons, a FTD diagnosis remains stable enough to conclude that 2 years is sufficient to say if a patient with late-life behavioral disorder has FTD.
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Affiliation(s)
- Sterre C M de Boer
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands.
| | - Flora Gossink
- Reinier van Arkel, Geriatric and Hospital Psychiatric Centre (COZ) (FG), Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Welmoed Krudop
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands; Department of Psychology and Psychiatry, Antonius Ziekenhuis Utrecht (WK), Utrecht, The Netherlands
| | - Everard Vijverberg
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry (SS), GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry (SS), Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Lianne Maria Reus
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands; Center for Neurobehavioral Genetics (LMR), University of California, Los Angeles, Los Angeles, CA
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Psychiatry (AD), UMC Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands
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Tafuri B, Filardi M, Frisullo ME, De Blasi R, Rizzo G, Nigro S, Logroscino G. Behavioral variant frontotemporal dementia in patients with primary psychiatric disorder: A magnetic resonance imaging study. Brain Behav 2023; 13:e2896. [PMID: 36864745 PMCID: PMC10097141 DOI: 10.1002/brb3.2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD) in patients with a history of primary psychiatric disorder (PPD) is challenging. PPD shows the typical cognitive impairments observed in patients with bvFTD. Therefore, the correct identification of bvFTD onset in patients with a lifetime history of PPD is pivotal for an optimal management. METHODS Twenty-nine patients with PPD were included in this study. After clinical and neuropsychological evaluations, 16 patients with PPD were clinically classified as bvFTD (PPD-bvFTD+), while in 13 cases clinical symptoms were associated with the typical course of the psychiatric disorder itself (PPD-bvFTD-). Voxel- and surface-based investigations were used to characterize gray matter changes. Volumetric and cortical thickness measures were used to predict the clinical diagnosis at a single-subject level using a support vector machine (SVM) classification framework. Finally, we compared classification performances of magnetic resonance imaging (MRI) data with automatic visual rating scale of frontal and temporal atrophy. RESULTS PPD-bvFTD+ showed a gray matter decrease in thalamus, hippocampus, temporal pole, lingual, occipital, and superior frontal gyri compared to PPD-bvFTD- (p < .05, family-wise error-corrected). SVM classifier showed a discrimination accuracy of 86.2% in differentiating PPD patients with bvFTD from those without bvFTD. CONCLUSIONS Our study highlights the utility of machine learning applied to structural MRI data to support the clinician in the diagnosis of bvFTD in patients with a history of PPD. Gray matter atrophy in temporal, frontal, and occipital brain regions may represent a useful hallmark for a correct identification of dementia in PPD at a single-subject level.
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Affiliation(s)
- Benedetta Tafuri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Maria Elisa Frisullo
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.,Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.,Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
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Boeve BF, Boxer AL, Kumfor F, Pijnenburg Y, Rohrer JD. Advances and controversies in frontotemporal dementia: diagnosis, biomarkers, and therapeutic considerations. Lancet Neurol 2022; 21:258-272. [DOI: 10.1016/s1474-4422(21)00341-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/16/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022]
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Balachandran S, Matlock EL, Conroy ML, Lane CE. Behavioral Variant Frontotemporal Dementia: Diagnosis and Treatment Interventions. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
The diagnosis and treatment of behavioral variant frontotemporal dementia is challenging and often delayed because of overlapping symptoms with more common dementia syndromes or primary psychiatric illnesses. The purpose of this paper is to explore the relevant presentation, diagnostic workup, pathophysiology, and both pharmacologic and non-pharmacologic management.
Recent Findings
Behavioral variant frontotemporal dementia is a highly heritable disorder. The gradual accumulation of diseased protein culminates in the destruction of those brain circuits responsible for much of one’s emotional and social functioning.
Summary
Behavioral variant frontotemporal dementia is a progressive neurodegenerative disorder with a far-reaching impact on patients and caregivers. Patients often present with emotional blunting, lack of empathy, apathy, and behavioral disinhibition. Non-pharmacologic interventions and caregiver support are the cornerstone of treatment. The use of cholinesterase inhibitors and memantine is not supported by the evidence. While current pharmacologic therapies target only certain symptoms, there are disease modifying agents currently in or nearing the clinical research stage.
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