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Cressot C, Vrillon A, Lilamand M, Francisque H, Méauzoone A, Hourregue C, Dumurgier J, Marlinge E, Paquet C, Cognat E. Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review. J Alzheimers Dis 2024; 99:85-99. [PMID: 38669539 DOI: 10.3233/jad-231363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties. Objective This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach. Methods A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports). Results Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6-78.3%) and visual hallucinations (50-69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1-60.3% and 3.10-41.5%). Limited data were found regarding psychosis in the early stages of these disorders. Conclusions Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.
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Affiliation(s)
- Coralie Cressot
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Agathe Vrillon
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Matthieu Lilamand
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Service de Gériatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Hélène Francisque
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Aurélie Méauzoone
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Julien Dumurgier
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Université Paris Cité, Inserm U1153, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Emmanuel Cognat
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
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Rifai OM, O’Shaughnessy J, Dando OR, Munro AF, Sewell MDE, Abrahams S, Waldron FM, Sibley CR, Gregory JM. Distinct neuroinflammatory signatures exist across genetic and sporadic amyotrophic lateral sclerosis cohorts. Brain 2023; 146:5124-5138. [PMID: 37450566 PMCID: PMC10690026 DOI: 10.1093/brain/awad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/31/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive loss of upper and lower motor neurons. ALS is on a pathogenetic disease spectrum with frontotemporal dementia, referred to as ALS-frontotemporal spectrum disorder (ALS-FTSD). For mutations associated with ALS-FTSD, such as the C9orf72 hexanucleotide repeat expansion, the molecular factors associated with heterogeneity along this spectrum require further characterization. Here, using a targeted NanoString molecular barcoding approach, we interrogate neuroinflammatory dysregulation and heterogeneity at the level of gene expression in post-mortem motor cortex tissue from a cohort of clinically heterogeneous C9-ALS-FTSD cases. We identified 20 dysregulated genes in C9-ALS-FTSD, with enrichment of microglial and inflammatory response gene sets. Two genes with significant correlations to available clinical metrics were selected for validation: FKBP5, a correlate of cognitive function, and brain-derived neurotrophic factor (BDNF), a correlate of disease duration. FKBP5 and its signalling partner, NF-κB, appeared to have a cell type-specific staining distribution, with activated (i.e. nuclear) NF-κB immunoreactivity in C9-ALS-FTSD. Expression of BDNF, a correlate of disease duration, was confirmed to be higher in individuals with long compared to short disease duration using BaseScope™ in situ hybridization. Our analyses also revealed two distinct neuroinflammatory panel signatures (NPS), NPS1 and NPS2, delineated by the direction of expression of proinflammatory, axonal transport and synaptic signalling pathways. We compared NPS between C9-ALS-FTSD cases and those from sporadic ALS and SOD1-ALS cohorts and identified NPS1 and NPS2 across all cohorts. Moreover, a subset of NPS was also able to separate publicly available RNA sequencing data from independent C9-ALS and sporadic ALS cohorts into two inflammatory subgroups. Importantly, NPS subgroups did not clearly segregate with available demographic, genetic, clinical or pathological features, highlighting the value of molecular stratification in clinical trials for inflammatory subgroup identification. Our findings thus underscore the importance of tailoring therapeutic approaches based on distinct molecular signatures that exist between and within ALS-FTSD cohorts.
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Affiliation(s)
- Olivia M Rifai
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Judi O’Shaughnessy
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Owen R Dando
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, EH8 9XF, UK
| | - Alison F Munro
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Michael D E Sewell
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, EH8 9AD, UK
| | - Fergal M Waldron
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Christopher R Sibley
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, EH8 9XF, UK
- Institute of Quantitative Biology, Biochemistry and Biotechnology, School of Biological Sciences, University of Edinburgh, The King’s Buildings, Edinburgh, EH9 3FF, UK
| | - Jenna M Gregory
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
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3
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Seritan AL. Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review. J Geriatr Psychiatry Neurol 2023; 36:435-460. [PMID: 36941085 PMCID: PMC10578041 DOI: 10.1177/08919887231164357] [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: 03/23/2023]
Abstract
Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.
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Affiliation(s)
- Andreea L. Seritan
- University of California, San Francisco Department of Psychiatry and UCSF Weill Institute for Neurosciences, CA, USA
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4
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Rifai OM, Longden J, O'Shaughnessy J, Sewell MDE, Pate J, McDade K, Daniels MJ, Abrahams S, Chandran S, McColl BW, Sibley CR, Gregory JM. Random forest modelling demonstrates microglial and protein misfolding features to be key phenotypic markers in C9orf72-ALS. J Pathol 2022; 258:366-381. [PMID: 36070099 PMCID: PMC9827842 DOI: 10.1002/path.6008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
Clinical heterogeneity observed across patients with amyotrophic lateral sclerosis (ALS) is a known complicating factor in identifying potential therapeutics, even within cohorts with the same mutation, such as C9orf72 hexanucleotide repeat expansions (HREs). Thus, further understanding of pathways underlying this heterogeneity is essential for appropriate ALS trial stratification and the meaningful assessment of clinical outcomes. It has been shown that both inflammation and protein misfolding can influence ALS pathogenesis, such as the manifestation or severity of motor or cognitive symptoms. However, there has yet to be a systematic and quantitative assessment of immunohistochemical markers to interrogate the potential relevance of these pathways in an unbiased manner. To investigate this, we extensively characterised features of commonly used glial activation and protein misfolding stains in thousands of images of post-mortem tissue from a heterogeneous cohort of deeply clinically profiled patients with a C9orf72 HRE. Using a random forest model, we show that microglial staining features are the most accurate classifiers of disease status in our panel and that clinicopathological relationships exist between microglial activation status, TDP-43 pathology, and language dysfunction. Furthermore, we detected spatially resolved changes in fused in sarcoma (FUS) staining, suggesting that liquid-liquid phase shift of this aggregation-prone RNA-binding protein may be important in ALS caused by a C9orf72 HRE. Interestingly, no one feature alone significantly impacted the predictiveness of the model, indicating that the collective examination of all features, or a combination of several features, is what allows the model to be predictive. Our findings provide further support to the hypothesis of dysfunctional immune regulation and proteostasis in the pathogenesis of C9-ALS and provide a framework for digital analysis of commonly used neuropathological stains as a tool to enrich our understanding of clinicopathological relationships within and between cohorts. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Olivia M Rifai
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Longden
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Judi O'Shaughnessy
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Michael DE Sewell
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Judith Pate
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Karina McDade
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | | | - Sharon Abrahams
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Barry W McColl
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher R Sibley
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK.,Institute of Quantitative Biology, Biochemistry and Biotechnology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.,Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, UK
| | - Jenna M Gregory
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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5
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Liu L, Liu S, Chu M, Wang J, Xie K, Cui Y, Ma J, Nan H, Cui C, Qiao H, Rosa-Neto P, Chan P, Wu L. Involvement of striatal motoric subregions in familial frontotemporal dementia with parkinsonism harboring the C9orf72 repeat expansions. NPJ Parkinsons Dis 2022; 8:128. [PMID: 36202819 PMCID: PMC9537191 DOI: 10.1038/s41531-022-00398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
The chromosome 9 open reading frame 72 (C9ORF72) has been proposed as the causative gene of frontotemporal dementia with parkinsonism (FTDP), but its pathophysiological mechanism of parkinsonism is poorly understood. To explore the roles of striatal motor subdivisions in the pathogenesis of parkinsonism resulting from C9ORF72 repeat expansions in the FTDP, two patients with FTDP from one pedigree and seventeen healthy controls were enrolled. The participants received clinical interviews, physical examinations, genetic testing, [18F]-fluorodeoxyglucose PET/MRI, and [18F]-dihydrotetrabenazine PET/CT. Voxel-wise and region of interest analysis were conducted with respect to gray matter volume, metabolism, and dopamine transport function between patients and controls, focusing on the motor part of the striatum according to the Oxford-GSK-Imanova Striatal Connectivity Atlas. Patient 1 presented with parkinsonism as the initial symptom, while patient 2 exhibited behavior disturbance as the first symptom, followed by parkinsonism within one year. Both patients had the hexanucleotide expansion detected in C9ORF72(>52 repeats). Gray matter volume atrophy, hypometabolism and dopamine dysfunction were observed in the motor areas of the striatum. Of the two patients, marked glucose hypometabolism within the striatal motor subregion was observed in patient 1, with corresponding gray matter atrophy. In addition, presynaptic dopaminergic integrity of patient 2 was deteriorated in the motor subregions which was consistent with gray matter atrophy. These findings imply that parkinsonism in FTDP may be associated with the degeneration and dopaminergic dysfunction of the striatal motor subregion, which might be attributed to C9orf72 repeat expansions.
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Affiliation(s)
- Li Liu
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China ,grid.500880.5Department of Neurology, Shenyang Fifth People Hospital, Shenyang, China
| | - Shuying Liu
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Chu
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingjuan Wang
- grid.413259.80000 0004 0632 3337Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kexin Xie
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yue Cui
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinghong Ma
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haitian Nan
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunlei Cui
- grid.413259.80000 0004 0632 3337Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongwen Qiao
- grid.413259.80000 0004 0632 3337Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Pedro Rosa-Neto
- grid.14709.3b0000 0004 1936 8649McGill Centre for Studies in Aging, Alzheimer’s Disease Research Unit, Montreal, H4H 1R3 Canada
| | - Piu Chan
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China ,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Liyong Wu
- grid.413259.80000 0004 0632 3337Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China ,National Clinical Research Center for Geriatric Diseases, Beijing, China
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6
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Mori K, Ikeda M. Biological basis and psychiatric symptoms in frontotemporal dementia. Psychiatry Clin Neurosci 2022; 76:351-360. [PMID: 35557018 DOI: 10.1111/pcn.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
Frontotemporal dementia is a neurodegenerative disease characterized by focal degeneration of the frontal and temporal lobes, clinically presenting with disinhibited behavior, personality changes, progressive non-fluent aphasia and/or impaired semantic memory. Research progress has been made in re-organizing the clinical concept of frontotemporal dementia and neuropathological classification based on multiple accumulating proteins. Alongside this progress a list of genetic mutations or variants that are causative or increase the risk of frontotemporal dementia have been identified and some of these gene products are extensively studied. However, there are still a lot of points that need to be overcome, including lack of specific diagnostic biomarker which enable antemortem diagnosis of underlying neurodegenerative process, and lack of disease modifying therapy which could prevent disease progression. Early and precise diagnosis of frontotemporal dementia is urgently required. In this context, how to define prodromal frontotemporal dementia and early differential diagnosis from primary psychiatric disorders are also important issues. In this review we will summarize and discuss current understanding of biological basis and psychiatric symptoms in frontotemporal dementia.
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Affiliation(s)
- Kohji Mori
- Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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7
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Tse NY, Tu S, Chen Y, Caga J, Dobson-Stone C, Kwok JB, Halliday GM, Ahmed RM, Hodges JR, Piguet O, Kiernan MC, Devenney EM. Schizotypal traits across the amyotrophic lateral sclerosis-frontotemporal dementia spectrum: pathomechanistic insights. J Neurol 2022; 269:4241-4252. [PMID: 35279757 PMCID: PMC9294025 DOI: 10.1007/s00415-022-11049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychiatric presentations similar to that observed in primary psychiatric disorders are well described across the amyotrophic lateral sclerosis-frontotemporal dementia (ALS-FTD) spectrum. Despite this, schizotypal personality traits associated with increased risks of clinical psychosis development and poor psychosocial outcomes have never been examined. The current study aimed to provide the first exploration of schizotypal traits and its neural underpinnings in the ALS-FTD spectrum to gain insights into a broader spectrum of psychiatric overlap with psychiatric disorders. METHODS Schizotypal traits were assessed using the targeted Schizotypal Personality Questionnaire in 99 participants (35 behavioural variant FTD, 10 ALS-FTD and 37 ALS patients, and 17 age-, sex- and education-matched healthy controls). Voxel-based morphometry analysis of whole-brain grey matter volume was conducted. RESULTS Relative to controls, pervasive schizotypal personality traits across positive and negative schizotypy and disorganised thought disorders were identified in behavioural variant FTD, ALS (with the exception of negative schizotypy) and ALS-FTDALS-FTD patients (all p < .013), suggesting the presence of a wide spectrum of subclinical schizotypal symptoms beyond classic psychotic symptoms. Atrophy in frontal, anterior cingulate and insular cortices, and caudate and thalamus was involved in positive schizotypy, while integrity of the cerebellum was associated with disorganised thought disorder traits. CONCLUSIONS The frontal-striatal-limbic regions underpinning manifestation of schizotypy in the ALS-FTDALS-FTD spectrum are similar to that established in previous schizophrenia research. This finding expands the concept of a psychiatric overlap in ALS-FTD and schizophrenia, and suggests potentially common underlying mechanisms involving disruptions to frontal-striatal-limbic networks, warranting a transdiagnostic approach for future investigations.
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Affiliation(s)
- Nga Yan Tse
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Sicong Tu
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Yu Chen
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jashelle Caga
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Carol Dobson-Stone
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - John B Kwok
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Glenda M Halliday
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
- Neuroscience Research Australia, Randwick, Australia
| | - Rebekah M Ahmed
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - John R Hodges
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Olivier Piguet
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Emma M Devenney
- The Brain and Mind Centre, University of Sydney; and Royal Prince Alfred Hospital, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia.
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8
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Barker MS, Gottesman RT, Manoochehri M, Chapman S, Appleby BS, Brushaber D, Devick KL, Dickerson BC, Domoto-Reilly K, Fields JA, Forsberg LK, Galasko DR, Ghoshal N, Goldman J, Graff-Radford NR, Grossman M, Heuer HW, Hsiung GY, Knopman DS, Kornak J, Litvan I, Mackenzie IR, Masdeu JC, Mendez MF, Pascual B, Staffaroni AM, Tartaglia MC, Boeve BF, Boxer AL, Rosen HJ, Rankin KP, Cosentino S, Rascovsky K, Huey ED. Proposed research criteria for prodromal behavioural variant frontotemporal dementia. Brain 2022; 145:1079-1097. [PMID: 35349636 PMCID: PMC9050566 DOI: 10.1093/brain/awab365] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023] Open
Abstract
At present, no research criteria exist for the diagnosis of prodromal behavioural variant frontotemporal dementia (bvFTD), though early detection is of high research importance. Thus, we sought to develop and validate a proposed set of research criteria for prodromal bvFTD, termed 'mild behavioural and/or cognitive impairment in bvFTD' (MBCI-FTD). Participants included 72 participants deemed to have prodromal bvFTD; this comprised 55 carriers of a pathogenic mutation known to cause frontotemporal lobar degeneration, and 17 individuals with autopsy-confirmed frontotemporal lobar degeneration. All had mild behavioural and/or cognitive changes, as judged by an evaluating clinician. Based on extensive clinical workup, the prodromal bvFTD group was divided into a Development Group (n = 22) and a Validation Group (n = 50). The Development Group was selected to be the subset of the prodromal bvFTD group for whom we had the strongest longitudinal evidence of conversion to bvFTD, and was used to develop the MBCI-FTD criteria. The Validation Group was the remainder of the prodromal bvFTD group and was used as a separate sample on which to validate the criteria. Familial non-carriers were included as healthy controls (n = 165). The frequencies of behavioural and neuropsychiatric features, neuropsychological deficits, and social cognitive dysfunction in the prodromal bvFTD Development Group and healthy controls were assessed. Based on sensitivity and specificity analyses, seven core features were identified: apathy without moderate-severe dysphoria, behavioural disinhibition, irritability/agitation, reduced empathy/sympathy, repetitive behaviours (simple and/or complex), joviality/gregariousness, and appetite changes/hyperorality. Supportive features include a neuropsychological profile of impaired executive function or naming with intact orientation and visuospatial skills, reduced insight for cognitive or behavioural changes, and poor social cognition. Three core features or two core features plus one supportive feature are required for the diagnosis of possible MBCI-FTD; probable MBCI-FTD requires imaging or biomarker evidence, or a pathogenic genetic mutation. The proposed MBCI-FTD criteria correctly classified 95% of the prodromal bvFTD Development Group, and 74% of the prodromal bvFTD Validation Group, with a false positive rate of <10% in healthy controls. Finally, the MBCI-FTD criteria were tested on a cohort of individuals with prodromal Alzheimer's disease, and the false positive rate of diagnosis was 11-16%. Future research will need to refine the sensitivity and specificity of these criteria, and incorporate emerging biomarker evidence.
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Affiliation(s)
- Megan S Barker
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Reena T Gottesman
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Masood Manoochehri
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Silvia Chapman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Brian S Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Danielle Brushaber
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Katrina L Devick
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Bradford C Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Julie A Fields
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Douglas R Galasko
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | - Nupur Ghoshal
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Jill Goldman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | | | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ging-Yuek Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Irene Litvan
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | - Ian R Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph C Masdeu
- Nantz National Alzheimer Center, Houston Methodist Neurological Institute, Houston, TX, USA and Weill Cornell Medicine, NY, USA
| | - Mario F Mendez
- Department of Neurology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Belen Pascual
- Nantz National Alzheimer Center, Houston Methodist Neurological Institute, Houston, TX, USA and Weill Cornell Medicine, NY, USA
| | - Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Carmela Tartaglia
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward D Huey
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Department of Psychiatry and New York Psychiatric Institute, Columbia University Medical Center, New York, USA
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9
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Le C, Finger E. Pharmacotherapy for Neuropsychiatric Symptoms in Frontotemporal Dementia. CNS Drugs 2021; 35:1081-1096. [PMID: 34426949 DOI: 10.1007/s40263-021-00854-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Despite significant progress in the understanding of the frontotemporal dementias (FTDs), there remains no disease-modifying treatment for these conditions, and limited effective symptomatic treatment. Behavioural variant frontotemporal dementia (bvFTD) is the most common FTD syndrome, and is characterized by severe impairments in behaviour, personality and cognition. Neuropsychiatric symptoms are common features of bvFTD but are present in the other FTD syndromes. Current treatment strategies therefore focus on ameliorating the neuropsychiatric features. Here we review the rationale for current treatments related to each of the main neuropsychiatric symptoms forming the diagnostic criteria for bvFTD relevant to all FTD subtypes, and two additional symptoms not currently part of the diagnostic criteria: lack of insight and psychosis. Given the paucity of effective treatments for these symptoms, we highlight how contributing mechanisms delineated in cognitive neuroscience may inform future approaches to clinical trials and more precise symptomatic treatments for FTDs.
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Affiliation(s)
- Christine Le
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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10
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Naasan G, Shdo SM, Rodriguez EM, Spina S, Grinberg L, Lopez L, Karydas A, Seeley WW, Miller BL, Rankin KP. Psychosis in neurodegenerative disease: differential patterns of hallucination and delusion symptoms. Brain 2021; 144:999-1012. [PMID: 33501939 DOI: 10.1093/brain/awaa413] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
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Affiliation(s)
- Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,Department of Psychology, University of California Berkeley, Berkeley, CA, USA
| | - Estrella Morenas Rodriguez
- Biomedizinisches Centrum (BMC), Biochemistry Chair, Ludwig-Maximilians-Universität and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lea Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lucia Lopez
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
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11
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Llibre‐Guerra JJ, Lee SE, Suemoto CK, Ehrenberg AJ, Kovacs GG, Karydas A, Staffaroni A, Franca Resende EDP, Kim E, Hwang J, Ramos EM, Wojta KJ, Pasquini L, Pang SY, Spina S, Allen IE, Kramer J, Miller BL, Seeley WW, Grinberg LT. A novel temporal-predominant neuro-astroglial tauopathy associated with TMEM106B gene polymorphism in FTLD/ALS-TDP. Brain Pathol 2021; 31:267-282. [PMID: 33314436 PMCID: PMC7946775 DOI: 10.1111/bpa.12924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/30/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Polymorphisms in TMEM106B, a gene on chromosome 7p21.3 involved in lysosomal trafficking, correlates to worse neuropathological, and clinical outcomes in frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS) with TDP-43 inclusions. In a small cohort of C9orf72 expansion carriers, we previously found an atypical, neuroglial tauopathy in cases harboring a TMEM106B rs1990622 A/A genotype. To test whether TMEM106B genotype affects the risk of developing atypical tauopathy under a recessive genotype model (presence versus absence of two major alleles: A/A vs. A/G and G/G). We characterized the atypical tauopathy neuropathologically and determined its frequency by TMEM106B rs1990622 genotypes in 90 postmortem cases with a primary diagnosis of FTLD/ALS-TDP [mean age at death 65.5 years (±8.1), 40% female]. We investigated the effect of this new atypical tauopathy on demographics and clinical and neuropsychological metrics. We also genotyped TMEM106B in an independent series with phenotypically similar cases. Sixteen cases (16/90, 17.7 %) showed the temporal-predominant neuro-astroglial tauopathy, and 93.7% of them carried an A/A genotype (vs. ~35% in a population cohort). The odds ratio of FTLD/ALS-TDP individuals with the A/A genotype showing neuro-astroglial tauopathy was 13.9. Individuals with this tauopathy were older at onset (p = 0.01). The validation cohort had a similarly high proportion of rs1990622 A/A genotype. TDP-43 and tau changes co-occur in a subset of neurons. Our data add to the growing body of evidence that TMEM106B polymorphisms may modulate neurodegeneration. A distinctive medial temporal predominant, 4-repeat, neuro-astroglial tauopathy strongly correlates to TMEM106B A/A genotype in FTLD/ALS-TDP cases.
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Affiliation(s)
- Jorge J. Llibre‐Guerra
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA,National Institute of Neurology and NeurosurgeryLa HabanaCuba,Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Suzee E. Lee
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Claudia K. Suemoto
- Biobank for Aging StudiesLIM‐22Department of PathologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil,Division of GeriatricsDepartment of Clinical MedicineUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Alexander J. Ehrenberg
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA,Department of Integrative BiologyUniversity of California, BerkeleyBerkeleyCAUSA
| | - Gabor G. Kovacs
- Institute of NeurologyMedical University ViennaViennaAustria,Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoONCanada,Laboratory Medicine Program & Krembil Brain InstituteUniversity Health NetworkTorontoONCanada
| | - Anna Karydas
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Adam Staffaroni
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Elisa De Paula Franca Resende
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA,Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCAUSA,Grupo de Pesquisa em Neurologia Cognitiva e do ComportamentoDepartamento de Clínica MédicaFaculdade de Medicina da Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Eun‐Joo Kim
- Department of NeurologyPusan National University HospitalPusan National University School of Medicine and Medical Research InstituteBusanRepublic of Korea
| | - Ji‐Hye Hwang
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Eliana Marisa Ramos
- Department of PsychiatryDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
| | - Kevin J. Wojta
- Department of PsychiatryDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
| | - Lorenzo Pasquini
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Shirley Yin‐Yu Pang
- Division of NeurologyDepartment of MedicineQueen Mary HospitalThe University of Hong KongHong Kong SARChina
| | - Salvatore Spina
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Isabel E. Allen
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCAUSA,Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Joel Kramer
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - Bruce L. Miller
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA
| | - William W. Seeley
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA,Department of Pathology and Laboratory MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Lea T. Grinberg
- Department of NeurologyUCSF Weill Institute for NeurosciencesUniversity of California, San Francisco, San FranciscoCAUSA,Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCAUSA,Biobank for Aging StudiesLIM‐22Department of PathologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil,Department of Pathology and Laboratory MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
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12
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Clinical Update on C9orf72: Frontotemporal Dementia, Amyotrophic Lateral Sclerosis, and Beyond. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:67-76. [PMID: 33433869 DOI: 10.1007/978-3-030-51140-1_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The identification of C9orf72 gene has led to important scientific progresses and has considerably changed our clinical practice. However, a decade after C9orf72 discovery, some important clinical questions remain unsolved. The reliable cutoff for the pathogenic repeat number and the implication of intermediate alleles in frontotemporal dementia, amyotrophic lateral sclerosis, or in other diseases are still uncertain. The occurrence of an anticipation phenomenon - at the clinical and molecular levels - in C9orf72 kindreds is still debated as well, and the factors driving age at onset and phenotype variability are largely unknown. All these questions have a significant impact not only in clinical practice for diagnosis and genetic counseling but also in a research context for the initiation of therapeutic trials. In this chapter, we will address all those issues and summarize the recent updates about clinical aspects of C9orf72 disease, focusing on both the common and the less typical phenotypes.
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13
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Neumann M, Lee EB, Mackenzie IR. Frontotemporal Lobar Degeneration TDP-43-Immunoreactive Pathological Subtypes: Clinical and Mechanistic Significance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:201-217. [PMID: 33433877 DOI: 10.1007/978-3-030-51140-1_13] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal lobar degeneration with TPD-43-immunoreactive pathology (FTLD-TDP) is subclassified based on the type and cortical laminar distribution of neuronal inclusions. The relevance of these pathological subtypes is supported by the presence of relatively specific clinical and genetic correlations. Recent evidence suggests that the different patterns of pathology are a reflection of biochemical differences in the pathological TDP-43 species, each of which is influenced by differing genetic factors. As a result, patient FTLD-TDP subtype may be an important factor to consider when developing biomarkers and targeted therapies for frontotemporal dementia. In this chapter, we first describe the pathological features, clinical and genetic correlations of the currently recognized FTLD-TDP subtypes. We then discuss a number of novel patterns of TDP-43 pathology. Finally, we provide an overview of what is currently known about the biochemical basis of the different FTLD-TDP subtypes and how this may explain the observed phenotypic and pathological heterogeneity.
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Affiliation(s)
- Manuela Neumann
- Department of Neuropathology, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian R Mackenzie
- Department of Pathology, University of British Columbia, Vancouver, BC, Canada. .,Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada.
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14
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Neumann M, Frick P, Paron F, Kosten J, Buratti E, Mackenzie IR. Antibody against TDP-43 phosphorylated at serine 375 suggests conformational differences of TDP-43 aggregates among FTLD-TDP subtypes. Acta Neuropathol 2020; 140:645-658. [PMID: 32778941 PMCID: PMC7547034 DOI: 10.1007/s00401-020-02207-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
Aggregation of hyperphosphorylated TDP-43 is the hallmark pathological feature of the most common molecular form of frontotemporal lobar degeneration (FTLD-TDP) and in the vast majority of cases with amyotrophic lateral sclerosis (ALS-TDP). However, most of the specific phosphorylation sites remain to be determined, and their relevance regarding pathogenicity and clinical and pathological phenotypic diversity in FTLD-TDP and ALS-TDP remains to be identified. Here, we generated a novel antibody raised against TDP-43 phosphorylated at serine 375 (pTDP-43S375) located in the low-complexity domain, and used it to investigate the presence of S375 phosphorylation in a series (n = 44) of FTLD-TDP and ALS-TDP cases. Immunoblot analysis demonstrated phosphorylation of S375 to be a consistent feature of pathological TDP-43 species, including full-length and C-terminal fragments, in all FTLD-TDP subtypes examined (A-C) and in ALS-TDP. Of particular interest, however, detailed immunohistochemical analysis showed striking differences in the immunoreactivity profile of inclusions with the pTDP-43S375 antiserum among pathological subtypes. TDP-43 pathology of ALS-TDP, FTLD-TDP type B (including cases with the C9orf72 mutation), and FTLD-TDP type C all showed strong pTDP-43S375 immunoreactivity that was similar in amount and morphology to that seen with an antibody against TDP-43 phosphorylated at S409/410 used as the gold standard. In stark contrast, TDP-43 pathology in sporadic and genetic forms of FTLD-TDP type A (including cases with GRN and C9orf72 mutations) was found to be almost completely negative by pTDP-43S375 immunohistochemistry. These data suggest a subtype-specific, conformation-dependent binding of pTDP-43S375 antiserum to TDP-43 aggregates, consistent with the idea of distinct structural TDP-43 conformers (i.e., TDP-43 strains) as the molecular basis for the phenotypic diversity in TDP-43 proteinopathies.
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Affiliation(s)
- Manuela Neumann
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Tübingen, Otfried-Müllerstr. 23, 72072, Tübingen, Germany.
- Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany.
| | - Petra Frick
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Tübingen, Otfried-Müllerstr. 23, 72072, Tübingen, Germany
| | - Francesca Paron
- Department of Molecular Pathology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Jonas Kosten
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Tübingen, Otfried-Müllerstr. 23, 72072, Tübingen, Germany
| | - Emanuele Buratti
- Department of Molecular Pathology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Ian R Mackenzie
- Department of Pathology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
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15
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Rostalski H, Hietanen T, Leskelä S, Behánová A, Abdollahzadeh A, Wittrahm R, Mäkinen P, Huber N, Hoffmann D, Solje E, Remes AM, Natunen T, Takalo M, Tohka J, Hiltunen M, Haapasalo A. BV-2 Microglial Cells Overexpressing C9orf72 Hexanucleotide Repeat Expansion Produce DPR Proteins and Show Normal Functionality but No RNA Foci. Front Neurol 2020; 11:550140. [PMID: 33123074 PMCID: PMC7573144 DOI: 10.3389/fneur.2020.550140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
Hexanucleotide repeat expansion (HRE) in the chromosome 9 open-reading frame 72 (C9orf72) gene is the most common genetic cause underpinning frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). It leads to the accumulation of toxic RNA foci and various dipeptide repeat (DPR) proteins into cells. These C9orf72 HRE-specific hallmarks are abundant in neurons. So far, the role of microglia, the immune cells of the brain, in C9orf72 HRE-associated FTLD/ALS is unclear. In this study, we overexpressed C9orf72 HRE of a pathological length in the BV-2 microglial cell line and used biochemical methods and fluorescence imaging to investigate its effects on their phenotype, viability, and functionality. We found that BV-2 cells expressing the C9orf72 HRE presented strong expression of specific DPR proteins but no sense RNA foci. Transiently increased levels of cytoplasmic TAR DNA-binding protein 43 (TDP-43), slightly altered levels of p62 and lysosome-associated membrane protein (LAMP) 2A, and reduced levels of polyubiquitinylated proteins, but no signs of cell death were detected in HRE overexpressing cells. Overexpression of the C9orf72 HRE did not affect BV-2 cell phagocytic activity or response to an inflammatory stimulus, nor did it shift their RNA profile toward disease-associated microglia. These findings suggest that DPR proteins do not affect microglial cell viability or functionality in BV-2 cells. However, additional studies in other models are required to further elucidate the role of C9orf72 HRE in microglia.
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Affiliation(s)
- Hannah Rostalski
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tomi Hietanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Stina Leskelä
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Andrea Behánová
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ali Abdollahzadeh
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Rebekka Wittrahm
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Petra Mäkinen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Dorit Hoffmann
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Teemu Natunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Mari Takalo
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Tohka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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16
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Neumann M, Mackenzie IRA. Review: Neuropathology of non-tau frontotemporal lobar degeneration. Neuropathol Appl Neurobiol 2020; 45:19-40. [PMID: 30357887 DOI: 10.1111/nan.12526] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) is a heterogeneous clinical syndrome associated with frontotemporal lobar degeneration (FTLD) as a relatively consistent neuropathological hallmark feature. However, the discoveries in the past decade of many of the relevant pathological proteins aggregating in human FTD brains in addition to several new FTD causing gene mutations underlined that FTD is a diverse condition on the neuropathological and genetic basis. This resulted in a novel molecular classification of these conditions based on the predominant protein abnormality and allows most cases of FTD to be placed now into one of three broad molecular subgroups; FTLD with tau, TAR DNA-binding protein 43 or FET protein accumulation (FTLD-tau, FTLD-TDP and FTLD-FET respectively). This review will provide an overview of the molecular neuropathology of non-tau FTLD, insights into disease mechanisms gained from the study of human post mortem tissue as well as discussion of current controversies in the field.
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Affiliation(s)
- M Neumann
- Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany.,Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - I R A Mackenzie
- Department of Pathology, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
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17
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Vismara M, Cirnigliaro G, Piccoli E, Giorgetti F, Molteni L, Cremaschi L, Fumagalli GG, D'addario C, Dell'Osso B. Crossing Borders Between Frontotemporal Dementia and Psychiatric Disorders: An Updated Overview. J Alzheimers Dis 2020; 75:661-673. [PMID: 32310172 DOI: 10.3233/jad-191333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Frontotemporal dementia (FTD) includes a group of neurocognitive syndromes, clinically characterized by altered behaviors, impairment of language proficiency, and altered executive functioning. FTD is one of the most frequently observed forms of dementia in the elderly population and the most common in presenile age. As for other subtypes of dementia, FTD incidence is constantly on the rise due to the steadily increasing age of the population, and its recognition is now becoming a determinant for clinicians. FTD and psychiatric disorders can overlap in terms of clinical presentations by sharing a common genetic predisposition and neuropathological mechanism in some cases. Nonetheless, this association is often unclear and underestimated. Since its first reports, research into FTD has constantly grown, with the identification of recent findings related to its neuropathology, genetic, clinical, and therapeutic issues. Literature is thriving on this topic, with numerous research articles published in recent years. In the present review, we aimed to provide an updated description of the clinical manifestations that link and potentially confound the diagnosis of FTD and psychiatric disorders in order to improve their differential diagnosis and early detection. In particular, we systematically reviewed the literature, considering articles specifically focused on the behavioral variant FTD, published after 2015 on the PubMed database.
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Affiliation(s)
- Matteo Vismara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Federica Giorgetti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Molteni
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Cremaschi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | | | - Claudio D'addario
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.,"Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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Parthimos TP, Karavasilis E, Rankin KP, Seimenis I, Leftherioti K, Papanicolaou AC, Miller B, Papageorgiou SG, Papatriantafyllou JD. The Neural Correlates of Impaired Self-Monitoring Among Individuals With Neurodegenerative Dementias. J Neuropsychiatry Clin Neurosci 2020; 31:201-209. [PMID: 30605361 DOI: 10.1176/appi.neuropsych.17120349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Self-monitoring is a crucial component of human empathy and necessary for the formation and repair of social relations. Several studies have brought to light possible neuronal substrates associated with self-monitoring, but the information that they have provided is inconclusive. The authors, therefore, studied a large group of patients with dementia to assess what brain structures are necessary for the self-monitoring function.Methods: Seventy-seven patients with dementia of various types were screened using voxel-based morphometry to assess possible volume reduction in the brain structures of patients with self-monitoring problems, and the decrease of socioemotional expressiveness and modification of self-presentation was estimated using the Revised Self-Monitoring Scale. Regression analysis was employed to investigate the correlation between gray matter loss and deficient self-monitoring.Results: The socioemotional expressiveness scores were associated with decreased gray matter volume in the right olfactory cortex, inferior frontal gyrus, superior temporal pole, parahippocampal gyrus, insula, and medial temporal gyrus bilaterally. Self-presentation scores were associated with bilateral gray matter volume reduction in the olfactory cortex, insula, rectus gyrus and inferior frontal gyrus, right superior temporal pole, and parahippocampal gyrus, as well as the left medial temporal gyrus and anterior superior frontal gyrus.Conclusions: These results suggest that patients with dementia present decreased ability of self-monitoring, probably due to impaired insula and orbitofrontal cortex and their disconnection from structures of the salience network.
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Affiliation(s)
- Theodore P Parthimos
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Efstratios Karavasilis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katherine P Rankin
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Ioannis Seimenis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katerina Leftherioti
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Andrew C Papanicolaou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Bruce Miller
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Sokratis G Papageorgiou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - John D Papatriantafyllou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
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19
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Subcortical TDP-43 pathology patterns validate cortical FTLD-TDP subtypes and demonstrate unique aspects of C9orf72 mutation cases. Acta Neuropathol 2020; 139:83-98. [PMID: 31501924 DOI: 10.1007/s00401-019-02070-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 02/07/2023]
Abstract
Frontotemporal lobar degeneration with TDP-43 immunoreactive (TDP-ir) inclusions (FTLD-TDP) is sub-classified based on the pattern of neocortical pathology, with each subtype showing clinical and genetic correlations. Recent studies indicate that accurate subtyping of cases may be important to help identify genetic risk factors and develop biomarkers. Although most FTLD-TDP cases are easily classified, some do not match well to one of the existing subtypes. In particular, cases with the C9orf72 repeat expansion (C9+) have been reported to show FTLD-TDP type A, type B or a combination of A and B pathology (A + B). In our series of FTLD-TDP cases, we found that those lacking the C9orf72 mutation (non-C9) were all readily classified as type A (n = 29), B (n = 16) or C (n = 18), using current criteria and standard observational methods. This classification was validated using non-biased hierarchical cluster analysis (HCA) of neocortical pathology data. In contrast, only 14/28 (50%) of the C9+ cases were classified as either pure type A or pure type B, with the remainder showing A + B features. HCA confirmed separation of the C9+ cases into three groups. We then investigated whether patterns of subcortical TDP-ir pathology helped to classify the difficult cases. For the non-C9 cases, each subtype showed a consistent pattern of subcortical involvement with significant differences among the groups. The most distinguishing features included white matter threads, neuronal intranuclear inclusions in hippocampus and striatum, and delicate threads in CA1 in type A; glial cytoplasmic inclusions in white matter and neuronal cytoplasmic inclusions (NCI) in lower motor neurons in type B; compact NCI in striatum in type C. HCA of the C9+ cases based on subcortical features increased the number that clustered with the non-C9 type A (46%) or non-C9 type B (36%); however, there remained a C9+ group with A + B features (18%). These findings suggest that most FTLD-TDP cases can be classified using existing criteria and that each group also shows characteristic subcortical TDP-ir pathology. However, C9+ cases may be unique in the degree to which their pathology overlaps between FTLD-TDP types A and B.
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20
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21
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Ehrenberg AJ, Suemoto CK, França Resende EDP, Petersen C, Leite REP, Rodriguez RD, Ferretti-Rebustini REDL, You M, Oh J, Nitrini R, Pasqualucci CA, Jacob-Filho W, Kramer JH, Gatchel JR, Grinberg LT. Neuropathologic Correlates of Psychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2019; 66:115-126. [PMID: 30223398 DOI: 10.3233/jad-180688] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Clarifying the relationships between neuropsychiatric symptoms and Alzheimer's disease (AD)-related pathology may open avenues for effective treatments. Here, we investigate the odds of developing neuropsychiatric symptoms across increasing burdens of neurofibrillary tangle and amyloid-β pathology. Participants who passed away between 2004 and 2014 underwent comprehensive neuropathologic evaluation at the Biobank for Aging Studies from the Faculty of Medicine at the University of São Paulo. Postmortem interviews with reliable informants were used to collect information regarding neuropsychiatric and cognitive status. Of 1,092 cases collected, those with any non-Alzheimer pathology were excluded, bringing the cohort to 455 cases. Braak staging was used to evaluate neurofibrillary tangle burden, and the CERAD neuropathology score was used to evaluate amyloid-β burden. The 12-item neuropsychiatric inventory was used to evaluate neuropsychiatric symptoms and CDR-SOB score was used to evaluate dementia status. In Braak I/II, significantly increased odds were detected for agitation, anxiety, appetite changes, depression, and sleep disturbances, compared to controls. Increased odds of agitation continue into Braak III/IV. Braak V/VI is associated with higher odds for delusions. No increased odds for neuropsychiatric symptoms were found to correlate with amyloid-β pathology. Increased odds of neuropsychiatric symptoms are associated with early neurofibrillary tangle pathology, suggesting that subcortical neurofibrillary tangle accumulation with minimal cortical pathology is sufficient to impact quality of life and that neuropsychiatric symptoms are a manifestation of AD biological processes.
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Affiliation(s)
- Alexander J Ehrenberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | | | - Elisa de Paula França Resende
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Cathrine Petersen
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Michelle You
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jun Oh
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Joel H Kramer
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Lea T Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,University of São Paulo Medical School, São Paulo, Brazil.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
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22
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Sellami L, Bocchetta M, Masellis M, Cash DM, Dick KM, van Swieten J, Borroni B, Galimberti D, Tartaglia MC, Rowe JB, Graff C, Tagliavini F, Frisoni G, Finger E, de Mendonça A, Sorbi S, Warren JD, Rohrer JD, Laforce R. Distinct Neuroanatomical Correlates of Neuropsychiatric Symptoms in the Three Main Forms of Genetic Frontotemporal Dementia in the GENFI Cohort. J Alzheimers Dis 2019; 65:147-163. [PMID: 30010122 PMCID: PMC6087430 DOI: 10.3233/jad-180053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The overlap between frontotemporal dementia (FTD) and primary psychiatric disorders has been brought to light by reports of prominent neuropsychiatric symptoms (NPS) in FTD-related genetic mutations, particularly among C9orf72 and GRN carriers. It has been recently demonstrated that early neuroanatomical changes in genetic FTD may be different across the major disease-causing mutations. Objective: We aimed to identify whether NPS could be driven by distinct structural correlates. Methods: One hundred and sixty-seven mutation carriers (75 GRN, 60 C9orf72, and 32 MAPT) were included from the Genetic FTD Initiative (GENFI) study, a large international cohort of genetic FTD. Neuropsychiatric symptoms including delusions, hallucinations (visual, auditory, and tactile), depression, and anxiety were investigated using a structured interview. Voxel-based morphometry was performed to identify neuroanatomical correlates of NPS. Results: Psychotic symptoms correlated mainly with grey matter (GM) atrophy in the anterior insula, left thalamus, cerebellum, and cortical regions including frontal, parietal, and occipital lobes in GRN mutations carriers. GM atrophy in posterior structures of the default-mode network was associated with anxiety in the GRN group. Delusions in C9orf72 expansion carriers were mainly associated with left frontal cortical atrophy. Cerebellar atrophy was found to be correlated only with anxiety in C9orf72 carriers. NPS in the MAPT group were mainly associated with volume loss in the temporal lobe. Conclusion: Neuroanatomical correlates of NPS appear to be distinct across the main forms of genetic FTD. Overall, our findings support overlapping brain structural changes between FTD and primary psychiatric disorders.
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Affiliation(s)
- Leila Sellami
- Clinique Interdisciplinaire de Mémoire(CIME), Université Laval, QC, Canada
| | - Martina Bocchetta
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Mario Masellis
- Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences ResearchProgram, Sunnybrook Research Institute; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David M Cash
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK.,Centre for Medical Image Computing, UCL, UK
| | - Katrina M Dick
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | | | | | - Daniela Galimberti
- Department of Pathophysiologyand Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cá Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Carmela Tartaglia
- TanzCentre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | | | - Caroline Graff
- Karolinska Institutet, Stockholm, Sweden; Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Elizabeth Finger
- Clinique Interdisciplinaire de Mémoire (CIME), Université Laval, QC, Canada
| | | | - Sandro Sorbi
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,IRCCS Don Carlo Gnocchi, Florence, Italy
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire(CIME), Université Laval, QC, Canada
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Forrest SL, Crockford DR, Sizemova A, McCann H, Shepherd CE, McGeachie AB, Affleck AJ, Carew-Jones F, Bartley L, Kwok JB, Kim WS, Jary E, Tan RH, McGinley CV, Piguet O, Hodges JR, Kril JJ, Halliday GM. Coexisting Lewy body disease and clinical parkinsonism in frontotemporal lobar degeneration. Neurology 2019; 92:e2472-e2482. [PMID: 31019099 DOI: 10.1212/wnl.0000000000007530] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of clinically relevant multiple system atrophy (MSA) and Lewy body disease (LBD) pathologies in a large frontotemporal lobar degeneration (FTLD) cohort to determine if concomitant pathologies underlie the heterogeneity of clinical features. METHODS All prospectively followed FTLD-tau and FTLD-TDP cases held by the Sydney Brain Bank (n = 126) were screened for coexisting MSA and LBD (Braak ≥ stage IV) pathology. Relevant clinical (including family history) and genetic associations were determined. RESULTS MSA pathology was not identified in this series. Of the FTLD cohort, 9 cases had coexisting LBD ≥ Braak stage IV and were associated with different FTLD subtypes including Pick disease (n = 2), corticobasal degeneration (n = 2), progressive supranuclear palsy (n = 2), and TDP type A (n = 3). All FTLD-TDP cases with coexisting LBD had mutations in progranulin (n = 2) or an abnormal repeat expansion in C9orf72 (n = 1). All FTLD-tau cases with coexisting LBD were sporadic. The H1H1 MAPT haplotype was found in all cases that could be genotyped (n = 6 of 9). Seven cases presented with a predominant dementia disorder, 3 of which developed parkinsonism. Two cases presented with a movement disorder and developed dementia in their disease course. The age at symptom onset (62 ± 11 years) and disease duration (8 ± 5 years) in FTLD cases with coexisting LBD did not differ from pure FTLD or pure LBD cases in the brain bank. CONCLUSION Coexisting LBD in FTLD comprises a small proportion of cases but has implications for clinical and neuropathologic diagnoses and the identification of biomarkers.
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Affiliation(s)
- Shelley L Forrest
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Daniel R Crockford
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Anastasia Sizemova
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Heather McCann
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Claire E Shepherd
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Andrew B McGeachie
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Andrew J Affleck
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Francine Carew-Jones
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Lauren Bartley
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - John B Kwok
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Woojin Scott Kim
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Eve Jary
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Rachel H Tan
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Ciara V McGinley
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Olivier Piguet
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - John R Hodges
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Jillian J Kril
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Glenda M Halliday
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia.
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Bourinaris T, Houlden H. C9orf72 and its Relevance in Parkinsonism and Movement Disorders: A Comprehensive Review of the Literature. Mov Disord Clin Pract 2018; 5:575-585. [PMID: 30637277 DOI: 10.1002/mdc3.12677] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background The C9orf72 hexanucleotide expansion is one of the latest discovered repeat expansion disorders related to neurodegeneration. Its association with the FTD/ALS spectrum disorders is well established, and it is considered to be one of the leading related genes. It has also been reported as a possible cause of several other phenotypes, including parkinsonism and other movement disorders. Its significance, though outside the FTD/ALS spectrum, is not well defined. Methods A comprehensive search of the literature was performed. All relevant papers, including reviews and case series/reports on movement disorder phenotypes reported with the C9orf72 repeat expansion, were reviewed. Data on frequency, natural history, phenotype, genetics, and possible underlying mechanisms were assessed. Results and Discussion In a number of studies, C9orf72 accounts for a small fraction of typical PD. Atypical parkinsonian syndromes, including CBS, PSP, and MSA have also been reported. Features that increase the probability of positive testing include early cognitive and/or behavioral symptoms, positive family history of ALS or FTD, and the presence of UMN and LMN signs. Furthermore, several studies conclude that C9orf72 is the most common cause of HD-phenocopies. Interestingly, many cases with the parkinsonian phenotype that bear an intermediate range of repeats are also reported, questioning the direct causal role of C9orf72 and suggesting the possibility of being a susceptibility factor, while the presence of the expansion in normal controls questions its clinical significance. Finally, studies on pathology reveal a distinctive broad range of C9orf72-related neurodegeneration that could explain the wide phenotypic variation.
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Affiliation(s)
- Thomas Bourinaris
- Department of Molecular Neuroscience Institute of Neurology, University College London London, WC1N 3BG UK
| | - Henry Houlden
- Department of Molecular Neuroscience Institute of Neurology, University College London London, WC1N 3BG UK
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25
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Sarà M, Cornia R, Conson M, Carolei A, Sacco S, Pistoia F. Cortical Brain Changes in Patients With Locked-In Syndrome Experiencing Hallucinations and Delusions. Front Neurol 2018; 9:354. [PMID: 29867752 PMCID: PMC5966526 DOI: 10.3389/fneur.2018.00354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/01/2018] [Indexed: 11/14/2022] Open
Abstract
Previous evidence suggests that hallucinations and delusions may be detected in patients with the most severe forms of motor disability including locked-in syndrome (LIS). However, such phenomena are rarely described in LIS and their presence may be underestimated as a result of the severe communication impairment experienced by the patients. In this study, we retrospectively reviewed the clinical history and the neuroimaging data of a cohort of patients with LIS in order to recognize the presence of hallucinations and delusions and to correlate it with the pontine damage and the presence of any cortical volumetric changes. Ten patients with LIS were included (5 men and 5 women, mean age 50.1 ± 14.6). According to the presence of indicators of symptoms, these patients were categorized as hallucinators (n = 5) or non-hallucinators (n = 5). MRI images of patients were analyzed using Freesurfer 6.0 software to evaluate volume differences between the two groups. Hallucinators showed a selective cortical volume loss involving the fusiform (p = 0.001) and the parahippocampal (p = 0.0008) gyrus and the orbital part of the inferior frontal gyrus (p = 0.001) in the right hemisphere together with the lingual (p = 0.01) and the fusiform gyrus (p = 0.01) in the left hemisphere. Moreover, a volumetric decrease of bilateral anterior portions of the precuneus was recognized in the hallucinators (right p = 0.01; left p = 0.001) as compared to non-hallucinators. We suggested that the presence of hallucinations and delusions in some LIS patients could be accounted for by the combination of a damage of the corticopontocerebellar pathways with cortical changes following the primary brainstem injury. The above areas are embedded within cortico-cortical and cortico-subcortical loops involved in self-monitoring and have been related to the presence of hallucinations in other diseases. The two main limitations of our study are the small sample of included patients and the lack of a control group of healthy individuals. Further studies would be of help to expand this field of research in order to integrate existing theories about the mechanisms underlying the generation of hallucinations and delusions in neurological patients.
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Affiliation(s)
- Marco Sarà
- Post-Coma Intensive Rehabilitation Care Unit, San Raffaele Hospital, Cassino, Italy
| | - Riccardo Cornia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - Massimiliano Conson
- Neuropsychology Laboratory, Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
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26
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Cheran G, Silverman H, Manoochehri M, Goldman J, Lee S, Wu L, Cines S, Fallon E, Kelly BD, Olszewska DA, Heidebrink J, Shair S, Campbell S, Paulson H, Lynch T, Cosentino S, Huey ED. Psychiatric symptoms in preclinical behavioural-variant frontotemporal dementia in MAPT mutation carriers. J Neurol Neurosurg Psychiatry 2018; 89:449-455. [PMID: 29353234 PMCID: PMC6317727 DOI: 10.1136/jnnp-2017-317263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterise psychiatric symptoms in preclinical and early behavioural-variant frontotemporal dementia (bvFTD), a neurodegenerative disorder whose symptoms overlap with and are often mistaken for psychiatric illness. METHODS The present study reports findings from a systematic, global, prospective evaluation of psychiatric symptoms in 12 preclinical carriers of pathogenic MAPT mutations, not yet meeting bvFTD diagnostic criteria, and 46 familial non-carrier controls. Current psychiatric symptoms, informant-reported symptoms and lifetime prevalence of psychiatric disorders were assessed with The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the Neuropsychiatric Inventory Questionnaire. Fisher exact test was used to compare carriers and non-carriers' lifetime prevalence of six DSM-IV disorders: major depressive disorder, panic attacks, alcohol abuse, generalised anxiety disorder, panic disorder, and depressive disorder not otherwise specified. Other DSM-IV disorders had insufficient prevalence across our sample for between-group comparisons, but are reported. RESULTS Non-carriers had greater prevalence of mood and anxiety disorders than has been reported for a general reference population. Preclinical carriers had lower lifetime prevalence of mood and anxiety disorders than non-carriers, except for depressive disorder not otherwise specified, an atypical syndrome comprising clinically significant depressive symptoms which fail to meet criteria for major depressive disorder. CONCLUSION Findings suggest that early psychiatric symptoms of emergent bvFTD may manifest as emotional blunting or mood changes not cleanly conforming to criteria for a DSM-defined mood disorder.
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Affiliation(s)
- Gayathri Cheran
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Hannah Silverman
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Masood Manoochehri
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Jill Goldman
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Seonjoo Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, USA
| | - Liwen Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, USA
| | - Sarah Cines
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Emer Fallon
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brendan Desmond Kelly
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity Centre for Health Sciences, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Diana Angelika Olszewska
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Judith Heidebrink
- Department of Neurology, The University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Shair
- Department of Neurology, The University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen Campbell
- Department of Neurology, The University of Michigan, Ann Arbor, Michigan, USA
| | - Henry Paulson
- Department of Neurology, The University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Lynch
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephanie Cosentino
- G H Sergievsky Center &Taub Institute in the Department of Neurology, Columbia University Medical Center, New York, USA
| | - Edward D Huey
- Departments of Psychiatry & Neurology, Columbia University Medical Center, New York, USA
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27
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Yang Y, Halliday GM, Hodges JR, Tan RH. von Economo Neuron Density and Thalamus Volumes in Behavioral Deficits in Frontotemporal Dementia Cases with and without a C9ORF72 Repeat Expansion. J Alzheimers Dis 2018; 58:701-709. [PMID: 28482638 DOI: 10.3233/jad-170002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The early and selective loss of von Economo neurons in the anterior cingulate cortex has been linked to behavioral deficits in frontotemporal dementia (FTD). Importantly, whether these neurons are also targeted in patients with the C9ORF72 repeat expansion has yet to be established. This is of particular interest given the recent evidence highlighting the thalamus rather than anterior cingulate cortex as a region of significant degeneration in patients with the C9ORF72 repeat expansion. OBJECTIVE To assess the von Economo neuron density and thalamus volumes in behavioral variant FTD (bvFTD) cases with the C9ORF72 repeat expansion, sporadic bvFTD, sporadic ALS, and controls. METHODS Volumetric and quantitative cell counting methods were employed to assess the von Economo neuron density and thalamus volumes in 37 pathologically-confirmed cases comprised of patients with bvFTD (n = 13) cases with the C9ORF72 repeat expansion (62% with psychosis), sporadic bvFTD (n = 8), sporadic amyotrophic lateral sclerosis (n = 7) and controls (n = 9). RESULTS von Economo neuron density was significantly reduced in sporadic bvFTD cases only. Thalamus degeneration was identified only in bvFTD cases with the C9ORF72 repeat expansion, and to a similar extent in cases with and without psychosis. No significant difference in von Economo neuron density or thalamus degeneration was seen between bvFTD cases with or without the C9ORF72 repeat expansion. CONCLUSION The present histological findings converge with neuroimaging results to corroborate the anterior cingulate cortex as a core region involved in sporadic bvFTD, and the thalamus as a major region targeted in patients with the C9ORF72 expansion.
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Affiliation(s)
- Yue Yang
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Glenda M Halliday
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Rachel H Tan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
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Reappraisal of TDP-43 pathology in FTLD-U subtypes. Acta Neuropathol 2017; 134:79-96. [PMID: 28466142 DOI: 10.1007/s00401-017-1716-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 12/13/2022]
Abstract
Frontotemporal lobar degeneration with tau-negative, ubiquitin-immunoreactive (-ir) pathology (FTLD-U) is subclassified based on the type and cortical laminar distribution of neuronal inclusions. Following the discovery of the transactive response DNA-binding protein Mr 43 kD (TDP-43) as the ubiquitinated protein in most FTLD-U, the same pathological criteria have been used to classify FTLD cases based on TDP-43-ir changes. However, the fact that immunohistochemistry (IHC) for ubiquitin and TDP-43 each recognizes slightly different pathological changes in these cases means that the original FTLD-U subtype criteria may not be directly applicable for use with TDP-43 IHC. We formally re-evaluated the TDP-43-ir pathological features that characterize the different FTLD-U subtypes to see if the current classification could be refined. In our series of 78 cases, 81% were classified as one of the common FTLD-U subtypes (29% A, 35% B, 17% C). With TDP-43 IHC, each subtype demonstrated consistent intra-group pathological features and clear inter-group differences. The TDP-43-ir changes that characterized type A and C cases were similar to those seen with ubiquitin IHC; specifically, compact neuronal cytoplasmic inclusions (NCI), short thick dystrophic neurites (DN), and lentiform neuronal intranuclear inclusions concentrated in cortical layer II in type A cases, and a predominance of long thick DN in type C. However, type B cases showed significant differences with TDP-43 compared with ubiquitin IHC; with many diffuse granular NCI and wispy thread and dots-like profiles in all cortical layers. The remaining 15 cases (12 with C9orf72 mutations) showed changes that were consistent with combined type A and type B pathology. These findings suggest that the pathological criteria for subtyping FTLD cases based on TDP-43 IHC might benefit from some refinement that recognizes differences in the morphologies of NCI and neurites. Furthermore, there is a significant subset of cases (most with the C9orf72 mutation) with the pathological features of multiple FTLD-TDP subtypes for which appropriate classification is difficult.
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Gossink FT, Vijverberg EG, Krudop W, Scheltens P, Stek ML, Pijnenburg YA, Dols A. Psychosis in behavioral variant frontotemporal dementia. Neuropsychiatr Dis Treat 2017; 13:1099-1106. [PMID: 28458550 PMCID: PMC5402723 DOI: 10.2147/ndt.s127863] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dementia is generally characterized by cognitive impairment that can be accompanied by psychotic symptoms; for example, visual hallucinations are a core feature of dementia with Lewy bodies, and delusions are often seen in Alzheimer's disease. However, for behavioral variant of frontotemporal dementia (bvFTD), studies on the broad spectrum of psychotic symptoms are still lacking. The aim of this study was to systematically and prospectively subtype the wide spectrum of psychotic symptoms in probable and definite bvFTD. METHODS In this study, a commonly used and validated clinical scale that quantifies the broad spectrum of psychotic symptoms (Positive and Negative Symptom Scale) was used in patients with probable and definite bvFTD (n=22) and with a primary psychiatric disorder (n=35) in a late-onset frontal lobe cohort. Median symptom duration was 2.8 years, and the patients were prospectively followed for 2 years. RESULTS In total, 22.7% of bvFTD patients suffered from delusions, hallucinatory behavior, and suspiciousness, although the majority of the patients exhibited negative psychotic symptoms such as social and emotional withdrawal and blunted affect (95.5%) and formal thought disorders (81.8%). "Difficulty in abstract thinking" and "stereotypical thinking" (formal thought disorders) differentiated bvFTD from psychiatric disorders. The combined predictors difficulty in abstract thinking, stereotypical thinking, "anxiety", "guilt feelings," and "tension" explained 75.4% of variance in the diagnosis of bvFTD versus psychiatric diagnoses (P<0.001). CONCLUSION Delusions, hallucinatory behavior, and suspiciousness were present in one-fifth of bvFTD patients, whereas negative psychotic symptoms such as social and emotional withdrawal, blunted affect, and formal thought disorders were more frequently present. This suggests that negative psychotic symptoms and formal thought disorders have an important role in the psychiatric misdiagnosis in bvFTD; misdiagnosis in bvFTD might be reduced by systematically exploring the broad spectrum of psychiatric symptoms.
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Affiliation(s)
- Flora T Gossink
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Everard Gb Vijverberg
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam.,Department of Neurology, HagaZiekenhuis, The Hague, the Netherlands
| | - Welmoed Krudop
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Max L Stek
- Department of Old Age Psychiatry, GGZinGeest
| | - Yolande Al Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
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Lagarde J, Sarazin M. [Reconciliating neurology and psychiatry: The prototypical case of frontotemporal dementia]. Encephale 2016; 43:471-479. [PMID: 27772665 DOI: 10.1016/j.encep.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
Frontotemporal degeneration (FTD) in its behavioral variant (bvFTD) is probably one of the conditions that best illustrates the links between psychiatry and neurology. It is indeed admitted that between a third and half of patients with this condition, especially in early-onset forms, receive an initial diagnosis of psychiatric disorder (depression, schizophrenia, bipolar disorder) and are then referred to a psychiatric ward. BvFTD can thus be considered a neurological disorder with a psychiatric presentation. Among psychiatric symptoms reported in this disease, psychotic symptoms (hallucinations, delusions, especially of persecution), which have long been underestimated in bvFTD and are not part of the current diagnostic criteria, are present in about 20% of cases and may be inaugural. They are particularly common in the genetic forms related to a mutation in the C9orf72 gene (up to 50%), and to a lesser extent in the GRN gene (up to 25%). C9orf72 gene mutation is often associated with a family history of dementia or motor neuron disease but also of psychiatric disorders. It has also been described in sporadic presentation forms. Sometimes, the moderate degree of brain atrophy on MRI described in patients carrying this mutation may complicate the differential diagnosis with late-onset psychiatric diseases. In the present article, we underline the importance of considering that psychiatric - especially psychotic - symptoms are not rare in bvFTD, which should lead to a revision of the diagnostic criteria of this disease by taking greater account of this fact. We also propose a diagnostic chart, based on concerted evaluation by neurologists and psychiatrists for cases of atypical psychiatric symptoms (late-onset or pharmacoresistant troubles) leading to consider the possibility of a neurological disorder, in order to shed a new light on these difficult clinical situations. In the field of research, bvFTD may constitute a model to explore the neural basis of certain psychiatric disorders, and a possible molecular link between bvFTD and psychoses, which could eventually lead to new therapeutic approaches, has been recently suggested. Thus, bvFTD illustrates how the links between neurology and psychiatry are close and tend to evolve with the progress of scientific knowledge. It is necessary to strengthen collaboration between the two disciplines both to improve the care - diagnosis and management of these patients - and to promote the emergence of innovative clinical research.
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Affiliation(s)
- J Lagarde
- Unité de neurologie de la mémoire et du langage, centre hospitalier Sainte-Anne, université Paris Descartes, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France.
| | - M Sarazin
- Unité de neurologie de la mémoire et du langage, centre hospitalier Sainte-Anne, université Paris Descartes, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
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Chi S, Jiang T, Tan L, Yu JT. Distinct neurological disorders with C9orf72 mutations: genetics, pathogenesis, and therapy. Neurosci Biobehav Rev 2016; 66:127-42. [PMID: 27139021 DOI: 10.1016/j.neubiorev.2016.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 12/12/2022]
Abstract
The G4C2 repeat expansion within C9orf72 has been recently identified as the most common genetic cause of frontotemporal dementia and amyotrophic lateral sclerosis. This mutation has also been detected in a variety of other neurological diseases with distinct clinical manifestations. The exact mechanisms of how this mutation leads to the wide spectrum of clinical syndromes remain unknown. A series of molecular changes together with some potential modifiers may play a key role. Nucleolar stress, nucleocytoplasmic transport defect, oxidative damage, inhibited stress granules assembly, activated endoplasmic reticulum stress, and inhibited proteasome activity are mechanisms that contribute to the pathogenesis of these diseases. Additional mutations, epigenetic modifiers, and repeat size are potential modifiers that modulate specific phenotypes on the basis of the molecular changes. Here, we summarize distinct C9orf72-related neurological disorders and their corresponding neuropathological changes. Then, we elucidate the existing molecular knowledge and the potential modifiers. Finally, we detail the main target of treatment aiming at controlling expanded RNA transcripts.
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Affiliation(s)
- Song Chi
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China.
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China.
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Atypical parkinsonism in C9orf72 expansions: a case report and systematic review of 45 cases from the literature. J Neurol 2016; 263:558-74. [PMID: 26810719 DOI: 10.1007/s00415-016-8021-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/01/2016] [Accepted: 01/02/2016] [Indexed: 12/13/2022]
Abstract
While C9orf72 repeat expansions usually present with frontotemporal dementia (FTD) and/or amyotrophic lateral sclerosis (ALS), an increasing number of reports suggests that the primary phenotype of C9orf72 patients may also include movement disorders. We here provide the first systematic clinical characterisation of C9orf72-associated parkinsonism. We report a C9orf72 expansion carrier presenting with a clinical syndrome of progressive supranuclear palsy (PSP), pronounced mesencephalic atrophy on MRI and PSP-characteristic electrooculography findings. Moreover, we systematically review all previous reports on C9orf72 patients with parkinsonian features. Review of 28 reports revealed 45 C9orf72-positive patients with hypokinesia, rigidity and/or resting tremor. C9orf72-associated parkinsonism predominantly consisted in a hypokinetic-rigid syndrome without resting tremor (61%), with both asymmetric (59%) and symmetric (41%) distributions. Additional features included upper motor neuron signs (60%), lower motor neuron signs (36%), cognitive dysfunction (85%), behaviour and/or personality change (55%) and psychiatric symptoms (29%). Vertical supranuclear gaze palsy was reported in three further cases and cerebellar dysfunction in four cases. Family history frequently yielded evidence of ALS (31%) and FTD (21%). Atypical parkinsonism is a recurrent phenotypic manifestation of C9orf72 expansions. It occurs as part of a broad spectrum of C9orf72-related multi-system neurodegeneration, which can include basal ganglia, mesencephalic and cerebellar dysfunction. C9orf72 genotyping should be considered in those patients with atypical parkinsonism who present with a family history of ALS or FTD, upper or lower motor neuron signs and/or cognitive dysfunction with pronounced frontotemporal impairment.
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Kämäläinen A, Herukka SK, Hartikainen P, Helisalmi S, Moilanen V, Knuuttila A, Jansson L, Tienari PJ, Remes AM. Cerebrospinal fluid biomarkers for Alzheimer's disease in patients with frontotemporal lobar degeneration and amyotrophic lateral sclerosis with the C9ORF72 repeat expansion. Dement Geriatr Cogn Disord 2015; 39:287-93. [PMID: 25791939 DOI: 10.1159/000371704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The C9ORF72 expansion is one of the most common causes of frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). The C9ORF72 expansion is associated with TDP-43 and p62 neuropathology, and amyloid plaques and neurofibrillary tangles are not common in patients with the C9ORF72 expansion. Therefore, we hypothesized that cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease [AD; Aβ1-42, total tau (T-tau) and phospho-tau] are normal in these patients. METHODS The CSF Aβ1-42, T-tau and phospho-tau levels were measured in 40 Finnish patients with the C9ORF72 expansion (29 FTLD, 10 ALS and 1 FTLD-ALS) using ELISA. RESULTS A decreased Aβ1-42 level was found in 25% of cases, while there were only single cases with changes in the t-Tau or phospho-tau level. The patients with abnormal biomarkers fulfilled the clinical criteria of the behavioral variant frontotemporal dementia and expressed no clinical signs of AD. CONCLUSIONS In clinical diagnostics, a decreased CSF Aβ1-42 level does not exclude the C9ORF72 expansion associated with FTLD.
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Affiliation(s)
- Anna Kämäläinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
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