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Dev SI, Dickerson BC, Touroutoglou A. Neuroimaging in Frontotemporal Lobar Degeneration: Research and Clinical Utility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:93-112. [PMID: 33433871 DOI: 10.1007/978-3-030-51140-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Frontotemporal lobar dementia (FTLD) is a clinically and pathologically complex disease. Advances in neuroimaging techniques have provided a specialized set of tools to investigate underlying pathophysiology and identify clinical biomarkers that aid in diagnosis, prognostication, monitoring, and identification of appropriate endpoints in clinical trials. In this chapter, we review data discussing the utility of neuroimaging biomarkers in sporadic FTLD, with an emphasis on current and future clinical applications. Among those modalities readily utilized in clinical settings, T1-weighted structural magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are best supported in differential diagnosis and as targets for clinical trial endpoints. However, a number of nonclinical neuroimaging modalities, including diffusion tensor imaging and resting-state functional connectivity MRI, show promise as biomarkers to predict progression and as clinical trial endpoints. Other neuroimaging modalities, including amyloid PET, Tau PET, and arterial spin labeling MRI, are also discussed, though more work is required to establish their utility in FTLD in clinical settings.
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Affiliation(s)
- Sheena I Dev
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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2
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Caso F, Agosta F, Magnani G, Cardamone R, Borghesani V, Miller Z, Riva N, La Joie R, Coppola G, Grinberg LT, Seeley WW, Miller BL, Gorno-Tempini ML, Filippi M. Temporal variant of frontotemporal dementia in C9orf72 repeat expansion carriers: two case studies. Brain Imaging Behav 2021; 14:336-345. [PMID: 32180125 DOI: 10.1007/s11682-019-00253-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The temporal variant of frontotemporal dementia (tv-FTD) is a progressive neurodegenerative disease with a complex clinical picture mainly characterized by behavioral and language disorders. In this work, we describe clinical, genetic, neuroanatomical and neuropathological (only in one case) features of two patients with tv-FTD carrying C9orf72 repeat expansion. The first patient (AB) presented with a 1-year disease duration showing focal right anterior temporal lobe (ATL) atrophy on magnetic resonance imaging (MRI). The second patient (BC) came to medical attention 13 years after disease onset and showed a prominent bilateral ATL involvement. Both patients showed naming deficits, impairment in identifying known faces and proper names, and personality changes with new onset behavioral rigidity, and progressing language difficulties to single-word and sentence comprehension difficulties. They were classified as tv-FTD. Clinical, cognitive and MRI follow-up were performed. As cognitive impairment progressed, MRI atrophy worsened in ATL and frontotemporal areas in both patients. Both cases had clear family histories of neurological and/or psychiatric disease. Genetic testing revealed a C9orf72 hexanucleotide repeat expansion in both cases. BC passed away after 15 years of disease and autopsy showed the expected TDP-type B pathology. These genetic cases of tv-FTD highlight the susceptibility of ATL to C9orf72-related pathology and emphasize the importance of genetical testing in FTD-spectrum disorders, regardless of the clinical phenotype.
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Affiliation(s)
- Francesca Caso
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Zachary Miller
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Nilo Riva
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Renaud La Joie
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Giovanni Coppola
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurophysiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
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3
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Dickerson B, Atri A. Molecular Imaging Biomarkers in Dementia: Amyloid and tau PET imaging aids evaluation of patients suspected of having Alzheimer disease or other dementias. PRACTICAL NEUROLOGY (FORT WASHINGTON, PA.) 2020; 19:34-45. [PMID: 34456638 PMCID: PMC8387980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Brad Dickerson
- Director, Frontotemporal Disorders, Unit Department of Neurology, Massachusetts General Hospital
| | - Alireza Atri
- Director, Banner Sun Health Research Institute, Banner Health, Sun City, AZ
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4
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Kim EJ, Hwang JHL, Gaus SE, Nana AL, Deng J, Brown JA, Spina S, Lee MJ, Ramos EM, Grinberg LT, Kramer JH, Boxer AL, Gorno-Tempini ML, Rosen HJ, Miller BL, Seeley WW. Evidence of corticofugal tau spreading in patients with frontotemporal dementia. Acta Neuropathol 2020; 139:27-43. [PMID: 31542807 DOI: 10.1007/s00401-019-02075-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/10/2019] [Accepted: 08/11/2019] [Indexed: 01/09/2023]
Abstract
Common neurodegenerative diseases feature progressive accumulation of disease-specific protein aggregates in selectively vulnerable brain regions. Increasing experimental evidence suggests that misfolded disease proteins exhibit prion-like properties, including the ability to seed corruptive templating and self-propagation along axons. Direct evidence for transneuronal spread in patients, however, remains limited. To test predictions made by the transneuronal spread hypothesis in human tissues, we asked whether tau deposition within axons of the corticospinal and corticopontine pathways can be predicted based on clinical syndromes and cortical atrophy patterns seen in frontotemporal lobar degeneration (FTLD). Sixteen patients with Pick's disease, 21 with corticobasal degeneration, and 3 with FTLD-MAPT were included, spanning a range of clinical syndromes across the frontotemporal dementia (FTD) spectrum. Cortical involvement was measured using a neurodegeneration score, a tau score, and a composite score based on semiquantitative ratings and complemented by an MRI-based cortical atrophy W-map based on antemortem imaging. Midbrain cerebral peduncle and pontine base descending fibers were divided into three subregions, representing prefrontopontine, corticospinal, and parieto-temporo-occipital fiber pathways. Tau area fraction was calculated in each subregion and related to clinical syndrome and cortical measures. Within each clinical syndrome, there were predicted relationships between cortical atrophy patterns and axonal tau deposition in midbrain cerebral peduncle and pontine base. Between syndromes, contrasting and predictable patterns of brainstem axonal tau deposition emerged, with, for example, greater tau in prefrontopontine fibers in behavioral variant FTD and in corticospinal fibers in corticobasal syndrome. Finally, semiquantitative and quantitative cortical degeneration scores predicted brainstem axonal tau deposition based on anatomical principles. Taken together, these findings provide important human evidence in support of axonal tau spreading in patients with specific forms of tau-related neurodegeneration.
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Affiliation(s)
- Eun-Joo Kim
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Ji-Hye L Hwang
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Stephanie E Gaus
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Alissa L Nana
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Jersey Deng
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Jesse A Brown
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Myung Jun Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Eliana Marisa Ramos
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lea T Grinberg
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
- Department of Pathology, University of California, San Francisco, USA
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA.
- Department of Pathology, University of California, San Francisco, USA.
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5
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Santos-Santos MA, Rabinovici GD, Iaccarino L, Ayakta N, Tammewar G, Lobach I, Henry ML, Hubbard I, Mandelli ML, Spinelli E, Miller ZA, Pressman PS, O'Neil JP, Ghosh P, Lazaris A, Meyer M, Watson C, Yoon SJ, Rosen HJ, Grinberg L, Seeley WW, Miller BL, Jagust WJ, Gorno-Tempini ML. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol 2019; 75:342-352. [PMID: 29309493 DOI: 10.1001/jamaneurol.2017.4309] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance The ability to predict the pathology underlying different neurodegenerative syndromes is of critical importance owing to the advent of molecule-specific therapies. Objective To determine the rates of positron emission tomography (PET) amyloid positivity in the main clinical variants of primary progressive aphasia (PPA). Design, Setting, and Participants This prospective clinical-pathologic case series was conducted at a tertiary research clinic specialized in cognitive disorders. Patients were evaluated as part of a prospective, longitudinal research study between January 2002 and December 2015. Inclusion criteria included clinical diagnosis of PPA; availability of complete speech, language, and cognitive testing; magnetic resonance imaging performed within 6 months of the cognitive evaluation; and PET carbon 11-labeled Pittsburgh Compound-B or florbetapir F 18 brain scan results. Of 109 patients referred for evaluation of language symptoms who underwent amyloid brain imaging, 3 were excluded because of incomplete language evaluations, 5 for absence of significant aphasia, and 12 for presenting with significant initial symptoms outside of the language domain, leaving a cohort of 89 patients with PPA. Main Outcomes and Measures Clinical, cognitive, neuroimaging, and pathology results. Results Twenty-eight cases were classified as imaging-supported semantic variant PPA (11 women [39.3%]; mean [SD] age, 64 [7] years), 31 nonfluent/agrammatic variant PPA (22 women [71.0%]; mean [SD] age, 68 [7] years), 26 logopenic variant PPA (17 women [65.4%]; mean [SD] age, 63 [8] years), and 4 mixed PPA cases. Twenty-four of 28 patients with semantic variant PPA (86%) and 28 of 31 patients with nonfluent/agrammatic variant PPA (90%) had negative amyloid PET scan results, while 25 of 26 patients with logopenic variant PPA (96%) and 3 of 4 mixed PPA cases (75%) had positive scan results. The amyloid positive semantic variant PPA and nonfluent/agrammatic variant PPA cases with available autopsy data (2 of 4 and 2 of 3, respectively) all had a primary frontotemporal lobar degeneration and secondary Alzheimer disease pathologic diagnoses, whereas autopsy of 2 patients with amyloid PET-positive logopenic variant PPA confirmed Alzheimer disease. One mixed PPA patient with a negative amyloid PET scan had Pick disease at autopsy. Conclusions and Relevance Primary progressive aphasia variant diagnosis according to the current classification scheme is associated with Alzheimer disease biomarker status, with the logopenic variant being associated with carbon 11-labeled Pittsburgh Compound-B positivity in more than 95% of cases. Furthermore, in the presence of a clinical syndrome highly predictive of frontotemporal lobar degeneration pathology, biomarker positivity for Alzheimer disease may be associated more with mixed pathology rather than primary Alzheimer disease.
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Affiliation(s)
- Miguel A Santos-Santos
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Autonomous University of Barcelona, Cerdanyola del Valles, Spain.,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundació Alzheimer Memory Clinic and Research Center, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nagehan Ayakta
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley
| | - Gautam Tammewar
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley
| | - Iryna Lobach
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Maya L Henry
- Department of Communication Sciences and Disorders, University of Texas, Austin
| | - Isabel Hubbard
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Maria Luisa Mandelli
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Edoardo Spinelli
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Vita-Salute San Raffaele University, Milan, Italy
| | - Zachary A Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Peter S Pressman
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,University of Colorado Denver, Denver
| | - James P O'Neil
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Pia Ghosh
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Andreas Lazaris
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Marita Meyer
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Christa Watson
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Soo Jin Yoon
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - Lea Grinberg
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Department of Pathology, University of California San Francisco, California
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California San Francisco.,Department of Pathology, University of California San Francisco, California
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley.,Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California
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6
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Bergeron D, Gorno-Tempini ML, Rabinovici GD, Santos-Santos MA, Seeley W, Miller BL, Pijnenburg Y, Keulen MA, Groot C, van Berckel BNM, van der Flier WM, Scheltens P, Rohrer JD, Warren JD, Schott JM, Fox NC, Sanchez-Valle R, Grau-Rivera O, Gelpi E, Seelaar H, Papma JM, van Swieten JC, Hodges JR, Leyton CE, Piguet O, Rogalski EJ, Mesulam MM, Koric L, Kristensen N, Pariente J, Dickerson B, Mackenzie IR, Hsiung GYR, Belliard S, Irwin DJ, Wolk DA, Grossman M, Jones M, Harris J, Mann D, Snowden JS, Chrem-Mendez P, Calandri IL, Amengual AA, Miguet-Alfonsi C, Magnin E, Magnani G, Santangelo R, Deramecourt V, Pasquier F, Mattsson N, Nilsson C, Hansson O, Keith J, Masellis M, Black SE, Matías-Guiu JA, Cabrera-Martin MN, Paquet C, Dumurgier J, Teichmann M, Sarazin M, Bottlaender M, Dubois B, Rowe CC, Villemagne VL, Vandenberghe R, Granadillo E, Teng E, Mendez M, Meyer PT, Frings L, Lleó A, Blesa R, Fortea J, Seo SW, Diehl-Schmid J, Grimmer T, Frederiksen KS, Sánchez-Juan P, Chételat G, Jansen W, Bouchard RW, Laforce RJ, Visser PJ, Ossenkoppele R. Prevalence of amyloid-β pathology in distinct variants of primary progressive aphasia. Ann Neurol 2018; 84:729-740. [PMID: 30255971 PMCID: PMC6354051 DOI: 10.1002/ana.25333] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the prevalence of amyloid positivity, defined by positron emission tomography (PET)/cerebrospinal fluid (CSF) biomarkers and/or neuropathological examination, in primary progressive aphasia (PPA) variants. METHODS We conducted a meta-analysis with individual participant data from 1,251 patients diagnosed with PPA (including logopenic [lvPPA, n = 443], nonfluent [nfvPPA, n = 333], semantic [svPPA, n = 401], and mixed/unclassifiable [n = 74] variants of PPA) from 36 centers, with a measure of amyloid-β pathology (CSF [n = 600], PET [n = 366], and/or autopsy [n = 378]) available. The estimated prevalence of amyloid positivity according to PPA variant, age, and apolipoprotein E (ApoE) ε4 status was determined using generalized estimating equation models. RESULTS Amyloid-β positivity was more prevalent in lvPPA (86%) than in nfvPPA (20%) or svPPA (16%; p < 0.001). Prevalence of amyloid-β positivity increased with age in nfvPPA (from 10% at age 50 years to 27% at age 80 years, p < 0.01) and svPPA (from 6% at age 50 years to 32% at age 80 years, p < 0.001), but not in lvPPA (p = 0.94). Across PPA variants, ApoE ε4 carriers were more often amyloid-β positive (58.0%) than noncarriers (35.0%, p < 0.001). Autopsy data revealed Alzheimer disease pathology as the most common pathologic diagnosis in lvPPA (76%), frontotemporal lobar degeneration-TDP-43 in svPPA (80%), and frontotemporal lobar degeneration-TDP-43/tau in nfvPPA (64%). INTERPRETATION This study shows that the current PPA classification system helps to predict underlying pathology across different cohorts and clinical settings, and suggests that age and ApoE genotype should be considered when interpreting amyloid-β biomarkers in PPA patients. Ann Neurol 2018;84:737-748.
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Affiliation(s)
- David Bergeron
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Miguel A Santos-Santos
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, Llobregat Hospital, Barcelona, Spain
- Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain
| | - William Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Yolande Pijnenburg
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - M Antoinette Keulen
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Colin Groot
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Oriol Grau-Rivera
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Ellen Gelpi
- Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harro Seelaar
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John C van Swieten
- Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John R Hodges
- Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Cristian E Leyton
- Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA
| | - Olivier Piguet
- Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Emily J Rogalski
- Neurological Sciences, Rush University, Chicago, IL
- Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL
| | - Marsel M Mesulam
- Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL
| | - Lejla Koric
- Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France
| | - Nora Kristensen
- Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France
| | - Jeéreémie Pariente
- University of Toulouse, INSERM, Toulouse Neuroimaging Center, Toulouse, France
| | - Bradford Dickerson
- Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA
| | - Ian R Mackenzie
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ging-Yuek R Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Belliard
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Irwin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA
| | - Matthew Jones
- Cerebral Function Unit, Greater Manchester Neurosciences Centre, Manchester, United Kingdom
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - Jennifer Harris
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - David Mann
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Julie S Snowden
- School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom
| | - Patricio Chrem-Mendez
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Ismael L Calandri
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Alejandra A Amengual
- Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina
| | - Carole Miguet-Alfonsi
- Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France
| | - Eloi Magnin
- Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France
| | - Giuseppe Magnani
- Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy
| | - Roberto Santangelo
- Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy
| | | | - Florence Pasquier
- University of Lille Nord de France, INSERM U1171, DISTALZ, Lille, France
| | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Neuropsychiatric Clinic, Skåne University Hospital, Malmö, Sweden
| | - Julia Keith
- Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jordi A Matías-Guiu
- Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain
| | - María-Nieves Cabrera-Martin
- Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Claire Paquet
- Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France
- Department of Pathology, Lariboisière-Fernand-Widal Hospital, Paris, France
| | - Julien Dumurgier
- Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France
| | - Marc Teichmann
- Department of Neurology, National Reference Center for PPA and rare dementias, Pitié Salpêtriére Hospital, AP-HP, Paris, France
| | - Marie Sarazin
- Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France
- University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France
| | - Michel Bottlaender
- Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France
- University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France
| | - Bruno Dubois
- Center for Cognitive and Behavioral Diseases, Pitié Salpêtrière University Hospital, Paris, France
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rik Vandenberghe
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Elias Granadillo
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Edmond Teng
- Neurobehavior Service, Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Mario Mendez
- Neurobehavior Unit, West Los Angeles VA Medical Center, Los Angeles, CA
| | - Philipp T Meyer
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - Lars Frings
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Neurodegenerative Diseases, Madrid, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain
- Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | | | - Gaël Chételat
- INSERM UMR-S U1237, University of Caen Normandy, Caen, France
| | - Willemijn Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Banner Alzheimer's Institute, Phoenix, AZ
| | - Rémi W Bouchard
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
| | - Robert Jr Laforce
- Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada
- Clinique Interdisciplinaire de Mémoire de l'Enfant-Jésus, CHU de Québec, Université Laval, Québec, Canada
| | - Pieter Jelle Visser
- Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia. Eur J Nucl Med Mol Imaging 2018; 45:1509-1525. [PMID: 29736698 DOI: 10.1007/s00259-018-4035-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer's disease (AD; both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia. METHODS A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted on six different diagnostic scenarios using the Delphi method. RESULTS The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD; fair for discriminating FTLD from AD; poor for atypical AD; and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations. Panellists supported the use of FDG-PET for all PICOs-including those where study evidence was poor or lacking-based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed. CONCLUSION Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.
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Tau-PET imaging with [18F]AV-1451 in primary progressive apraxia of speech. Cortex 2018; 99:358-374. [PMID: 29353121 DOI: 10.1016/j.cortex.2017.12.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/24/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022]
Abstract
Apraxia of speech is a motor speech disorder characterized by combinations of slow speaking rate, abnormal prosody, distorted sound substitutions, and trial-and-error articulatory movements. Apraxia of speech is due to abnormal planning and/or programming of speech production. It is referred to as primary progressive apraxia of speech (PPAOS) when it is the only symptom of a neurodegenerative condition. Past reports suggest an association of PPAOS with primary 4-repeat (4R) tau (e.g., progressive supranuclear palsy, corticobasal degeneration), rather than amyloid, pathology. The goal of the current study was to investigate the distribution of tau tracer uptake using [18F]AV-1451 positron emission tomography (PET) imaging in patients with PPAOS. Fourteen PPAOS patients underwent [18F]AV-1451 PET (tau-PET) imaging, [C11] Pittsburgh Compound B (PiB) PET and structural MRI and were matched 3:1 by age and sex to 42 cognitively normal controls. Tau-PET uptake was assessed at the region-of-interest (ROI) level and at the voxel-level. The PPAOS group (n = 14) showed increased tau-PET uptake in the precentral gyrus, supplementary motor area and Broca's area compared to controls. To examine whether tau deposition in Broca's area was related to the presence of aphasia, we examined a subgroup of the PPAOS patients who had predominant apraxia of speech, with concomitant aphasia (PPAOSa; n = 7). The PPAOSa patients showed tau-PET uptake in the same regions as the whole group. However, the remaining seven patients who did not have aphasia showed uptake only in superior premotor and precentral cortices, with no uptake observed in Broca's area. This cross-sectional study demonstrates that elevated tau tracer uptake is observed using [18F]AV-1451 in PPAOS. Further, it appears that [18F]AV-1451 is sensitive to the regional distribution of tau deposition in different stages of PPAOS, given the relationship between tau signal in Broca's area and the presence of aphasia.
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Canu E, Agosta F, Mandic-Stojmenovic G, Stojković T, Stefanova E, Inuggi A, Imperiale F, Copetti M, Kostic VS, Filippi M. Multiparametric MRI to distinguish early onset Alzheimer's disease and behavioural variant of frontotemporal dementia. NEUROIMAGE-CLINICAL 2017; 15:428-438. [PMID: 28616383 PMCID: PMC5458769 DOI: 10.1016/j.nicl.2017.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 12/11/2022]
Abstract
This prospective study explored whether an approach combining structural [cortical thickness and white matter (WM) microstructure] and resting state functional MRI can aid differentiation between 62 early onset Alzheimer's disease (EOAD) and 27 behavioural variant of frontotemporal dementia (bvFTD) patients. Random forest and receiver operator characteristic curve analyses assessed the ability of MRI in classifying the two clinical syndromes. All patients showed a distributed pattern of brain alterations relative to controls. Compared to bvFTD, EOAD patients showed bilateral inferior parietal cortical thinning and decreased default mode network functional connectivity. Compared to EOAD, bvFTD patients showed bilateral orbitofrontal and temporal cortical thinning, and WM damage of the corpus callosum, bilateral uncinate fasciculus, and left superior longitudinal fasciculus. Random forest analysis revealed that left inferior parietal cortical thickness (accuracy 0.78, specificity 0.76, sensitivity 0.83) and WM integrity of the right uncinate fasciculus (accuracy 0.81, specificity 0.96, sensitivity 0.43) were the best predictors of clinical diagnosis. The combination of cortical thickness and DT MRI measures was able to distinguish patients with EOAD and bvFTD with accuracy 0.82, specificity 0.76, and sensitivity 0.96. The diagnostic ability of MRI models was confirmed in a subsample of patients with biomarker-based clinical diagnosis. Multiparametric MRI is useful to identify brain alterations which are specific to EOAD and bvFTD. A severe cortical involvement is suggestive of EOAD, while a prominent WM damage is indicative of bvFTD. Multimodal MRI distinguishes in vivo EOAD and bvFTD patients EOAD and bvFTD show a distributed pattern of structural brain alterations A severe cortical involvement is suggestive of EOAD relative to bvFTD A prominent WM damage is indicative of bvFTD relative to EOAD
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Key Words
- ACE-R, Addenbrooke's Cognitive Examination-revised
- Behavioural variant of frontotemporal dementia
- CC, corpus callosum
- CSF, cerebrospinal fluid
- Cortical thickness
- DMN, default mode network
- DT, diffusion tensor
- Diagnosis
- EOAD, early onset Alzheimer's disease
- Early onset Alzheimer's disease
- GM, grey matter
- IC, independent component
- ILF, inferior longitudinal fasciculus
- LOAD, late onset Alzheimer's disease
- MNI, Montreal Neurological Institute
- NVI, Normalized Variable Importance
- RS fMRI, resting state functional MRI
- RSN, resting state network
- Resting state functional MRI
- SLF, superior longitudinal fasciculus
- TFCE, threshold-free cluster enhancement
- WM, white matter
- White matter (WM) damage
- bvFTD, behavioural variant frontotemporal dementia
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Affiliation(s)
- Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Gorana Mandic-Stojmenovic
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Clinic of Neurology, Faculty of Medicine, University of Belgrade, Dr Subotića 6, PO Box 12, 11129 Belgrade 102, Serbia
| | - Tanja Stojković
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Dr Subotića 6, PO Box 12, 11129 Belgrade 102, Serbia
| | - Elka Stefanova
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Dr Subotića 6, PO Box 12, 11129 Belgrade 102, Serbia
| | - Alberto Inuggi
- Unit of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Via Morego, 30, 16163 Genoa, Italy
| | - Francesca Imperiale
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Massimiliano Copetti
- Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo, 71013 Foggia, Italy
| | - Vladimir S Kostic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Dr Subotića 6, PO Box 12, 11129 Belgrade 102, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
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10
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Flanagan EP, Duffy JR, Whitwell JL, Vemuri P, Dickson DW, Josephs KA. Mixed tau and TDP-43 pathology in a patient with unclassifiable primary progressive aphasia. Neurocase 2016; 22:55-9. [PMID: 25929342 PMCID: PMC4628904 DOI: 10.1080/13554794.2015.1041534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Classifying primary progressive aphasia (PPA) into variants that may predict the underlying pathology is important. However, some PPA patients cannot be classified. A 78-year-old woman had unclassifiable PPA characterized by anomia, dysarthria, and apraxia of speech without agrammatism. Magnetic resonance imaging revealed left mesial temporal atrophy and 18-flourodeoxy-glucose positron emission tomography showed left anterior temporal and posterior frontal (premotor) hypometabolism. Autopsy revealed a mixed tauopathy (argyrophilic grain disease) and transactive response-DNA-binding-protein-43 proteinopathy. Dual pathologies may explain the difficulty classifying some PPA patients and recognizing this will be important as new imaging techniques (particularly tau-positron emission tomography) are introduced and patients begin enrollment in clinical trials targeting the underlying proteinopathy.
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Affiliation(s)
- Eoin P Flanagan
- a Department of Neurology, Divisions of Behavioral Neurology , Mayo Clinic , Rochester , MN , USA
| | - Joseph R Duffy
- b Department of Neurology, Divisions of Speech Pathology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Dennis W Dickson
- d Department of Laboratory Medicine and Pathology , Mayo Clinic , Jacksonville , FL , USA
| | - Keith A Josephs
- a Department of Neurology, Divisions of Behavioral Neurology , Mayo Clinic , Rochester , MN , USA
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11
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Ossenkoppele R, Jansen WJ, Rabinovici GD, Knol DL, van der Flier WM, van Berckel BNM, Scheltens P, Visser PJ, Verfaillie SCJ, Zwan MD, Adriaanse SM, Lammertsma AA, Barkhof F, Jagust WJ, Miller BL, Rosen HJ, Landau SM, Villemagne VL, Rowe CC, Lee DY, Na DL, Seo SW, Sarazin M, Roe CM, Sabri O, Barthel H, Koglin N, Hodges J, Leyton CE, Vandenberghe R, van Laere K, Drzezga A, Forster S, Grimmer T, Sánchez-Juan P, Carril JM, Mok V, Camus V, Klunk WE, Cohen AD, Meyer PT, Hellwig S, Newberg A, Frederiksen KS, Fleisher AS, Mintun MA, Wolk DA, Nordberg A, Rinne JO, Chételat G, Lleo A, Blesa R, Fortea J, Madsen K, Rodrigue KM, Brooks DJ. Prevalence of amyloid PET positivity in dementia syndromes: a meta-analysis. JAMA 2015; 313:1939-49. [PMID: 25988463 PMCID: PMC4517678 DOI: 10.1001/jama.2015.4669] [Citation(s) in RCA: 430] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Amyloid-β positron emission tomography (PET) imaging allows in vivo detection of fibrillar plaques, a core neuropathological feature of Alzheimer disease (AD). Its diagnostic utility is still unclear because amyloid plaques also occur in patients with non-AD dementia. OBJECTIVE To use individual participant data meta-analysis to estimate the prevalence of amyloid positivity on PET in a wide variety of dementia syndromes. DATA SOURCES The MEDLINE and Web of Science databases were searched from January 2004 to April 2015 for amyloid PET studies. STUDY SELECTION Case reports and studies on neurological or psychiatric diseases other than dementia were excluded. Corresponding authors of eligible cohorts were invited to provide individual participant data. DATA EXTRACTION AND SYNTHESIS Data were provided for 1359 participants with clinically diagnosed AD and 538 participants with non-AD dementia. The reference groups were 1849 healthy control participants (based on amyloid PET) and an independent sample of 1369 AD participants (based on autopsy). MAIN OUTCOMES AND MEASURES Estimated prevalence of positive amyloid PET scans according to diagnosis, age, and apolipoprotein E (APOE) ε4 status, using the generalized estimating equations method. RESULTS The likelihood of amyloid positivity was associated with age and APOE ε4 status. In AD dementia, the prevalence of amyloid positivity decreased from age 50 to 90 years in APOE ε4 noncarriers (86% [95% CI, 73%-94%] at 50 years to 68% [95% CI, 57%-77%] at 90 years; n = 377) and to a lesser degree in APOE ε4 carriers (97% [95% CI, 92%-99%] at 50 years to 90% [95% CI, 83%-94%] at 90 years; n = 593; P < .01). Similar associations of age and APOE ε4 with amyloid positivity were observed in participants with AD dementia at autopsy. In most non-AD dementias, amyloid positivity increased with both age (from 60 to 80 years) and APOE ε4 carriership (dementia with Lewy bodies: carriers [n = 16], 63% [95% CI, 48%-80%] at 60 years to 83% [95% CI, 67%-92%] at 80 years; noncarriers [n = 18], 29% [95% CI, 15%-50%] at 60 years to 54% [95% CI, 30%-77%] at 80 years; frontotemporal dementia: carriers [n = 48], 19% [95% CI, 12%-28%] at 60 years to 43% [95% CI, 35%-50%] at 80 years; noncarriers [n = 160], 5% [95% CI, 3%-8%] at 60 years to 14% [95% CI, 11%-18%] at 80 years; vascular dementia: carriers [n = 30], 25% [95% CI, 9%-52%] at 60 years to 64% [95% CI, 49%-77%] at 80 years; noncarriers [n = 77], 7% [95% CI, 3%-18%] at 60 years to 29% [95% CI, 17%-43%] at 80 years. CONCLUSIONS AND RELEVANCE Among participants with dementia, the prevalence of amyloid positivity was associated with clinical diagnosis, age, and APOE genotype. These findings indicate the potential clinical utility of amyloid imaging for differential diagnosis in early-onset dementia and to support the clinical diagnosis of participants with AD dementia and noncarrier APOE ε4 status who are older than 70 years.
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Affiliation(s)
- Rik Ossenkoppele
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 2Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands 3Memory and Aging Center, University of Californ
| | - Willemijn J Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, the Netherlands
| | - Gil D Rabinovici
- Memory and Aging Center, University of California, San Francisco4Helen Wills Neuroscience Institute, University of California, Berkeley
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 6Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 5Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, the Netherlan
| | - Sander C J Verfaillie
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 2Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Marissa D Zwan
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 2Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Sofie M Adriaanse
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 2Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley7Lawrence Berkeley National Laboratory, University of California, Berkeley
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco
| | - Howard J Rosen
- Memory and Aging Center, University of California, San Francisco
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley7Lawrence Berkeley National Laboratory, University of California, Berkeley
| | - Victor L Villemagne
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Australia
| | - Christopher C Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Australia
| | - Dong Y Lee
- Department of Neuropsychiatry, College of Medicine, Seoul National University, South Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University, Seoul, South Korea
| | - Sang W Seo
- Department of Neurology, Sungkyunkwan University, Seoul, South Korea
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Université Paris Descartes, France
| | - Catherine M Roe
- Department of Neurology, Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Germany
| | | | - John Hodges
- Neuroscience Research Australia, Sydney, Australia
| | | | - Rik Vandenberghe
- Laboratory for Cognitive Neurology and Alzheimer Research Center, Katholieke Universiteit Leuven, Catholic University Leuven, Belgium
| | - Koen van Laere
- Laboratory for Cognitive Neurology and Alzheimer Research Center, Katholieke Universiteit Leuven, Catholic University Leuven, Belgium
| | | | - Stefan Forster
- Department of Nuclear Medicine, Technische Universitaet Muenchen, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technische Universitaet Muenchen, Munich, Germany
| | - Pascual Sánchez-Juan
- IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Marqués de Valdecilla University Hospital, Cantabria, Spain
| | - Jose M Carril
- Department of Nuclear Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Spain
| | - Vincent Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, China
| | - Vincent Camus
- INSERM U930 and Université François Rabelais de Tours, Centre Hospitalier Régional Universitaire Hôpitaux de Tours, France
| | - William E Klunk
- Alzheimer's Disease Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ann D Cohen
- Alzheimer's Disease Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philipp T Meyer
- Department of Nuclear Medicine, University Hospital Freiburg, Germany
| | - Sabine Hellwig
- Centre for Geriatrics and Gerontology, University Hospital Freiburg, Germany
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - Kristian S Frederiksen
- Danish Dementia Research Center, Department of Neurology, Righospitalet, University of Copenhagen, Denmark
| | | | - Mark A Mintun
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Agneta Nordberg
- Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Juha O Rinne
- Turku PET Centre and Division of Clinical Neuroscience, Turku University Hospital, University of Turku, Finland
| | - Gaël Chételat
- Institut National de la Santé et de la Recherche Medicale, Caen, France
| | - Alberto Lleo
- Department of Neurology, Universitat Autònoma de Barcelona, Spain
| | - Rafael Blesa
- Department of Neurology, Universitat Autònoma de Barcelona, Spain
| | - Juan Fortea
- Department of Neurology, Universitat Autònoma de Barcelona, Spain
| | - Karine Madsen
- Neurobiology Research Unit, Copenhagen University Hospital, Denmark, Germany
| | | | - David J Brooks
- University of Texas Southwestern Medical Center, Dallas39Division of Neuroscience and Medical Research Council Clinical Sciences Centre, Imperial College London, United Kingdom
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12
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Josephs KA, Duffy JR, Strand EA, Machulda MM, Senjem ML, Lowe VJ, Jack CR, Whitwell JL. APOE ε4 influences β-amyloid deposition in primary progressive aphasia and speech apraxia. Alzheimers Dement 2014; 10:630-6. [PMID: 24985533 DOI: 10.1016/j.jalz.2014.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Apolipoprotein E ε4 (APOE ε4) is a risk factor for β-amyloid deposition in Alzheimer's disease dementia. Its influence on β-amyloid deposition in speech and language disorders, including primary progressive aphasia (PPA), is unclear. METHODS One hundred thirty subjects with PPA or progressive speech apraxia underwent APOE genotyping and Pittsburgh compound B (PiB) PET scanning. The relationship between APOE ε4 and PiB status, as well as severity and regional distribution of PiB, was assessed. RESULTS Forty-five subjects had an APOE ε4 allele and 60 subjects were PiB-positive. The odds ratio for a subject with APOE ε4 being PiB-positive compared with a subject without APOE ε4 being PiB-positive was 10.2 (95% confidence interval, 4.4-25.5; P < .0001). The APOE ε4 allele did not influence regional PiB distribution or severity. CONCLUSION APOE ε4 increases the risk of β-amyloid deposition in PPA and progressive speech apraxia but does not influence regional β-amyloid distribution or severity.
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Affiliation(s)
- Keith A Josephs
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Joseph R Duffy
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Edythe A Strand
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Division of Neuropsychology, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Whitwell
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
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13
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Murray ME, Kouri N, Lin WL, Jack CR, Dickson DW, Vemuri P. Clinicopathologic assessment and imaging of tauopathies in neurodegenerative dementias. ALZHEIMERS RESEARCH & THERAPY 2014; 6:1. [PMID: 24382028 PMCID: PMC3978456 DOI: 10.1186/alzrt231] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microtubule-associated protein tau encoded by the MAPT gene binds to microtubules and is important for maintaining neuronal morphology and function. Alternative splicing of MAPT pre-mRNA generates six major tau isoforms in the adult central nervous system resulting in tau proteins with three or four microtubule-binding repeat domains. In a group of neurodegenerative disorders called tauopathies, tau becomes aberrantly hyperphosphorylated and dissociates from microtubules, resulting in a progressive accumulation of intracellular tau aggregates. The spectrum of sporadic frontotemporal lobar degeneration associated with tau pathology includes progressive supranuclear palsy, corticobasal degeneration, and Pick’s disease. Alzheimer’s disease is considered the most prevalent tauopathy. This review is divided into two broad sections. In the first section we discuss the molecular classification of sporadic tauopathies, with a focus on describing clinicopathologic relationships. In the second section we discuss the neuroimaging methodologies that are available for measuring tau pathology (directly using tau positron emission tomography ligands) and tau-mediated neuronal injury (magnetic resonance imaging and fluorodeoxyglucose positron emission tomography). Both sections have detailed descriptions of the following neurodegenerative dementias – Alzheimer’s disease, progressive supranuclear palsy, corticobasal degeneration and Pick’s disease.
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Affiliation(s)
- Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Wen-Lang Lin
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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Sánchez-Juan P, Ghosh PM, Hagen J, Gesierich B, Henry M, Grinberg LT, O'Neil JP, Janabi M, Huang EJ, Trojanowski JQ, Vinters HV, Gorno-Tempini M, Seeley WW, Boxer AL, Rosen HJ, Kramer JH, Miller BL, Jagust WJ, Rabinovici GD. Practical utility of amyloid and FDG-PET in an academic dementia center. Neurology 2013; 82:230-8. [PMID: 24353340 DOI: 10.1212/wnl.0000000000000032] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of amyloid imaging on clinical decision making. METHODS We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from Aβ to non-Aβ diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%). RESULTS Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-Aβ diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis. CONCLUSIONS PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
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Affiliation(s)
- Pascual Sánchez-Juan
- From the Memory and Aging Center and Department of Neurology (P.S.-J., P.M.G., J.H., B.G., M.H., L.T.G., M.G.-T., W.W.S., A.L.B., H.J.R., J.H.K., B.L.M.,W.J.J., G.D.R.) and Department of Pathology and Laboratory Medicine (E.J.H.), University of California, San Francisco; University Hospital "Marqués de Valdecilla," IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.S.-J.), Santander, Spain; Helen Wills Neuroscience Institute (P.M.G., W.J.J., G.D.R.), University of California, Berkeley; Lawrence Berkeley National Laboratory (P.M.G., J.P.O., M.J., W.J.J., G.D.R.), Berkeley, CA; Center for Neurodegenerative Research (J.Q.T.), University of Pennsylvania, Philadelphia; and Department of Pathology and Laboratory Medicine (H.V.V.), University of California, Los Angeles
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Degerman Gunnarsson M, Lindau M, Santillo AF, Wall A, Engler H, Lannfelt L, Basun H, Kilander L. Re-evaluation of clinical dementia diagnoses with pittsburgh compound B positron emission tomography. Dement Geriatr Cogn Dis Extra 2013; 3:472-81. [PMID: 24516415 PMCID: PMC3919484 DOI: 10.1159/000356273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objectives There is an overlap regarding Pittsburgh compound B (PIB) retention in patients clinically diagnosed as Alzheimer's disease (AD) and non-AD dementia. The aim of the present study was to investigate whether there are any differences between PIB-positive and PIB-negative patients in a mixed cohort of patients with neurodegenerative dementia of mild severity regarding neuropsychological test performance and regional cerebral glucose metabolism measured with [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET). Methods Eighteen patients clinically diagnosed as probable AD or frontotemporal dementia were examined with PIB PET, FDG PET and neuropsychological tests and followed for 5-9 years in a clinical setting. Results The PIB-positive patients (7 out of 18) had slower psychomotor speed and more impaired visual episodic memory than the PIB-negative patients; otherwise performance did not differ between the groups. The initial clinical diagnoses were changed in one third of the patients (6 out of 18) during follow-up. Conclusions The subtle differences in neuropsychological performance, the overlap of hypometabolic patterns and clinical features between AD and non-AD dementia highlight the need for amyloid biomarkers and a readiness to re-evaluate the initial diagnosis.
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Affiliation(s)
- M Degerman Gunnarsson
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
| | - M Lindau
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden ; Department of Psychology, Stockholm University, Stockholm, Stockholm, Sweden
| | - A F Santillo
- Geriatric Psychiatry, Department of Clinical Medicine, Lund University, Lund, Stockholm, Sweden
| | - A Wall
- Section of Nuclear Medicine and PET, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Stockholm, Sweden
| | - H Engler
- Faculty of Medicine and Faculty of Science, University of the Republic Uruguay, Montevideo, Uruguay
| | - L Lannfelt
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
| | - H Basun
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden ; BioArctic Neuroscience AB, Stockholm, Sweden
| | - L Kilander
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
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Abstract
Neurodegenerative disorders leading to dementia are common diseases that affect many older and some young adults. Neuroimaging methods are important tools for assessing and monitoring pathological brain changes associated with progressive neurodegenerative conditions. In this review, the authors describe key findings from neuroimaging studies (magnetic resonance imaging and radionucleotide imaging) in neurodegenerative disorders, including Alzheimer's disease (AD) and prodromal stages, familial and atypical AD syndromes, frontotemporal dementia, amyotrophic lateral sclerosis with and without dementia, Parkinson's disease with and without dementia, dementia with Lewy bodies, Huntington's disease, multiple sclerosis, HIV-associated neurocognitive disorder, and prion protein associated diseases (i.e., Creutzfeldt-Jakob disease). The authors focus on neuroimaging findings of in vivo pathology in these disorders, as well as the potential for neuroimaging to provide useful information for differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
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17
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Mathis CA, Mason NS, Lopresti BJ, Klunk WE. Development of positron emission tomography β-amyloid plaque imaging agents. Semin Nucl Med 2013; 42:423-32. [PMID: 23026364 DOI: 10.1053/j.semnuclmed.2012.07.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For 100 years, β-amyloid (Aβ) plaques and neurofibrillary tangles (NFTs) have been recognized as the neuropathological hallmarks of Alzheimer's disease (AD), and their presence or absence could only be assessed postmortem using stains and dyes that identified these microscopic structures. Approximately 10 years ago, the first successful Aβ plaque-specific positron emission tomography (PET) imaging study was conducted in a living human subject clinically diagnosed with probable AD using the (11)C-labeled radiopharmaceutical Pittsburgh Compound B (PiB). Laboratory studies and preclinical evaluations to design PiB began a decade earlier than the first human PiB PET study and involved chemical modifications of different well-known dyes that bound specifically to the extended β-pleated sheets that comprise the fibrils of amyloid proteins such as Aβ plaques, NFTs, α-synuclein deposits, and prions. These preclinical studies were conducted in our laboratories at the University of Pittsburgh, starting with Congo red derivatives, followed by Chrysamine G derivatives, followed by X-series compounds, and finally with neutral derivatives of thioflavin-T. The in vitro and in vivo evaluations of the different derivatives as candidate PET radioligands for imaging Aβ plaques and neurofibrillary tangles in human brain are described in this review, along with the specific evaluation criteria by which the candidate radioligands were judged. Out of these studies came PiB, a PET radioligand that binds selectively and with high affinity to only fibrillar forms of Aβ. PiB has been used in many different human research protocols throughout the world and has demonstrated the usefulness of assessing the Aβ plaque status of subjects many years before the clinical diagnosis of probable AD. Recently, longer-lived (18)F-radiolabeled Aβ-selective radiopharmaceuticals have been developed. It is likely that the full clinical impact of these imaging agents will be realized by identifying presymptomatic subjects who would benefit from early drug treatments with future disease-modifying AD therapeutics.
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Affiliation(s)
- Chester A Mathis
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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