Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia - PubMed (original) (raw)

Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia

William W Seeley et al. Arch Neurol. 2008 Feb.

Abstract

Background: Behavioral variant frontotemporal dementia (bvFTD) strikes hardest at the frontal lobes, but the sites of earliest injury remain unclear.

Objective: To determine atrophy patterns in distinct clinical stages of bvFTD, testing the hypothesis that the mildest stage is restricted to frontal paralimbic cortex.

Design: A bvFTD cohort study.

Setting: University hospital dementia clinic.

Participants: Patients with bvFTD with Clinical Dementia Rating (CDR) scale scores of 0.5 (n = 15), 1 (n = 15), or 2 to 3 (n = 15) age and sex matched to each other and to 45 healthy controls.

Main outcome measures: Magnetic resonance voxel-based morphometry estimated gray matter and white matter atrophy at each disease stage compared with controls.

Results: Patients with a CDR score of 0.5 had gray matter loss in frontal paralimbic cortices, but atrophy also involved a network of anterior cortical and subcortical regions. A CDR score of 1 showed more extensive frontal gray matter atrophy and white matter losses in corpus callosum and brainstem. A CDR score of 2 to 3 showed additional posterior insula, hippocampus, and parietal involvement, with white matter atrophy in presumed frontal projection fibers.

Conclusions: Very mild bvFTD targets a specific subset of frontal and insular regions. More advanced disease affects white matter and posterior gray matter structures densely interconnected with the sites of earliest injury.

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Figures

Figure 1

Figure 1

Stage-specific gray matter atrophy in behavioral variant frontotemporal dementia. Maps of significantly atrophied voxels (each group vs controls: P<.05, whole brain corrected) are overlaid on the study-specific brain template, using an inclusive gray matter mask for visualization purposes only. On the right, the same color scheme is overlaid on a single image to show overlap of stage-related atrophy patterns. The right side of the axial and coronal images corresponds to the right side of the brain. Numbers indicate the MNI (Montreal Neurological Institute) coordinate of the template brain magnetic resonance image shown. CDR indicates Clinical Dementia Rating; CDR 1-3, mild to severe; CDR 0.5, very mild; CDR 1, mild; and CDR 2+, moderate to severe.

Figure 2

Figure 2

Stage-specific white matter atrophy in behavioral variant frontotemporal dementia. Areas of white matter loss are overlaid on gray matter atrophy maps for each stage. Bottom right images show basal pontine white matter loss that involves the middle cerebellar peduncles at later stages. Images are otherwise displayed as in Figure 1. Numbers indicate the MNI (Montreal Neurological Institute) coordinate of the template brain magnetic resonance image shown. CDR indicates Clinical Dementia Rating, CDR 0.5, very mild; CDR 1, mild; and CDR 2+, moderate to severe.

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References

    1. Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51(6):1546–1554. - PubMed
    1. Rosen HJ, Gorno-Tempini ML, Goldman WP, et al. Patterns of brain atrophy in frontotemporal dementia and semantic dementia. Neurology. 2002;58(2):198–208. - PubMed
    1. Rascovsky K, Salmon DP, Lipton AM, et al. Rate of progression differs in frontotemporal dementia and Alzheimer disease. Neurology. 2005;65(3):397–403. - PubMed
    1. Roberson ED, Hesse JH, Rose KD, et al. Frontotemporal dementia progresses to death faster than Alzheimer disease. Neurology. 2005;65(5):719–725. - PubMed
    1. Hodges JR, Davies R, Xuereb J, Kril J, Halliday G. Survival in frontotemporal dementia. Neurology. 2003;61(3):349–354. - PubMed

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