TY - JOUR
T1 - Role of brain infarcts in behavioral variant frontotemporal dementia. Clinicopathological characterization in the National Alzheimer's Coordinating Center database.
AU - Torralva, Teresa
AU - Sposato, Luciano A.
AU - Riccio, Patricia M.
AU - Gleichgerrcht, Ezequiel
AU - Roca, María
AU - Toledo, Jon B.
AU - Trojanowski, John Q.
AU - Kukull, Walter A.
AU - Manes, Facundo
AU - Hachinski, Vladimir
N1 - Funding Information:
Dr. Trojanowski may accrue revenue in the future on patents submitted by the University of Pennsylvania wherein he is co-inventor and he received revenue from the sale of Avid to Eli Lily as co-inventor on imaging related patents submitted by the University of Pennsylvania. He receives research support from the NIH, GSK, Janssen, and several nonprofits. Walter A. Kukull is funded primarily by an NIH grant U01AG016976 (NACC). The remaining authors disclose no conflicts.
Funding Information:
The NACC database is supported by UO1 AG016976 and the Penn ADCC by AG10124 . John Q. Trojanowski is the William Maul Measey-Truman G. Schnabel, Jr., Professor of Geriatric Medicine and Gerontology. The authors appreciate the ongoing support of Creighton Phelps, PhD, and Marcelle Morrison-Bogorad, PhD, from the NIA in developing the uniform data set and the cooperation of all NIA-supported ADC directors and their staff in its implementation. Thanks to all the clinical, neuropathology, and data management core and leaders and their associates for their input and responses to many surveys and questionnaires. The NACC database is funded by NIA / NIH grant U01 AG016976 . NACC data are contributed by the NIA funded ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI David Teplow, PhD), P50 AG005131 (PI Douglas Galasko, MD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P50 AG005136 (PI Thomas Montine, MD, PhD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), and P50 AG005681 (PI John Morris, MD). Teresa Torralva contributed to the study concept and design, analysis and interpretation, drafting of the manuscript. Luciano A. Sposato contributed to the study concept and design, acquisition of data, analysis and interpretation, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision. Patricia Riccio contributed to the acquisition of data, critical revision of the manuscript for important intellectual content. Ezequiel Gleichgerrcht contributed to the study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content. María Roca contributed to the study concept and design, critical revision of the manuscript for important intellectual content. Jon B. Toledo contributed to the study concept and design, critical revision of the manuscript for important intellectual content, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. John Q. Trojanowski contributed to the study concept and design, critical revision of the manuscript for important intellectual content. Walter A. Kukull contributed to the study concept and design, critical revision of the manuscript for important intellectual content. Facundo Manes contributed to the critical revision of the manuscript for important intellectual content. Vladimir Hachinski contributed to the study concept and design, critical revision of the manuscript for important intellectual content.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Diagnosing behavioral variant frontotemporal dementia (bvFTD) in patients with prior history of stroke or with silent brain infarcts on neuroimaging studies can be challenging. Vascular changes in patients with bvFTD are not unusual, but bvFTD tends to be ruled out in the presence of cerebrovascular disease. We aimed to identify the clinical, cognitive, and risk factor profile of bvFTD with coexistent cerebrovascular disease (V-bvFTD). We compared demographic data, clinical diagnoses, vascular risk factors, functional status, and normalized neuropsychological z-scores between patients with V-bvFTD versus bvFTD without concomitant cerebrovascular disease (NV-bvFTD) from the National Alzheimer's Coordinating Centre database. We included 391 neuropathologically-diagnosed cases of frontotemporal lobe degeneration. We excluded patients that were diagnosed with aphasic variants of frontotemporal dementia before death. Patients with V-bvFTD (n = 62) were older at the time of onset of cognitive decline (71.6 vs. 62.5 years, p < 0.001) and death (78.7 vs. 69.6, p < 0.001), more likely to be hypertensive (75.8% vs. 45.7%, p = 0.002) and to have a history of stroke (21.2% vs. 6.1%, p = 0.007) than those with NV-bvFTD (n = 329). V-bvFTD was often underdiagnosed, affected elderly patients, and had a similar cognitive profile as NV-bvFTD despite the presence of brain infarcts. In the whole cohort, we observed enhanced cognitive performance with increasing age quintiles despite larger proportions of cerebrovascular disease pathology, likely meaning that frontotemporal lobe degeneration-related primary neurodegeneration exerts a stronger impact on cognition than cerebrovascular disease. Coexisting cerebrovascular disease should not preclude the diagnosis of bvFTD.
AB - Diagnosing behavioral variant frontotemporal dementia (bvFTD) in patients with prior history of stroke or with silent brain infarcts on neuroimaging studies can be challenging. Vascular changes in patients with bvFTD are not unusual, but bvFTD tends to be ruled out in the presence of cerebrovascular disease. We aimed to identify the clinical, cognitive, and risk factor profile of bvFTD with coexistent cerebrovascular disease (V-bvFTD). We compared demographic data, clinical diagnoses, vascular risk factors, functional status, and normalized neuropsychological z-scores between patients with V-bvFTD versus bvFTD without concomitant cerebrovascular disease (NV-bvFTD) from the National Alzheimer's Coordinating Centre database. We included 391 neuropathologically-diagnosed cases of frontotemporal lobe degeneration. We excluded patients that were diagnosed with aphasic variants of frontotemporal dementia before death. Patients with V-bvFTD (n = 62) were older at the time of onset of cognitive decline (71.6 vs. 62.5 years, p < 0.001) and death (78.7 vs. 69.6, p < 0.001), more likely to be hypertensive (75.8% vs. 45.7%, p = 0.002) and to have a history of stroke (21.2% vs. 6.1%, p = 0.007) than those with NV-bvFTD (n = 329). V-bvFTD was often underdiagnosed, affected elderly patients, and had a similar cognitive profile as NV-bvFTD despite the presence of brain infarcts. In the whole cohort, we observed enhanced cognitive performance with increasing age quintiles despite larger proportions of cerebrovascular disease pathology, likely meaning that frontotemporal lobe degeneration-related primary neurodegeneration exerts a stronger impact on cognition than cerebrovascular disease. Coexisting cerebrovascular disease should not preclude the diagnosis of bvFTD.
KW - Dementia
KW - Frontotemporal
KW - Infarct
KW - Risk
KW - Stroke
KW - Vascular
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U2 - 10.1016/j.neurobiolaging.2015.06.026
DO - 10.1016/j.neurobiolaging.2015.06.026
M3 - Article
C2 - 26220367
AN - SCOPUS:84940962177
SN - 0197-4580
VL - 36
SP - 2861
EP - 2868
JO - Neurobiology of Aging
JF - Neurobiology of Aging
IS - 10
ER -