Document Detail


Multimodal predictors for Alzheimer disease in nonfluent primary progressive aphasia.
MedLine Citation:
PMID:  20713948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD) are hypothesized to cause clinically distinct forms of primary progressive aphasia (PPA) that predominantly affect expressive speech. AD is thought to cause logopenic progressive aphasia (LPA), and FTLD may cause progressive nonfluent aphasia (PNFA). We sought to determine the value of clinical characterization, neuropsychological analysis, and MRI atrophy in predicting pathology of LPA and PNFA.
METHODS: Patients with LPA (n = 19) and patients with PNFA (n = 19) were evaluated with neuropsychological assessments, structural MRI, CSF analysis, and neuropathologic examination.
RESULTS: Twelve of 19 patients with LPA (63%) and 6 of 19 patients with PNFA (32%) had neuropathologic findings or CSF biomarkers consistent with AD. Neuropsychological testing showed that naming was more impaired in patients with AD, and letter-guided fluency was more affected in patients with a non-AD disorder. Voxel-based morphometry analysis revealed that in patients with AD, patients with LPA and PNFA had significant posterior-superior temporal atrophy; in patients with non-AD, patients with LPA had peri-Sylvian atrophy and patients with PNFA had dorsolateral prefrontal and insular atrophy. Receiver operator characteristic curve analysis showed that combining neuropsychological testing with MRI atrophy pattern had 90% specificity for pathology or CSF biomarkers consistent with AD, and combining clinical features with neuropsychological analysis had 100% sensitivity for pathology or CSF biomarkers consistent with AD.
CONCLUSIONS: Neither PPA phenotyping nor imaging alone is a reliable predictor of pathology. Multimodal predictors, such as combining neuropsychological testing with MRI analysis, can improve noninvasive prediction of underlying pathology in nonfluent forms of PPA.
Authors:
W T Hu; C McMillan; D Libon; S Leight; M Forman; V M-Y Lee; J Q Trojanowski; M Grossman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Neurology     Volume:  75     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-17     Completed Date:  2010-09-13     Revised Date:  2013-03-25    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  595-602     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19106, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Alzheimer Disease / cerebrospinal fluid,  complications*
Atrophy / pathology
Cerebral Cortex / pathology
Female
Frontotemporal Lobar Degeneration / cerebrospinal fluid,  complications
Humans
Image Processing, Computer-Assisted / methods
Magnetic Resonance Imaging / methods
Male
Middle Aged
Neuropsychological Tests
Predictive Value of Tests
Primary Progressive Nonfluent Aphasia / cerebrospinal fluid,  diagnosis*,  etiology*
ROC Curve
Grant Support
ID/Acronym/Agency:
AG15116/AG/NIA NIH HHS; AG17586/AG/NIA NIH HHS; NS44266/NS/NINDS NIH HHS; NS53488/NS/NINDS NIH HHS; P01 AG017586/AG/NIA NIH HHS; P50 NS053488/NS/NINDS NIH HHS; R01 AG015116/AG/NIA NIH HHS; R01 NS044266/NS/NINDS NIH HHS
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