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Item Clinical and neuropathological associations of plasma Aβ42/Aβ40, p‐tau217 and neurofilament light in sporadic frontotemporal dementia spectrum disorders(Wiley, 2025-01-29) Rajbanshi, Binita; Araujo, Igor Prufer Q. C.; VandeVrede, Lawren; Ljubenkov, Peter A.; Staffaroni, Adam M.; Heuer, Hilary W.; Lago, Argentina Lario; Ramos, Eliana Marisa; Petrucelli, Leonard; Gendron, Tania; Dage, Jeffrey L.; Seeley, William W.; Grinberg, Lea T.; Spina, Salvatore; Bateman, Randall J.; Rosen, Howard J.; Boeve, Bradley F.; Boxer, Adam L.; Rojas, Julio C.; ALLFTD Consortium; Neurology, School of MedicineIntroduction: Plasma amyloid beta42/amyloid beta40 (Aβ42/Aβ40) and phosphorylated tau217 (p-tau217) identify individuals with primary Alzheimer's disease (AD). They may detect AD co-pathology in the setting of other primary neurodegenerative diseases, but this has not been systematically studied. Methods: We compared the clinical, neuroimaging, and neuropathological associations of plasma Aβ42/Aβ40 (mass spectrometry), p-tau217 (electrochemiluminescence), and neurofilament light ([NfL], single molecule array [Simoa]), as markers of AD co-pathology, in a sporadic frontotemporal dementia (FTD) cohort (n = 620). Results: Aβ42/Aβ40 showed no clinicopathological associations. High p-tau217 was present in amnestic dementia (AmD) presumed to be due to FTD, logopenic primary progressive aphasia (lvPPA), and APOEε4 carriers, and correlated with worse baseline and longitudinal clinical scores, lower hippocampal volumes, and more severe AD co-pathology (Braak Stage). NfL was elevated in all FTD phenotypes, and correlated with clinical scores and frontotemporal brain volumes. Discussion: Plasma p-tau217 has clinical, neuroimaging, and neuropathological correlates in sporadic FTD and may identify FTD cases with AD co-pathology. Highlights: Alzheimer's disease (AD) features could be identified with plasma phosphorylated tau217 (p-tau217) in frontotemporal lobar degeneration (FTLD).Plasma p-tau217 is a better discriminator of AD co-pathology and AD-associated features in FTLD than plasma amyloid beta42/amyloid beta40 (Aβ42/Aβ40) and neurofilament light (NfL).In FTLD, plasma p-tau217, but not Aβ42/Aβ40 or neurofilament light, has phenotypical, neurocognitive, and neuroimaging correlates suggestive of AD co-pathology.Item Proposed research criteria for prodromal behavioural variant frontotemporal dementia(Oxford University Press, 2022) Barker, Megan S.; Gottesman, Reena T.; Manoochehri, Masood; Chapman, Silvia; Appleby, Brian S.; Brushaber, Danielle; Devick, Katrina L.; Dickerson, Bradford C.; Domoto-Reilly, Kimiko; Fields, Julie A.; Forsberg, Leah K.; Galasko, Douglas R.; Ghoshal, Nupur; Goldman, Jill; Graff-Radford, Neill R.; Grossman, Murray; Heuer, Hilary W.; Hsiung, Ging-Yuek; Knopman, David S.; Kornak, John; Litvan, Irene; Mackenzie, Ian R.; Masdeu, Joseph C.; Mendez, Mario F.; Pascual, Belen; Staffaroni, Adam M.; Tartaglia, Maria Carmela; Boeve, Bradley F.; Boxer, Adam L.; Rosen, Howard J.; Rankin, Katherine P.; Cosentino, Stephanie; Rascovsky, Katya; Huey, Edward D.; ALLFTD Consortium; Neurology, School of MedicineAt present, no research criteria exist for the diagnosis of prodromal behavioural variant frontotemporal dementia (bvFTD), though early detection is of high research importance. Thus, we sought to develop and validate a proposed set of research criteria for prodromal bvFTD, termed 'mild behavioural and/or cognitive impairment in bvFTD' (MBCI-FTD). Participants included 72 participants deemed to have prodromal bvFTD; this comprised 55 carriers of a pathogenic mutation known to cause frontotemporal lobar degeneration, and 17 individuals with autopsy-confirmed frontotemporal lobar degeneration. All had mild behavioural and/or cognitive changes, as judged by an evaluating clinician. Based on extensive clinical workup, the prodromal bvFTD group was divided into a Development Group (n = 22) and a Validation Group (n = 50). The Development Group was selected to be the subset of the prodromal bvFTD group for whom we had the strongest longitudinal evidence of conversion to bvFTD, and was used to develop the MBCI-FTD criteria. The Validation Group was the remainder of the prodromal bvFTD group and was used as a separate sample on which to validate the criteria. Familial non-carriers were included as healthy controls (n = 165). The frequencies of behavioural and neuropsychiatric features, neuropsychological deficits, and social cognitive dysfunction in the prodromal bvFTD Development Group and healthy controls were assessed. Based on sensitivity and specificity analyses, seven core features were identified: apathy without moderate-severe dysphoria, behavioural disinhibition, irritability/agitation, reduced empathy/sympathy, repetitive behaviours (simple and/or complex), joviality/gregariousness, and appetite changes/hyperorality. Supportive features include a neuropsychological profile of impaired executive function or naming with intact orientation and visuospatial skills, reduced insight for cognitive or behavioural changes, and poor social cognition. Three core features or two core features plus one supportive feature are required for the diagnosis of possible MBCI-FTD; probable MBCI-FTD requires imaging or biomarker evidence, or a pathogenic genetic mutation. The proposed MBCI-FTD criteria correctly classified 95% of the prodromal bvFTD Development Group, and 74% of the prodromal bvFTD Validation Group, with a false positive rate of <10% in healthy controls. Finally, the MBCI-FTD criteria were tested on a cohort of individuals with prodromal Alzheimer's disease, and the false positive rate of diagnosis was 11-16%. Future research will need to refine the sensitivity and specificity of these criteria, and incorporate emerging biomarker evidence.Item Sex differences in clinical phenotypes of behavioral variant frontotemporal dementia(Wiley, 2025) Liu, Xulin; de Boer, Sterre C. M.; Cortez, Kasey; Poos, Jackie M.; Illán-Gala, Ignacio; Heuer, Hilary; Forsberg, Leah K.; Casaletto, Kaitlin; Memel, Molly; Appleby, Brian S.; Barmada, Sami; Bozoki, Andrea; Clark, David; Cobigo, Yann; Darby, Ryan; Dickerson, Bradford C.; Domoto-Reilly, Kimiko; Galasko, Douglas R.; Geschwind, Daniel H.; Ghoshal, Nupur; Graff-Radford, Neill R.; Grant, Ian M.; Hsiung, Ging-Yuek Robin; Honig, Lawrence S.; Huey, Edward D.; Irwin, David; Kantarci, Kejal; Léger, Gabriel C.; Litvan, Irene; Mackenzie, Ian R.; Masdeu, Joseph C.; Mendez, Mario F.; Onyike, Chiadi U.; Pascual, Belen; Pressman, Peter; Bayram, Ece; Ramos, Eliana Marisa; Roberson, Erik D.; Rogalski, Emily; Bouzigues, Arabella; Russell, Lucy L.; Foster, Phoebe H.; Ferry-Bolder, Eve; Masellis, Mario; van Swieten, John; Jiskoot, Lize; Seelaar, Harro; Sanchez-Valle, Raquel; Laforce, Robert; Graff, Caroline; Galimberti, Daniela; Vandenberghe, Rik; de Mendonça, Alexandre; Tiraboschi, Pietro; Santana, Isabel; Gerhard, Alexander; Levin, Johannes; Sorbi, Sandro; Otto, Markus; Pasquier, Florence; Ducharme, Simon; Butler, Chris R.; Le Ber, Isabelle; Finger, Elizabeth; Rowe, James B.; Synofzik, Matthis; Moreno, Fermin; Borroni, Barbara; Boeve, Brad F.; Boxer, Adam L.; Rosen, Howie J.; Pijnenburg, Yolande A. L.; Rohrer, Jonathan D.; Tartaglia, Maria Carmela; ALLFTD Consortium; GENFI Consortium; Medicine, School of MedicineIntroduction: Higher male prevalence in sporadic behavioral variant frontotemporal dementia (bvFTD) has been reported. We hypothesized differences in phenotypes between genetic and sporadic bvFTD females resulting in underdiagnosis of sporadic bvFTD females. Methods: We included genetic and sporadic bvFTD patients from two multicenter cohorts. We compared behavioral and cognitive symptoms, and gray matter volumes, between genetic and sporadic cases in each sex. Results: Females with sporadic bvFTD showed worse compulsive behavior (p = 0.026) and language impairments (p = 0.024) compared to females with genetic bvFTD (n = 152). Genetic bvFTD females had smaller gray matter volumes than sporadic bvFTD females, particularly in the parietal lobe. Discussion: Females with sporadic bvFTD exhibit a distinct clinical phenotype compared to females with genetic bvFTD. This difference may explain the discrepancy in prevalence between genetic and sporadic cases, as some females without genetic mutations may be misdiagnosed due to atypical bvFTD symptom presentation. Highlights: Sex ratio is equal in genetic behavioral variant of frontotemporal dementia (bvFTD), whereas more males are present in sporadic bvFTD. Distinct neuropsychiatric phenotypes exist between sporadic and genetic bvFTD in females. Phenotype might explain the sex ratio difference between sporadic and genetic cases.Item Sex differences in the clinical manifestation of autosomal dominant frontotemporal dementia(Wiley, 2025) Memel, Molly; Staffaroni, Adam M.; Ilan-Gala, Ignacio; Garcia Castro, Jesús; Kornak, John; Tartaglia, Carmela M.; Saloner, Rowan; VandeBunte, Anna M.; Paolillo, Emily W.; Cadwallader, Claire J.; Chen, Coty; Gorno-Tempini, Maria Luisa; Mandelli, Malu; Apostolova, Liana; Graff-Radford, Neil; Litvan, Irene; Bayram, Ece; Pressman, Peter S.; Miyagawa, Toji; Mackenzie, Ian; Goldman, Jill; Darby, Richard R.; Appleby, Brian S.; Petrucelli, Len; Gendron, Tania; Heuer, Hilary W.; Forseberg, Leah K.; Rojas, Julio C.; Boeve, Brad F.; Brushaber, Nellie; Domoto-Reilly, Kimiko; Ghoshal, Nupur; Lapid, Maria; Pascual, Belen; Lee, Suzee; Ramos, Eliana Marisa; Ramanan, Vijay; Rademakers, Rosa; Rascovsky, Katya; Pantelyat, Alex; Masdeu, Joseph C.; Snyder, Allison; Boxer, Adam L.; Rosen, Howard J.; Casaletto, Kaitlin; ALLFTD Consortium; Neurology, School of MedicineIntroduction: Sex differences are apparent in neurodegenerative diseases but have not been comprehensively characterized in frontotemporal dementia (FTD). Methods: Participants included 337 adults with autosomal dominant FTD enrolled in the ALLFTD Consortium. Clinical assessments and plasma were collected annually for up to 6 years. Linear mixed-effects models investigated how sex and disease stage are associated with longitudinal trajectories of cognition, function, and neurofilament light chain (NfL). Results: While sex differences were not apparent at asymptomatic stages, females showed more rapid declines across all outcomes in symptomatic stages compared to males. In asymptomatic participants, the association between baseline NfL and clinical trajectories was weaker in females versus males, a difference that was not present in symptomatic participants. Discussion: In genetic FTD, females show cognitive resilience in early disease stages followed by steeper clinical declines later in the disease. Baseline NfL may be a less sensitive prognostic tool for clinical progression in females with FTD-causing mutations. Highlights: Females with genetic FTD exhibit overall steeper increases in plasma neurofilament light chain (NfL) than males. Females with genetic FTD outperform NfL levels in asymptomatic stages compared to males. Once symptomatic, females with genetic FTD decline more rapidly than males. Plasma NfL is a stronger prognostic marker in asymptomatic males than females.