Subcortical atrophy in frontotemporal dementia and Alzheimer's disease: Significance for differential diagnosis and correlation with clinical manifestations

Vieira, Renata Teles; Caixeta, Leonardo

doi:10.1590/S1980-57642009DN20400009

Abstract

Cerebral subcortical atrophy occurs in both Alzheimer's disease (AD) and frontotemporal dementia (FTD) but its significance for clinical manifestations and differential diagnosis between these common types of dementia has not been extensively investigated. Objectives: To compare the severity of cerebral subcortical atrophy in FTD and AD and to analyze the correlations between cerebral subcortical atrophy and demographics and clinical characteristics. Methods: Twenty three patients with FTD and 21 with AD formed the sample, which comprised 22 men and 22 women, aged 33 to 89, with mean age (±SD) of 68.52±12.08 years, with schooling ranging from 1 to 20 years, with a mean (±SD) of 7.35±5.54 years, and disease duration with a mean (±SD) of 3.66±3.44 years. The degree of cerebral subcortical atrophy was measured indirectly with a linear measurement of subcortical atrophy, the Bifrontal Index (BFI), using magnetic resonance imaging. We evaluated cognition, activities of daily living and dementia severity with the Mini-Mental State Examination, Functional Activities Questionnaire and the Clinical Dementia Rating, respectively. Results: There was no significant difference (p>0.05) in BFI between FTD and AD. The severity of cognitive deficits (for both FTD and AD groups) and level of daily living activities (only for AD group) were correlated with BFI. Conclusions: A linear measurement of cerebral subcortical atrophy did not differentiate AD from FTD in this sample. Cognitive function (in both FTD and AD groups) and capacity for independent living (only in AD group) were inversely correlated with cerebral subcortical atrophy.

Key words:
frontotemporal dementia; Alzheimer's disease; structural neuroimaging; subcortical atrophy.

Resumo

Atrofia subcortical cerebral ocorre na doença de Alzheimer e na demência frontotemporal (DFT) mas sua importância para as manifestações clínicas e para o diagnóstico diferencial não foram amplamente investigadas. Objetivos: Comparar a gravidade da atrofia subcortical cerebral na DA e na DFT e analisar as correlações entre atrofia subcortical cerebral e características demográficas e clínicas. Métodos: Vinte e três pacientes com diagnóstico de DFT e 21 com DA formaram a amostra que foi constituída por 22 homens e 22 mulheres, com idades entre 33 e 89 anos, idade média (±DP) de 68,52 (±12,08) anos, escolaridade variando de 1 a 20 anos, média de 7,35 (±5,54) e duração da doença com média de 3,66 (±3,44). O grau de atrofia subcortical foi avaliado indiretamente com uma medida linear de atrofia subcortical, o índice bifrontal (IBF) com o emprego de imagem por ressonância magnetica. A cognição, atividades de vida diária e gravidade da demência foram avaliadas com o Mini-Exame do Estado Mental, Questionário de Atividades Funcionais e Escore Clínico de Demência, respectivamente. Resultados: O IBF não foi diferente entre os grupos com AD e DFT (p>0.05). A gravidade do transtorno cognitivo (tanto para DA como DFT) e as atividades de vida diária (apenas para DA) correlacionaram-se com o IBF. Conclusões: Uma medida linear de atrofia subcortical não foi diferente entre pacientes com DA e DFT nesta amostra. A cognição (na DA e na DFT) e a capacidade de vida independente (apenas na DA) correlacionaram-se inversamente com a atrofia subcortical cerebral.

Palavras-chave:
demência frontotemporal; doença de Alzheimer; neuroimagem estrutural; atrofia subcortical.

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References

¹
Rascovsky K, Hodges JR, Kipps CM, et al. Diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD): current limitations and future directions. Alzheimer Dis Assoc Disord 2007;21:S14-S18.
²
Kazee AM, Eskin TA, Lapham LW, Gabriel KR, McDaniel KD, Hamill RW. Clinicopathologic correlates in Alzheimer disease: assessment of clinical and pathologic diagnostic criteria. Alz Dis Assoc Disord 1993;3:152-164.
³
Tierney MC, Fisher RH, Lewis AJ, et al. The NINCDS-ADRD-A work group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology 1988;38:359-364.
⁴
Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. CMAJ 2008;179:787-793.
⁵
Bocti C, Rockel C, Roy P, Gao F, Black SE. Topographical patterns of lobar atrophy in frontotemporal dementia and Alzheimer's disease. Dement Geriatr Cogn Disord 2006;21:364-372.
⁶
Perry RJ; Hodges JR. Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer's disease. Neurology 2000;54:2277-2284.
⁷
Lindau M, Almkvist O, Johansson SE, Wahlund LO. Cognitive and behavioral differentiation of frontal lobe degeneration of the non-Alzheimer type and Alzheimers disease. Dement Geriatr Cogn Disord 1998;9:205-213.
⁸
Lipton AM, Benavides R, Hynan LS, et al. Lateralization on neuroimaging does not differentiate frontotemporal lobar degeneration from Alzheimer's Disease. Dement Geriatr Cogn Disord 2004;17:324-327.
⁹
Du AT, Schuff N, Kramer JH, et al. Different regional patterns of cortical thinning in Alzheimer's disease and frontotemporal dementia. Brain 2007;130:1159-1166.
¹⁰
Varma AR, Adams W, Lloyd JJ, et al. Diagnostic patterns of regional atrophy on MRI and regional cerebral blood flow change on SPECT in young onset patients with Alzheimer's disease, frontotemporal dementia and vascular dementia. Acta Neurol Scand 2002;105:261-269.
¹¹
Julin P, Wahlund LO, Basun H, Persson A, Måre K, Rudberg U. Clinical diagnosis of frontal lobe dementia and Alzheimer's disease: relation to cerebral perfusion, brain atrophy and electroencephalography. Dementia 1995;6:142-147.
¹²
Akyama H, Meyer JS, Mortel KF, Terayama Y, Thornby JI, Konno S. Normal human aging: factors contributing to cerebral atrophy. J Neurol Sci 1997;152:39-49.
¹³
Synek V, Reuben JR .The ventricle-brain ratio using planimetric measurement of EMI scans. Br J Radiology 1976;49:233-237.
¹⁴
Heinz ER, Ward A, Drayer BP, Dubois PJ. Distinction between obstructive and atrophic dilatation of ventricles in children. J Comput Assist Tomogr 1980;4:320-325.
¹⁵
Aylward EH, Scwartz J, Machlin S, Pearlson G. Bicaudate Ratio as a Measure of Caudate Volume on MR Images. Am J Neuroradiol 1991;12:1217-1222.
¹⁶
Frisoni GB, Beltramello A, Weiss C, Geroldi C, Bianchetti A, Trabucci M. Linear Measures of Atrophy in Mild Alzheimer Disease. Am J Neuroradiol 1996;17:913-923.
¹⁷
Fox NC, Schott JM. Imaging cerebral atrophy: normal ageing to Alzheimer's Disease. Lancet 2004;363:362-394.
¹⁸
Chaves MLF, Maia ALG, Lehmen R, Oliveira LM. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Braz J Med Biol Res 1999; 32:1133-1143.
¹⁹
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
²⁰
American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th ed. Washington DC: American Psychiatric Association; 1994.
²¹
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.
²²
McKhann G; Drachman D; Folstein M; Katzman R; Price D; Stadlan EM. Clinical Diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34: 939-944.
²³
Baar AN, Heinze WJ, Dobben GD, Valvassori GE, Sugar O. Bicaudate index computerized tomography of Huntington disease and cerebral atrophy. Neurology 1978;28:1196-1200.
²⁴
Hahn FJY, Rim K. Frontal Ventricular Dimensions on Normal Computed Tomography. AJR Am J Roentgenol 1976;126: 593-596.
²⁵
Zhang Y, Wahlund, LH. Lean Frontal Horns Ratio- A New Linear Measurement to predict early cerebral atrophy on CT. Neurobiol Aging 2004;25:371-372.
²⁶
Folstein MF, Folstein SE, Mchugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for clinician. J Psychiatr Research 1975;12:189-198.
²⁷
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.
²⁸
Bigler ED, Hubler DW, Cullum CM, Turkheimer E. Intellectual and Memory in Dementia. Computed Axial Topography Volume Correlations. J Nerv Ment Dis 1985;173:347-354.
²⁹
Woods BT, Douglass A, Gescuk B. Is the VBR still a useful measure of changes in the cerebral ventricles? Psychiatry Research: Neuroimaging 1991;40:1-10.
³⁰
Brinkman SD, Sarwar M, Levin HS, Morris HH. Quantitative indexes of computed tomography in dementia and normal aging. Radiology 1981;138:89-92.
³¹
Doraiswamy PM, Patterson L, Na C, et al. Bicaudate index on magnetic resonance imaging: effects of normal aging. J Geriatr Psychiatry Neurol 1994;7:13-17.
³²
Söderlund H, Nillsson L-G, Berger K, et al. Cerebral changes on MRI and cognitive functions: The CASCADE study. Neurobiol Aging 2006;27:16-23.
³³
Laakson MP, Soininem H, Partamnem K, et al. Volumes of hippocampus, amygadala and frontal lobes in the MRI-bases diagnosis of early Alzheimer's disease: Correlation with memory functions. J Neural Transm 1995;9:73-86.
³⁴
Laakson MP, Soininem H, Partamnem K, et al. MRI of the Hippocampus in Alzheimer's disease: sensitivity, specificity, and analysis of the incorrectly classified subjects. Neurobiol Aging 1998;19:23-31.
³⁵
Broderick JP, Gaskill M, Dhawan A, Khoury JC. Temporal changes in brain volume and cognition in a randomized treatment trial of vascular dementia. J Neuroimaging 2001;11:6-12.
³⁶
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.
³⁷
Laakson MP, Soininem H, Partamnem K, et al. MRI of the Hippocampus in Alzheimer's disease: Sensitivity, Specificity, and Analysis of the Incorrectly Classified Subjects. Neurobiol Aging 1998; 19:23-31.
³⁸
Broderick JP, Gaskill M, Dhawan A, Khoury JC. Temporal changes in brain volume and cognition in a randomized treatment trial of vascular dementia. J Neuroimaging 2001;11:6-12.
³⁹
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
06 Oct 2008
Accepted
13 Nov 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Rascovsky K, Hodges JR, Kipps CM, et al. Diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD): current limitations and future directions. Alzheimer Dis Assoc Disord 2007;21:S14-S18.

[2] ²
Kazee AM, Eskin TA, Lapham LW, Gabriel KR, McDaniel KD, Hamill RW. Clinicopathologic correlates in Alzheimer disease: assessment of clinical and pathologic diagnostic criteria. Alz Dis Assoc Disord 1993;3:152-164.

[3] ³
Tierney MC, Fisher RH, Lewis AJ, et al. The NINCDS-ADRD-A work group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases. Neurology 1988;38:359-364.

[4] ⁴
Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. CMAJ 2008;179:787-793.

[5] ⁵
Bocti C, Rockel C, Roy P, Gao F, Black SE. Topographical patterns of lobar atrophy in frontotemporal dementia and Alzheimer's disease. Dement Geriatr Cogn Disord 2006;21:364-372.

[6] ⁶
Perry RJ; Hodges JR. Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer's disease. Neurology 2000;54:2277-2284.

[7] ⁷
Lindau M, Almkvist O, Johansson SE, Wahlund LO. Cognitive and behavioral differentiation of frontal lobe degeneration of the non-Alzheimer type and Alzheimers disease. Dement Geriatr Cogn Disord 1998;9:205-213.

[8] ⁸
Lipton AM, Benavides R, Hynan LS, et al. Lateralization on neuroimaging does not differentiate frontotemporal lobar degeneration from Alzheimer's Disease. Dement Geriatr Cogn Disord 2004;17:324-327.

[9] ⁹
Du AT, Schuff N, Kramer JH, et al. Different regional patterns of cortical thinning in Alzheimer's disease and frontotemporal dementia. Brain 2007;130:1159-1166.

[10] ¹⁰
Varma AR, Adams W, Lloyd JJ, et al. Diagnostic patterns of regional atrophy on MRI and regional cerebral blood flow change on SPECT in young onset patients with Alzheimer's disease, frontotemporal dementia and vascular dementia. Acta Neurol Scand 2002;105:261-269.

[11] ¹¹
Julin P, Wahlund LO, Basun H, Persson A, Måre K, Rudberg U. Clinical diagnosis of frontal lobe dementia and Alzheimer's disease: relation to cerebral perfusion, brain atrophy and electroencephalography. Dementia 1995;6:142-147.

[12] ¹²
Akyama H, Meyer JS, Mortel KF, Terayama Y, Thornby JI, Konno S. Normal human aging: factors contributing to cerebral atrophy. J Neurol Sci 1997;152:39-49.

[13] ¹³
Synek V, Reuben JR .The ventricle-brain ratio using planimetric measurement of EMI scans. Br J Radiology 1976;49:233-237.

[14] ¹⁴
Heinz ER, Ward A, Drayer BP, Dubois PJ. Distinction between obstructive and atrophic dilatation of ventricles in children. J Comput Assist Tomogr 1980;4:320-325.

[15] ¹⁵
Aylward EH, Scwartz J, Machlin S, Pearlson G. Bicaudate Ratio as a Measure of Caudate Volume on MR Images. Am J Neuroradiol 1991;12:1217-1222.

[16] ¹⁶
Frisoni GB, Beltramello A, Weiss C, Geroldi C, Bianchetti A, Trabucci M. Linear Measures of Atrophy in Mild Alzheimer Disease. Am J Neuroradiol 1996;17:913-923.

[17] ¹⁷
Fox NC, Schott JM. Imaging cerebral atrophy: normal ageing to Alzheimer's Disease. Lancet 2004;363:362-394.

[18] ¹⁸
Chaves MLF, Maia ALG, Lehmen R, Oliveira LM. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Braz J Med Biol Res 1999; 32:1133-1143.

[19] ¹⁹
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[20] ²⁰
American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th ed. Washington DC: American Psychiatric Association; 1994.

[21] ²¹
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.

[22] ²²
McKhann G; Drachman D; Folstein M; Katzman R; Price D; Stadlan EM. Clinical Diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34: 939-944.

[23] ²³
Baar AN, Heinze WJ, Dobben GD, Valvassori GE, Sugar O. Bicaudate index computerized tomography of Huntington disease and cerebral atrophy. Neurology 1978;28:1196-1200.

[24] ²⁴
Hahn FJY, Rim K. Frontal Ventricular Dimensions on Normal Computed Tomography. AJR Am J Roentgenol 1976;126: 593-596.

[25] ²⁵
Zhang Y, Wahlund, LH. Lean Frontal Horns Ratio- A New Linear Measurement to predict early cerebral atrophy on CT. Neurobiol Aging 2004;25:371-372.

[26] ²⁶
Folstein MF, Folstein SE, Mchugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for clinician. J Psychiatr Research 1975;12:189-198.

[27] ²⁷
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.

[28] ²⁸
Bigler ED, Hubler DW, Cullum CM, Turkheimer E. Intellectual and Memory in Dementia. Computed Axial Topography Volume Correlations. J Nerv Ment Dis 1985;173:347-354.

[29] ²⁹
Woods BT, Douglass A, Gescuk B. Is the VBR still a useful measure of changes in the cerebral ventricles? Psychiatry Research: Neuroimaging 1991;40:1-10.

[30] ³⁰
Brinkman SD, Sarwar M, Levin HS, Morris HH. Quantitative indexes of computed tomography in dementia and normal aging. Radiology 1981;138:89-92.

[31] ³¹
Doraiswamy PM, Patterson L, Na C, et al. Bicaudate index on magnetic resonance imaging: effects of normal aging. J Geriatr Psychiatry Neurol 1994;7:13-17.

[32] ³²
Söderlund H, Nillsson L-G, Berger K, et al. Cerebral changes on MRI and cognitive functions: The CASCADE study. Neurobiol Aging 2006;27:16-23.

[33] ³³
Laakson MP, Soininem H, Partamnem K, et al. Volumes of hippocampus, amygadala and frontal lobes in the MRI-bases diagnosis of early Alzheimer's disease: Correlation with memory functions. J Neural Transm 1995;9:73-86.

[34] ³⁴
Laakson MP, Soininem H, Partamnem K, et al. MRI of the Hippocampus in Alzheimer's disease: sensitivity, specificity, and analysis of the incorrectly classified subjects. Neurobiol Aging 1998;19:23-31.

[35] ³⁵
Broderick JP, Gaskill M, Dhawan A, Khoury JC. Temporal changes in brain volume and cognition in a randomized treatment trial of vascular dementia. J Neuroimaging 2001;11:6-12.

[36] ³⁶
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.

[37] ³⁷
Laakson MP, Soininem H, Partamnem K, et al. MRI of the Hippocampus in Alzheimer's disease: Sensitivity, Specificity, and Analysis of the Incorrectly Classified Subjects. Neurobiol Aging 1998; 19:23-31.

[38] ³⁸
Broderick JP, Gaskill M, Dhawan A, Khoury JC. Temporal changes in brain volume and cognition in a randomized treatment trial of vascular dementia. J Neuroimaging 2001;11:6-12.

[39] ³⁹
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.

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