Convergence of Connected Language and SPECT in Variants of Frontotemporal Lobar Degeneration

The characterization of frontotemporal lobar degeneration (FTLD) is complicated and not widely recognized. Connected language measures (ie, discourse) and functional neuroimaging may advance knowledge specifying early distinctions among frontal dementias. The present study examined the correspondence of discourse measures with (1) clinical diagnosis and (2) single photon emission computed tomography (SPECT) imaging. Nineteen subjects were selected from Alzheimer's Disease Center (ADC) participants if they were diagnosed with early-stage frontotemporal lobar degeneration and also underwent single photon emission computed tomography and discourse evaluation. First, clinical diagnoses given by specialists at an Alzheimer's Disease Center were compared with the discourse-based diagnostic profiles. Secondly, compromised brain regions that were predicted from discourse profiles were compared with SPECT findings. Results revealed a significant correspondence between the ADC diagnosis and the discourse-based diagnoses. Also, the discourse profiles across frontotemporal lobar degeneration subtypes were consistently associated with distinctive patterns of SPECT hypometabolism in the right frontal, left frontal, or left temporal lobes. These findings suggest that discourse methods may be systematized to provide an efficient adjunct measure beyond the traditional word and sentential level measures. Objectifying complex language performance may contribute to early detection and differentiation among frontotemporal lobar degeneration variants because consensus in the literature states that language is a core disturbance of frontotemporal lobar degeneration.

[1]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[2]  Julie S. Snowden,et al.  The contribution of single photon emission tomography to the clinical differentiation of degenerative cortical brain disorders , 1995, Journal of Neurology.

[3]  M. Roth,et al.  The Association Between Quantitative Measures of Dementia and of Senile Change in the Cerebral Grey Matter of Elderly Subjects , 1968, British Journal of Psychiatry.

[4]  C. P. Hughes,et al.  A New Clinical Scale for the Staging of Dementia , 1982, British Journal of Psychiatry.

[5]  Norbert Schuff,et al.  Patterns of cerebral atrophy in primary progressive aphasia. , 2002, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[6]  A. Kertesz,et al.  Clinical and Pathological Overlap between Frontotemporal Dementia, Primary Progressive Aphasia and Corticobasal Degeneration: The Pick Complex , 1999, Dementia and Geriatric Cognitive Disorders.

[7]  A. J. North,et al.  Production of narrative and procedural discourse in aphasia , 1981, Brain and Language.

[8]  Andrew Kertesz,et al.  Primary progressive aphasia and Pick complex , 2003, Journal of the Neurological Sciences.

[9]  J. Hodges,et al.  Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy. , 1992, Brain : a journal of neurology.

[10]  P. Pietrini,et al.  Where the brain appreciates the moral of a story. , 1995, Neuroreport.

[11]  S. Chapman,et al.  Discourse in fluent aphasia and Alzheimer's disease: Linguistic and pragmatic considerations , 1998, Journal of Neurolinguistics.

[12]  R. Petersen,et al.  Primary progressive aphasia , 1992 .

[13]  T. Thomsen,et al.  Galanthamine Hydrobromide in a Long-Term Treatment of Alzheimer's Disease , 1990 .

[14]  A. Kertesz,et al.  Discourse Analyses and Dementia , 2000, Brain and Language.

[15]  E. Bigio,et al.  Brain blood flow in the dementias: SPECT with histopathologic correlation. , 1993, Radiology.

[16]  Richard S. J. Frackowiak,et al.  Functional anatomy of a common semantic system for words and pictures , 1996, Nature.

[17]  M. Mesulam,et al.  Primary progressive aphasia. Longitudinal course, neuropsychological profile, and language features. , 1990, Archives of neurology.

[18]  M. Mendez,et al.  Pick's disease versus Alzheimer's disease , 1993, Neurology.

[19]  M. Torrens.  Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268 , 1990 .

[20]  J R Hodges,et al.  Early diagnosis of the frontal variant of frontotemporal dementia: how sensitive are standard neuroimaging and neuropsychologic tests? , 1999, Neuropsychiatry, neuropsychology, and behavioral neurology.

[21]  B Miller,et al.  Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. , 2001, Archives of neurology.

[22]  Linda S Hynan,et al.  Differential diagnosis between Alzheimer's and frontotemporal disease by the posterior cingulate sign. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[23]  Wallace L. Chafe,et al.  Some things that narratives tell us about the mind. , 1990 .

[24]  Murray Grossman,et al.  Frontotemporal dementia: A review , 2002, Journal of the International Neuropsychological Society.

[25]  J. Gee,et al.  Neural basis for sentence comprehension deficits in frontotemporal dementia , 2003, Brain and Language.

[26]  Myron Weiner,et al.  Discourse Changes in Early Alzheimer Disease, Mild Cognitive Impairment, and Normal Aging , 2002, Alzheimer disease and associated disorders.

[27]  D. A. Robertson,et al.  Functional Neuroanatomy of the Cognitive Process of Mapping During Discourse Comprehension , 2000, Psychological science.

[28]  M. Weiner,et al.  Cognition and anatomy in three variants of primary progressive aphasia , 2004, Annals of neurology.

[29]  C. Elfgren,et al.  Performance on Neuropsychological Tests Related to Single Photon Emission Computerised Tomography Findings in Frontotemporal Dementia , 1996, British Journal of Psychiatry.

[30]  K. Boone,et al.  Neuropsychological performance of right- and left-frontotemporal dementia compared to Alzheimer's disease , 2001, Journal of the International Neuropsychological Society.

[31]  J. Hodges,et al.  Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer’s disease , 2000, Neurology.

[32]  S. Chapman,et al.  Autosomal dominant progressive syndrome of motor-speech loss without dementia , 1997, Neurology.

[33]  P Garrard,et al.  The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. , 1999, Neuropsychology.

[34]  D R Wekstein,et al.  Linguistic ability in early life and cognitive function and Alzheimer's disease in late life. Findings from the Nun Study. , 1996, JAMA.

[35]  E. Wolters,et al.  [Slowly progressive aphasia without dementia]. , 1991, Nederlands tijdschrift voor geneeskunde.

[36]  D. Maraganore,et al.  Speech and language disorders associated with corticobasal degeneration , 2003 .

[37]  Alex Martin,et al.  Semantic memory and the brain: structure and processes , 2001, Current Opinion in Neurobiology.

[38]  F. Block,et al.  [Primary progressive aphasia]. , 2004, Der Nervenarzt.

[39]  J. Hodges.  Frontotemporal dementia (Pick’s disease): Clinical features and assessment , 2001, Neurology.

[40]  N. Dronkers.  A new brain region for coordinating speech articulation , 1996, Nature.

[41]  D. Neary,et al.  Distinct behavioural profiles in frontotemporal dementia and semantic dementia , 2001, Journal of neurology, neurosurgery, and psychiatry.

[42]  Karl J. Friston,et al.  Statistical parametric maps in functional imaging: A general linear approach , 1994 .

[43]  B. L. Miller,et al.  Frontal lobe degeneration , 1991, Neurology.

[44]  S. Chapman,et al.  Discourse in healthy old-elderly adults: A longitudinal study , 1998 .

[45]  V. Rivera,et al.  Deviant speech characteristics in motor neuron disease. , 1974, Archives of otolaryngology.

[46]  E. Bigio,et al.  Lateralization on Neuroimaging Does Not Differentiate Frontotemporal Lobar Degeneration from Alzheimer’s Disease , 2004, Dementia and Geriatric Cognitive Disorders.

[47]  A R McIntosh,et al.  Functional brain maps of retrieval mode and recovery of episodic information , 1995, Neuroreport.

[48]  Murray Grossman,et al.  The core and halo of primary progressive aphasia and semantic dementia , 2003, Annals of neurology.

[49]  M. Mesulam,et al.  Slowly progressive aphasia without generalized dementia , 1982, Annals of neurology.

[50]  K. Patterson,et al.  Disrupted temporal lobe connections in semantic dementia , 1998, NeuroImage.

[51]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[52]  R. Faber,et al.  Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. , 1999, Neurology.

[53]  Bruce L. Miller,et al.  Neuroimaging in the Diagnosis of Frontotemporal Dementia , 1999, Dementia and Geriatric Cognitive Disorders.

[54]  J. Hodges,et al.  Neuroradiological findings in primary progressive aphasia: CT, MRI and cerebral perfusion SPECT , 1996, Neuroradiology.

[55]  D. Neary,et al.  Evaluation of the NINCDS-ADRDA criteria in the differentiation of Alzheimer’s disease and frontotemporal dementia , 1999, Journal of neurology, neurosurgery, and psychiatry.

[56]  T. Robbins,et al.  Specific cognitive deficits in mild frontal variant frontotemporal dementia. , 1999, Brain : a journal of neurology.