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Mapping brain morphological and functional conversion patterns in predementia late-onset bvFTD

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The diagnosis of behavioural variant frontotemporal dementia (bvFTD) is challenging during the predementia stage when symptoms are subtle and confounding. Morphological and functional neuroimaging can be particularly helpful during this stage but few data are available.

Methods

We retrospectively selected 25 patients with late-onset probable bvFTD. Brain structural MRI and FDG PET were performed during the predementia stage (mean MMSE score 27.1 ± 2.5) on average 2 years before. The findings with the two imaging modalities were compared (SPM8) with those in a group of 20 healthy subjects. The bvFTD patients were divided into two subgroups: those with predominant disinhibition (bvFTD+) and those with apathy (bvFTD−).

Results

Hypometabolism exceeded grey matter (GM) density reduction in terms of both extension and statistical significance in all comparisons. In the whole bvFTD group, hypometabolism involved the bilateral medial, inferior and superior lateral frontal cortex, anterior cingulate, left temporal and right parietal cortices and the caudate nuclei. GM density reduction was limited to the right frontal cortex and the left medial temporal lobe. In bvFTD+ patients hypometabolism was found in the bilateral medial and basal frontal cortex, while GM reduction involved the left anterior cingulate and left inferior frontal cortices, and the right insula. In bvFTD− patients, atrophy and mainly hypometabolism involved the lateral frontal cortex and the inferior parietal lobule.

Conclusion

These findings suggest that hypometabolism is more extensive than, and thus probably precedes, atrophy in predementia late-onset bvFTD, underscoring different topographic involvement in disinhibited and apathetic presentations. If confirmed in a larger series, these results should prompt biomarker operationalization in bvFTD, especially for patient selection in therapeutic clinical trials.

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Author information

Authors and Affiliations

  1. Nuclear Medicine Unit, Department of Health Science (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132, Genoa, Italy

    Silvia Morbelli, Francesco Fiz, Irene Bossert, Ambra Buschiazzo, Lorena Picori & Gianmario Sambuceti

  2. Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy

    Michela Ferrara, Barbara Dessi, Dario Arnaldi, Agnese Picco, Jennifer Accardo, Nicola Girtler & Flavio Nobili

  3. Clinical Psychology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy

    Nicola Girtler

  4. Medical Genetics, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy

    Paola Mandich

  5. Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy

    Marco Pagani

  6. Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden

    Marco Pagani

Authors
  1. Silvia Morbelli
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  2. Michela Ferrara
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  3. Francesco Fiz
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  4. Barbara Dessi
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  8. Ambra Buschiazzo
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  9. Jennifer Accardo
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  13. Marco Pagani
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  15. Flavio Nobili
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Corresponding author

Correspondence to Silvia Morbelli.

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Conflicts of interest

This study received no sponsorship. Dr. Morbelli received honoraria to teach amyloid PET reading on behalf of Eli-Lilly & Co. in 2014 – 2015. Dr. Nobili received honoraria to teach amyloid PET reading on behalf of Eli-Lilly & Co. in 2014 – 2015. He received speaker honoraria from G.E. Healthcare in 2015. The other authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study protocol was approved by the local Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Morbelli, S., Ferrara, M., Fiz, F. et al. Mapping brain morphological and functional conversion patterns in predementia late-onset bvFTD. Eur J Nucl Med Mol Imaging 43, 1337–1347 (2016). https://doi.org/10.1007/s00259-016-3335-3

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  • DOI: https://doi.org/10.1007/s00259-016-3335-3

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