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

Silvia Morbelli1, Michela Ferrara2, Francesco Fiz3

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

European Journal of Nuclear Medicine and Molecular Imaging
|March 2, 2016
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Summary

Functional neuroimaging reveals hypometabolism precedes atrophy in behavioral variant frontotemporal dementia (bvFTD) predementia stages. This finding may aid in early diagnosis and patient selection for clinical trials.

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Brain PETFrontotemporal dementiaMild cognitive impairment

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Area of Science:

  • Neuroscience
  • Neurology
  • Medical Imaging

Background:

  • Diagnosing behavioral variant frontotemporal dementia (bvFTD) in its early, predementia stage is difficult due to subtle symptoms.
  • Neuroimaging techniques like structural MRI and FDG PET are valuable for early bvFTD detection, but data is limited.

Purpose of the Study:

  • To compare the diagnostic utility of structural MRI and FDG PET in identifying brain changes during the predementia stage of late-onset bvFTD.
  • To investigate whether hypometabolism or grey matter (GM) density reduction is a more sensitive indicator of early bvFTD.

Main Methods:

  • Retrospective analysis of 25 patients with late-onset probable bvFTD and 20 healthy controls.
  • Structural MRI and FDG PET scans were acquired during the predementia stage (mean MMSE 27.1).
  • SPM8 was used to compare imaging findings between bvFTD patients and controls, with bvFTD patients further categorized by symptom presentation (disinhibition vs. apathy).

Main Results:

  • Hypometabolism was more extensive and statistically significant than GM density reduction in bvFTD patients.
  • In the overall bvFTD group, hypometabolism affected frontal, temporal, parietal, and caudate regions, while GM reduction was more localized.
  • Distinct patterns of hypometabolism and atrophy were observed between bvFTD subtypes with disinhibition and apathy.

Conclusions:

  • Hypometabolism appears to precede or be more widespread than atrophy in the predementia stage of late-onset bvFTD.
  • These findings highlight potential differences in brain involvement based on clinical presentation (disinhibition vs. apathy).
  • The results suggest that FDG PET hypometabolism could serve as an early biomarker for bvFTD, aiding in patient selection for clinical trials.