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Longitudinal structural and metabolic changes in frontotemporal dementia

Alexandre Bejanin1, Gautam Tammewar2, Gabe Marx2

  • 1From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley. abejanin@santpau.cat.

Neurology
|June 28, 2020
PubMed
Abstract

Insights

Structural MRI and 18F-fludeoxyglucose PET (18FDG-PET) are sensitive for tracking frontotemporal dementia (FTD) progression. Both methods show overlapping brain changes and similar sample size needs for clinical trials.

Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Frontotemporal dementia (FTD) encompasses a group of neurodegenerative disorders characterized by progressive behavioral, cognitive, and/or language impairments.
  • Accurate detection of longitudinal changes is crucial for understanding FTD progression and evaluating therapeutic interventions.

Purpose of the Study:

  • To compare the sensitivity of structural Magnetic Resonance Imaging (MRI) and 18F-fludeoxyglucose Positron Emission Tomography (18FDG-PET) in detecting longitudinal brain changes in patients with different FTD subtypes.
  • To assess the utility of these neuroimaging modalities for future clinical trials in FTD.

Main Methods:

  • Thirty patients with behavioral variant FTD (bvFTD), 7 with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA), 16 with semantic variant primary progressive aphasia (svPPA), and 43 healthy controls underwent 2-4 MRI and 18FDG-PET scans.
  • Linear mixed-effects models were applied voxel-wise and in regions of interest to identify longitudinal decreases in brain volume (MRI) and metabolism (18FDG-PET) in patients compared to controls.

Main Results:

  • Patients with bvFTD, nfvPPA, and svPPA exhibited distinct patterns of baseline atrophy and hypometabolism, with progression into adjacent brain regions over time.
  • Substantial overlap was observed in brain regions affected by both volume loss (MRI) and metabolic decline (18FDG-PET) across FTD syndromes.
  • While metabolic changes (18FDG-PET) were more extensive, they also showed greater variability; sample size estimates for detecting longitudinal changes were similar or higher for 18FDG-PET compared to MRI.

Conclusions:

  • Both 18FDG-PET and structural MRI are sensitive tools for tracking disease progression in FTD.
  • These neuroimaging modalities demonstrate highly overlapping patterns of longitudinal change and comparable sample size requirements, making them suitable for future FTD clinical trials.

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