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Distinct and shared neuropsychiatric phenotypes in FTLD-tauopathies
Rachel Keszycki1,2, Allegra Kawles1,2, Grace Minogue1
1Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Frontiers in Aging Neuroscience
|June 26, 2023
Summary
Neuropsychiatric symptoms like irritability and sleep disturbance in frontotemporal lobar degeneration (FTLD) can help predict specific tau pathologies. This aids in differential diagnosis and treatment planning for FTLD-tau dementia.
Area of Science:
- Neurology
- Neuroscience
- Pathology
Background:
- Frontotemporal lobar degeneration with tau pathology (FTLD-tau) causes dementia syndromes like primary progressive aphasia (PPA) and behavioral variant frontotemporal dementia (bvFTD).
- Neuropsychiatric symptoms frequently accompany cognitive decline in PPA and bvFTD, impacting patient well-being and potentially offering diagnostic clues.
Purpose of the Study:
- To characterize neuropsychiatric symptoms in participants with autopsy-confirmed FTLD-tau at early and late disease stages.
- To determine if specific neuropsychiatric symptoms predict underlying FTLD-tau pathologic subtypes, including 3-repeat and 4-repeat tauopathies and progressive supranuclear palsy (PSP).
Main Methods:
- Evaluated 44 participants with PPA or bvFTD due to FTLD-tau using annual research visits.
- Assessed neuropsychiatric symptoms via the Neuropsychiatric Inventory-Questionnaire (NPI-Q) at initial (CDR ≤ 2) and final visits.
- Employed logistic regression to identify symptom predictors of specific FTLD-tau pathologies.
Main Results:
- Irritability and apathy were the most common symptoms at initial and final visits, respectively; psychosis was rare.
- Initial irritability predicted a higher likelihood of 4-repeat tauopathy versus 3-repeat tauopathy (OR=3.95).
- Initial sleep disturbance predicted higher odds of PSP (OR=10.68), while final appetite disturbance predicted lower odds of PSP (OR=0.15).
Conclusions:
- Characterizing neuropsychiatric symptoms in FTLD-tau can aid in predicting specific underlying tau pathologies.
- Neuropsychiatric symptom profiles may assist in the differential diagnosis and personalized treatment planning for heterogeneous FTLD-tau dementias.
