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Clinical Manifestations.

Ismael Luis Calandri1, Jeffrey S Phillips2, Pontus Tideman3

  • 1Alzheimer center, VUMC, Amsterdam, Netherlands.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 26, 2025
PubMed
Summary
This summary is machine-generated.

The behavioral variant of Alzheimer's disease (bvAD) shows cognitive and anatomical progression similar to typical Alzheimer's disease (tAD), differing from the behavioral variant of fronto-temporal dementia (bvFTD). This highlights the need to consider Alzheimer's pathology in cognitive-behavioral decline.

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Area of Science:

  • Neuroscience
  • Neurology
  • Cognitive Science

Background:

  • Behavioral variant of Alzheimer's disease (bvAD) presents with early behavioral changes, mimicking the behavioral variant of fronto-temporal dementia (bvFTD).
  • The natural history and progression patterns of bvAD remain poorly understood.
  • This study aims to elucidate the progression of bvAD by comparing it with matched bvFTD and typical AD (tAD) cohorts.

Purpose of the Study:

  • To investigate and compare the longitudinal cognitive and neuroimaging trajectories of bvAD with bvFTD, tAD, and healthy controls.
  • To understand the distinct progression patterns of bvAD in relation to other dementia subtypes.
  • To identify key differences and similarities in cognitive decline and brain atrophy between bvAD and related neurodegenerative conditions.

Main Methods:

  • Analysis of 81 bvAD participants from a multinational cohort, matched with 80 bvFTD, 81 tAD, and 78 control participants.
  • Longitudinal clinical assessments and structural MRI scans were utilized to track cognitive function and brain changes.
  • Linear mixed models were employed to evaluate cognitive domain trajectories and regional brain atrophy (AD-signature and frontal regions).

Main Results:

  • bvAD patients showed significant cognitive decline across executive function, memory, language, and visuospatial abilities compared to controls.
  • Compared to bvFTD, bvAD patients exhibited better preservation of memory and language functions over time.
  • bvAD progression was anatomically characterized by greater atrophy in AD-signature regions and less atrophy in frontal regions compared to bvFTD, while showing similarities to tAD.

Conclusions:

  • The cognitive and anatomical progression of bvAD is distinct from bvFTD, aligning more closely with the progression observed in typical AD (tAD).
  • These findings emphasize the importance of considering Alzheimer's disease pathology in cases presenting with cognitive-behavioral decline.
  • Further research into the specific pathological mechanisms driving bvAD is warranted.