Network-based cortical atrophy predicts longitudinal clinical decline in sporadic behavioral variant frontotemporal...

Behavioral variant frontotemporal dementia (bvFTD) is typically characterized by progressive deficits across several socioemotional and cognitive functions. Clinical prognostication in bvFTD remains a challenge due to the considerable variability in the rate of clinical progression and symptomatology.

In a sample of sporadic bvFTD patients (N = 72), we generated cortical thickness estimates from baseline magnetic resonance imaging scans, which were used to predict longitudinal change in Clinical Dementia Rating Sum of Boxes (CDR-SB) scores adapted for frontotemporal lobar degeneration (FTLD) (mean follow-up duration = 2.00 ± 1.28 years).

The magnitude of cortical atrophy in regions of the default mode network that were largely spatially distinct from those exhibiting baseline atrophy most prominently and reliably predicted the rate of subsequent clinical decline.

We propose a latent network vulnerability model of clinical progression in neurodegenerative disease, which, with additional empirical support, may provide a unified framework for estimating person-specific trajectories of clinical decline.

At baseline, bvFTD is associated with prominent atrophy in anterior cortical regions.Atrophy in the posterior default mode network predicts subsequent clinical decline.Network-based atrophy has potential to be a useful clinical prognostication tool in bvFTD.