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Latent profile analysis in frontotemporal lobar degeneration and related disorders: clinical presentation and SPECT functional correlates.

Borroni B, Grassi M, Agosti C, Paghera B, Alberici A, Di Luca M, Perani D, Padovani A - BMC Neurol (2007)

Bottom Line: Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes.These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3.The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy. bborroni@inwind.it

ABSTRACT

Background: Frontotemporal Lobar Degeneration (FTLD) thus recently renamed, refers to a spectrum of heterogeneous conditions. This same heterogeneity of presentation represents the major methodological limit for the correct evaluation of clinical designation and brain functional correlates. At present, no study has investigated clinical clusters due to specific cognitive and behavioural disturbances beyond current clinical criteria. The aim of this study was to identify clinical FTLD presentation, based on cognitive and behavioural profile, and to define their SPECT functional correlations.

Methods: Ninety-seven FTLD patients entered the study. A clinical evaluation and standardised assessment were preformed, as well as a brain SPECT perfusion imaging study. Latent Profile Analysis on clinical, neuropsychological, and behavioural data was performed. Voxel-basis analysis of SPECT data was computed.

Results: Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes. These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3.

Conclusion: These findings provide evidence that specific functional-cluster symptom relationship can be delineated in FTLD patients by a standardised assessment. The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.

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Related in: MedlinePlus

Scatter-plot of FTLD patients labelled according to generated three Latent Classes. y axis: values of behavioural disturbances (measured by Frontal Behavioural Inventory Scale, FBI-A plus FBI-B,); x axis: values of cognitive deficits (cognitive sum, i.e. the sum of Equivalent Scores of all the neuropsychological tests included in the assessment, the higher the value the better the performance; see Table 4). The centroid (0;0) represents the overall mean profile; compared to the average value of the whole sample, LC1 patients have higher cognitive sum values (i.e. less severe cognitive impairment); while LC2 and LC3 patients have lower cognitive sum values (i.e. more severe cognitive impairment); vice versa the behavioural deficit values are higher in the LC1 than in the LC2 and LC3 patients.
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Figure 2: Scatter-plot of FTLD patients labelled according to generated three Latent Classes. y axis: values of behavioural disturbances (measured by Frontal Behavioural Inventory Scale, FBI-A plus FBI-B,); x axis: values of cognitive deficits (cognitive sum, i.e. the sum of Equivalent Scores of all the neuropsychological tests included in the assessment, the higher the value the better the performance; see Table 4). The centroid (0;0) represents the overall mean profile; compared to the average value of the whole sample, LC1 patients have higher cognitive sum values (i.e. less severe cognitive impairment); while LC2 and LC3 patients have lower cognitive sum values (i.e. more severe cognitive impairment); vice versa the behavioural deficit values are higher in the LC1 than in the LC2 and LC3 patients.

Mentions: As shown in Figure 2, these three LCs were significantly separated from each other.


Latent profile analysis in frontotemporal lobar degeneration and related disorders: clinical presentation and SPECT functional correlates.

Borroni B, Grassi M, Agosti C, Paghera B, Alberici A, Di Luca M, Perani D, Padovani A - BMC Neurol (2007)

Scatter-plot of FTLD patients labelled according to generated three Latent Classes. y axis: values of behavioural disturbances (measured by Frontal Behavioural Inventory Scale, FBI-A plus FBI-B,); x axis: values of cognitive deficits (cognitive sum, i.e. the sum of Equivalent Scores of all the neuropsychological tests included in the assessment, the higher the value the better the performance; see Table 4). The centroid (0;0) represents the overall mean profile; compared to the average value of the whole sample, LC1 patients have higher cognitive sum values (i.e. less severe cognitive impairment); while LC2 and LC3 patients have lower cognitive sum values (i.e. more severe cognitive impairment); vice versa the behavioural deficit values are higher in the LC1 than in the LC2 and LC3 patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1884173&req=5

Figure 2: Scatter-plot of FTLD patients labelled according to generated three Latent Classes. y axis: values of behavioural disturbances (measured by Frontal Behavioural Inventory Scale, FBI-A plus FBI-B,); x axis: values of cognitive deficits (cognitive sum, i.e. the sum of Equivalent Scores of all the neuropsychological tests included in the assessment, the higher the value the better the performance; see Table 4). The centroid (0;0) represents the overall mean profile; compared to the average value of the whole sample, LC1 patients have higher cognitive sum values (i.e. less severe cognitive impairment); while LC2 and LC3 patients have lower cognitive sum values (i.e. more severe cognitive impairment); vice versa the behavioural deficit values are higher in the LC1 than in the LC2 and LC3 patients.
Mentions: As shown in Figure 2, these three LCs were significantly separated from each other.

Bottom Line: Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes.These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3.The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy. bborroni@inwind.it

ABSTRACT

Background: Frontotemporal Lobar Degeneration (FTLD) thus recently renamed, refers to a spectrum of heterogeneous conditions. This same heterogeneity of presentation represents the major methodological limit for the correct evaluation of clinical designation and brain functional correlates. At present, no study has investigated clinical clusters due to specific cognitive and behavioural disturbances beyond current clinical criteria. The aim of this study was to identify clinical FTLD presentation, based on cognitive and behavioural profile, and to define their SPECT functional correlations.

Methods: Ninety-seven FTLD patients entered the study. A clinical evaluation and standardised assessment were preformed, as well as a brain SPECT perfusion imaging study. Latent Profile Analysis on clinical, neuropsychological, and behavioural data was performed. Voxel-basis analysis of SPECT data was computed.

Results: Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes. These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3.

Conclusion: These findings provide evidence that specific functional-cluster symptom relationship can be delineated in FTLD patients by a standardised assessment. The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.

Show MeSH
Related in: MedlinePlus