Frequency and Longitudinal Course of Motor Signs In Genetic Frontotemporal Dementia.
Neurology. 2022 Aug 10:10.1212/WNL.0000000000200828. doi: 10.1212/WNL.0000000000200828. Epub ahead of print. PMID: 35948443.
|Authors/Editors:||Schönecker S, Martinez-Murcia FJ, Rauchmann BS, Franzmeier N, Prix C, Wlasich E, Loosli SV, Bochmann K, Gorriz Saez JM, Laforce R Jr, Ducharme S, Tartaglia MC, Finger E, de Mendonça A, Santana I, Sanchez-Valle R, Moreno F, Sorbi S, Tagliavini F, Borroni B, Otto M, Synofzik M, Galimberti D, Vandenberghe R, van Swieten J, Butler C, Gerhard A, Graff C, Danek A, Rohrer JD, Masellis M, Rowe J, Levin J; Genetic Frontotemporal Dementia Intiative (GENFI).|
Background and Objectives: Frontotemporal dementia (FTD) is a highly heritable disorder. The majority of genetic cases are caused by autosomal dominant pathogenic variants in the c9orf72, GRN and MAPT gene. As motor disorders are increasingly recognized as part of the clinical spectrum the current study aimed to describe motor phenotypes caused by genetic FTD, quantify their temporal association, and investigate their regional association with brain atrophy.
Methods: We analyzed baseline visit data of known carriers of a pathogenic variant in the c9orf72, GRN or MAPT gene from the Genetic Frontotemporal dementia Initiative cohort study. Principal component analysis with varimax rotation was performed to identify motor sign clusters that were compared with respect to frequency and severity between groups. Associations with cross-sectional atrophy patterns were determined using voxel-wise regression. We applied linear mixed effects models to assess whether groups differed in the association between motor signs and estimated time to symptom onset.
Results: 322 pathogenic variant carriers were included in the analysis: 122 c9orf72 (79 presymptomatic), 143 GRN (112 presymptomatic) and 57 MAPT (43 presymptomatic) pathogenic variant carriers. Principal component analysis revealed five motor clusters, which we call progressive supranuclear palsy like (PSP-like), bulbar amyotrophic lateral sclerosis (ALS) like, mixed/ALS-like, Parkinson’s disease like (PD-like), and corticobasal syndrome like motor phenotypes. There was no significant group difference in the frequency of signs of different motor phenotypes. However, mixed/ALS-like motor signs were most frequent, followed by PD-like motor signs. While the PSP-like phenotype was associated with mesencephalic atrophy, the mixed/ALS-like phenotype was associated with motor cortex and corticospinal tract atrophy. The PD-like phenotype was associated with widespread cortical and subcortical atrophy. Estimated time to onset, genetic group and their interaction, influenced motor signs. In c9orf72 pathogenic variant carriers, motor signs could be detected up to 25 years prior to expected symptom onset.
Discussion: These results indicate the presence of multiple natural clusters of motor signs in genetic FTD, each correlated with specific atrophy patterns. Their motor severity depends on time and the affected gene. These clinico-genetic associations can guide diagnostic evaluations and the design of clinical trials for new disease-modifying and preventive treatments.