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. 2020 Mar 27;12(1):34.
doi: 10.1186/s13195-020-00600-x.

In vivo staging of frontotemporal lobar degeneration TDP-43 type C pathology

Martina Bocchetta  1 , Maria Del Mar Iglesias Espinosa  2 , Tammaryn Lashley  3   4 , Jason D Warren  1 , Jonathan D Rohrer  5
Affiliations

In vivo staging of frontotemporal lobar degeneration TDP-43 type C pathology

Martina Bocchetta et al. Alzheimers Res Ther. .

Abstract

Background: TDP-43 type C is one of the pathological forms of frontotemporal lobar degeneration (FTLD) and mainly associated clinically with the semantic variant of primary progressive aphasia (svPPA). We aimed to define in vivo the sequential pattern of neuroanatomical involvement in a cohort of patients with FTLD-TDP type C pathology.

Methods: We extracted the volumes of a set of cortical and subcortical regions from MRI scans of 19 patients with post mortem confirmed TDP-43 type C pathology (all with left hemisphere-predominant atrophy at baseline). In the initial development phase, we used w-scores computed from 81 cognitively normal controls to define a set of sequential stages of neuroanatomical involvement within the FTLD-TDP type C cohort where a w-score of < - 1.65 was considered abnormal. In a subsequent validation phase, we used 31 follow-up scans from 14 of the 19 patients in the same cohort to confirm the staging model.

Results: Four sequential stages were identified in the initial development phase. Stage 1 was defined by atrophy in the left amygdala, medial temporal cortex, temporal pole, lateral temporal cortex and right medial temporal cortex; Stage 2 by atrophy in the left supratemporal cortex; Stage 3 by atrophy in the right anterior insula; and Stage 4 by atrophy in the right accumbens. In the validation phase, calculation of w-scores in the longitudinal scans confirmed the staging system, with all patients either staying in the same stage or progressing to a later stage at follow-up.

Conclusion: In vivo imaging is able to detect distinct stages of neuroanatomical involvement in FTLD-TDP type C pathology. Using an imaging-derived staging system allows a more refined stratification of patients with svPPA during life.

Keywords: Disease progression; Magnetic resonance imaging; Semantic variant PPA; TDP-43 type C.

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Conflict of interest statement

JDR has been on a Medical Advisory Board for Wave Life Sciences and Ionis Pharmaceuticals. All the other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Regions of interest used in the staging analysis. Abbreviations: THA thalamus, PUT putamen, GP pallidum, CAU caudate, NA nucleus accumbens, HIP hippocampus, AMY amygdala, OCC occipital, LP lateral parietal, S sensory, PI posterior insular, AI anterior insular, LT lateral temporal, ST supratemporal, TP temporal pole, DLPFC dorsolateral prefrontal, OP opercular, OF orbitofrontal, FP frontal pole, VMPFC ventromedial prefrontal, AC anterior cingulate, MC middle cingulate, PC posterior cingulate, MT medial temporal, MP medial parietal, MOT motor
Fig. 2
Fig. 2
Sequential pattern of neuroanatomical involvement in FTLD-TDP type C. The colour map indicates the stage when the specific region of interest becomes involved
See this image and copyright information in PMC

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