Patterns of Striatal Degeneration in Frontotemporal Dementia

*Departments of Neurology ∥Pathology, University of California, San Francisco, CA †Department of Neurology, National Yang-Ming University, School of Medicine ‡Taipei Veterans General Hospital, Taipei, Taiwan §Department of Pathology, University of Pennsylvania, Philadelphia, PA.
Alzheimer disease and associated disorders (Impact Factor: 2.44). 02/2012; 27(1). DOI: 10.1097/WAD.0b013e31824a7df4
Source: PubMed


Behavioral variant frontotemporal dementia and semantic dementia have been associated with striatal degeneration, but few studies have delineated striatal subregion volumes in vivo or related them to the clinical phenotype. We traced caudate, putamen, and nucleus accumbens on magnetic resonance images to quantify volumes of these structures in behavioral variant frontotemporal dementia, semantic dementia, Alzheimer disease, and healthy controls (n=12 per group). We further related these striatal volumes to clinical deficits and neuropathologic findings in a subset of patients. Behavioral variant frontotemporal dementia and semantic dementia showed significant overall striatal atrophy compared with controls. Moreover, behavioral variant frontotemporal dementia showed panstriatal degeneration, whereas semantic dementia featured a more focal pattern involving putamen and accumbens. Right-sided striatal atrophy, especially in the putamen, correlated with the overall behavioral symptom severity and with specific behavioral domains. At autopsy, patients with behavioral variant frontotemporal dementia and semantic dementia showed striking and severe tau or TAR DNA-binding protein of 43 kDa pathology, especially in ventral parts of the striatum. These results demonstrate that ventral striatum degeneration is a prominent shared feature in behavioral variant frontotemporal dementia and semantic dementia and may contribute to the social-emotional deficits common to both disorders.

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    • "This prevents optimization of behavior or decision-making. In frontotemporal dementia patients, for example, in which the salient network [32]–[34] that includes the Acb has degenerated, there is a tendency not to make decisions based on contexts relating to moral and sociality [35], [36]. Such decisions mismatched with context may, as a result, increase the frequency of stress for the patient. "
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