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Abstract
Objective: In this prospective cohort study, we investigated cerebral glucose metabolism reductions on [18F]-fluorodeoxyglucose (FDG)-PET in progranulin (GRN) mutation carriers prior to frontotemporal dementia (FTD) onset.
Methods: Nine mutation carriers (age 51.5 ± 13.5 years) and 11 noncarriers (age 52.7 ± 9.5 years) from 5 families with FTD due to GRN mutations underwent brain scanning with FDG-PET and MRI and clinical evaluation. Normalized FDG uptake values were calculated with reference to the pons. PET images were analyzed with regions of interest (ROI) and statistical parametric mapping (SPM) approaches.
Results: Compared with noncarriers, GRN mutation carriers had a lowered anterior-to-posterior (AP) ratio of FDG uptake (0.86 ± 0.09 vs 0.92 ± 0.05) and less left-right asymmetry, consistent with an overall pattern of right anterior cerebral hypometabolism. This pattern was observed regardless of whether they were deemed clinically symptomatic no dementia or asymptomatic. Individual ROIs with lowered FDG uptake included right anterior cingulate, insula, and gyrus rectus. SPM analysis supported and extended these findings, demonstrating abnormalities in the right and left medial frontal regions, right insular cortex, right precentral and middle frontal gyri, and right cerebellum. Right AP ratio was correlated with cognitive and clinical scores (modified Mini-Mental State Examination r = 0.74; Functional Rating Scale r = −0.73) but not age and years to estimated onset in mutation carriers.
Conclusion: The frontotemporal lobar degenerative process associated with GRN mutations appears to begin many years prior to the average age at FTD onset (late 50s–early 60s). Right medial and ventral frontal cortex and insula may be affected in this process but the specific regional patterns associated with specific clinical variants remain to be elucidated.
GLOSSARY
- ANCOVA=
- analysis of covariance;
- AP ratio=
- anterior-posterior ratio;
- AUC=
- area under the curve;
- BA=
- Brodmann area;
- bvFTD=
- behavioral variant frontotemporal dementia;
- CI=
- confidence interval;
- CSND=
- clinically symptomatic no dementia;
- FDG=
- [18F]-fluorodeoxyglucose;
- FTD=
- frontotemporal dementia;
- GRN=
- progranulin;
- ICC=
- intraclass coefficient;
- LR ratio=
- left-right ratio;
- PNFA=
- progressive nonfluent aphasia;
- PV=
- partial volume;
- ROI=
- region of interest;
- SPM=
- statistical parametric mapping;
- SUV=
- standard uptake value;
- UBC=
- University of British Columbia
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1282
Supplemental data at www.neurology.org
- Received November 29, 2012.
- Accepted in final form June 4, 2013.
- © 2013 American Academy of Neurology
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