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1
Factors that predict diagnostic stability in neurodegenerative dementia.
In: Journal of neurology, vol 266, iss 8 (2019)
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Factors that predict diagnostic stability in neurodegenerative dementia.
In: Journal of neurology, vol 266, iss 8 (2019)
Abstract: ObjectiveTo determine the frequency and characteristics of clinical diagnostic change in frontotemporal dementia (FTD)-spectrum syndromes and Alzheimer's disease (AD)-type dementia.MethodsWe reviewed records and categorized diagnostic changes in patients seen ≥ 2 times with behavioral variant FTD (bvFTD, n = 99), nonfluent and semantic variant primary progressive aphasia (nfvPPA, n = 32; svPPA, n = 59), corticobasal syndrome (CBS, n = 40), progressive supranuclear palsy-Richardson syndrome (PSP-RS, n = 34), and AD-type dementia (n = 49). For bvFTD, we compared patients with and without diagnostic change, and assessed predictors of diagnostic change by logistic regression.ResultsInitial diagnoses changed infrequently at subsequent visits in svPPA (6.8%), PSP-RS (8.8%), and nfvPPA (12.5%), with rare changes largely involving clinicopathological overlap or diagnostic ambiguity. Changes in AD-type dementia (30.6%) and CBS (37.5%) were more common, but reflected greater specificity, predicted co-pathology, or overlapping syndromes. Diagnostic change in bvFTD was also common (32.3%), but more diverse, including motor neuron disease development, alternative neurodegenerative syndromes, and non-neurodegenerative diseases. Diagnostic change occurred more often in those who met possible rather than probable bvFTD criteria (70.6% vs 15.3%, p < 0.001). Patients with stable diagnoses showed greater overall impairment, bvFTD behavioral severity, and atrophy in core right-hemisphere bvFTD regions. Patients with diagnostic change had more severe depression (p < 0.05) and more frequent contributing, secondary diagnoses (p = 0.01), such as cerebrovascular disease. By logistic regression, the accuracy of predicting stable bvFTD diagnoses using first-visit data was 80%.ConclusionbvFTD displays more diverse diagnostic change than other neurodegenerative syndromes. First-visit bvFTD diagnoses may waver if based on meeting possible criteria only.
Keyword: Aged; Alzheimer Disease; Alzheimer's disease; Alzheimer’s disease; Aphasia; Clinical Sciences; Corticobasal degeneration; Female; Frontotemporal Dementia; Humans; Male; Middle Aged; Neurodegenerative Diseases; Neurology & Neurosurgery; Neurosciences; Predictive Value of Tests; Primary Progressive; Progressive; Progressive supranuclear palsy; Retrospective Studies; Supranuclear Palsy
URL: https://escholarship.org/uc/item/4rz1t2j1
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3
Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia.
In: JAMA neurology, vol 75, iss 3 (2018)
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4
Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia.
In: JAMA neurology, vol 75, iss 3 (2018)
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5
Interrater reliability of the new criteria for behavioral variant frontotemporal dementia.
In: Neurology, vol 80, iss 21 (2013)
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