“The Big Four” dementias – AD, LBD, FTD, and Vascular

There’s a wonderful article in the November/December 2009 issue of Neurology Now magazine.  It features Jerome and Renata Rafferty; Jerome had Lewy Body Dementia and Renata was his caregiver.

The “Other” Dementias (featuring Lewy Body Dementia story)

A companion article is titled “The Big Four.”  It gives short descriptions of four types of dementia – Alzheimer’s, Lewy Body Dementia, Frontotemporal Dementia, and Vascular Dementia.  The article notes that there are over 100 types of dementia.

Below the full text of the article, and a link to it online. You can also download the PDF of the article.

Robin
————————————

journals.lww.com/neurologynow/Fulltext/2009/05060/The__Other__Dementias.14.aspx –> HTML version

The Big Four
Neurology Now
November/December 2009 – Volume 5 – Issue 6 – p 26-27,31-34

More than 100 types of dementia have been found, but four of them account for nearly 98 percent of all cases of dementia in the United States.

ALZHEIMER’S DISEASE (AD)

DESCRIPTION: People with AD develop memory problems, often followed by confusion, apathy, depression, emotional volatility, and other problems.

CAUSE: People with AD develop two types of dysfunctional protein in the hippocampus, the part of the brain essential for creating new memories. Tau protein accumulates within neurons in that region, while clumps of amyloid protein develop between neurons in that region. Some researchers, however, suspect that the toxic proteins may be the result of the disease rather than the cause.

TYPICAL CASE: The first symptom of AD almost always involves memory problems, such as forgetting familiar names and misplacing items. As the disease progresses people may have trouble finding their way home or keeping up with routine obligations such as doctor appointments, paying bills, and preparing meals. Later stages may affect the frontal lobes, resulting in erratic emotions, loss of normal inhibition, and hallucinations.

TREATMENT: Since AD results in decreased levels of acetylcholine, a neurotransmitter essential for memory and learning, drugs that boost acetylcholine, such as donepezil and memantine, often help, at least for a while. Other treatments are available for specific symptoms such as depression, hallucinations, and movement disorders, but nothing seems to slow development of the disease.

ON THE HORIZON: Several drugs and vaccines designed to inhibit the production of toxic tau and amyloid protein, or remove it once it appears, are in development. However, people who have tried the drug experimentally failed to improve significantly, even though protein levels declined, sometimes dramatically.

LEWY BODY DEMENTIA (LBD)

DESCRIPTION: Like Alzheimer’s, LBD produces cognitive decline, but with three additional traits. Instead of declining continuously, people with LBD tend to fluctuate in terms of attention, alertness, ability to speak coherently, and other symptoms. They also tend to have visual hallucinations, often benign. Finally, they tend to develop symptoms of Parkinson’s disease, including rigidity, tremor, and slowness of movement.

CAUSE: A type of protein known as alpha-synuclein clumps into Lewy bodies, which appear inside of cells, or neurons. Lewy bodies may result from the inability of the cell to break down and recycle alpha-synuclein efficiently. As the protein accumulates, it sticks together, as though the cell is trying to gather its own debris to keep it out of the way.

TYPICAL CASE: People with LBD often act out violent dreams that involve being pursued or attacked. They may develop benign hallucinations involving, for example, children or animals running around the house. Attention and concentration may fluctuate, and patients may start to have trouble with visual-spatial abilities-they may misjudge the height of a step or miss a cup when they reach for it. Some people with LBD experience an overwhelming urge to sleep during the day. Their movements also may become rigid and slow, like the symptoms of Parkinson’s disease, and they may develop problems with memory, judgment, and mood, like the symptoms of AD.

TREATMENT: No treatment specifically for LBD exists. However, since LBD affects nearly every neurochemical system in the brain, specific aspects of the disease can be treated. Memory problems can be treated with donepezil and other drugs for AD. Movement disorders may respond to L-dopa and other medications for Parkinson’s disease. Modafinil may alleviate daytime sleepiness.

ON THE HORIZON: No drug yet exists that affects the synuclein protein, although some drugs exist for daytime sleepiness, and another, which resembles methylfenidate, is in development.

FRONTOTEMPORAL DEMENTIA (FTD)

DESCRIPTION: FTD includes several disorders that cause the frontal lobes behind the forehead, and the temporal lobes at the sides of the brain, to atrophy and shrink. Patients either develop speech difficulties, known as aphasia, or they display inappropriate social behavior. Aphasia may involve halting, effortful speech with the patient struggling to produce the right word. Behavioral changes may involve indifference to the concerns of others. Some patients developing FTD may start shoplifting or become attracted to shiny objects or fire.

CAUSE: In FTD, a protein known as TDP-43 accumulates within cells at the front of the brain. In one form of FTD known as Pick’s disease, tau protein, found in the hippocampus of people with AD, accumulates within cells in the frontal lobes.

TYPICAL CASE: A person developing FTD generally exhibits personality or mood changes. An outgoing person may become withdrawn and depressed, while an introverted person may become loud and outgoing. Socially inappropriate behavior may also become more common. Later, FTD patients may develop speech difficulties as they lose the ability to recall the meaning of words, or they may start to speak with great fluency while making no sense.

TREATMENT: Only symptomatic treatments are available with medications developed for other disorders, such as psychiatric medications for behavioral problems or mood disorders. There are no treatments for language problems.

ON THE HORIZON: Methylene blue, a drug in development for AD, inhibits the aggregation of tau protein, so it may help patients with Pick’s disease. Another tau aggregation inhibitor known as AL-108, or davunetide, is in clinical trials, and may soon become the first tau-active drug available in the U.S. TDP-43, the offending protein in other forms of FTD, was discovered only three years ago, leaving little time for the development of effective treatments.

VASCULAR DEMENTIA

DESCRIPTION: Since this dementia results from several small strokes, and strokes can affect any part of the brain, the symptoms of vascular can vary widely. However, they usually include declines in problem-solving ability, memory, and socially appropriate behavior.

CAUSE: Vascular dementia is believed to result from damage to brain cells caused by lack of oxygen when the blood supply is cut during a series of mild strokes. However, one study of 1,000 brains from demented patients who had died found only six that had pure vascular dementia, with the slow progression typical of the disorder. The rest also had another form of dementia.

TYPICAL CASE: To be diagnosed with vascular dementia, a patient must show evidence of a stroke in a location that could affect cognition, and cognitive problems must develop within three to six months of the stroke. A patient who meets these criteria may develop memory problems and have trouble speaking coherently or understanding the speech of others. They may also develop motor difficulties that prevent them from dressing themselves.

TREATMENT: The first goal is to reduce stroke risk by improving cardiovascular health. Statins may be prescribed to lower cholesterol, anti-hypertensives to lower blood pressure, and omega-3 pills to improve triglyceride levels. Low-dose aspirin may be prescribed to inhibit the clotting of the blood, and patients may be urged to give up smoking and drinking and reduce stress.

ON THE HORIZON: Damage from strokes cannot be reversed, but the brain can compensate for some deficits. Physical therapy designed to stimulate brain plasticity may provide some help.

Copyright © 2009, AAN Enterprises, Inc.

Famous amnesic launches a bold, new brain project at UCSD’s Brain Observatory

This post is likely only of interest to those curious about brain tissue analysis. I’ve been watching the slicing of this brain tissue today at UCSD’s Brain Observatory, and agree that it’s “mesmerizing.” The process will produce about 2500 tissue samples for analysis.

Here’s the live video:
http://thebrainobservatory.ucsd.edu/hm_live.php

In the New York Times article from yesterday on this “famous brain” — http://www.nytimes.com/2009/12/03/healt … brain.html — a researcher said “It’s just amazing that this one patient — this one person — would contribute so much historically to the early study of memory.”

And here’s a good article on the Brain Observatory and the analysis of this particular brain from Monday’s San Diego Union-Tribune newspaper. For me, the last two sections of the article were the most interesting (starting with “The Brain Observatory is divided between…”).

http://www3.signonsandiego.com/news/200 … ld-new-br/

H.M. recollected
Famous amnesic launches a bold, new brain project at UCSD

By Scott LaFee, San Diego Union-Tribune Staff Writer
Monday, November 30, 2009 at 12:04 a.m.

As best he could remember, Henry Gustav Molaison never visited San Diego, spending his entire life on the East Coast. When he died late last year at the age of 82, Molaison was a man almost entirely unknown except by his initials H.M. and the fact that experimental brain surgery had erased his ability to form new memories.

He forgot names, places, events and faces almost immediately. Half an hour after lunch, he couldn’t recall what he had eaten, or that he had eaten at all. His face in the mirror was a constant surprise because he remembered only what he looked like as a young man. Every question was new, even those asked just minutes before.

Yet Molaison bore this strange and unimaginable burden with grace and stoicism, allowing scores of scientists to study, probe and ponder his condition for decades, each seeking to better understand the mysteries of the human brain, memory and personal identity.

“H.M. started a revolution in the study of memory,” said Dr. Vilayanur S. Ramachandran, a professor of psychology and neuroscience and director of the Center for Brain and Cognition at UCSD at the time of Molaison’s death. “His was an unforgettable contribution.”

Molaison died of respiratory failure on Dec. 2, 2008, but his story — and his legacy — does not end in that Connecticut nursing home. Within hours of death, Molaison’s brain would be scanned, removed and placed in the preservative formalin, the first steps on a journey to San Diego and a new kind of immortality.

On a cold night in mid-February, Jacopo Annese returned to San Diego, arriving on Jet Blue Flight 411 from Boston. With him was the brain of H.M. They had flown coach: Annese in the aisle seat, H.M.’s brain in a 19-quart white plastic cooler strapped next to him in the window seat. More than a few fellow travelers looked curiously at the arrangement; some inquired directly.

“I tried not to be coy,” said Annese. “I told them the cooler contained a very important scientific specimen. I didn’t say a brain. I didn’t want to risk upsetting any passengers.”

Sophisticated and articulate, educated and trained in Italy, England and the United States, the 43-year-old Annese came to the University of California San Diego in 2005 to develop and direct the Brain Observatory, with an ambitious plan to create a new and unrivaled collection of human brains for scientific study.

These brains, normal and with various pathologies, will be preserved on thousands of slides that, in turn, are converted into extraordinarily high-resolution digital images freely available online. Researchers around the world will be able to use the material to conduct investigations ranging from parsing basic cognitive functions or the physical effects of diseases like Alzheimer’s to more abstract inquiries such as how memories are created and changed and the organic nature of consciousness.

The project has already begun with a handful of brains. Annese envisions the collection as a kind of library, each brain containing a life story. “We strive to treat the brains we study not as anonymous tissue, but as representations of a person and of a mind. We want to write books about people’s lives, neurological biographies that survive in glass and pixels.”

In this most novel of libraries, Molaison’s brain is the rarest of volumes. He is the most famous amnesic of all time, perhaps the most-studied neurological patient in history.

When he was 10 years old, Molaison began suffering epileptic seizures and blackouts, which increased in severity and frequency until, in his 20s, he was no longer able to work or live alone. In 1953 at the age of 27, Molaison agreed to undergo a radical experimental operation intended to relieve his suffering. Dr. William Beecher Scoville, a noted neurosurgeon at Hartford Hospital in Connecticut who had refined many of the techniques used in lobotomies, suctioned out finger-sized portions of the temporal lobes on both sides of his brain. The removed tissue contained most of Molaison’s hippocampus, a brain region whose function was poorly understood at the time, if at all.

The seizures largely stopped, but so too did Molaison’s ability to form new memories, though he could recall parts of his life before the surgery, a condition called severe anterograde amnesia. Scoville and a Canadian psychologist named Brenda Milner quickly realized that Molaison represented a tragic but rare opportunity to explore how human memory works.

With Molaison serving as willing and genial subject, identified only as H.M. to protect his privacy, they began a series of studies. In a landmark 1957 paper, Scoville and Milner described H.M.’s bifurcated memory for the first time. The paper, which has been cited by other researchers almost 2,000 times, led to the startling realization that memory is not a generalized brain function, but rather is controlled by key regions like the hippocampus, which regulates the flow of information destined to become long-term memory.

In many ways, H.M. appeared to be an ordinary fellow. He liked crossword puzzles and watching TV. He was polite, funny and self-effacing. “He was a very endearing person,” said Annese, who met H.M. once in 2006 during early planning for the Brain Observatory and library. “I was happy to get to know the man.”

Surprisingly, even with no ability to form long-term memories, H.M. could learn new things, in particular new muscle memory skills like drawing or playing golf. He didn’t remember taking lessons or practicing, but the acquired abilities stuck.

That discovery generated another new and fundamental insight into human cognitive function. There are different types of memories: Long-term declarative memories, which H.M. could no longer form; short-term memories which H.M. still possessed to a degree; and motor memories, such as recalling how to ride a bike, which H.M. never lost.

Each kind of memory, scientists deduced, must essentially be created and reside in different parts of the brain. Sometimes H.M. learned and remembered things that happened post-surgery, such as the assassination of John F. Kennedy in 1963. This suggested portions of H.M.’s memory system survived his 1953 surgery or that other regions had taken up some of those duties. No one really knew.

To really understand what was going on inside H.M.’s head, researchers needed to venture more deeply inside the brain itself.

The Brain Observatory is divided between an elaborately equipped wet lab for handling flesh-and-blood brains, and separate areas housing high-powered microscopes and computers for digitizing them.

Converting biology to bytes takes time. It is complex, painstaking and fraught with unprecedented technical challenges. A brain like H.M.’s represents a singular chance to advance scientific knowledge, but there is almost no room for mistakes.

“It’s a huge responsibility that many labs might not want,” said Annese.

Within four hours of his death, Molaison’s body was moved to Massachusetts General Hospital (MGH), where researchers, led by Suzanne Corkin, a professor of behavioral neuroscience at the Massachusetts Institute of Technology who had worked with H.M. for 46 years, conducted an overnight series of magnetic resonance imaging scans, a last chance to record his brain’s structure and condition “in situ.”

The next morning, after Annese had flown overnight to get there, he and MGH neuropathologist Matthew Frosch delicately removed H.M.’s brain from his skull.

“I was sweating bullets,” Annese later told the journal Science.

Like all fresh brains, H.M.’s had the consistency of Jell-O. It could be easily damaged, harm that might render it less useful — perhaps even useless — for further study. But the removal went smoothly and the brain was immediately deposited in formalin, suspended by a string so that it wouldn’t become deformed by resting on the bottom of the container. It would remain in formalin for two months until firm enough to travel safely to San Diego.

After returning in February with the brain, Annese conducted a second, more exhaustive series of MRI scans over two days, producing a more comprehensive anatomical map and a final record of the brain intact.

Next, the brain was immersed for weeks in increasing levels of sucrose solution. As the sucrose (sugar) infused the brain, it replaced water in cells, reducing the risk that ice crystals might later form, which could cause tissue to tear and reduce the brain’s research value.

High-security freezers house the project’s brains. (Annese has 10 so far.) The freezers are constantly and continuously monitored, with emergency backup power and an automatic alert system.

H.M.’s brain is scheduled to be sectioned on Wednesday, with segments of the procedure broadcast live via the Brain Observatory’s Web site (thebrainobservatory.ucsd.edu). Annese has been practicing the procedure on control brains.

Just prior to cutting, H.M.’s brain will be dipped in a liquid bath of isopentane at minus 40 degrees Celsius until frozen solid. The actual slicing is reminiscent of a delicatessen. The prepared brain is locked inside a cuff containing circulating ethanol to keep it precisely frozen. Too cold and the tissue might shatter during cutting; too warm and the tissue becomes sloppy. The cuff and brain are then mounted atop a commercial microtome modified by Annese with help from machinists at the Scripps Institution of Oceanography. Every component has been meticulously measured and engineered. A razor-sharp blade of tempered steel glides over the exposed brain, cutting from the front of the brain to the back, producing opaque, whitish slices that crinkle and wad on the blade’s edge like slivers of cut ginger.

Each brain slice is approximately 70 microns thick, about the width of a hair. An average-sized brain produces 2,600 to 3,000 such slices. Once the cutting begins, it continues until the brain is completely sectioned, a 30-hour endeavor.

A camera mounted above methodically records every slice, though a human operator must constantly attend to gently dab up each crumpled slice off the blade and deposit it into a sequentially numbered container filled with buffer solution.

“There’s something mesmerizing about doing this,” said Natalie Schenker, a postdoctoral research associate as she dabbed and deposited slices of control brain. “It’s like going on a journey, each slice getting you to another place in the brain.”

The majority of slices will be left untouched, cryogenically preserved for future experiments. Some slices, perhaps every 30th to 50th, will be mounted on postcard-sized glass slides. Mounting is an exacting process. A technician uses fine arts brushes to tease a wadded slice floating in a tray of buffer solution to lie flat upon an underlying slide, a physical match to the photo taken of that same slice during the cutting procedure. One mounting can take up to an hour.

The slides are then dried and some sequentially stained, what Annese calls “the club sandwich idea.” Different stain colors reveal different components of the brain. Blue shows individual neurons; brown highlights myelin-coated connective structures and support cells.

Finally, the slides are ready to be digitized. Each is placed under a microscope at 20X magnification to distinguish individual cell types. A computerized camera next begins snapping pictures of the microscopic scene. It requires 20,000 such “capture tiles” to produce a mosaic of just one slide, enough digital information to fill 200 DVDs.

Annese and colleagues have designed an automated system to do this demanding but tedious work. The data are sent to UCSD’s California Institute for Telecommunications and Information Technology (Calit2) and the San Diego Supercomputer Center, where it will be managed and stored for future use.

A fully sliced, mounted, stained and digitized brain is, in some ways, a return to wholeness, a brain reassembled in cyberspace. “We’re taking all of the two-dimensional image data (from the slides) and reconstructing them in a 3-D system,” said Alain Pitiot, a computer scientist at the University of Nottingham in England. “We’re reforming the brain so that researchers can see things in context.”

The intended result will be a bit like Google Earth. Scientists will be able to zoom in and out of a digitized brain; focusing down to the level of individual neurons or pulling back to examine whole brain circuits or regions.

When fully up and operating, the project will be an interactive affair. All data will be online and open to viewing and discussion. Neuroscientists will be able to watch procedures, make recommendations and observations, suggest experiments or request tissue samples. Nonscientists will have similar, if more limited, access.

For obvious reasons, H.M.’s brain holds special interest. It’s the catalyst for the entire endeavor. But more importantly, researchers are eager to compare what they learned about Molaison while he was alive with what they can discover in his digitally revealed brain.

“The extraordinary value of H.M.’s brain is that we have roughly 50 years of behavioral data, including measures of different kinds of memory as well as other cognitive functions and even sensory and motor functions,” said Corkin at MIT.

“We know what he was able to do and not do. Our goal is to link his deficits to damaged brain areas and his preserved functions to spared areas.”

H.M.’s brain will also be compared with those of other amnesic patients. Larry Squire, a professor of psychiatry and neurosciences at UCSD, has donated the brains of three much-studied patients. Some of Ramachandran’s patients have also agreed to donate their brains after death.

But the Brain Observatory and library project is about more that just H.M. and the mystery of memory. It promises the chance to investigate all things that ail the brain. For example, Annese is already processing brains that are part of an HIV study. And he has established partnerships with Lifesharing and the San Diego Eye Bank, which handle organ and tissue donations in San Diego County, to secure new donors.

Annese is quick to note that he’s not solely interested in afflicted or particular brains. He hopes people who have no known neurological issues will donate their brains to the Observatory, too.

“Healthy brains for study are very rare, but they are essential if we want to understand how brains age and why some people avoid neurological disease and dysfunction. We want to know what a normal brain is.”

But more profoundly, Annese hopes the Observatory and the future research that flows through and out of it will help answer the enduring question of what exactly makes each of us human and unique.

“We know that the human brain has a basic pattern,” said Annese. “We’re all born with the same kind of instrument, let’s say a violin. But how we play this violin and what we decide to play shapes this instrument during our lives. We can learn a lot by the wear-and-tear of life on our violins, how each of us has modified it. These could prove to be anatomical fingerprints of individuality, biological clues of what makes us who we are.”

OBSERVING LIVING DONORS IS PART OF STUDY

The Brain Observatory and its related brain library project will necessarily rely upon donated brains, primarily through the services of two regional organ and tissue banks, Lifesharing and the San Diego Eye Bank.

Much of the emphasis will be on finding donors who are able to participate in a monitoring, data-gathering program while they are still alive and well, people like Clint and Maggie Spangler.

The La Jolla couple is reasonably healthy. “I’m told I have the brain of a 60-year-old,” said Clint, who is 81. Nonetheless, he and his wife both suffer from essential tremor, a progressive neurological condition characterized by uncontrollable trembling, typically of the hands though it can affect many parts of the body.

Often confused with Parkinson’s disease, essential tremor is not life-threatening. “It’s more of a nuisance,” said Maggie. But it is common. According to the National Institutes of Health, the condition affects up to 14 percent of Americans over the age of 65.

The exact cause of essential tremor is not known, but there’s a clear genetic component. Two of the Spangler’s four children have the condition; a third appears likely to develop it. Clint and Maggie have promised their brains to the observatory, hoping that the donations might help researchers solve their condition and others.

“We’re not too philosophical about it,” said Maggie. “We’d like to be able to help, and we’re certainly not going to need our brains after we’re dead. Besides, do you know what a funeral costs these days?”

To learn more about organ and tissue donations, visit Lifesharing at lifesharing.org or the San Diego Eye Bank at sdeb.org

Correlations between language problems and brain pathology

This is an interesting French study correlating clinical symptoms related to language and speech with the pathology seen in autopsied brain tissue. Eighteen patients were monitored over a 15-year period. Four patients developed right-predominant corticobasal syndrome. One patient was given a clinical diagnosis of PSP.

“Of the 18 cases, 8 had FTLD-TDP, 3 had AD, 2 had PSP, 2 had CBD, 2 had PiD, and 1 had AGD,” upon brain autopsy. Of the two who had confirmed PSP diagnoses, one was diagnosed with the behavioral variant of FTD during life though the diagnosis was later changed to PSP when supranuclear palsy appeared. The other was diagnosed with corticobasal syndrome during life.

Of the four patients diagnosed with corticobasal syndrome during life, one had PSP upon brain autopsy, one had CBD, one had Pick’s Disease, and one had FTLD-TDP.

Of the two cases who had confirmed CBD diagnoses, one was diagnosed with FTDbv during life and the other with CBS during life.

The five patients who stopped speaking (“progressive anarthria”) all had tau pathology — either PSP, CBD, or Pick disease. (“[All] progressed to mutism, swallowing difficulties, and orofacial apraxia.”)

Findings of atrophy (on a CT or MRI) and findings of hypometabolism (on a SPECT) in nearly all of the the cases are provided along with info such as disease duration, MMSE score, Frontotemporal Behavior Scale rating, and Dementia Rating Scale score.

Eighteen patients is a very small study. We’ll have to see if the results can be replicated.

Robin

———–

Neurology. 2009 Nov 25. [Epub ahead of print]

Prediction of pathology in primary progressive language and speech disorders.

Deramecourt V, Lebert F, Debachy B, Mackowiak-Cordoliani MA, Bombois S, Kerdraon O, Buée L, Maurage CA, Pasquier F.
From the Memory Clinic (V.D., F.L., B.D., M.A.M.-C., S.B., F.P.) and Department of Neuropathology (O.K., C.-A.M.), CHU-Lille, Lille; University Lille Nord de France (V.D., F.L., B.D., M.A.M.-C., S.B., O.K., L.B., C.-A.M., F.P.), Lille; and INSERM (O.K., L.B., C.-A.M.), JP Aubert Research Centre, Lille, France.

OBJECTIVE: Frontotemporal lobar degeneration (FTLD) encompasses a variety of clinicopathologic entities. The antemortem prediction of the underlying pathologic lesions is reputed to be difficult.

This study sought to characterize correlations between 1) the different clinical variants of primary progressive language and speech disorders and 2) the pathologic diagnosis.

METHODS: The latter was available for 18 patients having been prospectively monitored in the Lille Memory Clinic (France) between 1993 and 2008.

RESULTS: The patients were diagnosed with progressive anarthria (n = 5), agrammatic progressive aphasia (n = 6), logopenic progressive aphasia (n = 1), progressive jargon aphasia (n = 2), typical semantic dementia (n = 2), and atypical semantic dementia (n = 2).

All patients with progressive anarthria had a tau pathology at postmortem evaluation: progressive supranuclear palsy (n = 2), Pick disease (n = 2), and corticobasal degeneration (n = 1).

All patients with agrammatic primary progressive aphasia had TDP-43-positive FTLD (FTLD-TDP).

The patients with logopenic progressive aphasia and progressive jargon aphasia had Alzheimer disease.

Both cases of typical semantic dementia had FTLD-TDP.

The patients with atypical semantic dementia had tau pathologies: argyrophilic grain disease and corticobasal degeneration.

CONCLUSIONS: The different anatomic distribution of the pathologic lesions could explain these results: opercular and subcortical regions in tau pathologies with progressive anarthria, the left frontotemporal cortex in TDP-43-positive frontotemporal lobar degeneration (FTLD-TDP) with agrammatic progressive aphasia, the bilateral lateral and anterior temporal cortex in FTLD-TDP or argyrophilic grain disease with semantic dementia, and the left parietotemporal cortex in Alzheimer disease with logopenic progressive aphasia or jargon aphasia. These correlations have to be confirmed in larger series.

PubMed ID#: 19940270 (see pubmed.gov for abstract only)

Robin’s note: I suggest looking up terms in wikipedia.