title: Neuropathologic heterogeneity in HDDD1: a familial frontotemporal lobar degeneration with ubiquitin-positive inclusions and progranulin mutation.
abstract: Hereditary dysphasic disinhibition dementia (HDDD) describes a familial disorder characterized by personality changes, and language and memory deficits. The neuropathology includes frontotemporal lobar atrophy, neuronal loss and gliosis and, in most cases, abundant Abeta plaques and neurofibrillary tangles (NFTs). A Pick/Alzheimer's spectrum was proposed for the original family (HDDD1). Here we report the clinicopathologic case of an HDDD1 individual using modern immunohistochemical methods, contemporary neuropathologic diagnostic criteria to distinguish different frontotemporal lobar degenerations (FTLDs), and progranulin (PRGN) mutation analysis. Clinical onset was at age 62 years with personality changes and disinhibition, followed by nonfluent dysphasia, and memory loss that progressed to muteness and total dependence with death at age 84 years. There was severe generalized brain atrophy (weight=570 g). Histopathology showed superficial microvacuolation, marked neuronal loss, gliosis, and ubiquitin-positive, tau-negative cytoplasmic and intranuclear neuronal inclusions in frontal, temporal, and parietal cortices. There were also frequent neuritic plaques and NFTs in parietal and occipital cortices. The case met neuropathologic criteria for both FTLD with ubiquitin-positive, tau-negative inclusions (FTLD-U), and Alzheimer disease (Braak NFT stage V). We discovered a novel pathogenic PGRN mutation c.5913 A>G (IVS6-2 A>G) segregating with FTLD-U in this kindred. In conclusion, HDDD1 is an FTLD-U caused by a PGRN mutation and is neuropathologically heterogeneous with Alzheimer disease as a common comorbidity.
authors.affiliation: Alzheimer's Disease Research Center, Department of Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Behrens
authors.forename: Odity
authors.initials: O
authors.lastname: Mukherjee
authors.forename: Pang-hsien
authors.initials: PH
authors.lastname: Tu
authors.forename: Rajka M
authors.initials: RM
authors.lastname: Liscic
authors.forename: Lea Tenenholz
authors.initials: LT
authors.lastname: Grinberg
authors.forename: Deborah
authors.initials: D
authors.lastname: Carter
authors.forename: Katherine
authors.initials: K
authors.lastname: Paulsmeyer
authors.forename: Lisa
authors.initials: L
authors.lastname: Taylor-Reinwald
authors.forename: Michael
authors.initials: M
authors.lastname: Gitcho
authors.forename: Joanne B
authors.initials: JB
authors.lastname: Norton
authors.forename: Sumi
authors.initials: S
authors.lastname: Chakraverty
authors.forename: Alison M
authors.initials: AM
authors.lastname: Goate
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Cairns
mesh_terms: D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000235:genetics / Q000473:pathology; D001921:Brain / Q000473:pathology*; D003704:Dementia / Q000209:etiology / Q000235:genetics / Q000473:pathology; D005260:Female; D020271:Heredodegenerative Disorders, Nervous System / Q000235:genetics* / Q000473:pathology* / Q000523:psychology; D006801:Humans; D007266:Inhibition, Psychological; D036341:Intercellular Signaling Peptides and Proteins / Q000235:genetics*; D009154:Mutation / Q000235:genetics*; D010375:Pedigree; D010554:Personality Disorders / Q000209:etiology / Q000235:genetics / Q000473:pathology; D000077153:Progranulins; D025801:Ubiquitin / Q000235:genetics*
chemical_list: C492314:GRN protein, human; D036341:Intercellular Signaling Peptides and Proteins; D000077153:Progranulins; D025801:Ubiquitin