title: Behavioral changes in early ALS correlate with voxel-based morphometry and diffusion tensor imaging.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a multisystem disorder with impairment of frontotemporal functions such as cognition and behavior, but the behavioral changes associated with ALS are not well defined.
  
  
  METHODS
  Twenty-one consecutive patients with sporadic ALS and 21 control subjects participated in the study. The Frontal System Behavior Scale (FrSBe) was used to assess behavioral change. Voxel-based morphometry (VBM) and voxel-based analysis of diffusion tensor images (DTI) were performed to explore the associations of brain degeneration with behavior. All patients were evaluated before the notification of ALS.
  
  
  RESULTS
  FrSBe scores of ALS patients before notification were significantly increased compared to those of control subjects. Moreover, the FrSBe Apathy score of ALS patients significantly changed from pre- to post-illness (P<0.001). The severity of apathy was significantly correlated with atrophy in the prefrontal cortex, especially in the orbitofrontal (P=0.006) and dorsolateral prefrontal (P=0.006) cortices in VBM, and in the right frontal gyrus (P<0.001) in DTI.
  
  
  CONCLUSIONS
  ALS patients exhibited apathy during the early course of the illness, the severity of which was significantly associated with frontal lobe involvement. These findings support the view that a continuum exits between ALS and frontotemporal dementia.
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Tsujimoto
authors.forename: Jo
authors.initials: J
authors.lastname: Senda
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ishihara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Niimi
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Kawai
authors.forename: Naoki
authors.initials: N
authors.lastname: Atsuta
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Watanabe
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology*; D001284:Atrophy; D015897:Comorbidity; D056324:Diffusion Tensor Imaging / Q000379:methods; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D057180:Frontotemporal Dementia / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index