Frontotemporal dementia associated with the C9ORF72 mutation: a unique clinical profile.
OBJECTIVE
While advances have been made in characterizing the C9ORF72 clinical phenotype, the hallmark features that discriminate between carriers and noncarriers remain unclear.


OBJECTIVE
To determine the frequency of the C9ORF72 mutation in a frontotemporal dementia (FTD) cohort and to define the clinical, neuropsychological, behavioral, and imaging features of C9ORF72 mutation carriers in comparison with noncarriers in a well-defined behavioral-variant (bv)-FTD cohort.


METHODS
A prospective cohort study of patients assessed during a 5-year period from January 1, 2008, to December 31, 2012, at an FTD specialist referral center (FRONTIER). A total of 114 consecutive patients with FTD, FTD-amyotrophic lateral sclerosis (ALS), and corticobasal syndrome were assessed at FRONTIER. Patients with bvFTD who carried the C9ORF72 mutation (n = 10) were compared with noncarriers (n = 19) and a healthy control group (n = 35). These were matched for age, sex, and education history. Blood sampling for gene analysis was performed after informed consent was obtained.


METHODS
Clinical, behavioral, cognitive, and neuropsychological deficits, cortical atrophy on a magnetic resonance imaging visual rating scale, and family history as quantified by the Goldman Scale.


RESULTS
In a cohort of 114 FTD cases, 14 patients expressed the C9ORF72 mutation, representing a frequency rate of 34% in bvFTD and 17% in FTD-ALS. Family histories of ALS (P = .001) and psychiatric disorders (P = .02) were significantly more common in mutation carriers. The C9ORF72 carriers were also more likely to experience psychotic symptoms (P = .03). The degree of brain atrophy was significantly less in the C9ORF72 cohort, and in many the progression was slow. Presenting features of C9ORF72 carriers were compared against International Consensus Diagnostic Criteria for bvFTD, and most cases failed to satisfy criteria for probable bvFTD.


CONCLUSIONS
The C9ORF72 mutation appears to be a common cause of bvFTD. Many of the C9ORF72 carriers have a family history of ALS or psychiatric illness. Psychotic features emerged as the most discriminating clinical feature between mutation carriers and noncarriers. Progression is often slow and brain atrophy is less pronounced than in nonmutation cases of bvFTD. These findings have clinical relevance for both diagnosis and selection of patients for genetic testing.
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia2Neuroscience Research Australia, Sydney, Australia.
Emma
E
Devenney
Neuroscience Research Australia, Sydney, Australia3School of Medical Sciences, University of New South Wales, Sydney, Australia.
Michael
M
Hornberger
Neuroscience Research Australia, Sydney, Australia4School of Psychology, University of New South Wales, Sydney, Australia.
Muireann
M
Irish
Neuroscience Research Australia, Sydney, Australia3School of Medical Sciences, University of New South Wales, Sydney, Australia.
Eneida
E
Mioshi
Neuroscience Research Australia, Sydney, Australia3School of Medical Sciences, University of New South Wales, Sydney, Australia.
James
J
Burrell
Neuroscience Research Australia, Sydney, Australia3School of Medical Sciences, University of New South Wales, Sydney, Australia.
Rachel
R
Tan
Neuroscience Research Australia, Sydney, Australia5Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
Matthew C
MC
Kiernan
Neuroscience Research Australia, Sydney, Australia3School of Medical Sciences, University of New South Wales, Sydney, Australia.
John R
JR
Hodges
D000690:Amyotrophic Lateral Sclerosis / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D001284:Atrophy; D000073885:C9orf72 Protein; D018450:Disease Progression; D057180:Frontotemporal Dementia / Q000145:classification* / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology; D014644:Genetic Variation; D006801:Humans; D009154:Mutation / Q000235:genetics; D011446:Prospective Studies; D011506:Proteins / Q000235:genetics*; D011618:Psychotic Disorders / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index
D000073885:C9orf72 Protein; C568651:C9orf72 protein, human; D011506:Proteins