title: Structural and functional brain connectivity in presymptomatic familial frontotemporal dementia.
abstract: OBJECTIVE
  We aimed to investigate whether cognitive deficits and structural and functional connectivity changes can be detected before symptom onset in a large cohort of carriers of MAPT (microtubule-associated protein tau) or GRN (progranulin) mutations.
  
  
  METHODS
  In this case-control study, 75 healthy individuals (aged 20-70 years) with 50% risk of frontotemporal dementia (FTD) underwent DNA screening, neuropsychological assessment, structural MRI, and fMRI. We used voxel-based morphometry and tract-based spatial statistics for voxel-wise analyses of gray matter volume and diffusion tensor imaging measures. Using resting-state fMRI scans, we assessed whole-brain functional connectivity to frontoinsular, anterior midcingulate, and posterior cingulate cortices.
  
  
  RESULTS
  Carriers (n = 39) and noncarriers (n = 36) had similar neuropsychological performance, except for lower Letter Digit Substitution Test scores in carriers. Worse performance on Stroop III, Rivermead Behavioral Memory Test, and Happé Cartoons correlated with higher age in carriers, but not controls. Reduced fractional anisotropy in the right uncinate fasciculus was found in carriers compared with controls. Reductions in functional connectivity between anterior midcingulate cortex and frontoinsula and several other brain regions were found in carriers compared with controls and correlated with higher age in carriers, but not controls. We found no significant differences or age correlations in posterior cingulate cortex connectivity. No differences in regional gray matter volume were found, except for a small cluster of higher volume in the precentral gyrus in carriers.
  
  
  CONCLUSIONS
  This study demonstrates that alterations in structural and functional connectivity develop before the first symptoms of FTD arise. These findings suggest that diffusion tensor imaging and resting-state fMRI may have the potential to become sensitive biomarkers for early FTD in future clinical trials.
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Elise G P
authors.initials: EG
authors.lastname: Dopper
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Serge A R B
authors.initials: SA
authors.lastname: Rombouts
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Lize C
authors.initials: LC
authors.lastname: Jiskoot
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Tom
authors.initials: T
authors.lastname: den Heijer
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: J Roos A
authors.initials: JR
authors.lastname: de Graaf
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Inge
authors.initials: I
authors.lastname: de Koning
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Anke R
authors.initials: AR
authors.lastname: Hammerschlag
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Harro
authors.initials: H
authors.lastname: Seelaar
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: William W
authors.initials: WW
authors.lastname: Seeley
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Ilya M
authors.initials: IM
authors.lastname: Veer
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Rizzu
authors.affiliation: From the Departments of Neurology (E.G.P.D., L.C.J., T.d.H., H.S., J.C.v.S.), Epidemiology (T.d.H.), and Neuropsychology (J.R.A.d.G., I.d.K.), Erasmus Medical Center, Rotterdam; Department of Radiology (E.G.P.D., S.A.R.B.R., I.M.V., M.A.v.B.), Leiden University Medical Center; Departments of Neurology (E.G.P.D.) and Clinical Genetics (A.R.H., P.R., J.C.v.S.), VU Medical Center, Amsterdam; Leiden Institute for Brain and Cognition (S.A.R.B.R., I.M.V., M.A.v.B.) and Institute of Psychology (S.A.R.B.R., I.M.V.), Leiden University; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam, the Netherlands; and Department of Neurology (W.W.S.) and Memory and Aging Center (W.W.S.), University of California, San Francisco. j.c.vanswieten@erasmusmc.nl.
authors.forename: John C
authors.initials: JC
authors.lastname: van Swieten
mesh_terms: D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology; D056324:Diffusion Tensor Imaging; D004522:Educational Status; D056344:Executive Function / Q000502:physiology; D005260:Female; D057180:Frontotemporal Dementia / Q000473:pathology* / Q000523:psychology; D006579:Heterozygote; D006801:Humans; D007091:Image Processing, Computer-Assisted; D036341:Intercellular Signaling Peptides and Proteins / Q000235:genetics; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology*; D009483:Neuropsychological Tests; D000077153:Progranulins; D013028:Space Perception; D055815:Young Adult; D016875:tau Proteins / Q000235:genetics / Q000378:metabolism
chemical_list: C492314:GRN protein, human; D036341:Intercellular Signaling Peptides and Proteins; C054369:MAPT protein, human; D000077153:Progranulins; D016875:tau Proteins