Clinical and Neuropsychological Comparisons of Early-Onset Versus Late-Onset Frontotemporal Dementia: A CREDOS-FTD Study

Article type: Research Article

Authors: Ye, Byoung Seok^a | Choi, Seong Hye^b | Han, Seol-Heui^c | Kim, SangYun^d | Yang, Dong-Won^e | Park, Kee Hyung^f | Han, Hyun Jeong^g | Youn, Young Chul^h | Choi, Byung-Okⁱ | Kim, Seung H.^j | Woo, Sook-young^k | Na, Duk L.ⁱ | Kim, Eun-Joo^{l; *}

Affiliations: [a] Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea | [b] Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea | [c] Department of Neurology, Konkuk University College of Medicine, Seoul, Republic of Korea | [d] Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea | [e] Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea | [f] Department of Neurology, Gachon University Gil Hospital, Incheon, Republic of Korea | [g] Department of Neurology, Myongji Hospital, College of Medicine, Kwandong University, Goyang, Republic of Korea | [h] Department of Neurology, Chung-Ang University, Seoul, Republic of Korea | [i] Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea | [j] Department of Neurology, Hanyang University College of Medicine, Seoul, Korea | [k] Biostatistics team, Samsung Biomedical Research Institute, Seoul, Korea | [l] Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea

Correspondence: [*] Correspondence to: Eun-Joo Kim, MD, Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739 Korea. Tel.: +82 51 240 7829; Fax: +82 51 245 2783; E-mail: [email protected].

Abstract: Background:Cognitive performance changes with chronological aging. Previous studies investigating clinical heterogeneity in frontotemporal dementia (FTD) according to the age of symptom onset did not consider the effect of chronological aging on cognition. Objective:We compared cognitive and behavioral symptoms in patients with early-onset (EO) and late-onset (LO) FTD with consideration of chronological aging effect. Methods:A total of 166 FTD patients were enrolled consecutively from multi-center memory clinics using a nationwide FTD register. To control for the effects of chronological aging on neuropsychological scores, seven hundred and two subjects with normal cognition were also enrolled and regression models were set up. Neuropsychological scores that were detrended with the regression models and the behavioral symptoms of the EO-FTD and LO-FTD groups were compared. Subgroup analyses were performed for three main subtypes of FTD, behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SD), and progressive non-fluent aphasia (PNFA). Results:Among 166 FTD patients, there were 76 bvFTD, 57 SD, and 33 PNFA patients who met new diagnostic criteria for bvFTD or primary progressive aphasia, respectively. LO-FTD (48.2%) was more common than previously thought and the proportions of EO and LO groups differed across FTD subtypes. EO-FTD patients had lower memory and frontal/executive scores and more prominent frontal/behavioral symptoms than LO-FTD patients. Conclusion:Our study suggested that FTD could be heterogeneous with respect the age of symptom onset. After controlling for the effects of chronological aging, EO-FTD patients exhibited more profound memory and frontal/executive dysfunction and more behavioral symptoms than LO-FTD patients.

Keywords: Age at symptom onset, behavior, frontotemporal dementia, neuropsychology

DOI: 10.3233/JAD-141044

Journal: Journal of Alzheimer's Disease, vol. 45, no. 2, pp. 599-608, 2015