Apraxia screening predicts Alzheimer pathology in frontotemporal dementia

J Neurol Neurosurg Psychiatry. 2019 May;90(5):562-569. doi: 10.1136/jnnp-2018-318470. Epub 2018 Oct 10.

Abstract

Objectives: Frontotemporal dementia (FTD) is a heterogeneous clinical syndrome linked to diverse types of underlying neuropathology. Diagnosis is mainly based on clinical presentation and accurate prediction of underlying neuropathology remains difficult.

Methods: We present a large cohort of patients with FTD spectrum diseases (n=84). All patients were thoroughly characterised by cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers, neuroimaging, neuropsychological testing and standardised apraxia screening.

Results: A potential AD pathology was found in 43% of patients with FTD. CSF AD biomarker levels positively correlated with AD-typical apraxia scores in patients with FTD. The discriminative power of apraxia test results indicative of AD pathology was high (sensitivity: 90%, specificity: 66%).

Conclusions: Apraxia is common in neurodegenerative dementias but under-represented in clinical workup and diagnostic criteria. Standardised apraxia screening may serve as bedside test to objectify an AD-typical apraxia profile as an early and robust sign of AD pathology in patients with FTD.

Keywords: Alzheimer’s disease; amyloid pathology; apraxia; biomarker; default mode network; frontotemporal dementia; primary progressive aphasia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / complications
  • Alzheimer Disease / pathology*
  • Amyloid beta-Peptides
  • Apraxias / diagnosis*
  • Apraxias / etiology
  • Biomarkers / cerebrospinal fluid
  • Cohort Studies
  • Female
  • Frontotemporal Dementia / complications*
  • Frontotemporal Dementia / pathology
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • tau Proteins / cerebrospinal fluid

Substances

  • Amyloid beta-Peptides
  • Biomarkers
  • tau Proteins