Neural correlates of the DemTect in Alzheimer's disease and frontotemporal lobar degeneration - A combined MRI & FDG-PET study

Neuroimage Clin. 2013 May 27;2:746-58. doi: 10.1016/j.nicl.2013.05.008. eCollection 2013.

Abstract

Valid screening devices are critical for an early diagnosis of dementia. The DemTect is such an internationally accepted tool. We aimed to characterize the neural networks associated with performance on the DemTect's subtests in two frequent dementia syndromes: early Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). Voxel-based group comparisons of cerebral glucose utilization (as measured by F-18-fluorodeoxyglucose positron emission tomography) and gray matter atrophy (as measured by structural magnetic resonance imaging) were performed on data from 48 subjects with AD (n = 21), FTLD (n = 14) or subjective cognitive impairment (n = 13) as a control group. We performed group comparisons and correlation analyses between multimodal imaging data and performance on the DemTect's subtests. Group comparisons showed regional patterns consistent with previous findings for AD and FTLD. Interestingly, atrophy dominated in FTLD, whereas hypometabolism in AD. Across diagnostic groups performance on the "wordlist" subtest was positively correlated with glucose metabolism in the left temporal lobe. The "number transcoding" subtest was significantly associated with glucose metabolism in both a predominantly left lateralized frontotemporal network and a parietooccipital network including parts of the basal ganglia. Moreover, this subtest was associated with gray matter density in an extensive network including frontal, temporal, parietal and occipital areas. No significant correlates were observed for the "supermarket task" subtest. Scores on the "digit span reverse" subtest correlated with glucose metabolism in the left frontal cortex, the bilateral putamen, the head of caudate nucleus and the anterior insula. Disease-specific correlation analyses could partly verify or extend the correlates shown in the analyses across diagnostic groups. Correlates of gray matter density were found in FTLD for the "number transcoding" subtest and the "digit span reverse" subtest. Correlates of glucose metabolism were found in AD for the "wordlist" subtest and in FTLD for the "digit span reverse" subtest. Our study contributes to the understanding of the neural correlates of cognitive deficits in AD and FTLD and supports an external validation of the DemTect providing preliminary conclusions about disease-specific correlates.

Keywords: AD, Alzheimer's disease; ANOVA, Analysis of variance; Alzheimer's disease; BA, Brodmann area; CDR, Clinical dementia rating scale; DARTEL, Diffeomorphic anatomical registration through exponentiated lie algebra; DemTect; FDG-PET; FDG-PET, F-18-fluorodeoxyglucose positron emission tomography; FTLD, Frontotemporal lobar degeneration; Frontotemporal lobar degeneration; MMSE, Mini-Mental State Examination; MNI, Montreal Neurological Institute; MRI; MRI, Magnetic resonance imaging; PVE, Partial volume effects; SPM, Statistical parametric mapping; Voxel based morphometry.