Differential Diagnosis of Behavioral Variant and Semantic Variant of Frontotemporal Dementia Using Visual Rating Scales

Stamo Manouvelou; Vasilios Koutoulidis; Ioannis Tsougos; Maria Tolia; George Kyrgias; Georgios Anyfantakis; Lia-Angela Moulopoulos; Athanasios Gouliamos; Sokratis Papageorgiou

doi:10.2174/1573405615666190225154834

Differential Diagnosis of Behavioral Variant and Semantic Variant of Frontotemporal Dementia Using Visual Rating Scales

Curr Med Imaging. 2020;16(4):444-451. doi: 10.2174/1573405615666190225154834.

Authors

Stamo Manouvelou¹, Vasilios Koutoulidis², Ioannis Tsougos³, Maria Tolia⁴, George Kyrgias⁴, Georgios Anyfantakis², Lia-Angela Moulopoulos², Athanasios Gouliamos², Sokratis Papageorgiou¹

Affiliations

¹ 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 72- 74 Vasilissis Sofias, 11528, Athens, Greece.
² 1st Department of Radiology, University of Athens Medical School, Aretaieion University Hospital, Vassilissis Sofias 76, 115 28 Athens, Greece.
³ Medical Physics Department, Faculty of Medicine, University of Thessaly, Biopolis, Larissa 41110, Greece.
⁴ Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larisa, Greece.

PMID: 32410545
DOI: 10.2174/1573405615666190225154834

Abstract

Background: Frontotemporal dementia (FTD) represents the second most frequent early onset of dementia in people younger than 65 years. The main syndromes encompassed by the term FTD are behavioral variant of Frontotemporal dementia (bvFTD), non-fluent variant primary progressive aphasia (nfvPPA) and semantic variant (SD).

Aims: To assess the bvFTD and SD, which represent the most common subtypes of FTD, using visual rating scales.

Methods: Brain MRI exams of 77 patients either with bvFTD (n=43) or SD (n=34) were evaluated. The rating scales used were: Global cortical atrophy (GCA), Fazekas Scale: periventricular (PV) and white matter (WM) changes, Koedam rating scale and visual scales regarding specific cortical regions: dorsofrontal (DF), orbitofrontal (OF), anterior cingulate (AC), basal ganglia (BG), anterior- temporal (AT), insula, lateral-temporal (LT), entorhinal (ERC), perirhinal (PRC), anterior fusiform( AF), anterior hippocampus (AHIP) and posterior hippocampus (PHIP). Both Left (L) and Right (R) hemispheres were evaluated.

Results: R-OF (p=0.059), L-OF (p<0.0005), L-AT (p=0.047) and L-AHIP (p=0.007) have a statistically significant effect on the variable occurrence of SD compared to bvFTD. The indicators with the highest value of the area under the curve (AUC) were R-AC (0.829), L-OF (0.808), L-AC (0.791) and L-AF (0.778). Highest sensitivity was achieved by R-OF (97%) and L-AF (75%). Highest specificity was achieved by L-OF (95%), L-AT (91%) followed by R-AC (84%). Best combination of sensitivity and specificity was achieved by L-AF (74%-79%), L-OF (56%-95%) and R-OF (97%-42%). Best combination of PPV and NPV was achieved by L-OF (90%-73%), LAT (83%-72%) and R-AC (77%-77%).

Conclusion: Visual rating scales can be a practical diagnostic tool in the characterization of patterns of atrophy in FTLD and may be used as an alternative to highly technical methods of quantification.

Keywords: FTD; SD; bvFTD; global cortical atrophy; semantic variant; visual rating scales..

MeSH terms

Atrophy
Brain / diagnostic imaging
Brain / pathology
Brain Mapping / methods*
Diagnosis, Differential
Female
Frontotemporal Dementia / diagnostic imaging*
Frontotemporal Dementia / pathology*
Humans
Image Interpretation, Computer-Assisted / methods*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Neuropsychological Tests
Observer Variation
Reproducibility of Results
Semantics