Frequency and Longitudinal Course of Motor Signs in Genetic Frontotemporal Dementia
Sonja Schönecker, Francisco J. Martínez-Murcia, Boris‐Stephan Rauchmann, Nicolai Franzmeier, Catharina Prix, Elisabeth Wlasich, Sandra Loosli, Katja Bochmann, J. M. Górriz, Robert Laforce, Simon Ducharme, Maria Carmela Tartaglia, Elizabeth Finger, Alexandre de Mendonça, Isabel Santana, Raquel Sánchez‐Valle, Fermín Moreno, Sandro Sorbi, Fabrizio Tagliavini, Barbara Borroni, Markus Otto, Matthis Synofzik, Daniela Galimberti, Rik Vandenberghe, John C. van Swieten, Christopher Butler, Alexander Gerhard, Caroline Graff, Adrian Danek, Jonathan D. Rohrer, Mario Masellis, James B. Rowe, Johannes Levin, on behalf of The Genetic Frontotemporal Dementia Initiative (GENFI), Sónia Afonso, Maria Rosario Almeida, Sarah Anderl-Straub, Christin Andersson, Anna Antonell, Silvana Archetti, Andrea Arighi, Mircea Balasa, Myriam Barandiaran, Nuria Bargalló, Robart Bartha, Benjamin Bender, Alberto Benussi, Luisa Benussi, Valentina Bessi, Giuliano Binetti, Sandra Black, Martina Bocchetta, Sergi Borrego-Ecija, Jose Bras, Rose Bruffaerts, Marta Cañada, Valentina Cantoni, Paola Caroppo, David Cash, Miguel Castelo-Branco, Rhian Convery, Thomas Cope, Maura Cosseddu, María de Arriba, Giuseppe Di Fede, Zigor Díaz, Alina Díez, Diana Duro, Chiara Fenoglio, Camilla Ferrari, Carlos Ferreira, Catarina B. Ferreira, Toby Flanagan, Nick C. Fox, Giorgio Fumagalli, Alazne Gabilondo, Roberto Gasparotti, Serge Gauthier, Stefano Gazzina, Giorgio Giaccone, Ana Gorostidi, Caroline Greaves, Rita Guerreiro, Carolin Heller, Tobias Hoegen, Begoña Indakoetxea, Vesna Jelic, Lize Jiskoot, Hans-Otto Karnath, Ron Keren, Tobias Langheinrich, Maria João Leitão, Albert Lladó, Gemma Lombardi, Carolina Maruta, Simon Mead, Lieke Meeter, Gabriel Miltenberger, Rick van Minkelen, Sara Mitchell
Abstract
<h3>Background and Objectives</h3> Frontotemporal dementia (FTD) is a highly heritable disorder. The majority of genetic cases are caused by autosomal dominant pathogenic variants in the chromosome 9 open reading frame 72 (<i>c9orf72</i>), progranulin (<i>GRN</i>), and microtubule-associated protein tau (<i>MAPT</i>) gene. As motor disorders are increasingly recognized as part of the clinical spectrum, the current study aimed to describe motor phenotypes caused by genetic FTD, quantify their temporal association, and investigate their regional association with brain atrophy. <h3>Methods</h3> We analyzed baseline visit data of known carriers of a pathogenic variant in the <i>c9orf72</i>, <i>GRN</i>, or <i>MAPT</i> gene from the Genetic Frontotemporal Dementia Initiative cohort study. Principal component analysis with varimax rotation was performed to identify motor sign clusters that were compared with respect to frequency and severity between groups. Associations with cross-sectional atrophy patterns were determined using voxel-wise regression. We applied linear mixed effects models to assess whether groups differed in the association between motor signs and estimated time to symptom onset. <h3>Results</h3> A total of 322 pathogenic variant carriers were included in the analysis: 122 <i>c9orf72</i> (79 presymptomatic), 143 <i>GRN</i> (112 presymptomatic), and 57 <i>MAPT</i> (43 presymptomatic) pathogenic variant carriers. Principal component analysis revealed 5 motor clusters, which we call progressive supranuclear palsy (PSP)-like, bulbar amyotrophic lateral sclerosis (ALS)-like, mixed/ALS-like, Parkinson disease (PD) like, and corticobasal syndrome–like motor phenotypes. There was no significant group difference in the frequency of signs of different motor phenotypes. However, mixed/ALS-like motor signs were most frequent, followed by PD-like motor signs. Although the PSP-like phenotype was associated with mesencephalic atrophy, the mixed/ALS-like phenotype was associated with motor cortex and corticospinal tract atrophy. The PD-like phenotype was associated with widespread cortical and subcortical atrophy. Estimated time to onset, genetic group and their interaction influenced motor signs. In <i>c9orf72</i> pathogenic variant carriers, motor signs could be detected up to 25 years before expected symptom onset. <h3>Discussion</h3> These results indicate the presence of multiple natural clusters of motor signs in genetic FTD, each correlated with specific atrophy patterns. Their motor severity depends on time and the affected gene. These clinicogenetic associations can guide diagnostic evaluations and the design of clinical trials for new disease-modifying and preventive treatments.