Degeneration of basal and limbic networks is a core feature of behavioural variant frontotemporal dementia

Vesna Vuksanovic, Roger Staff, Suzannah Morson, Trevor Ahearn, Luc Bracoud, Alison D Murray, Peter Bentham, Christopher M. Kipps, Charles Harrington, Claude Wischik* (Corresponding Author)

*Corresponding author for this work

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The behavioural variant of frontotemporal dementia is a clinical syndrome
characterised by changes in behaviour, cognition and functional ability. Although
atrophy in frontal and temporal regions would appear to be a defining feature,
neuroimaging studies have identified volumetric differences distributed across large parts of the cortex, giving rise to a classification into distinct neuroanatomical subtypes. Here, we extended these neuroimaging studies to examine how distributed patterns of cortical atrophy map onto brain network hubs. We used baseline structural magnetic resonance imaging data collected from 213 behavioural variant of frontotemporal dementia patients meeting consensus diagnostic criteria and having definite evidence of frontal and/or temporal lobe atrophy from a global clinical trial
conducted in 70 sites in Canada, United States of America, Australia, Asia and Europe. These were compared with data from 244 healthy elderly subjects from a well characterised cohort study. We have used statistical methods of hierarchical agglomerative clustering of 68 regional cortical and subcortical volumes (34 in each hemisphere) to determine the reproducibility of previously described neuroanatomical subtypes in a global study. We have also attempted to link the structural findings to clinical features defined systematically using well-validated clinical scales (Addenbrooke’s Cognitive Examination Revised, the Mini-Mental Status Examination, the Frontotemporal Dementia Rating Scale and the Functional Assessment Questionnaire) and subscales derived from them. Whilst we can confirm that the subtypes are robust, they have limited value in explaining the clinical heterogeneity of the syndrome. We have found that a common pattern of degeneration affecting a small number of subcortical, limbic and frontal nodes within highly connected networks (most previously identified as rich club members or functional binding nodes) is shared by all the anatomical subtypes. Degeneration in these core regions is correlated with cognitive and functional impairment, but less so with behavioural impairment. These findings suggest that degeneration in highly connected basal, limbic and frontal networks is a core feature of the behavioural variant of fronto temporal dementia phenotype irrespective of neuroanatomical and clinical heterogeneity, and may underly the impairment of integration in cognition, function
and behaviour responsible for the loss of insight that characterises the syndrome.
Original languageEnglish
Article number fcab241
Number of pages15
JournalBrain Communications
Issue number4
Publication statusPublished - 21 Oct 2021


  • behavioural variant frontotemporal dementia
  • brain networks
  • rich club
  • neurodegeneration
  • anatomical subtypes


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