Volume 84, Issue 5 pp. 729-740
Research Article

Prevalence of amyloid-β pathology in distinct variants of primary progressive aphasia

David Bergeron MD

Corresponding Author

David Bergeron MD

Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

Address correspondence to Dr Bergeron, Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques du CHU de Québec, 1401 18e Rue, Québec, QC G1J 1Z4, QC, Canada. E-mail: [email protected]Search for more papers by this author
Maria L. Gorno-Tempini MD, PhD

Maria L. Gorno-Tempini MD, PhD

Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA

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Gil D. Rabinovici MD, PhD

Gil D. Rabinovici MD, PhD

Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA

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Miguel A. Santos-Santos MD

Miguel A. Santos-Santos MD

Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA

Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, Llobregat Hospital, Barcelona, Spain

Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain

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William Seeley MD, PhD

William Seeley MD, PhD

Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA

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Bruce L. Miller MD

Bruce L. Miller MD

Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA

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Yolande Pijnenburg MD

Yolande Pijnenburg MD

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

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M. Antoinette Keulen PhD

M. Antoinette Keulen PhD

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

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Colin Groot MSc

Colin Groot MSc

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

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Bart N. M. van Berckel MD

Bart N. M. van Berckel MD

Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands

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Wiesje M. van der Flier PhD

Wiesje M. van der Flier PhD

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

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Philip Scheltens PhD

Philip Scheltens PhD

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

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Jonathan D. Rohrer MD

Jonathan D. Rohrer MD

Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom

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Jason D. Warren MD

Jason D. Warren MD

Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom

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Jonathan M. Schott MD

Jonathan M. Schott MD

Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom

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Nick C. Fox MD

Nick C. Fox MD

Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom

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Raquel Sanchez-Valle MD, PhD

Raquel Sanchez-Valle MD, PhD

Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain

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Oriol Grau-Rivera MD

Oriol Grau-Rivera MD

Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain

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Ellen Gelpi MD

Ellen Gelpi MD

Alzheimer's Disease and Other Cognitive Disorders Unit, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain

Institute of Neurology, Medical University of Vienna, Vienna, Austria

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Harro Seelaar MD

Harro Seelaar MD

Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands

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Janne M. Papma MD

Janne M. Papma MD

Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands

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John C. van Swieten MD

John C. van Swieten MD

Alzheimer Center, Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands

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John R. Hodges MD

John R. Hodges MD

Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia

Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia

Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia

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Cristian E. Leyton PhD

Cristian E. Leyton PhD

Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA

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Olivier Piguet PhD

Olivier Piguet PhD

Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia

Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia

Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia

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Emily J. Rogalski MD

Emily J. Rogalski MD

Neurological Sciences, Rush University, Chicago, IL

Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL

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Marsel M. Mesulam MD

Marsel M. Mesulam MD

Cognitive Neurology and Alzheimer Disease Center, Northwestern University Medical School, Chicago, IL

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Lejla Koric MD

Lejla Koric MD

Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France

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Nora Kristensen MD

Nora Kristensen MD

Department of Neurology and Neuropsychology, La Timone Hospital, Marseille, France

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Jeéreémie Pariente MD

Jeéreémie Pariente MD

University of Toulouse, INSERM, Toulouse Neuroimaging Center, Toulouse, France

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Bradford Dickerson MD, PhD

Bradford Dickerson MD, PhD

Frontotemporal Dementia Unit, Department of Neurology, Massachusetts Alzheimer's Disease Research Center, Harvard Medical School, Boston, MA

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Ian R. Mackenzie MD

Ian R. Mackenzie MD

Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

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Ging-Yuek R. Hsiung MD

Ging-Yuek R. Hsiung MD

Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

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Serge Belliard MD

Serge Belliard MD

Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

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David J. Irwin MD

David J. Irwin MD

Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA

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David A. Wolk MD

David A. Wolk MD

Department of Neurology, University of Pennsylvania, Philadelphia, PA

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Murray Grossman MD

Murray Grossman MD

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA

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Matthew Jones MD

Matthew Jones MD

Cerebral Function Unit, Greater Manchester Neurosciences Centre, Manchester, United Kingdom

School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom

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Jennifer Harris PhD

Jennifer Harris PhD

School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom

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David Mann PhD

David Mann PhD

Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom

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Julie S. Snowden PhD

Julie S. Snowden PhD

School of Community-Based Medicine, University of Manchester, Manchester, United Kingdom

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Patricio Chrem-Mendez MD

Patricio Chrem-Mendez MD

Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina

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Ismael L. Calandri MD

Ismael L. Calandri MD

Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina

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Alejandra A. Amengual MD

Alejandra A. Amengual MD

Center of Aging and Memory, Neurological Research Institute, Buenos Aires, Argentina

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Carole Miguet-Alfonsi MD

Carole Miguet-Alfonsi MD

Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France

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Eloi Magnin MD, PhD

Eloi Magnin MD, PhD

Department of Neurology, CHRU Besançon and Integrative and Clinical Neurosciences Laboratory, Regional Memory Center, University of Bourgogne Franche-Comté, Besançon, France

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Giuseppe Magnani MD

Giuseppe Magnani MD

Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy

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Roberto Santangelo MD

Roberto Santangelo MD

Department of Neurology, Vita Salute University and IRCCS San Raffaele Hospital, INSPE, Milan, Italy

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Vincent Deramecourt MD

Vincent Deramecourt MD

University of Lille Nord de France, INSERM U1171, DISTALZ, Lille, France

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Florence Pasquier MD

Florence Pasquier MD

University of Lille Nord de France, INSERM U1171, DISTALZ, Lille, France

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Niklas Mattsson MD, PhD

Niklas Mattsson MD, PhD

Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

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Christer Nilsson MD, PhD

Christer Nilsson MD, PhD

Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

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Oskar Hansson MD, PhD

Oskar Hansson MD, PhD

Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

Neuropsychiatric Clinic, Skåne University Hospital, Malmö, Sweden

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Julia Keith MD

Julia Keith MD

Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Mario Masellis MD

Mario Masellis MD

Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Sandra E. Black MD

Sandra E. Black MD

Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Jordi A. Matías-Guiu MD

Jordi A. Matías-Guiu MD

Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain

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María-Nieves Cabrera-Martin MD

María-Nieves Cabrera-Martin MD

Department of Neurology and Nuclear Medicine, San Carlos Clinical Hospital, San Carlos Health Research Institute, Complutense University of Madrid, Madrid, Spain

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Claire Paquet MD

Claire Paquet MD

Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France

Department of Pathology, Lariboisière-Fernand-Widal Hospital, Paris, France

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Julien Dumurgier MD

Julien Dumurgier MD

Memory Center, Department of Neurology, Lariboisière-Fernand-Widal Hospital, Paris, France

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Marc Teichmann MD

Marc Teichmann MD

Department of Neurology, National Reference Center for PPA and rare dementias, Pitié Salpêtriére Hospital, AP-HP, Paris, France

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Marie Sarazin MD

Marie Sarazin MD

Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France

University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France

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Michel Bottlaender MD

Michel Bottlaender MD

Frederic Joliot Hospital Service, ERL 9218 CNRS, CEA, Orsay, Île-de-France, France

University of Paris-Sud, IMIV, UMR 1023 INSERM, CEA, Orsay, Île-de-France, France

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Bruno Dubois MD

Bruno Dubois MD

Center for Cognitive and Behavioral Diseases, Pitié Salpêtrière University Hospital, Paris, France

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Christopher C. Rowe MD

Christopher C. Rowe MD

Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia

Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia

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Victor L. Villemagne MD

Victor L. Villemagne MD

Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia

Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia

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Rik Vandenberghe MD

Rik Vandenberghe MD

Department of Neurology, University Hospital Leuven, Leuven, Belgium

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Elias Granadillo MD

Elias Granadillo MD

Department of Neurology, University of California, Los Angeles, Los Angeles, CA

VA Greater Los Angeles Healthcare System, Los Angeles, CA

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Edmond Teng MD, PhD

Edmond Teng MD, PhD

Neurobehavior Service, Department of Neurology, University of California, Los Angeles, Los Angeles, CA

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Mario Mendez MD, PhD

Mario Mendez MD, PhD

Neurobehavior Unit, West Los Angeles VA Medical Center, Los Angeles, CA

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Philipp T. Meyer MD

Philipp T. Meyer MD

Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany

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Lars Frings PhD

Lars Frings PhD

Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Freiburg, Freiburg, Germany

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Alberto Lleó MD

Alberto Lleó MD

Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain

Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain

Center for Biomedical Network Research on Neurodegenerative Diseases, Madrid, Spain

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Rafael Blesa MD

Rafael Blesa MD

Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain

Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain

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Juan Fortea MD

Juan Fortea MD

Memory Unit, Department of Neurology, Santa Cruz and Saint Paul Hospital, Barcelona, Spain

Saint Paul Biomedical Research Institute, Autonomous University of Barcelona, Barcelona, Spain

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Sang Won Seo MD

Sang Won Seo MD

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

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Janine Diehl-Schmid MD

Janine Diehl-Schmid MD

Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany

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Timo Grimmer MD

Timo Grimmer MD

Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany

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Kristian Steen Frederiksen MD

Kristian Steen Frederiksen MD

Department of Neurology, Danish Dementia Research Center, Copenhagen, Denmark

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Pascual Sánchez-Juan MD

Pascual Sánchez-Juan MD

Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain

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Gaël Chételat MD

Gaël Chételat MD

INSERM UMR-S U1237, University of Caen Normandy, Caen, France

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Willemijn Jansen MD

Willemijn Jansen MD

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands

Banner Alzheimer's Institute, Phoenix, AZ

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Rémi W. Bouchard MD

Rémi W. Bouchard MD

Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada

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Robert Jr. Laforce MD, PhD

Robert Jr. Laforce MD, PhD

Interdisciplinary Clinic of Memory of the Child Jesus, Laval University, Quebec City, Quebec, Canada

Clinique Interdisciplinaire de Mémoire de l'Enfant-Jésus, CHU de Québec, Université Laval, Québec, Canada

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Pieter Jelle Visser PhD

Pieter Jelle Visser PhD

Llobregat Hospital, ACE Foundation, Catalan Institute of Applied Neurosciences, UIC Barcelona, Barcelona, Spain

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands

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Rik Ossenkoppele PhD

Rik Ossenkoppele PhD

Alzheimer center Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands

Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

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First published: 26 September 2018
Citations: 159

Abstract

Objective

To estimate the prevalence of amyloid positivity, defined by positron emission tomography (PET)/cerebrospinal fluid (CSF) biomarkers and/or neuropathological examination, in primary progressive aphasia (PPA) variants.

Methods

We conducted a meta-analysis with individual participant data from 1,251 patients diagnosed with PPA (including logopenic [lvPPA, n = 443], nonfluent [nfvPPA, n = 333], semantic [svPPA, n = 401], and mixed/unclassifiable [n = 74] variants of PPA) from 36 centers, with a measure of amyloid-β pathology (CSF [n = 600], PET [n = 366], and/or autopsy [n = 378]) available. The estimated prevalence of amyloid positivity according to PPA variant, age, and apolipoprotein E (ApoE) ε4 status was determined using generalized estimating equation models.

Results

Amyloid-β positivity was more prevalent in lvPPA (86%) than in nfvPPA (20%) or svPPA (16%; p < 0.001). Prevalence of amyloid-β positivity increased with age in nfvPPA (from 10% at age 50 years to 27% at age 80 years, p < 0.01) and svPPA (from 6% at age 50 years to 32% at age 80 years, p < 0.001), but not in lvPPA (p = 0.94). Across PPA variants, ApoE ε4 carriers were more often amyloid-β positive (58.0%) than noncarriers (35.0%, p < 0.001). Autopsy data revealed Alzheimer disease pathology as the most common pathologic diagnosis in lvPPA (76%), frontotemporal lobar degeneration–TDP-43 in svPPA (80%), and frontotemporal lobar degeneration–TDP-43/tau in nfvPPA (64%).

Interpretation

This study shows that the current PPA classification system helps to predict underlying pathology across different cohorts and clinical settings, and suggests that age and ApoE genotype should be considered when interpreting amyloid-β biomarkers in PPA patients. Ann Neurol 2018;84:737–748

Potential Conflicts of Interest

Nothing to report.

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