Factors influencing accelerated progression in behavioral variant frontotemporal dementia.
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Split Molly, Kunicki Zachary J, Ross Daliah, Keszycki Rachel, Prieto Sarah, Manoochehri Masood, De Vito Alyssa N, Appleby Brian, Hales Chadwick M, Onyike Chiadi, McMillan Corey T, Clark David, Irwin David, Knopman David, Galasko Douglas R, Wint Dylan, Roberson Erik D, Léger Gabriel C, Hsiung Ging-Yuek Robin, Heuer Hilary W, Rosen Howard J, Grant Ian M, Mackenzie Ian R, Litvan Irene, Kornak John, Kwan Justin, Rascovsky Katya, Domoto-Reilly Kimiko, Massimo Lauren, Honig Lawrence S, Forsberg Leah K, Tartaglia M Carmela, Mendez Mario F, Graff-Radford Neill, Ghoshal Nupur, Ljubenkov Peter, Darby R Ryan, Barmada Sami, Weintraub Sandra, Lee Suzee, Sullivan A Campbell, Boxer Adam, Staffaroni Adam M, Snyder Allison, Bozoki Andrea, Pascual Belen, Dickerson Bradford C, Boeve Bradley F, Huey Edward D, Barker Megan
Аннотация
METHODS: 192 participants were classified as having mild or moderate disease severity based on CDR + NACC FTLD global scores, with scores of 0.5 or 1.0 defined as mild (n = 106) and 2.0 as moderate (n = 86). Participants were further categorized as having accelerated (mild: n = 35; moderate: n = 32) or non-accelerated (mild: n = 71; moderate: n = 54) progression rates based on change in CDR + NACC FTLD-SB sum of boxes (SB) scores (≥ 3.5 points) between Visit 1 and 2. Random forest modeling and logistic regression identified features most predictive of accelerated progression within each group.
RESULTS: In mild bvFTD, episodic memory impairment and presence of frontal-behavioral neuropsychiatric symptoms were predictive of accelerated progression, whereas in moderate bvFTD, language impairments and motor signs were the strongest predictors. Identified features improved prediction of accelerated progression beyond demographic and clinical factors in mild (∆R2 = .22, p < 0.001) and moderate bvFTD (∆R2 = 0.11, p = 0.08) but did not achieve statistical significance in the moderate group.
DISCUSSION: Distinct clinical profiles predict accelerated progression in mild versus moderate bvFTD, underscoring the importance of stage-specific clinical markers for prognosis and care.