Caregiver burden and needs in frontotemporal dementia.

BACKGROUND: It is well known that burden among caregivers of patients with frontotemporal dementia (FTD) is high. However, little is known about the specific problems, the factors that contribute to caregiver burden, and the needs of the FTD caregivers-particularly those needs that are accessible by external support strategies. OBJECTIVE: We developed a standardized questionnaire that addressed burdens, problems, and the actual needs of FTD caregivers. A total of 94 caregivers were interviewed. RESULTS: It appears that changes in the patients' behavior and in the interpersonal relations between caregivers and patients are associated with caregiver depression. The most important needs and requests of the caregivers included information and psychosocial support through educated staff, financial support as well as the education of medical staff about the disease. CONCLUSIONS: Support strategies should focus on information and psychosocial support. Given the low prevalence of FTD, internet- and telephone-based strategies appear suitable.

Brain size and white matter content of cerebrospinal tracts determine the upper cervical cord area: evidence from structural brain MRI.

INTRODUCTION: Measurement of the upper cervical cord area (UCCA) from brain MRI may be an effective way to quantify spinal cord involvement in neurological disorders such as multiple sclerosis. However, knowledge on the determinants of UCCA in healthy controls (HCs) is limited. METHODS: In two cohorts of 133 and 285 HCs, we studied the influence of different demographic, body-related, and brain-related parameters on UCCA by simple and partial correlation analyses as well as by voxel-based morphometry (VBM) across both cerebral gray matter (GM) and white matter (WM). RESULTS: First, we confirmed the known but moderate effect of age on UCCA in the older cohort. Second, we studied the correlation of UCCA with sex, body height, and total intracranial volume (TIV). TIV was the only variable that correlated significantly with UCCA after correction for the other variables. Third, we studied the correlation of UCCA with brain-related parameters. Brain volume correlated stronger with UCCA than TIV. Both volumes of the brain tissue compartments GM and WM correlated with UCCA significantly. WM volume explained variance of UCCA after correction for GM volume, whilst the opposite was not observed. Correspondingly, VBM did not yield any brain region, whose GM content correlated significantly with UCCA, whilst cerebral WM content of cerebrospinal tracts strongly correlated with UCCA. This latter effect increased along a craniocaudal gradient. CONCLUSION: UCCA is mainly determined by brain volume as well as by WM content of cerebrospinal tracts.

Caregivers of patients with frontotemporal lobar degeneration: a review of burden, problems, needs, and interventions.

BACKGROUND: Frontotemporal lobar degeneration (FTLD) is a relatively rare disease compared to Alzheimer' disease (AD), but nevertheless causes higher burden and stress to caregivers. Only little is known about the problems and needs of the caregivers of patients with FTLD. Such information is crucial for the development of caregiver support interventions. The aim of the current study is to systematically review publications on (1) burden, problems, and needs of FTLD caregivers, and (2) the feasibility and efficacy of caregiver interventions in FTLD. METHODS: A systematic review was conducted. Medical, psychological, and social sciences databases were searched for publications on burden, problems, needs of FTLD caregivers, and support interventions. RESULTS: Very little published data are available on burden, problems, and needs of FTLD caregivers. Burden among FTLD caregivers is higher than among AD caregivers and correlated with neuropsychiatric symptoms. Specific problems include delayed diagnosis, young age of patients, behavioral disturbances, lack of information and suitable care facilities, caregivers' depression, social isolation, and neglect of personal needs. Hardly any literature is available on the actual needs of FTLD caregivers. Regarding interventions for caregivers, no randomized controlled trials exist. Eight publications could be identified that provide narrative reports on structured caregiver support groups or respite care in combination with caregiver support intervention or advanced practice nursing. CONCLUSION: More research and funding are needed to elucidate the complex construct of burden of FTLD caregivers to identify and quantify their problems and needs in order to develop helpful interventions and services.

Survival in a German population with frontotemporal lobar degeneration.

BACKGROUND: The present study aimed at analysing survival of patients with behavioural-variant frontotemporal dementia (bvFTD), semantic dementia (SD) and progressive non-fluent aphasia (PNFA). Furthermore, the objective of the study was to identify prognostic factors associated with survival and to examine causes of death. METHODS: Interviews were performed with the proxies of 124 patients with frontotemporal lobar degeneration (FTLD). RESULTS: Survival from the onset of first symptoms was significantly longer in SD than in bvFTD (10.5 years). Median survival in PNFA was 12.6 years. Age at onset, gender, education and severity of dementia at diagnosis did not significantly influence survival. We did not identify any phenocopy cases. The most frequent cause of death as reported by caregivers was respiratory system disorder. CONCLUSION: This study adds to the growing literature on survival in patients with FTLD and provides insights into the causes of death.

Accelerated aging of the putamen in men but not in women.

Age-related structural brain changes have been demonstrated repeatedly but data on the effect of gender on age-related structural brain changes are conflicting. Using high-resolution T1-weighted magnetic resonance imaging and voxel-based morphometry, we examined a population of 133 healthy adults (women, 73; men, 60; age range, 29-80 years) focusing on differential aging between men and women (i.e., interaction of age and gender). Compared to women, men showed accelerated age-related gray matter (GM) loss in the posterior putamen. Our data may constitute the structural substrate for age-related differences in motor function between men and women such as the higher incidence and earlier onset of Parkinson's disease in men.

Neural correlates of spontaneous percept switches in ambiguous stimuli: an event-related functional magnetic resonance imaging study.

When ambiguous visual stimuli are being looked at, perception alternates spontaneously between two competing interpretations of the same sensory input. One major issue in understanding the underlying neural process is whether spontaneous percept switches result from fluctuations at the level of sensory processes or whether they are initiated by higher-order areas. To further study this question, we developed an ambiguous apparent motion paradigm that specifically focused on the generation of percept switches. The percept switches occurred either spontaneously or were experimentally triggered. The differential analysis of spontaneous and triggered percept switches was aimed at disentangling the causes and effects of percept switches. Spontaneous percept switches were associated with stronger activations at the right occipitotemporal junction, whereas prefrontal, superior temporal and inferior parietal regions showed greater activations during experimentally triggered percept switches. We propose that complex networks including both sensory and higher-order areas are involved in percept switches, whereas stimulus-specific sensory processes are crucial for the initiation of spontaneous percept switches.

Gray matter decrease of the anterior cingulate cortex in anorexia nervosa.

OBJECTIVE: The brain regions that are critically involved in the pathophysiology of anorexia nervosa have not been clearly elucidated. Moreover, decrease in cerebral tissue during extreme malnutrition has been demonstrated repeatedly in anorexia nervosa, but data regarding the reversibility of this cerebral tissue decrease are conflicting. The authors examined region-specific gray matter changes and global cerebral volumes in recovered patients with anorexia nervosa. METHOD: High-resolution, T1-weighted magnetic resonance imaging (MRI) and voxel-based morphometry were performed in 22 recovered women with anorexia nervosa and in 37 healthy comparison women. Recovery was defined as a body mass index above 17.0 kg/m(2) and regular menses for at least 6 months. RESULTS: The global volumes of gray matter (but not white matter) were decreased in patients with anorexia nervosa by approximately 1%. Analyses of region-specific gray matter changes revealed a gray matter decrease bilaterally in the anterior cingulate cortex of approximately 5%, which remained significant after correction for global effects. This gray matter decrease correlated significantly with the lowest body mass index of lifetime but not with other clinical variables. CONCLUSIONS: In anorexia nervosa, part of the global gray matter loss persists over the long run. Region-specific gray matter loss in the anterior cingulate cortex is directly related to the severity of anorexia nervosa, indicating an important role of this area in the pathophysiology of the disorder. Further research is warranted to determine the cause, specificity, and functional consequences of this structural brain change in anorexia nervosa.