• Alexander G Murley, Matthew A Rouse, Coyle-GilchristIan T SITSClinical Neurosciences, University of Cambridge, Cambridge, UK.Neurology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK., P Simon Jones, Win Li, Julie Wiggins, Claire Lansdall, Patricia Vázquez Rodríguez, Alicia Wilcox, Karalyn Patterson, and James B Rowe.
• Clinical Neurosciences, University of Cambridge, Cambridge, UK am2505@medschl.cam.ac.uk.
• J. Neurol. Neurosurg. Psychiatr. 2021 Jul 1; 92 (7): 737744737-744.

ObjectiveTo test the hypothesis that in syndromes associated with frontotemporal lobar degeneration, behavioural impairment predicts loss of functional independence and motor clinical features predict mortality, irrespective of diagnostic group.MethodsWe used a transdiagnostic approach to survival in an epidemiological cohort in the UK, testing the association between clinical features, independence and survival in patients with clinical diagnoses of behavioural variant frontotemporal dementia (bvFTD n=64), non-fluent variant primary progressive aphasia (nfvPPA n=36), semantic variant primary progressive aphasia (svPPA n=25), progressive supranuclear palsy (PSP n=101) and corticobasal syndrome (CBS n=68). A principal components analysis identified six dimensions of clinical features. Using Cox proportional hazards and logistic regression, we identified the association between each of these dimensions and both functionally independent survival (time from clinical assessment to care home admission) and absolute survival (time to death). Analyses adjusted for the covariates of age, gender and diagnostic group. Secondary analysis excluded specific diagnostic groups.ResultsBehavioural disturbance, including impulsivity and apathy, was associated with reduced functionally independent survival (OR 2.46, p<0.001), even if patients with bvFTD were removed from the analysis. Motor impairments were associated with reduced absolute survival, even if patients with PSP and CBS were removed from the analysis.ConclusionOur results can assist individualised prognostication and planning of disease-modifying trials, and they support a transdiagnostic approach to symptomatic treatment trials in patients with clinical syndromes associated with frontotemporal lobar degeneration.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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