• Janne M Papma, Lize C Jiskoot, Jessica L Panman, Elise G Dopper, Tom den Heijer, Laura Donker Kaat, PijnenburgYolande A LYALFrom the Departments of Neurology (J.M.P., L.C.J., J.L.P., E.G.D., L.D.K., L.H.M., J.C.v.S.), Epidemiology (T.d.H.), and Clinical Genetics (R.v.M.), Erasmus Medical Center, Rotterdam; Departments of Radiology (L.C.J., J.L.P., E.G.D, Lieke H Meeter, Rick van Minkelen, RomboutsSerge A R BSARBFrom the Departments of Neurology (J.M.P., L.C.J., J.L.P., E.G.D., L.D.K., L.H.M., J.C.v.S.), Epidemiology (T.d.H.), and Clinical Genetics (R.v.M.), Erasmus Medical Center, Rotterdam; Departments of Radiology (L.C.J., J.L.P., E.G.D., and John C van Swieten.
• From the Departments of Neurology (J.M.P., L.C.J., J.L.P., E.G.D., L.D.K., L.H.M., J.C.v.S.), Epidemiology (T.d.H.), and Clinical Genetics (R.v.M.), Erasmus Medical Center, Rotterdam; Departments of Radiology (L.C.J., J.L.P., E.G.D., S.A.R.B.R.) and Clinical Genetics (L.D.K.), Leiden University Medical Center; Alzheimer Center and Department of Neurology (E.G.D., Y.A.L.P.) and Department of Clinical Genetics (J.C.v.S.), VU Medical Center, Amsterdam; Department of Neurology (T.d.H.), Sint Franciscus Gasthuis, Rotterdam; and Department of Radiology (S.A.R.B.R.) and Leiden Institute for Brain and Cognition (S.A.R.B.R.), Leiden University, the Netherlands. j.papma@erasmusmc.nl.
• Neurology. 2017 Sep 19; 89 (12): 1256-1264.

ObjectiveTo investigate cognitive function, gray matter volume, and white matter integrity in the presymptomatic stage of chromosome 9 open reading frame 72 repeat expansion (C9orf72RE).MethodsPresymptomatic C9orf72RE carriers (n = 18) and first-degree family members without a pathogenic expansion (healthy controls [HC], n = 15) underwent a standardized protocol of neuropsychological tests, T1-weighted MRI, and diffusion tensor imaging within our cohort study of autosomal dominant frontotemporal dementia (FTD). We investigated group differences in cognitive function, gray matter volume through voxel-based morphometry, and white matter integrity by means of tract-based spatial statistics. We correlated cognitive change with underlying gray or white matter.ResultsOur data demonstrate lower scores on letter fluency, Stroop card I, and Stroop card III, accompanied by white matter integrity loss in tracts connecting the frontal lobe, the thalamic radiation, and tracts associated with motor functioning in presymptomatic C9orf72RE compared with HC. In a subgroup of C9orf72RE carriers above 40 years of age, we found gray matter volume loss in the thalamus, cerebellum, and parietal and temporal cortex. We found no significant relationship between subtle cognitive decline and underlying gray or white matter.ConclusionsThis study demonstrates that a decline in cognitive functioning, white matter integrity, and gray matter volumes are present in presymptomatic C9orf72RE carriers. These findings suggest that neuropsychological assessment, T1-weighted MRI, and diffusion tensor imaging might be useful to identify early biomarkers in the presymptomatic stage of FTD or amyotrophic lateral sclerosis.© 2017 American Academy of Neurology.

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