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Abnormal TDP-43 immunoreactivity in AD modifies clinicopathologic and radiologic phenotype

From the Departments of Neurology (K.A.J., D.S.K., W.T.H., B.F.B., R.C.P.), Radiology Research (J.L.W., C.R.J.), Laboratory Medicine and Pathology (J.E.P.), and Neuropsychiatry and Neuropsychology (G.E.S., R.J.I.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (Neuropathology [D.A.S., D.W.D.] and Neurogenetics [M.B., R.R.]), Mayo Clinic, Jacksonville, FL.

Address correspondence and reprint requests to Dr. Keith A. Josephs, Department of Neurology, Mayo Clinic, Rochester, MN 55905 josephs.keith{at}mayo.edu.

Background: TAR DNA-binding protein 43 (TDP-43) is one of the major disease proteins in frontotemporal lobar degeneration with ubiquitin immunoreactivity. Approximately one-fourth of subjects with pathologically confirmed Alzheimer disease (AD) have abnormal TDP-43 (abTDP-43) immunoreactivity. The aim of this study was to determine whether subjects with pathologically confirmed AD and abTDP-43 immunoreactivity have distinct clinical, neuropsychological, imaging, or pathologic features compared with subjects with AD without abTDP-43 immunoreactivity.

Methods: Eighty-four subjects were identified who had a pathologic diagnosis of AD, neuropsychometric testing, and volumetric MRI. Immunohistochemistry for TDP-43 was performed on sections of hippocampus and medial temporal lobe, and positive cases were classified into one of three types. Neuropsychometric data were collated and compared in subjects with and without abTDP-43 immunoreactivity. Voxel-based morphometry was used to assess patterns of gray matter atrophy in subjects with and without abTDP-43 immunoreactivity compared with age- and sex-matched controls.

Results: Twenty-nine (34%) of the 84 AD subjects had abTDP-43 immunoreactivity. Those with abTDP-43 immunoreactivity were older at onset and death and performed worse on the Clinical Dementia Rating scale, Mini-Mental State Examination, and Boston Naming Test than subjects without abTDP-43 immunoreactivity. Subjects with and without abTDP-43 immunoreactivity had medial temporal and temporoparietal gray matter loss compared with controls; however, those with abTDP-43 immunoreactivity showed greater hippocampal atrophy. Multivariate logistic regression adjusting for age at death demonstrated that hippocampal sclerosis was the only pathologic predictor of abTDP-43 immunoreactivity.

Conclusions: The presence of abnormal TDP-43 immunoreactivity is associated with a modified Alzheimer disease clinicopathologic and radiologic phenotype.

Abbreviations: abTDP-43 = abnormal TAR DNA-binding protein 43; AD = Alzheimer disease; ADPR = Alzheimer's Disease Patient Registry; ADRC = Alzheimer's Disease Research Center; CDR-SB = Clinical Dementia Rating Sum of Boxes; CERAD = Consortium to Establish a Registry for Alzheimer's Disease; FDR = false discovery rate; FTLD = frontotemporal lobar degeneration; FTLD-U = frontotemporal lobar degeneration with ubiquitin-immunoreactive inclusions; FWE = family-wise error; HpScl = hippocampal sclerosis; LB = Lewy body; MMSE = Mini-Mental State Examination; MOANS = Mayo Older American Normative Studies; NCI = neuronal cytoplasmic inclusion; NFT = neurofibrillary tangle; NIA–Reagan = National Institute on Aging and Reagan Institute Working Group; NII = neuronal intranuclear inclusions; TDP-43 = TAR DNA-binding protein 43; VBM = voxel-based morphometry; WMS-R = Wechsler Memory Scale–Revised.

Supplemental data at www.neurology.org.

e-Pub ahead of print on April 9, 2008, at www.neurology.org.

K.A.J. is supported by the NIH Roadmap Multidisciplinary Clinical Research Career Development Award Grant (K12/NICHD)-HD49078. Coauthors on this study are also supported by NIH grants P50-AG16574, U01-AG06786, R01-AG11378, and P50-NS40256 and the generous support of the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program of the Mayo Foundation.

Disclosure: D.S.K. has been a consultant to GE HealthCare, GlaxoSmithKline, and Myriad Pharmaceuticals; has served on a data safety monitoring board for Neurochem Pharmaceuticals; and is an investigator in a clinical trial sponsored by Elan Pharmaceuticals. B.F.B. is an investigator in a clinical trial sponsored by Myriad Pharmaceuticals. R.C.P. has been a consultant to GE Healthcare and has served on a data safety monitoring board in a clinical trial sponsored by Elan Pharmaceuticals.

Received August 8, 2007. Accepted in final form October 24, 2007.

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				J. van der Zee, K. Sleegers, and C. V. Broeckhoven Invited Article: The Alzheimer disease-frontotemporal lobar degeneration spectrum Neurology, October 7, 2008; 71(15): 1191 - 1197. [Abstract] [Full Text] [PDF]