Parkinsonism and Related Disorders 20 (2014) 957e964
Contents lists available at ScienceDirect
Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
Editor's comment: Familial frontotemporal dementia with parkinsonism is one of those disorders that occurs frequently enough that movement disorders specialists know they should be familiar with it, but infrequently enough that it is difficult to remember it, particularly in light of its complexities. Therefore, this review by Siuda and colleagues is an especially informative refresher that provides a cogent, succinct exposition of the clinical presentation of the various mutations, not just on the more familiar chromosome 17, but also on chromosomes 1, 3, 9 and 16, that produce the disorder. In addition to detailing the clinical presentation of the various mutations, the authors describe the neuroimaging characteristics, delineate the pathologic findings and discuss the differential diagnosis and treatment of this important disorder. Ronald F. Pfeiffer, Editor-in-Chief Department of Neurology, University of Tennessee HSC, 855 Monroe Avenue, Memphis, TN 38163, USA
Review
Parkinsonian syndrome in familial frontotemporal dementia Joanna Siuda a, b, Shinsuke Fujioka c, Zbigniew K. Wszolek c, * a b c
Department of Neurology, Silesian Medical University, Katowice, Poland Department of Neuroscience, Mayo Clinic Jacksonville, FL, USA Department of Neurology, Mayo Clinic Jacksonville, FL, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 26 March 2014 Received in revised form 27 May 2014 Accepted 6 June 2014
Parkinsonism in frontotemporal dementia (FTD) was first described in families with mutations in the microtubule-associated protein tau (MAPT) and progranulin (PRGN) genes. Since then, mutations in several other genes have been identified for FTD with parkinsonism, including chromosome 9 open reading frame 72 (C9ORF72), chromatin modifying protein 2B (CHMP2B), valosin-containing protein (VCP), fused in sarcoma (FUS) and transactive DNA-binding protein (TARDBP). The clinical presentation of patients with familial forms of FTD with parkinsonism is highly variable. The parkinsonism seen in FTD patients is usually characterized by akinetic-rigid syndrome and is mostly associated with the behavioral variant of FTD (bvFTD); however, some cases may present with classical Parkinson's disease. In other cases, atypical parkinsonism resembling progressive supranuclear palsy (PSP) or corticobasal syndrome (CBS) has also been described. Although rare, parkinsonism in FTD may coexist with motor neuron disease. Structural neuroimaging, which is crucial for the diagnosis of FTD, shows characteristic patterns of brain atrophy associated with specific mutations. Structural neuroimaging is not helpful in distinguishing among patients with parkinsonian features. Furthermore, dopaminergic imaging that shows nigrostriatal neurodegeneration in FTD with parkinsonism cannot discriminate parkinsonian syndromes that arise from different mutations. Generally, parkinsonism in FTD is levodopa unresponsive, but there have been cases where a temporary benefit has been reported, so dopaminergic treatment is worth trying, especially, when motor and non-motor manifestations can cause significant problems with daily functioning. In this review, we present an update on the clinical and genetic correlations of FTD with parkinsonism. © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Keywords: Parkinsonism Familial Frontotemporal dementia Genetics Autosomal dominant Mutation
1. Introduction
* Corresponding author. Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel.: þ1 904 953 7229; fax: þ1 904 953 0760. E-mail address: [email protected] (Z.K. Wszolek).
In 1996, an international consensus conference was held in Ann Arbor, MI, USA, to discuss the association of parkinsonism with frontotemporal dementia (FTD), and the term Frontotemporal Dementia and Parkinsonism linked to chromosome 17 (FTDP-17) was introduced [1]. At that time, 13 families were described as having FTDP-17 with an autosomal dominant pattern of inheritance. The
http://dx.doi.org/10.1016/j.parkreldis.2014.06.004 1353-8020/© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
958
J. Siuda et al. / Parkinsonism and Related Disorders 20 (2014) 957e964
parkinsonian features and other motor and non-motor manifestations that could be present in patients with FTD.
clinical features of patients in these families were characterized as behavioral changes, dementia, parkinsonism, amyotrophy, dystonia, and supranuclear gaze palsy. FTD is clinically characterized by early behavioral changes and/or language impairment, which is followed by cognitive decline and dementia. Parkinsonism is usually present in the behavioral variant of FTD (bvFTD), but it is rarely seen in primary progressive aphasia (PPA), which is a language variant of FTD [2e4]. Parkinsonism in FTD may present before, during, or after the development of behavioral or language disturbances. The clinical manifestations of parkinsonism seen in FTD patients are varied. Parkinsonian syndrome in FTD ranges from an apparent classical presentation of Parkinson's disease (PD) to atypical parkinsonism that resembles progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) [2]. Up to 40% of FTD patients have a positive family history, which suggests a strong genetic component to these disorders. It is estimated that autosomal dominant cases account for over 13% of the total number of FTD cases [5,6]. Currently, the best understood forms of autosomal dominant FTD associated with parkinsonism are those linked to chromosome 17 and related to mutations in the microtubule-associated protein tau (MAPT) and progranulin (PGRN) genes [7e9]. Besides MAPT and PGRN, the chromosome 9 open reading frame 72 (C9ORF72) gene, which was identified in 2011, is known to be the major causative gene for familial FTD that is also associated with parkinsonism [10,11]. Mutations in four other genes: chromatin modifying protein 2B (CHMP2B), valosin-containing protein (VCP), transactive DNA-binding protein (TARDBP), and fused-in-sarcoma (FUS) are identified in a minority of FTD cases accompanied by the parkinsonian phenotype [12e15]. In this review we describe the clinical features in familial FTD with parkinsonism with known genetic defect.
2.1. FTDP-17 (MAPT) Mutations in the MAPT account for up to approximately 50% of FTD cases and the majority of FTDP-17 cases. Over 50 pathogenic MAPT mutations have been described (www.molgen.ua.ac.be/ FTDMutations) [16]. The mode of inheritance is autosomal dominant. The mean age at onset is 49 years, but this can range from 25 to 76 years. The mean disease duration is approximately 7 years, but the disease duration could be longer; for example, tau p.R406W mutation carriers can survive into the eighth decade of life [12,17e19]. A positive family history is almost always present in MAPT mutation carriers, and their penetrance is nearly 100% [20]. No gender predilection has been identified [21]. The clinical presentation of FTDP-17 (MAPT) is variable, but cardinal signs include personality and behavioral changes, dementia, and parkinsonism. At the onset of the disease, only one of these signs is typically exhibited, but in advanced disease stages, all of the signs could be present. Based on the type of MAPT mutation, the initial FTDP-17 phenotype can be divided into frontotemporal dementiapredominant or parkinsonism-predominant [22]. However, the most common clinical presentation of FTDP-17 (MAPT) is bvFTD. FTDP-17 (MAPT) patients experience slowly progressive dementia with gradual functional decline. Motor neuron deficits such as amyotrophy and fasciculation are rarely seen [23e25]. 2.1.1. Parkinsonism in FTDP-17 (MAPT) Parkinsonism can be the first manifestation of FTDP-17 caused by mutations in MAPT (FTDP-17 (MAPT)), and it can initially have a good response to levodopa therapy. Because of this, some patients could be misdiagnosed as having PD at the early stage of the disease. When parkinsonism is the first symptom of FTDP-17, it is usually caused by mutations in exon 10 of the MAPT gene (p.N279K, p.delN296, p.S305S, p.N296N, and p.G303V) [17,25]. However in some FTDP-17 (MAPT) mutations, parkinsonism occurs late in the disease course (p.P301S and p.N296H), or is rare and minimal (p.P301L, p.S305N and p.G272V). Parkinsonism seen in FTDP-17 (MAPT) patients includes severe limb bradykinesia, axial and limb rigidity, and postural instability. These signs are often symmetric, and there is usually no resting tremor. Postural or action tremor
2. Clinical genetics, general characteristic, and parkinsonian features in familial FTD with parkinsonism Molecular genetic studies in patients with FTD associated with parkinsonism have identified mutations in several genes: MAPT, PGRN, C9ORF72, CHMP2B, and VCP. Mutations found in common ALS genes, TARDBP and FUS, may also contribute to FTD associated with parkinsonism (Table 1). Parkinsonism seen in FTD patients carrying different autosomal dominant gene mutations can have a diverse clinical manifestation. In Table 2 we provide a summary of
Table 1 The profile of genes associated with parkinsonism in FTD. MAPT
PGRN
C9ORF72
CHMP2B
VCP
TARDBP
FUS
Chromosomal localization Inheritance Penetrance Anticipation Estimated mutation frequency in FTD Mean AAO (range)
17q21.32 AD Almost 100% 0 0e50% 49 years (25e76)
17q.21.31 AD 90% by 70 years þ 3e26% 59 years (44e83)
9p21.2 AD Probably high þþ 14-48% 55 years (33e75)
Mean DD (range) Most frequent initial Dx. Clinical Dx. during the Most disease course frequent Dx. Relatively common Dx. Rare Dx.
7 years (2e30) bvFTD ± P FTD Parkinsonism Pyramidal signs PSP CBS MDSa
7 years (1e14) bvFTD ± P FTD CBS Parkinsonism Pyramidal signs MDSa Hallucinations
4.5 years (3e10) FTD/ALS FTD MNDa Parkinsonism
3p11.2 AD UKN UKN A PGRN mutation. Neurology 2009;73:1367e74. [33] Espay AJ, Litvan I. Parkinsonism and frontotemporal dementia: the clinical overlap. J Mol Neurosci 2011;45:343e9. [34] Schofield EC, Halliday GM, Kwok J, Loy C, Double KL, Hodges JR. Low serum progranulin predicts the presence of mutations: a prospective study. J Alzheimers Dis 2010;22:981e4. [35] McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, et al., Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005;65(12):1863e72. [36] Boeve BF, Lang AE, Litvan I. Corticobasal degeneration and its relationship to progressive supranuclear palsy and frontotemporal dementia. Ann Neurol 2003;54:S15e9. [37] Yu CE, Bird TD, Bekris LM, Montine TJ, Leverenz JB, Steinbart E, et al. The spectrum of mutations in progranulin: a collaborative study screening 545 cases of neurodegeneration. Arch Neurol 2010;67:161e70. [38] Di Fabio R, Tessa A, Simons EJ, Santorelli FM, Casali C, Serrao M, et al. Familial frontotemporal dementia with parkinsonism associated with the progranulin c.C1021T (p.Q341X) mutation. Parkinsonism Relat Disord 2010;16:484e5. [39] van Blitterswijk M, DeJesus-Hernandez M, Niemantsverdriet E, Murray ME, Heckman MG, Diehl NN, et al. Association between repeat sizes and clinical and pathological characteristics in carriers of C9ORF72 repeat expansions (Xpansize-72): a cross-sectional cohort study. Lancet Neurol 2013;12:978e88. [40] Boeve BF, Boylan KB, Graff-Radford NR, DeJesus-Hernandez M, Knopman DS, Pedraza O, et al. Characterization of frontotemporal dementia and/or amyotrophic lateral sclerosis associated with the GGGGCC repeat expansion in C9ORF72. Brain 2012;135:765e83. [41] Smith BN, Newhouse S, Shatunov A, Vance C, Topp S, Johnson L, et al. The C9ORF72 expansion mutation is a common cause of ALSþ/-FTD in Europe and has a single founder. Eur J Hum Genet 2013;21:102e8. [42] Waldo ML, Gustafson L, Nilsson K, Traynor BJ, Renton AE, Englund E, et al. Frontotemporal dementia with a C9ORF72 expansion in a Swedish family: clinical and neuropathological characteristics. Am J Neurodegener Dis 2013;2: 276e86. [43] Yeh TH, Lai SC, Weng YH, Kuo HC, Wu-Chou YH, Huang CL, et al. Screening for C9orf72 repeat expansions in parkinsonian syndromes. Neurobiol Aging 2013;34:1311.e3e4. [44] Friedland RP, Shah JJ, Farrer LA, Vardarajan B, Rebolledo-Mendez JD, Mok K, et al. Behavioral variant frontotemporal lobar degeneration with amyotrophic lateral sclerosis with a chromosome 9p21 hexanucleotide repeat. Front Neurol 2012;3:136. [45] Savica R, Adeli A, Vemuri P, Knopman DS, DeJesus-Hernandez M, Rademakers R, et al. Characterization of a family with c9FTD/ALS associated with the GGGGCC repeat expansion in C9ORF72. Arch Neurol 2012;69:1164e9. [46] O’Dowd S, Curtin D, Waite AJ, Roberts K, Pender N, Reid V, et al. C9ORF72 expansion in amyotrophic lateral sclerosis/frontotemporal dementia also causes parkinsonism. Mov Disord 2012;27:1072e4. [47] Lindquist SG, Duno M, Batbayli M, Puschmann A, Braendgaard H, Mardosiene S, et al. Corticobasal and ataxia syndromes widen the spectrum of C9ORF72 hexanucleotide expansion disease. Clin Genet 2013;83:279e83. [48] Arvanitakis Z. Update on frontotemporal dementia. Neurologist 2010;16: 16e22. [49] Holm IE, Isaacs AM, Mackenzie IR. Absence of FUS-immunoreactive pathology in frontotemporal dementia linked to chromosome 3 (FTD-3) caused by mutation in the CHMP2B gene. Acta Neuropathol 2009;118:719e20. [50] Gydesen S, Brown JM, Brun A, Chakrabarti L, Gade A, Johannsen P, et al. Chromosome 3 linked frontotemporal dementia (FTD-3). Neurology 2002;59:1585e94. [51] Stokholm J, Teasdale TW, Johannsen P, Nielsen JE, Nielsen TT, Isaacs A, et al., the Frontotemporal Dementia Research in Jutland Association (FReJA) Consortium. Cognitive impairment in the preclinical stage of dementia in FTD-3 CHMP2B mutation carriers: a longitudinal prospective study. J Neurol Neurosurg Psychiatry 2013;84:170e6. [52] Ghanim M, Guillot-Noel L, Pasquier F, Jornea L, Deramecourt V, Dubois B, et al. CHMP2B mutations are rare in French families with frontotemporal lobar degeneration. J Neurol 2010;257:2032e6. [53] Watts GD, Wymer J, Kovach MJ, Mehta SG, Mumm S, Darvish D, et al. Inclusion body myopathy associated with Paget disease of bone and frontotemporal dementia is caused by mutant valosin-containing protein. Nat Genet 2004;36:377e81. [54] Spina S, Van Laar AD, Murrell JR, Hamilton RL, Kofler JK, Epperson F, et al. Phenotypic variability in three families with valosin-containing protein mutation. Eur J Neurol 2013;20:251e8.
[55] van der Zee J, Pirici D, Van Langenhove T, Engelborghs S, Vandenberghe R, Hoffmann M, et al. Clinical heterogeneity in 3 unrelated families linked to VCP p.Arg159His. Neurology 2009;73:626e32. [56] Spina S, Van Laar A, Murrell J, de Courten-Myers G, Hamilton RL, Farlow MR, et al. Frontotemporal dementia associated with a valosin-containing protein mutation: report of three families. FASEB J 2008;22:58.4. [57] Mehta SG, Khare M, Ramani R, Watts GDJ, Simon M, Osann KE, et al. Genotypeephenotype studies of VCP-associated inclusion body myopathy with Paget disease of bone and/or frontotemporal dementia. Clin Genet 2013;83:422e31. rez P, Cirulli ET, Drory VE, Dabby R, Nisipeanu P, Carasso RL, et al. [58] Gonz alez-Pe Novel mutation in VCP gene causes atypical amyotrophic lateral sclerosis. Neurology 2012;79:2201e8. [59] Chan N, Le C, Shieh P, Mozaffar T, Khare M, Bronstein J, et al. Valosin-containing protein mutation and Parkinson's disease. Letter to the Editor Parkinsonism Relat Disord 2012;18:107e9. [60] Rayaprolu S, Fujioka S, Traynor S, Soto-Ortolaza AI, Petrucelli L, Dickson DW, et al. TARDBP mutations in Parkinson's disease. Parkinsonism Relat Disord 2013;19:312e5. [61] Mosca L, Lunetta C, Tarlarini C, Avemaria F, Maestri E, Melazzini M, et al. Wide phenotypic spectrum of the TARDBP gene: homozygosity of A382T mutation in a patient presenting with amyotrophic lateral sclerosis, Parkinson's disease, and frontotemporal lobar degeneration, and in neurologically healthy subject. Neurobiol Aging 2012;33:1846.e1e4. [62] Quadri M, Cossu G, Saddi V, Simons EJ, Murgia D, Melis M, et al. Broadening the phenotype of TARDBP mutations: the TARDBP Ala382Thr mutation and Parkinson's disease in Sardinia. Neurogenetics 2011;12:203e9. [63] Kwiatkowski TJ Jr, Bosco DA, LeClerc AL, Tamrazian E, Vanderburg CR, Russ C, et al. Mutations in the FUS/TLS gene on chromosome 16 cause familial amyotrophic lateral sclerosis. Science 2009;323:1205e8. [64] Van Langenhove T, van der Zee J, Van Broeckhoven C. The molecular basis of the frontotemporal lobar degeneration e amyotrophic lateral sclerosis spectrum. Ann Med 2012;44:817e28. [65] Sieben A, Van Langenhove T, Engelborghs S, Martin JJ, Boon P, Cras P, et al. The genetics and neuropathology of frontotemporal lobar degeneration. Acta Neuropathol 2012;124:353e72. [66] Gao K, Zheng W, Deng X, Xiong W, Song Z, Yang Y, et al. Genetic analysis of the fused in sarcoma gene in Chinese Han patients with Parkinson's disease. Short communication Parkinsonism Relat Disord 2014;20:119e21. [67] Labbe C, Rayaprolu S, Soto-Ortolaza A, Ogaki K, Uitti RJ, Wszolek ZK, et al. Investigating FUS variation in Parkinson's disease. Parkinsonism Relat Disord 2014;20:S147e9. [68] Rohrer JD, Ridgway GR, Modat M, Ourselin S, Mead S, Fox NC, et al. Distinct profiles of brain atrophy in frontotemporal lobar degeneration caused by progranulin and tau mutations. Neuroimage 2010;53:1070e6. [69] Rohrer JD. Structural brain imaging in frontotemporal dementia. Biochim Biophys Acta 2012;1822:325e32. [70] Whitwell JL, Josephs KA. Recent advances in the imaging of frontotemporal dementia. Curr Neurol Neurosci Rep 2012;12:715e23. [71] Chio A, Calvo A, Moglia C, Restagno G, Ossola I, Brunetti M, et al. Amyotrophic lateral sclerosis-frontotemporal lobar dementia in 3 families with p.Ala382Thr TARDBP mutations. Arch Neurol 2010;67:1002e9. [72] Kim EJ, Park YE, Kim DS, Ahn BY, Kim HS, Chang YH, et al. Inclusion body myopathy with Paget disease of bone and frontotemporal dementia linked to VCP p.Arg155Cys in a Korean family. Arch Neurol 2011;68:787e96. [73] Kalbe E, Onur OA, Minnerop M, Reimann J, Althaus A, Ahmadzadehfar H, et al. Early signs of VCP-related frontotemporal dementia: a neuropsychological, FDG-PET and fMRI study. J Neurol 2011;258:515e8. [74] Josephs KA, Whitwell JL, Parisi JE, Petersen RC, Boeve BF, Jack CR Jr, et al. Caudate atrophy on MRI is a characteristic feature of FTLD-FUS. Eur J Neurol 2010;17:969e75. [75] Cummings JL, Henchcliffe C, Schaier S, Simuni T, Waxman A, Kemp P. The role of dopaminergic imaging in patients with symptoms of dopaminergic system neurodegeneration. Brain 2011;134(Pt 11):3146e66. [76] Pal PK, Wszolek ZK, Kishore A, de la Fuente-Fernandez R, Sossi V, Uitti RJ, et al. Positron emission tomography in pallido-ponto-nigral degeneration (PPND) family (frontotemporal dementia with parkinsonism linked to chromosome 17 and point mutation in tau gene). Parkinsonism Relat Disord 2001;7:81e8. [77] Kono S, Ouchi Y, Terada T, Suzuki M, Yagi S, Miyajima H. Combined FDG and raclopride PET study in a case of ALS with the R521C FUS gene mutation. J Neurol 2012;259:367e9. [78] Tateishi T, Hokonohara T, Yamasaki R, Miura S, Kikuchi H, Iwaki A, et al. Multiple system degeneration with basophilic inclusions in Japanese ALS patients with FUS mutation. Acta Neuropathol 2010;119:355e64. [79] Diaz-Corrales FJ, Sanz-Viedma S, Garcia-Solis D, Escobar-Delgado T, Mir P. Clinical features and 123I-FP-SPECT imaging in drug-induced parkinsonism and Parkinson's disease. Eur J Med Mol Imaging 2010;37:556e64. [80] Pirker W, Djamshidian S, Asenbaum S, Gerschlager W, Tribl G, Hoffman M, et al. Progression of dopaminergic degeneration in Parkinson's disease and atypical parkinsonism: a longitudinal beta-CIT SPECT study. Mov Disord 2002;17:45e53. [81] Seltman RE, Matthews BR. Frontotemporal lobar degeneration. Epidemiology, pathology, diagnosis and management. CNS Drugs 2012;26: 841e70. [82] Jicha GA. Medical management of frontotemporal dementias: the importance of the caregiver in symptom assessment and guidance of treatment strategies. J Mol Neurosci 2011;45:713e23.
Contents lists available at ScienceDirect
Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
Editor's comment: Familial frontotemporal dementia with parkinsonism is one of those disorders that occurs frequently enough that movement disorders specialists know they should be familiar with it, but infrequently enough that it is difficult to remember it, particularly in light of its complexities. Therefore, this review by Siuda and colleagues is an especially informative refresher that provides a cogent, succinct exposition of the clinical presentation of the various mutations, not just on the more familiar chromosome 17, but also on chromosomes 1, 3, 9 and 16, that produce the disorder. In addition to detailing the clinical presentation of the various mutations, the authors describe the neuroimaging characteristics, delineate the pathologic findings and discuss the differential diagnosis and treatment of this important disorder. Ronald F. Pfeiffer, Editor-in-Chief Department of Neurology, University of Tennessee HSC, 855 Monroe Avenue, Memphis, TN 38163, USA
Review
Parkinsonian syndrome in familial frontotemporal dementia Joanna Siuda a, b, Shinsuke Fujioka c, Zbigniew K. Wszolek c, * a b c
Department of Neurology, Silesian Medical University, Katowice, Poland Department of Neuroscience, Mayo Clinic Jacksonville, FL, USA Department of Neurology, Mayo Clinic Jacksonville, FL, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 26 March 2014 Received in revised form 27 May 2014 Accepted 6 June 2014
Parkinsonism in frontotemporal dementia (FTD) was first described in families with mutations in the microtubule-associated protein tau (MAPT) and progranulin (PRGN) genes. Since then, mutations in several other genes have been identified for FTD with parkinsonism, including chromosome 9 open reading frame 72 (C9ORF72), chromatin modifying protein 2B (CHMP2B), valosin-containing protein (VCP), fused in sarcoma (FUS) and transactive DNA-binding protein (TARDBP). The clinical presentation of patients with familial forms of FTD with parkinsonism is highly variable. The parkinsonism seen in FTD patients is usually characterized by akinetic-rigid syndrome and is mostly associated with the behavioral variant of FTD (bvFTD); however, some cases may present with classical Parkinson's disease. In other cases, atypical parkinsonism resembling progressive supranuclear palsy (PSP) or corticobasal syndrome (CBS) has also been described. Although rare, parkinsonism in FTD may coexist with motor neuron disease. Structural neuroimaging, which is crucial for the diagnosis of FTD, shows characteristic patterns of brain atrophy associated with specific mutations. Structural neuroimaging is not helpful in distinguishing among patients with parkinsonian features. Furthermore, dopaminergic imaging that shows nigrostriatal neurodegeneration in FTD with parkinsonism cannot discriminate parkinsonian syndromes that arise from different mutations. Generally, parkinsonism in FTD is levodopa unresponsive, but there have been cases where a temporary benefit has been reported, so dopaminergic treatment is worth trying, especially, when motor and non-motor manifestations can cause significant problems with daily functioning. In this review, we present an update on the clinical and genetic correlations of FTD with parkinsonism. © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Keywords: Parkinsonism Familial Frontotemporal dementia Genetics Autosomal dominant Mutation
1. Introduction
* Corresponding author. Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel.: þ1 904 953 7229; fax: þ1 904 953 0760. E-mail address: [email protected] (Z.K. Wszolek).
In 1996, an international consensus conference was held in Ann Arbor, MI, USA, to discuss the association of parkinsonism with frontotemporal dementia (FTD), and the term Frontotemporal Dementia and Parkinsonism linked to chromosome 17 (FTDP-17) was introduced [1]. At that time, 13 families were described as having FTDP-17 with an autosomal dominant pattern of inheritance. The
http://dx.doi.org/10.1016/j.parkreldis.2014.06.004 1353-8020/© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
958
J. Siuda et al. / Parkinsonism and Related Disorders 20 (2014) 957e964
parkinsonian features and other motor and non-motor manifestations that could be present in patients with FTD.
clinical features of patients in these families were characterized as behavioral changes, dementia, parkinsonism, amyotrophy, dystonia, and supranuclear gaze palsy. FTD is clinically characterized by early behavioral changes and/or language impairment, which is followed by cognitive decline and dementia. Parkinsonism is usually present in the behavioral variant of FTD (bvFTD), but it is rarely seen in primary progressive aphasia (PPA), which is a language variant of FTD [2e4]. Parkinsonism in FTD may present before, during, or after the development of behavioral or language disturbances. The clinical manifestations of parkinsonism seen in FTD patients are varied. Parkinsonian syndrome in FTD ranges from an apparent classical presentation of Parkinson's disease (PD) to atypical parkinsonism that resembles progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) [2]. Up to 40% of FTD patients have a positive family history, which suggests a strong genetic component to these disorders. It is estimated that autosomal dominant cases account for over 13% of the total number of FTD cases [5,6]. Currently, the best understood forms of autosomal dominant FTD associated with parkinsonism are those linked to chromosome 17 and related to mutations in the microtubule-associated protein tau (MAPT) and progranulin (PGRN) genes [7e9]. Besides MAPT and PGRN, the chromosome 9 open reading frame 72 (C9ORF72) gene, which was identified in 2011, is known to be the major causative gene for familial FTD that is also associated with parkinsonism [10,11]. Mutations in four other genes: chromatin modifying protein 2B (CHMP2B), valosin-containing protein (VCP), transactive DNA-binding protein (TARDBP), and fused-in-sarcoma (FUS) are identified in a minority of FTD cases accompanied by the parkinsonian phenotype [12e15]. In this review we describe the clinical features in familial FTD with parkinsonism with known genetic defect.
2.1. FTDP-17 (MAPT) Mutations in the MAPT account for up to approximately 50% of FTD cases and the majority of FTDP-17 cases. Over 50 pathogenic MAPT mutations have been described (www.molgen.ua.ac.be/ FTDMutations) [16]. The mode of inheritance is autosomal dominant. The mean age at onset is 49 years, but this can range from 25 to 76 years. The mean disease duration is approximately 7 years, but the disease duration could be longer; for example, tau p.R406W mutation carriers can survive into the eighth decade of life [12,17e19]. A positive family history is almost always present in MAPT mutation carriers, and their penetrance is nearly 100% [20]. No gender predilection has been identified [21]. The clinical presentation of FTDP-17 (MAPT) is variable, but cardinal signs include personality and behavioral changes, dementia, and parkinsonism. At the onset of the disease, only one of these signs is typically exhibited, but in advanced disease stages, all of the signs could be present. Based on the type of MAPT mutation, the initial FTDP-17 phenotype can be divided into frontotemporal dementiapredominant or parkinsonism-predominant [22]. However, the most common clinical presentation of FTDP-17 (MAPT) is bvFTD. FTDP-17 (MAPT) patients experience slowly progressive dementia with gradual functional decline. Motor neuron deficits such as amyotrophy and fasciculation are rarely seen [23e25]. 2.1.1. Parkinsonism in FTDP-17 (MAPT) Parkinsonism can be the first manifestation of FTDP-17 caused by mutations in MAPT (FTDP-17 (MAPT)), and it can initially have a good response to levodopa therapy. Because of this, some patients could be misdiagnosed as having PD at the early stage of the disease. When parkinsonism is the first symptom of FTDP-17, it is usually caused by mutations in exon 10 of the MAPT gene (p.N279K, p.delN296, p.S305S, p.N296N, and p.G303V) [17,25]. However in some FTDP-17 (MAPT) mutations, parkinsonism occurs late in the disease course (p.P301S and p.N296H), or is rare and minimal (p.P301L, p.S305N and p.G272V). Parkinsonism seen in FTDP-17 (MAPT) patients includes severe limb bradykinesia, axial and limb rigidity, and postural instability. These signs are often symmetric, and there is usually no resting tremor. Postural or action tremor
2. Clinical genetics, general characteristic, and parkinsonian features in familial FTD with parkinsonism Molecular genetic studies in patients with FTD associated with parkinsonism have identified mutations in several genes: MAPT, PGRN, C9ORF72, CHMP2B, and VCP. Mutations found in common ALS genes, TARDBP and FUS, may also contribute to FTD associated with parkinsonism (Table 1). Parkinsonism seen in FTD patients carrying different autosomal dominant gene mutations can have a diverse clinical manifestation. In Table 2 we provide a summary of
Table 1 The profile of genes associated with parkinsonism in FTD. MAPT
PGRN
C9ORF72
CHMP2B
VCP
TARDBP
FUS
Chromosomal localization Inheritance Penetrance Anticipation Estimated mutation frequency in FTD Mean AAO (range)
17q21.32 AD Almost 100% 0 0e50% 49 years (25e76)
17q.21.31 AD 90% by 70 years þ 3e26% 59 years (44e83)
9p21.2 AD Probably high þþ 14-48% 55 years (33e75)
Mean DD (range) Most frequent initial Dx. Clinical Dx. during the Most disease course frequent Dx. Relatively common Dx. Rare Dx.
7 years (2e30) bvFTD ± P FTD Parkinsonism Pyramidal signs PSP CBS MDSa
7 years (1e14) bvFTD ± P FTD CBS Parkinsonism Pyramidal signs MDSa Hallucinations
4.5 years (3e10) FTD/ALS FTD MNDa Parkinsonism
3p11.2 AD UKN UKN A PGRN mutation. Neurology 2009;73:1367e74. [33] Espay AJ, Litvan I. Parkinsonism and frontotemporal dementia: the clinical overlap. J Mol Neurosci 2011;45:343e9. [34] Schofield EC, Halliday GM, Kwok J, Loy C, Double KL, Hodges JR. Low serum progranulin predicts the presence of mutations: a prospective study. J Alzheimers Dis 2010;22:981e4. [35] McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, et al., Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005;65(12):1863e72. [36] Boeve BF, Lang AE, Litvan I. Corticobasal degeneration and its relationship to progressive supranuclear palsy and frontotemporal dementia. Ann Neurol 2003;54:S15e9. [37] Yu CE, Bird TD, Bekris LM, Montine TJ, Leverenz JB, Steinbart E, et al. The spectrum of mutations in progranulin: a collaborative study screening 545 cases of neurodegeneration. Arch Neurol 2010;67:161e70. [38] Di Fabio R, Tessa A, Simons EJ, Santorelli FM, Casali C, Serrao M, et al. Familial frontotemporal dementia with parkinsonism associated with the progranulin c.C1021T (p.Q341X) mutation. Parkinsonism Relat Disord 2010;16:484e5. [39] van Blitterswijk M, DeJesus-Hernandez M, Niemantsverdriet E, Murray ME, Heckman MG, Diehl NN, et al. Association between repeat sizes and clinical and pathological characteristics in carriers of C9ORF72 repeat expansions (Xpansize-72): a cross-sectional cohort study. Lancet Neurol 2013;12:978e88. [40] Boeve BF, Boylan KB, Graff-Radford NR, DeJesus-Hernandez M, Knopman DS, Pedraza O, et al. Characterization of frontotemporal dementia and/or amyotrophic lateral sclerosis associated with the GGGGCC repeat expansion in C9ORF72. Brain 2012;135:765e83. [41] Smith BN, Newhouse S, Shatunov A, Vance C, Topp S, Johnson L, et al. The C9ORF72 expansion mutation is a common cause of ALSþ/-FTD in Europe and has a single founder. Eur J Hum Genet 2013;21:102e8. [42] Waldo ML, Gustafson L, Nilsson K, Traynor BJ, Renton AE, Englund E, et al. Frontotemporal dementia with a C9ORF72 expansion in a Swedish family: clinical and neuropathological characteristics. Am J Neurodegener Dis 2013;2: 276e86. [43] Yeh TH, Lai SC, Weng YH, Kuo HC, Wu-Chou YH, Huang CL, et al. Screening for C9orf72 repeat expansions in parkinsonian syndromes. Neurobiol Aging 2013;34:1311.e3e4. [44] Friedland RP, Shah JJ, Farrer LA, Vardarajan B, Rebolledo-Mendez JD, Mok K, et al. Behavioral variant frontotemporal lobar degeneration with amyotrophic lateral sclerosis with a chromosome 9p21 hexanucleotide repeat. Front Neurol 2012;3:136. [45] Savica R, Adeli A, Vemuri P, Knopman DS, DeJesus-Hernandez M, Rademakers R, et al. Characterization of a family with c9FTD/ALS associated with the GGGGCC repeat expansion in C9ORF72. Arch Neurol 2012;69:1164e9. [46] O’Dowd S, Curtin D, Waite AJ, Roberts K, Pender N, Reid V, et al. C9ORF72 expansion in amyotrophic lateral sclerosis/frontotemporal dementia also causes parkinsonism. Mov Disord 2012;27:1072e4. [47] Lindquist SG, Duno M, Batbayli M, Puschmann A, Braendgaard H, Mardosiene S, et al. Corticobasal and ataxia syndromes widen the spectrum of C9ORF72 hexanucleotide expansion disease. Clin Genet 2013;83:279e83. [48] Arvanitakis Z. Update on frontotemporal dementia. Neurologist 2010;16: 16e22. [49] Holm IE, Isaacs AM, Mackenzie IR. Absence of FUS-immunoreactive pathology in frontotemporal dementia linked to chromosome 3 (FTD-3) caused by mutation in the CHMP2B gene. Acta Neuropathol 2009;118:719e20. [50] Gydesen S, Brown JM, Brun A, Chakrabarti L, Gade A, Johannsen P, et al. Chromosome 3 linked frontotemporal dementia (FTD-3). Neurology 2002;59:1585e94. [51] Stokholm J, Teasdale TW, Johannsen P, Nielsen JE, Nielsen TT, Isaacs A, et al., the Frontotemporal Dementia Research in Jutland Association (FReJA) Consortium. Cognitive impairment in the preclinical stage of dementia in FTD-3 CHMP2B mutation carriers: a longitudinal prospective study. J Neurol Neurosurg Psychiatry 2013;84:170e6. [52] Ghanim M, Guillot-Noel L, Pasquier F, Jornea L, Deramecourt V, Dubois B, et al. CHMP2B mutations are rare in French families with frontotemporal lobar degeneration. J Neurol 2010;257:2032e6. [53] Watts GD, Wymer J, Kovach MJ, Mehta SG, Mumm S, Darvish D, et al. Inclusion body myopathy associated with Paget disease of bone and frontotemporal dementia is caused by mutant valosin-containing protein. Nat Genet 2004;36:377e81. [54] Spina S, Van Laar AD, Murrell JR, Hamilton RL, Kofler JK, Epperson F, et al. Phenotypic variability in three families with valosin-containing protein mutation. Eur J Neurol 2013;20:251e8.
[55] van der Zee J, Pirici D, Van Langenhove T, Engelborghs S, Vandenberghe R, Hoffmann M, et al. Clinical heterogeneity in 3 unrelated families linked to VCP p.Arg159His. Neurology 2009;73:626e32. [56] Spina S, Van Laar A, Murrell J, de Courten-Myers G, Hamilton RL, Farlow MR, et al. Frontotemporal dementia associated with a valosin-containing protein mutation: report of three families. FASEB J 2008;22:58.4. [57] Mehta SG, Khare M, Ramani R, Watts GDJ, Simon M, Osann KE, et al. Genotypeephenotype studies of VCP-associated inclusion body myopathy with Paget disease of bone and/or frontotemporal dementia. Clin Genet 2013;83:422e31. rez P, Cirulli ET, Drory VE, Dabby R, Nisipeanu P, Carasso RL, et al. [58] Gonz alez-Pe Novel mutation in VCP gene causes atypical amyotrophic lateral sclerosis. Neurology 2012;79:2201e8. [59] Chan N, Le C, Shieh P, Mozaffar T, Khare M, Bronstein J, et al. Valosin-containing protein mutation and Parkinson's disease. Letter to the Editor Parkinsonism Relat Disord 2012;18:107e9. [60] Rayaprolu S, Fujioka S, Traynor S, Soto-Ortolaza AI, Petrucelli L, Dickson DW, et al. TARDBP mutations in Parkinson's disease. Parkinsonism Relat Disord 2013;19:312e5. [61] Mosca L, Lunetta C, Tarlarini C, Avemaria F, Maestri E, Melazzini M, et al. Wide phenotypic spectrum of the TARDBP gene: homozygosity of A382T mutation in a patient presenting with amyotrophic lateral sclerosis, Parkinson's disease, and frontotemporal lobar degeneration, and in neurologically healthy subject. Neurobiol Aging 2012;33:1846.e1e4. [62] Quadri M, Cossu G, Saddi V, Simons EJ, Murgia D, Melis M, et al. Broadening the phenotype of TARDBP mutations: the TARDBP Ala382Thr mutation and Parkinson's disease in Sardinia. Neurogenetics 2011;12:203e9. [63] Kwiatkowski TJ Jr, Bosco DA, LeClerc AL, Tamrazian E, Vanderburg CR, Russ C, et al. Mutations in the FUS/TLS gene on chromosome 16 cause familial amyotrophic lateral sclerosis. Science 2009;323:1205e8. [64] Van Langenhove T, van der Zee J, Van Broeckhoven C. The molecular basis of the frontotemporal lobar degeneration e amyotrophic lateral sclerosis spectrum. Ann Med 2012;44:817e28. [65] Sieben A, Van Langenhove T, Engelborghs S, Martin JJ, Boon P, Cras P, et al. The genetics and neuropathology of frontotemporal lobar degeneration. Acta Neuropathol 2012;124:353e72. [66] Gao K, Zheng W, Deng X, Xiong W, Song Z, Yang Y, et al. Genetic analysis of the fused in sarcoma gene in Chinese Han patients with Parkinson's disease. Short communication Parkinsonism Relat Disord 2014;20:119e21. [67] Labbe C, Rayaprolu S, Soto-Ortolaza A, Ogaki K, Uitti RJ, Wszolek ZK, et al. Investigating FUS variation in Parkinson's disease. Parkinsonism Relat Disord 2014;20:S147e9. [68] Rohrer JD, Ridgway GR, Modat M, Ourselin S, Mead S, Fox NC, et al. Distinct profiles of brain atrophy in frontotemporal lobar degeneration caused by progranulin and tau mutations. Neuroimage 2010;53:1070e6. [69] Rohrer JD. Structural brain imaging in frontotemporal dementia. Biochim Biophys Acta 2012;1822:325e32. [70] Whitwell JL, Josephs KA. Recent advances in the imaging of frontotemporal dementia. Curr Neurol Neurosci Rep 2012;12:715e23. [71] Chio A, Calvo A, Moglia C, Restagno G, Ossola I, Brunetti M, et al. Amyotrophic lateral sclerosis-frontotemporal lobar dementia in 3 families with p.Ala382Thr TARDBP mutations. Arch Neurol 2010;67:1002e9. [72] Kim EJ, Park YE, Kim DS, Ahn BY, Kim HS, Chang YH, et al. Inclusion body myopathy with Paget disease of bone and frontotemporal dementia linked to VCP p.Arg155Cys in a Korean family. Arch Neurol 2011;68:787e96. [73] Kalbe E, Onur OA, Minnerop M, Reimann J, Althaus A, Ahmadzadehfar H, et al. Early signs of VCP-related frontotemporal dementia: a neuropsychological, FDG-PET and fMRI study. J Neurol 2011;258:515e8. [74] Josephs KA, Whitwell JL, Parisi JE, Petersen RC, Boeve BF, Jack CR Jr, et al. Caudate atrophy on MRI is a characteristic feature of FTLD-FUS. Eur J Neurol 2010;17:969e75. [75] Cummings JL, Henchcliffe C, Schaier S, Simuni T, Waxman A, Kemp P. The role of dopaminergic imaging in patients with symptoms of dopaminergic system neurodegeneration. Brain 2011;134(Pt 11):3146e66. [76] Pal PK, Wszolek ZK, Kishore A, de la Fuente-Fernandez R, Sossi V, Uitti RJ, et al. Positron emission tomography in pallido-ponto-nigral degeneration (PPND) family (frontotemporal dementia with parkinsonism linked to chromosome 17 and point mutation in tau gene). Parkinsonism Relat Disord 2001;7:81e8. [77] Kono S, Ouchi Y, Terada T, Suzuki M, Yagi S, Miyajima H. Combined FDG and raclopride PET study in a case of ALS with the R521C FUS gene mutation. J Neurol 2012;259:367e9. [78] Tateishi T, Hokonohara T, Yamasaki R, Miura S, Kikuchi H, Iwaki A, et al. Multiple system degeneration with basophilic inclusions in Japanese ALS patients with FUS mutation. Acta Neuropathol 2010;119:355e64. [79] Diaz-Corrales FJ, Sanz-Viedma S, Garcia-Solis D, Escobar-Delgado T, Mir P. Clinical features and 123I-FP-SPECT imaging in drug-induced parkinsonism and Parkinson's disease. Eur J Med Mol Imaging 2010;37:556e64. [80] Pirker W, Djamshidian S, Asenbaum S, Gerschlager W, Tribl G, Hoffman M, et al. Progression of dopaminergic degeneration in Parkinson's disease and atypical parkinsonism: a longitudinal beta-CIT SPECT study. Mov Disord 2002;17:45e53. [81] Seltman RE, Matthews BR. Frontotemporal lobar degeneration. Epidemiology, pathology, diagnosis and management. CNS Drugs 2012;26: 841e70. [82] Jicha GA. Medical management of frontotemporal dementias: the importance of the caregiver in symptom assessment and guidance of treatment strategies. J Mol Neurosci 2011;45:713e23.
