Early functional MRI changes in a prodromal semantic variant of primary progressive aphasia: a longitudinal case report
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SHORT COMMENTARY
Early functional MRI changes in a prodromal semantic variant of primary progressive aphasia: a longitudinal case report Elisa Canu1 · Valentina Bessi4 · Davide Calderaro1 · David Simoni4 · Veronica Castelnovo1 · Michela Leocadi1 · Sonia Padiglioni4 · Salvatore Mazzeo4 · Camilla Cividini1 · Benedetta Nacmias4 · Sandro Sorbi4,5 · Massimo Filippi1,2,3 · Federica Agosta1,3 Received: 25 March 2020 / Revised: 2 July 2020 / Accepted: 4 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To assess longitudinal patterns of brain functional MRI (fMRI) activity in a case of prodromal semantic variant of a primary progressive aphasia (svPPA). Methods Clinical, cognitive and neuroimaging data (T1-weighted and task-based fMRI during silent naming [SN] and object knowledge [OK]) were obtained at baseline, month 8 and month 16 from a 49-year-old lady presenting with anomias and evolving to overt svPPA in 8 months. Results At baseline, the patient showed isolated anomias and mild left anterior temporal pole atrophy. During SN–fMRI, she showed bilateral temporal and left inferior frontal gyri (iFG) activations. During OK–fMRI, we observed normal performance and the recruitment of bilateral posterior hippocampi, iFG and left middle orbitofrontal gyrus (mOFG). At month 8, the patient received a diagnosis of svPPA and showed isolated right iFG activity during SN–fMRI, and a borderline performance during OK–fMRI together with a disappearance of mOFG recruitment. At the last visit (after 7-month language therapy), the patient showed a stabilization of naming disturbances, and, compared to previous visits, an increased left iFG recruitment during SN–fMRI. During OK–fMRI, she performed abnormally and did not show the activity of mOFG and iFG. Across all visits, brain atrophy remained stable. Conclusions This case report showed longitudinal fMRI patterns during semantic-related tasks from prodromal to overt svPPA. Frontal brain recruitment may represent a compensatory mechanism in patients with early svPPA, which is likely to be reinforced by language-therapy. Brain fMRI is more sensitive compared with structural MRI to detect progressive brain changes associated with disease and treatment. Keywords Primary progressive aphasia · PPA · Semantic variant · svPPA · Task-based functional MRI · fMRI · Speech therapy Several task-based functional MRI (fMRI) studies demonstrated the pattern of brain functional activity associated with semantic processing in healthy and pathological Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10053-9) contains supplementary material, which is available to authorized users. * Federica Agosta [email protected] 1
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Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
conditions, including the semantic variant of a primary progressive aphasia (svPPA) [1–9]. Longitud
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