Differing patterns of temporal atrophy in Alzheimer’s disease and semantic dementia
Abstract
Objective: To characterize and quantify the patterns of temporal lobe atrophy in AD vs semantic dementia and to relate the findings to the cognitive profiles. Medial temporal lobe atrophy is well described in AD. In temporal variant frontotemporal dementia (semantic dementia), clinical studies suggest polar and inferolateral temporal atrophy with hippocampal sparing, but quantification is largely lacking.
Methods: A volumetric method for quantifying multiple temporal structures was applied to 26 patients with probable AD, 18 patients with semantic dementia, and 21 matched control subjects.
Results: The authors confirmed the expected bilateral hippocampal atrophy in AD relative to controls, with involvement of the amygdala bilaterally and the right parahippocampal gyrus. Contrary to expectations, patients with semantic dementia had asymmetric hippocampal atrophy, more extensive than AD on the left. As predicted, the semantic dementia group showed more severe involvement of the temporal pole bilaterally and the left amygdala, parahippocampal gyrus (including the entorhinal cortex), fusiform gyrus, and the inferior and middle temporal gyri. Performance on semantic association tasks correlated with the size of the left fusiform gyrus, whereas naming appeared to depend upon a wider left temporal network. Episodic memory measures, with the exception of recognition memory for faces, did not correlate with temporal measures.
Conclusions: Hippocampal atrophy is not specific for AD but is also seen in semantic dementia. Distinguishing the patients with semantic dementia was the severe global but asymmetric (left > right) atrophy of the amygdala, temporal pole, and fusiform and inferolateral temporal gyri. These findings have implications for diagnosis and understanding of the cognitive deficits in AD and semantic dementia.
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Received: December 8, 2000
Accepted: April 7, 2001
Published online: July 24, 2001
Published in print: July 24, 2001
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We read with interest the article by Galton et al. [1]. Their results complement those obtained in our study, in which quantitative MRI analysis was also used to measure the volumes of the temporal lobe structures in semantic dementia (SD) and Alzheimer's disease (AD). [2]. There is a reassuring level of agreement between the two sets of results. Both studies revealed that there was marked hippocampal atrophy in the SD patients. The degree of right-sided hippocampal atrophy was comparable between the SD and AD groups, whereas the atrophy of the left hippocampus was more severe in the SD group.
Episodic memory is relatively preserved in SD, as evidenced by the demonstration in both studies that the SD patients were less impaired on tests of episodic memory than the AD patients. Given the role of the hippocampus in episodic memory, [3] these observations of hippocampal atrophy in SD appear somewhat surprising at first sight.
Galtonet al. suggested several possible explanations for this apparent discrepancy. [1] First, there is the possibility that episodic memory function in the SD patients is maintained by the right hippocampus. However, in both studies the right hippocampus in the SD patients was found to be at least as atrophied as in the AD patients. A second option is that there is a greater degree of frontal lobe dysfunction in the AD patients, and that this additional dysfunction may exacerbate the memory problem in AD. This argument, though, is weakened by the knowledge that the frontal lobes are frequently affected in SD, as Galton et al. point out. [1] Finally, the difference in episodic memory performance between SD and AD might be attributed to different effects of the two diseases on neurotransmitter systems.
We would like to propose an alternative explanation. We undertook an assessment of the anteroposterior gradient of hippocampal atrophy by measuring cross-sectional areas through both hippocampi along their rostrocaudal extents. In SD the hippocampal atrophy was predominantly anterior in location, with relative preservation of the posterior hippocampi. On this basis, we hypothesise that the relative sparing of episodic memory in SD is attributable to the sparing of the posterior hippocampi. This would be in keeping with functional imaging studies that show greater activation of the hippocampus posteriorly during episodic encoding and retrieval. [4, 5] Taken together, these data have implications for our understanding of the role of the hippocampus in episodic memory.
We would welcome further discussion on this intriguing subject.
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