Hippocampal Sclerosis and Amnesia Not Due to Alzheimer's Disease

Last updated: July 10, 2024
Sponsor: Centre Hospitalier St Anne
Overall Status: Completed

Phase

N/A

Condition

Memory Problems

Memory Loss

Scar Tissue

Treatment

MRI 7T

Neurological examinations

Neuropsychological examinations

Clinical Study ID

NCT02576821
D14-P010
  • Ages > 18
  • All Genders
  • Accepts Healthy Volunteers

Study Summary

Hippocampal Sclerosis (HS) leads to anterograde amnesia mimicking early Alzheimer's disease (AD) (so called HSA-nonAD). Recent studies showed that (a) the deficit of episodic memory as well as the level of hippocampal atrophy in bvFTD may be of similar severity to that observed in AD, even at initial presentation, leading to misdiagnosis in 22% of cases with post mortem diagnosis; (b) amnesia with HS due to microvascular lesion and microinfarcts can also cause impairment of episodic memory mimicking AD, without subcortical cognitive profile. Because these diseases involve distinct pathophysiological processes, they require different specific care and treatment. In consequence, it is very important to improve our knowledge about HS in order to identify its mechanism and improve the diagnosis.

Eligibility Criteria

Inclusion

Inclusion Criteria:

General inclusion criteria

  • Be older than18 years old.

  • Consulting in one of the centers (patients only)

  • Sufficient cognitive capacities for the realization of the clinical andneuropsychological evaluations, left to the judgement by the investigator.

  • Women old enough to procreate under effective contraception

  • Signed consent

  • Absence of general or systemic disorders that may interfere with cognition.

  • If available before inclusion, absence of brain lesions as determined by MRI thatmay account for even part of the clinical presentation.

Patients with Hippocampal sclerosis non AD (n=40)

Clinical criteria :

  • CDR (Clinical Dementia Rating Scale) = 0.5 or 1

  • Progressive amnestic syndrome of the hippocampal type, defined by a free recallscore ≤ 17/48 and a total recall score ≤ 40/48 on the FCSRT.

Biological criteria : Absence of Profile suggestive of AD on the study of the biomarkers of the CSF (IATI ratio > 0.8)

Patients with Alheimer's Disase (n=40)

Clinical criteria :

  • CDR (Clinical Dementia Rating Scale) = 0.5 or 1

  • Typical amnesic AD : Progressive amnestic syndrome of the hippocampal type, definedby a free recall score ≤ 17/48 and a total recall score ≤ 40/48 on the FCSRT,associated or not with others cognitive impairment

  • Posterior Cortical Atrophy : initial presentation of progressive visual orvisuospatial impairment; absence of ophthalmologic impairment with evidence ofcomplex visual and/or visuospatial disorder on examination; a relatively preservedepisodic memory

  • Logopenic progressive aphasia : word retrieval deficits in spontaneous speech andconfrontation naming, impaired repetition of sentences, errors in spontaneous speechand naming (eg, phonological errors), and relative sparing of word and objectknowledge and motor speech.

Biological criteria : CSF biomarkers suggestive of AD defined on CSF.

Patients with DLFT (n=20) :

Clinical criteria :

  • Modifications of the personality and the social conducts in the foreground

  • Compatible brain imaging with the diagnosis : profile of atrophy and/orhypometabolism in TEP-FDG (or hypoerfusion in Spect) compatible with the diagnosisof DFT and/or absence of atypie Biological criteria : No AD profile on CSFbiomarkers

Patients with CBD/PSP (n=20) (Armstrong et al., 2013)

  1. Corticobasal syndrome :
  • at least one of the following signs : limb rigidity or akinesia, limb dystonia,limb myoclonusplus at least one of the following sign : orobuccal or limbapraxia, e) cortical sensory deficit, alien limb phenomena (more than simplelevitation)

  • Nonfluent/agrammatic variant of primary progressive aphasia: Effortful,agrammatic speech plus at least one of: a) impaired grammar/sentencecomprehension with relatively preserved, single word comprehension, or b)groping, distorted speech production (apraxia of speech)

  1. Progressive supranuclear palsy syndrome :
  • Three of the following items present: a) axial or symmetric limb rigidity orakinesia, b) postural instability or falls, c) urinary incontinence, d)behavioural changes, e) supranuclear vertical gaze palsy or decreased velocityof vertical saccades

Normal controls (n=20):

Absence of known psychiatric disorder Score on the Folstein Mini Mental Status (MMSE > or = 27) Normal neuropsychological assessment for the age and the educational level

Exclusion

Exclusion Criteria:

  • Subject with a psychiatric evolutionary and/or badly checked pathology (left to thejudgement of the investigator).

  • Subject with a grave, severe or unstable pathology (left to the judgement of theinvestigator) the nature of which can interfere with the variables of evaluation.

  • Epileptics subjects, badly tolerant MRI (1.5T, 3T or 7T), Subject presentingcontraindications to the MRI (if necessary, a blood pregnancy test will be performedbefore 7T MRI) (Pacemaker or stimulating neurosensory or implantable defibrillator,cochlear implants, eye or cerebral ferromagnetic foreign bodies close to nervousstructures, metallic prostheses, agitation of the patient : not cooperative oragitated patients, very young children, claustrophobics subjects, pregnant women,neurosurgical ventriculoperitoneal shunt valves, brace)

  • Known or supposed histories (< or = 5 years) of severe alcoholism or misuse of drugs

  • Vascular, inflammatory or expansive, visible lesion in the MRI which can interfereon the criteria of diagnosis.

  • No health insurance

  • Pregnant, breast-feeding woman or planning a pregnancy in two years of follow-up.

  • For controls : anomaly detected on the MRI in the appreciation of the investigator

Study Design

Total Participants: 141
Treatment Group(s): 5
Primary Treatment: MRI 7T
Phase:
Study Start date:
January 27, 2016
Estimated Completion Date:
October 16, 2023

Study Description

Hippocampal sclerosis (HS) refers to neuronal cell loss and astrocytosis in subiculum and cornu ammonis subfields of the hippocampal formation unrelated to Alzheimer's disease pathology. In contrast to HS that affects younger adults with epilepsy, older individuals with HS have significant ante-mortem cognitive dysfunction but no epilepsy. Neuropathological studies demonstrated three main types of HS associated with aging: (a) HS-Ageing to refer to the disease with HS pathology in ageing individuals, observed in more than 10% of subjects aged over 85 years; (b) HS observed in the behavioural variant of frontotemporal dementia (bvFTD), HS being more frequent in tau-negative pathology, especially in FTLD-TDP. bvFTD patients may manifest severe episodic memory impairment and hippocampal atrophy; (c) HS associated with cortical or subcortical cerebral microinfarcts, which are invisible on conventional MRI. Cerebral microinfarcts are observed in 33% of elderly over 85 years in post-mortem studies.

HS leads to anterograde amnesia mimicking early Alzheimer's disease (AD) (so called HSA-nonAD). Recent studies showed that (a) the deficit of episodic memory as well as the level of hippocampal atrophy in bvFTD may be of similar severity to that observed in AD, even at initial presentation, leading to misdiagnosis in 22% of cases with post mortem diagnosis; (b) amnesia with HS due to microvascular lesion and microinfarcts can also cause impairment of episodic memory mimicking AD, without subcortical cognitive profile. Because these diseases involve distinct pathophysiological processes, they require different specific care and treatment. In consequence, it is very important to improve our knowledge about HS in order to identify its mechanism and improve the diagnosis.

Connect with a study center

  • Neurologie de la mémoire et du langage, Service de Neurologie, Centre Hospitalier Sainte-Anne

    Paris, 75014
    France

    Site Not Available

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