Temporal order of clinical and biomarker changes in familial frontotemporal dementia.

Staffaroni, Adam MORCID logo; Quintana, MelanieORCID logo; Wendelberger, BarbaraORCID logo; Heuer, Hilary W; Russell, Lucy LORCID logo; Cobigo, YannORCID logo; Wolf, Amy; Goh, Sheng-Yang Matt; Petrucelli, Leonard; Gendron, Tania FORCID logo; +95 more...Heller, CarolinORCID logo; Clark, Annie L; Taylor, Jack CarsonORCID logo; Wise, Amy; Ong, Elise; Forsberg, Leah; Brushaber, Danielle; Rojas, Julio C; VandeVrede, LawrenORCID logo; Ljubenkov, Peter; Kramer, Joel; Casaletto, Kaitlin B; Appleby, Brian; Bordelon, Yvette; Botha, HugoORCID logo; Dickerson, Bradford C; Domoto-Reilly, KimikoORCID logo; Fields, Julie A; Foroud, TatianaORCID logo; Gavrilova, Ralitza; Geschwind, DanielORCID logo; Ghoshal, NupurORCID logo; Goldman, Jill; Graff-Radford, Jonathon; Graff-Radford, Neill; Grossman, Murray; Hall, Matthew GH; Hsiung, Ging-YuekORCID logo; Huey, Edward D; Irwin, David; Jones, David TORCID logo; Kantarci, Kejal; Kaufer, Daniel; Knopman, DavidORCID logo; Kremers, Walter; Lago, Argentina Lario; Lapid, Maria IORCID logo; Litvan, IreneORCID logo; Lucente, Diane; Mackenzie, Ian R; Mendez, Mario FORCID logo; Mester, Carly; Miller, Bruce L; Onyike, Chiadi U; Rademakers, RosaORCID logo; Ramanan, Vijay KORCID logo; Ramos, Eliana Marisa; Rao, Meghana; Rascovsky, Katya; Rankin, Katherine P; Roberson, Erik DORCID logo; Savica, Rodolfo; Tartaglia, M CarmelaORCID logo; Weintraub, Sandra; Wong, Bonnie; Cash, David MORCID logo; Bouzigues, ArabellaORCID logo; Swift, Imogen J; Peakman, GeorgiaORCID logo; Bocchetta, MartinaORCID logo; Todd, Emily G; Convery, Rhian S; Rowe, James BORCID logo; Borroni, Barbara; Galimberti, DanielaORCID logo; Tiraboschi, Pietro; Masellis, Mario; Finger, Elizabeth; van Swieten, John C; Seelaar, HarroORCID logo; Jiskoot, Lize C; Sorbi, SandroORCID logo; Butler, Chris R; Graff, Caroline; Gerhard, AlexanderORCID logo; Langheinrich, TobiasORCID logo; Laforce, RobertORCID logo; Sanchez-Valle, RaquelORCID logo; de Mendonça, Alexandre; Moreno, Fermin; Synofzik, Matthis; Vandenberghe, Rik; Ducharme, Simon; Le Ber, Isabelle; Levin, Johannes; Danek, AdrianORCID logo; Otto, Markus; Pasquier, FlorenceORCID logo; Santana, Isabel; Kornak, John; Boeve, Bradley FORCID logo; Rosen, Howard J; Rohrer, Jonathan D; Boxer, Adam LORCID logo; and Frontotemporal Dementia Prevention Initiative (FPI) Investigator (2022) Temporal order of clinical and biomarker changes in familial frontotemporal dementia. Nature medicine, 28 (10). pp. 2194-2206. ISSN 1078-8956 DOI: 10.1038/s41591-022-01942-9
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Unlike familial Alzheimer's disease, we have been unable to accurately predict symptom onset in presymptomatic familial frontotemporal dementia (f-FTD) mutation carriers, which is a major hurdle to designing disease prevention trials. We developed multimodal models for f-FTD disease progression and estimated clinical trial sample sizes in C9orf72, GRN and MAPT mutation carriers. Models included longitudinal clinical and neuropsychological scores, regional brain volumes and plasma neurofilament light chain (NfL) in 796 carriers and 412 noncarrier controls. We found that the temporal ordering of clinical and biomarker progression differed by genotype. In prevention-trial simulations using model-based patient selection, atrophy and NfL were the best endpoints, whereas clinical measures were potential endpoints in early symptomatic trials. f-FTD prevention trials are feasible but will likely require global recruitment efforts. These disease progression models will facilitate the planning of f-FTD clinical trials, including the selection of optimal endpoints and enrollment criteria to maximize power to detect treatment effects.


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