2026-03-16 ブラウン大学
＜関連情報＞
- https://www.brown.edu/news/2026-03-16/alzheimers-ftld-diagnosis
- https://www.neurology.org/doi/10.1212/WNL.0000000000214750
病理学的にアルツハイマー病と前頭側頭葉変性症の併発が確認された患者における神経精神症状 Neuropsychiatric Symptoms in Patients With Pathologically Confirmed Comorbid Alzheimer Disease and Frontotemporal Lobar Degeneration
Daliah Ross, Molly Split, Zachary Kunicki, Rachel Keszycki, Sarah Prieto, Alyssa N. De Vito, Masood Manoochehri, Edward D. Huey, and Megan S. Barker
Neurology Published:March 5, 2026
DOI:https://doi.org/10.1212/WNL.0000000000214750
Abstract
Background and Objectives
Little is known about the clinical presentation in patients with comorbid Alzheimer disease neuropathologic change (ADNC) and frontotemporal lobar degeneration (FTLD) neuropathology, despite frequent comorbidity of neurodegenerative diseases on autopsy. In other neurodegenerative conditions, multiple pathologies alter the presentation of neuropsychiatric symptoms, complicating clinical care. We examined whether neuropsychiatric symptoms differ in patients with comorbid ADNC/FTLD compared with patients with each pathology alone.
Methods
This was a retrospective examination of data from 29 US Alzheimer’s Disease Research Centers, obtained through the National Alzheimer’s Coordinating Center September 2024 data freeze. Patients with intermediate-to-high ADNC and/or FTLD neuropathology on autopsy were included. Neuropsychiatric symptoms were apathy, depressed mood, visual/auditory hallucinations, delusions, disinhibition, irritability, agitation, personality change, REM sleep behavior disorder, and anxiety, identified by clinicians at patients’ final visit. Logistic regression models examined the odds of the comorbid vs single pathology groups expressing each neuropsychiatric symptom, controlling for age, sex, race, ethnicity, education, and interval between first visit and death.
Results
Data from 919 patients (mean age 81 years [SD 12 years], 49% female) were analyzed. Ninety-four patients (mean age 84 years [SD 10 years], 46% female) had comorbid ADNC/FTLD pathology, 590 had ADNC only, and 235 had FTLD only. Compared with the FTLD-only group, patients in the comorbid ADNC/FTLD group were more likely to present with anxiety (odds ratio [OR] 3.11, 95% CI 1.38–6.98, p = 0.007), delusions (OR 2.59, 95% CI 1.15–5.79, p = 0.02), and irritability (OR 1.87, 95% CI 1.07–3.25, p = 0.03). Conversely, compared with the ADNC-only group, patients in the comorbid ADNC and FTLD group were more likely to present with personality change (OR 3.17, 95% CI 1.70–5.90, p < 0.001) and disinhibition (OR 2.00, 95% CI 1.14–3.53, p = 0.02).
Discussion
Comorbid presence of ADNC and FTLD neuropathology, compared with each pathology alone, was associated with a greater likelihood of presenting with known neuropsychiatric symptoms of the other disease, irrespective of patients’ clinical syndrome. Findings highlight the potential clinical diagnostic value of antemortem behavioral symptoms in identifying patients with comorbid pathology, although conclusions are limited by the cross-sectional nature of the neuropsychiatric data.
