The dementias are persistent or progressive disorders affecting more than one cognitive domain that interfere with an individual’s ability to function at work or home, and represent a decline from a previous level of function. In this thesis I consider the neurophysiology of dementia at a number of levels. I investigate the ways in which the connectivity and function of the brain predisposes to the specific focal patterns of neurodegeneration seen in the various dementias. I aim to identify the mesoscopic changes that occur in individuals with neurodegeneration and how these relate to their cognitive difficulties. I show how, by assessing patients in whom there is focal disruption of brain networks and observing the outcomes in comparison to controls, I can gain insight into the mechanisms by which the normal brain makes predictions and processes language. In Chapter 1, I set the scene for the focussed experimental investigations of model diseases by beginning with an introductory, clinically-focussed review that sets out the features, aetiology, management, epidemiology and prognosis of the dementias. This places these model diseases in the context of the broader clinical challenge posed by the dementias. In Chapter 2, I turn to ‘prototypical’ model diseases that represent neurodegenerative tauopathies with predominantly cortical (Alzheimer’s disease, AD) and subcortical (Progressive Supranuclear Palsy, PSP) disease burdens. I investigate the neurophysiological causes and consequences of Tau accumulation by combining graph theoretical analyses of resting state functional MR imaging and in vivo ‘Tau’ PET imaging using the ligand AV-1451. By relating Tau distribution to the functional connectome I provide in vivo evidence consistent with ‘prion-like’ trans-neuronal spread of Tau in AD but not PSP. This provides important validation of disease modification strategies that aim to halt or slow down the progression of AD by sequestration of pathological Tau in the synapse. In contrast, I demonstrate associations consistent with regional vulnerability to Tau accumulation due to metabolic demand and a lack of trophic support in PSP but not AD. With a cross-sectional approach, using Tau burden as a surrogate marker of disease severity, I then go on to show how the changes in functional connectivity that occur as disease progresses account for the contrasting cognitive phenotypes in AD and PSP. In advancing AD, functional connectivity across the whole brain becomes increasingly random and disorganised, accounting for symptomatology across multiple cognitive domains. In advancing PSP, by contrast, disrupted cortico-subcortical and cortico-brainstem interactions meant that information transfer passed through a larger number of cortical nodes, reducing closeness centrality and eigenvector centrality, while increasing weighted degree, clustering, betweenness centrality and local efficiency. Together, this resulted in increasingly modular processing with inter-network communication taking less direct paths, accounting for the bradyphrenia characteristic of the ‘subcortical dementias’. From chapter 3 onwards, I turn to the in-depth study of a model disease called non-fluent variant Primary Progressive Aphasia (nfvPPA). This disease has a clear clinical phenotype of speech apraxia and agrammatism, associated with a focal pattern of mild atrophy in frontal lobes. Importantly, general cognition is usually well preserved until late disease. In chapter 3 itself, I relate an experiment in which patients with nfvPPA and matched controls performed a receptive language task while having their brain activity recorded with magnetoencephalography. I manipulated expectations and sensory detail to explore the role of top-down frontal contributions to predictive processes in speech perception. I demonstrate that frontal neurodegeneration led to inflexible and excessively precise predictions, and that fronto-temporal interactions play a causal role in reconciling prior predictions with degraded sensory signals. The discussion here concentrates on the insights provided by neurodegenerative disease into the normal function of the brain in processing language. Overall, I demonstrate that higher level frontal mechanisms for cognitive and behavioural flexibility make a critical functional contribution to the hierarchical generative models underlying speech perception In chapter 4, I precisely define the sequence processing and statistical learning abilities of patients with nfvPPA in comparison to patients with non-fluent aphasia due to stroke and neurological controls. I do this by exposing participants to a novel, mixed-complexity artificial grammar designed to assess processing of increasingly complex sequencing relationships, and then assessing the degree of implicit rule learning. I demonstrate that agrammatic aphasics of two different aetiologies are not disproportionately impaired on complex sequencing relationships, and that the learning of phonological and non-linguistic sequences occurs independently in health and disease. In chapter 5, I summarise the synergies between the experimental chapters, and explain how I have applied a systems identification framework to a diverse set of experimental methods, with the common goal of defining the physiology of dementia. I then return to the results of chapter 3 with a clinical focus to explain how inflexible predictions can account for subjective speech comprehension difficulties, auditory processing abnormalities and (in synthesis with chapter 4) receptive agrammatism in nfvPPA. Overall, this body of work has contributed to knowledge in several ways. It has achieved its tripartite aims by: 1) Providing in vivo evidence consistent with theoretical models of trans-neuronal Tau spread (chapter 2), and a comprehensive clinical account of the previously poorly-understood receptive symptomatology of nfvPPA (chapter 5), thus demonstrating that systems neuroscience can provide a translational bridge between the molecular biology of dementia and clinical trials of therapies and medications. In this way, I begin to disentangle the network-level causes of neurodegeneration from its consequences. 2) Providing evidence for a causal role for fronto-temporal interactions in language processing (chapter 3), and demonstrating domain separation of statistical learning between linguistic and non-linguistic sequences (chapter 4), thus demonstrating that studies of patients with neurodegenerative disease can further our understanding of normative brain function. 3) Successfully integrating neuropsychology, behavioural psychophysics, functional MRI, structural MRI, magnetoencephalography and computational modelling to provide comprehensive research training, as the platform for a future research programme in the physiology of dementia.

Le travail présenté dans ce mémoire de thèse avait pour but de synthétiser de nouveaux composés pour des applications en imagerie médicale. La première partie porte sur la synthèse de ligands hétéroleptiques pour la chélation de deux métaux différents en vue d’une utilisation dans deux types d’imagerie. Pour cela, nous avons d’abord synthétisé des porphyrines. Ces molécules sont connues pour la chélation de nombreux métaux de transition et notamment le cuivre, dont l’isotope cuivre-64 est un radioémetteur β+ utilisable en Tomographie par Émission de Positron (TEP). Ces porphyrines ont été couplées à un dérivé du DOTA, molécule connue pour son application, après métallation avec du gadolinium, en Imagerie par Résonance Magnétique (IRM). Ces composés possèdent des valeurs de relaxivité encourageantes pour une application en IRM. Enfin, des biomolécules ont été modifiées afin de vectoriser nos composés. La seconde partie porte sur la synthèse de composés pour l’imagerie médicale par optique non-linéaire. Nous avons dans un premier temps synthétisé des porphyrines amphiphiles et zwiterrioniques pour la Génération de Second Harmonique (GSH). Leur efficacité a été mesurée et celle-ci est suffisante pour pouvoir envisager l’obtention d’images. Dans un second temps, nous avons travaillé sur la synthèse d’un composé pour une application en imagerie biphotonique et en IRM. Pour cela, nous avons relié un dérivé du DOTA avec un fluorophore de type DPP. Le composé final a été métallé avec du gadolinium et sa relaxivité est supérieure à celle du DOTA(Gd). / The goal of my PhD studies was to synthesize new compounds for possible medical imaging applications. The first part of my thesis focused on the synthesis of heteroleptic ligands to achieve the chelation of two different metals aimed at addressing two types of medical imaging. We first synthesized porphyrins, which are well-known for the chelation of numerous transition metals. We focused on copper, whose copper-64 isotope is a β+ emitter usable in Positron Emission Tomography (PET). These porphyrins have been coupled with a DOTA derivative. This molecule, metallated with gadolinium, is well-known in Magnetic Resonance Imaging (MRI). Our compounds display encouraging relaxivities for MRI applications. At last, these molecular probes have been conjugated to a few biomolecules in order to vectorize our compounds. The second part of this work is related to the synthesis of fluorophores for nonlinear optical imaging. We first synthesized amphiphilic zwitterionic porphyrins for Second Harmonic Generation (SHG). The efficiency of these compounds has been measured and was satisying enough to consider the possibility to perform imaging studies. We also worked on the synthesis of compounds for Two Photon Emission Fluorescence (TPEF) imaging and MRI. We have linked a DOTA derivative with a diketopyrrolopyrrole (DPP). This conjugate has been metallated with gadolinium and its relaxivity has been measured. Interestingly, this value is superior to that of DOTA(Gd).

Le travail présenté dans ce mémoire avait pour but de synthétiser de nouvelles molécules dont l’architecture donne accès à des complexes hétérobimétalliques aux propriétés intéressantes pour l’imagerie médicale multimodale. Dans ce manuscrit plusieurs points principaux ont donc été abordés. La première partie de se travail porte sur la synthèse et la caractérisation des ligands. Nous décrivons dans ce manuscrit la synthèse de cinq nouveaux ligands hétérobismacrocycliques basés sur l’association d’une porphyrine et d’un ou de plusieurs dérivés du cyclène. Ces ligands présentent la particularité d’être solubles en milieux aqueux. Au cours des synthèses, nous avons ciblé les améliorations à apporter à notre travail et élaboré une nouvelle voie de synthèse qui permet d’accéder, en seulement six étapes, à un ligand composé d’une porphyrine, d’un dérivé du cyclène et d’une fonction amine libre qui permettra de greffer le ligand sur un vecteur biologique. La seconde partie de ce manuscrit porte sur l’incorporation de centres métalliques dans les ligands synthétisés ainsi que l’étude de leur efficacité en tant qu’agent de contraste de l’IRM. Nous décrivons la synthèse de cinq complexes de gadolinium (III) et de trois complexes hétérobimétalliques associant du gadolinium (III) et du cuivre (II). En effet, le gadolinium est actuellement utilisé dans les agents de contraste de l’IRM et un des isotopes du cuivre, le cuivre-64, est utilisé en imagerie PET. Nous décrivons un protocole de mesure de la relaxivité des complexes à haut et à bas champs magnétiques. Cinq complexes présentent des valeurs de relaxivité quatre fois supérieures à celles des agents de contraste commerciaux de l’IRM. Le dernier chapitre de ce travail porte sur la synthèse, la caractérisation et les études photophysiques de quatre antennes moléculaires associant des porphyrines et des BODIPY. Nous avons développé deux voies de synthèses originales. La première est basée sur la création de liaisons bore-oxygène en substituant les atomes de fluor portés par l’atome de bore des BODIPY. L’autre voie de synthèse utilise la réaction de cycloaddition dipolaire d’Huisgen. Nous décrivons des études photophysiques qui mettent en évidence des transferts d’énergie du BODIPY vers la porphyrine Nous avons mis en évidence le premier exemple de transfert d’énergie d’une porphyrine vers un BODIPY grâce à un système “blue” BODIPY étendu couplé à des porphyrines par une réaction de chimie “click”. / The goal of my PhD thesis was to synthesize new molecules, which give access to heterobimetallic complexes with interesting properties for multimodal imaging. In this manuscript, several main points have been studied. The first part of this work concerns the synthesis and characterization of ligands. We describe here the synthesis of five new ligands based on the association of one porphyrin and one or several cyclen derivatives. Those ligands are water-soluble. During the synthesis, we have targeted improvements to our work and developed a new synthetic pathway, which allowed us to obtain one ligand incorporating a porphyrin, a cyclen derivative and a free amine function. This function could be activated to further graft the ligand onto a biological vector. The second part of this manuscript describes the chelation of metallic centers into the ligands and the study of their efficiency as MRI contrast agents. We describe the synthesis of five gadolinium (III) complexes and three heterobimetallic complexes associating gadolinium (III) with copper (II). Indeed, gadolinium is currently used in contrast agents for MRI and the radioactive isotope of copper, copper-64 is used in PET imaging. We describe also a procedure to measure the relaxivity of the gadolinium complexes at low and high magnetic fields. Five complexes exhibit relaxivity values five times larger than commercially available MRI contrast agents. The last part of this work is related to the synthesis, characterization and photophysical studies of four molecular antennas incorporating porphyrins and BODIPY. We describe two original synthetic pathways. The first one is based on the formation of boron-oxygen bonds by substitution of the fluorine atoms bound to BODIPY boron atom. The second synthetic pathway involves the Huisgen’s dipolar cycloaddition. We describe photophysical data and give evidences of the energy transfer from BODIPY to porphyrin. We present also the first example of energy transfer from porphyrin to BODIPY in the system obtained by “click” chemistry involving an extended “blue” BODIPY.