La sclérose latérale amyotrophique (SLA) et la démence fronto-temporale (DFT) sont des maladies neurodégénératives fatales, actuellement sans traitement. Ces maladies entrainent la dégénérescence des neurones moteurs et corticaux, engendrant des troubles moteurs et cognitifs et ultimement menant à la mort des patients souvent par détresse respiratoire trois à cinq ans après l’apparition des premiers symptômes. À l’échelle d’une vie, le risque de développer ces pathologies est de 1 pour 300-400 pour la SLA et 1 pour 742 pour la DFT, faisant de ces pathologies un risque majeur. Avec le vieillissement de la population que nous connaissons actuellement, il est évident que l’incidence de ces maladies deviendra de plus en plus élevée. Ainsi il est essentiel de comprendre les mécanismes moléculaires sous-jacents à ces pathologies dans le but de développer des thérapies effectives et prévenir l’impact de ces pathologies dans notre société. À ce jour, l’étiologie de la SLA-DFT est encore débattue, cependant la communauté scientifique s’accorde sur le fait que l’interaction entre la génétique et l’environnement joue un rôle essentiel dans le développement de ces maladies. La caractéristique moléculaire principale de ces pathologies est la localisation cytoplasmique de la protéine, normalement, nucléaire TDP-43. TDP-43 est un régulateur clef de l’homéostasie des ARNs. Parmi ces nombreuses fonctions, TDP-43 régule la formation des granules de stress, en régulant leur protéine régulatrice G3BP1. Ces granules formés d’ARN et de protéines se forment pour protéger les cellules durant une période de stress. Récemment, ces granules ont fait l’objet de nombreuses études et leurs dysfonctions ont été associées à la SLA-DFT. Dans cette thèse, nous avons approfondi l’étude de la régulation de TDP-43 sur G3BP1. Nous avons défini que TDP-43 stabilise les transcrits de G3BP1 de par une liaison forte à une séquence conservée à travers l’évolution se situant dans le 3’UTR de G3BP1. La perte de localisation nucléaire, la présence de mutations ou de TDP-35, une isoforme pathologique de TDP-43, sont associées à une diminution des niveaux de G3BP1. Également, d’un point de vue histopathologique, dans le cortex orbitofrontal des patients atteints de SLA-DFT, les neurones présentant une localisation cytoplasmique de TDP-43 ont une perte des niveaux transcriptionnels de G3BP1, associant alors directement G3BP1 à la maladie. Par la suite, nous avons défini que la perte de fonction en tant que stabilisateur, permet la liaison de microARNs sur les transcrits de G3BP1, engendrant leur dégradation. Le blocage de la liaison de microARNs sur G3BP1 empêche la dégradation des transcrits et restaure les fonctions de la protéine. Ainsi, nous avons déterminé un moyen de contrer la perte de fonction de TDP-43 sur G3BP1. De façon intéressante, en plus de la formation des granules de stress, G3BP1 est essentielle pour l’homéostasie neuronale et la survie neuronale post-stress. Par conséquent, la restauration de la protéine est potentiellement une avenue thérapeutique multi-approche pour le traitement de ces maladies. / Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are two fatal neurodegenerative diseases, currently without cure. These diseases lead to the degeneration of motor and cortical neurons, causing motor and cognitive disorders and ultimately leading to death, often from respiratory distress three to five years after the onset. Over a lifetime, the risk of developing these conditions is 1 in 300-400 for ALS and 1 in 742 for FTD, making these conditions a major risk. With the current aging of the population, it is evident that the incidence of these diseases will become increasingly high. It is therefore essential to understand the molecular mechanisms underlying these pathologies in order to develop effective therapies. To this day, the etiology of ALS-FTD is still debated. However, the scientific community agrees that the interaction between genetics and the environment play an essential role in the development of these diseases. The main molecular characteristic of these pathologies is the cytoplasmic localization of the normally nuclear protein TDP-43. TDP-43 is a key regulator of RNA homoeostasis. Among these many functions, TDP-43 regulates the formation of stress granules, by regulating their nucleator protein G3BP1. These granules of RNA and protein form to protect cells during times of stress. Recently these granules have been the subject of several studies and their dysfunction has been associated with ALS-FTD. In this thesis, we have deepened the study of the regulation of TDP-43 on G3BP1. We have defined that TDP-43 stabilizes G3BP1 transcripts by strong binding to a sequence conserved through evolution located in the 3'UTR of G3BP1. Loss of nuclear localization, the presence of mutations or of TDP-35, a pathological isoform of TDP-43, are associated with decreased levels of G3BP1. Also, histopathologically, in the orbitofrontal cortex of patients with ALS-DFT, neurons with cytoplasmic localization of TDP-43 have a loss of transcriptional levels of G3BP1, directly associating G3BP1 with the disease. Subsequently, we defined that TDP-43 loss of function as a stabilizer allows the binding of two microRNAs on the G3BP1 transcripts, causing their degradation. Blocking the binding of these microRNAs to G3BP1 prevents the degradation of the transcripts and restores the functions of the protein. Thus, we have determined a way to counter the loss of function of TDP-43 on G3BP1. Interestingly, in addition to the formation of stress granules, G3BP1 is essential for neuronal homoeostasis and post-stress neuronal survival. Therefore, the restoration of the protein is potentially a multi-approach therapeutic avenue for the treatment of these diseases.

No / The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study. DESIGN: A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial. RESULTS: Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme. CONCLUSIONS: Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal.

Thèse de doctorat présentée en vue de l'obtention du doctorat en psychologie (Ph.D). / L'enfance et l'adolescence sont des périodes uniques de la vie où les changements neuronaux favorisent l'établissement de réseaux cérébraux matures et le développement des capacités intellectuelles. Le langage est un domaine cognitif qui est, non seulement essentiel pour la communication interhumaine, mais qui contribue également au développement de nombreuse capacités et prédit de manière significative la réussite académique. Les régions cérébrales frontotemporales sont des régions clés du réseau langagier du cerveau. Il a été démontré que les neuropathologies telles que l'épilepsie des lobes frontal et temporal (ELF et ELT) interfèrent avec le développement des réseaux cérébraux du langage et provoquent des circuits cérébraux aberrants. Les patrons exacts de réorganisation des réseaux cérébraux fonctionnels ne sont toutefois, pas entièrement compris et l'association avec le profil neuropsychologique reste spéculative. Par conséquent, l'objectif principal de cette thèse est d'accroître la compréhension des altérations du réseau langagier et d'améliorer les connaissances de l'association de l'architecture du réseau et des capacités cognitives chez les enfants et les adolescents avec ELF ou ELT. La présente thèse est composée de trois articles scientifiques, les deux premiers présentant des travaux méthodologiques qui ont permis d'optimiser les méthodes appliquées dans le troisième article, l'étude empirique principale menée auprès d'enfants avec ELF et ELT. Le premier article présente le bilan neuropsychologique pédiatrique comme un outil important pour estimer les capacités cognitives et dresser un profil cognitif avec ses forces et ses faiblesses. Dans le deuxième article, l'analyse factorielle parallèle (PARAFAC) est présentée et validée comme une nouvelle technique employée pour corriger les artefacts de mouvement qui contaminent le signal hémodynamique évalué par la spectroscopie fonctionnelle proche infrarouge (fNIRS). Une meilleure qualité du signal permet une interprétation fiable de la réponse cérébrale en plis de déduire des métriques d'organisation du réseau cérébral. Le troisième article consiste en une étude empirique, où le traitement cérébral du langage, est comparé entre des enfants avec ELF et ELT, et des pairs neuroptypiques. Les schémas de connectivité fonctionnelle indiquent que le groupe de patients présente moins de connexions intra-hémisphériques dans l'hémisphère gauche et entre les hémisphères, et des connexions accrues dans l'hémisphère droit par rapport au groupe témoin. Les mesures de l'architecture du réseau révèlent en outre une efficacité de traitement local plus élevée dans l'hémisphère droit chez les enfants atteints de ELF et ELT par rapport aux enfants en bonne santé. L'architecture du réseau local de l'hémisphère gauche et la capacité intellectuelle globale dans le groupe de patients sont négativement liées, tandis que dans le groupe contrôle, aucune association de ce type n'est identifiable. Ces résultats suggèrent que la réorganisation du réseau de langage chez les enfants avec ELF ou ELT semble dans certains cas soutenir un meilleur résultat cognitif, soit lorsque l'efficacité du traitement local dans l'hémisphère gauche est diminuée. Au contraire, une plus grande efficacité de traitement local semble être une caractéristique d'un réseau de langage cérébral associé à de moins bonnes capacités cognitives. Les travaux de recherche de cette thèse de doctorat fournissent des lignes directrices pour l'utilisation de l'évaluation neuropsychologique pédiatrique, à la fois dans un contexte clinique et scientifique. L'introduction de PARAFAC pour corriger les artefacts de mouvement dans le signal fNIRS est un ajout important au pipeline de prétraitement qui permet d'augmenter la qualité du signal pour une analyse ultérieure. De futurs projets pourront s'appuyer sur cette validation initiale et étendre l'utilisation de PARAFAC pour les analyses du signal fNIRS. Sur cette base méthodologique solide, le travail empirique confirme l'incidence accrue de circuits cérébraux aberrants liés au traitement du langage chez les enfants atteints de ELF et de ELT, et soutient en outre l'efficacité du réseau local en tant que déterminant clé de l'impact de la plasticité cérébrale précoce sur les capacités cognitives. Afin de mieux comprendre les altérations du réseau en réponse aux neuropathologies et leur impact, des études avec des échantillons plus grands et de différents groupes d'âge, devraient étudier plus spécifiquement le rôle des facteurs cliniques (e.g., le type d'épilepsie, la latéralisation de l'épilepsie, le contrôle des crises, etc.) et aborder leurs influences sur le développement. À long terme, cela augmentera le pronostic des phénotypes cliniques chez les patients pédiatriques atteints de ELF et de ELT, et offrira des opportunités d'interventions précoces pour soutenir un développement typique. / Childhood and adolescence are unique periods in life where neuronal changes support the establishment of mature brain networks and the development of intellectual capacities. Language is one cognitive domain that is not only an essential part of inter-human communication but also contributes to the development of other capacities and significantly influences academic achievement. Frontotemporal brain areas are key regions of the brain's language network. Neuropathologies such as frontal and temporal lobe epilepsies (FLE and TLE) have been shown to interfere with developing brain language networks and cause aberrant cerebral circuits. The exact patterns of functional brain network reorganization are not fully understood and the association with the neuropsychological profile remains speculative. Therefore, the main objective of this thesis was to increase comprehension of language network alterations and enhance the knowledge on the association of network topology and cognitive capacities in children and adolescents with FLE or TLE. This thesis consists of three scientific articles, with the first two presenting methodological work that allowed for the optimization of the methods applied in the third article, which is the main empirical study conducted on children with FLE and TLE. The first article presents the pediatric neuropsychological assessment as a valuable tool to estimate cognitive capacities and draw a cognitive profile with strengths and weaknesses. In the second article, parallel factor analysis (PARAFAC) is presented and validated as a novel technique to correct motion artifacts that contaminate the hemodynamic signal assessed with functional near-infrared spectroscopy (fNIRS). A better signal quality is the basis for a reliable interpretation of the cerebral response and derive metrics of brain network organization. The third article consists of an empirical study where cerebral language processing is compared between children with FLE and TLE, and neuroptypical peers. Patterns of functional connectivity indicate that the patient group demonstrates fewer intra-hemispheric connections in the left hemisphere and between hemispheres, and increased connections within the right hemisphere as compared to the control group. Metrics of network architecture further reveal a higher local processing efficiency within the right hemisphere in children with FLE and TLE compared to healthy peers. Local network architecture of the left hemisphere and the overall intellectual capacity in the patient group is negatively related, while in the control group no such association is identifiable. These findings suggest that language network reorganization in children with FLE or TLE in some cases seems to support a better cognitive outcome, namely when local processing efficiency in the left hemisphere is decreased. On the contrary, a higher local processing efficiency seems to be a characteristic of a brain language network that goes along with worse cognitive capacities. The research work of this doctoral thesis provides guidelines for the use of pediatric neuropsychological assessment both in a clinical and scientific context. The introduction of PARAFAC to correct motion artifact in the fNIRS signal is an important add-on to the preprocessing pipeline that allows to increase signal quality for subsequent analysis. Future projects will be able to build on this initial validation and extend PARAFAC's use for fNIRS analysis. On this solid methodological foundation, the empirical work confirms the increased incidence of aberrant brain circuits related to language processing in children with FLE and TLE, and further supports local network efficiency as a key determinant of the impact of early brain plasticity on cognitive capacities. In order to further understand network alterations in response to neuropathologies and their impact, studies with larger samples sizes and different age groups should further investigate the specific role of clinical factors (e.g., epilepsy type, epilepsy lateralization, seizure control, etc.) and address developmental influences. Ultimately, this will increase prognosis of clinical phenotypes in pediatric patients with FLE and TLE, and offer opportunities for early interventions to support a healthy development.

Text in English / The present paper analyses the neuroanatomical and neuropsychological backgrounds of art reception and art creation in modern visual art and creative processes. It critically presents two models of aesthetic experience to provide a comprehensive theoretical basis for the discussion. The research purpose is to show that with increasing experience and expertise the referential frame of the aesthetic judgment is changing and that neural processes involved in object recognition provide a starting point for visual aesthetics. Thus, the investigation focuses on constructing and testing neuropsychological theories that fall in the domain called 'neuroaesthetics'. These theories, in turn, serve as a starting point to formulate neural laws of art and aesthetics and aesthetic experience. Some artistic styles, such as expressionism, reflect specific neural processes. Various studies indicate correlations between hemispheric specialisation and art or creativity and show the right hemisphere plays a particular role in it. However, studies exploring the neural correlates of aesthetic preference have yielded mixed results. Furthermore, neuroimaging studies have proved that different categories of modern artworks are processed in different areas of the brain. These diverging results will be discussed in a critical assessment of the two models of aesthetic experience. Besides, the question of identifying exclusive neural correlates of aesthetic preference will be raised. Comparing amateurs and experts has revealed the more reduced the cortical activation, the more efficiently it works. Biological and neuropsychological factors of creativity point out the meaning of the activation level, cognitive inhibition and prefrontal cortex. Divergent thinking differs from convergent thinking in terms of the neural level. Neurodegenerative processes and brain injuries sometimes influence the artistic output surprisingly or even launch it. Lesion studies contributing to understanding art experience will be explained. / Psychology / M.A. (Psychology)

The present paper analyses the neuroanatomical and neuropsychological backgrounds of art reception and art creation in modern visual art and creative processes. It critically presents two models of aesthetic experience to provide a comprehensive theoretical basis for the discussion. The research purpose is to show that with increasing experience and expertise the referential frame of the aesthetic judgment is changing and that neural processes involved in object recognition provide a starting point for visual aesthetics. Thus, the investigation focuses on constructing and testing neuropsychological theories that fall in the domain called 'neuroaesthetics'. These theories, in turn, serve as a starting point to formulate neural laws of art and aesthetics and aesthetic experience. Some artistic styles, such as expressionism, reflect specific neural processes. Various studies indicate correlations between hemispheric specialisation and art or creativity and show the right hemisphere plays a particular role in it. However, studies exploring the neural correlates of aesthetic preference have yielded mixed results. Furthermore, neuroimaging studies have proved that different categories of modern artworks are processed in different areas of the brain. These diverging results will be discussed in a critical assessment of the two models of aesthetic experience. Besides, the question of identifying exclusive neural correlates of aesthetic preference will be raised. Comparing amateurs and experts has revealed the more reduced the cortical activation, the more efficiently it works. Biological and neuropsychological factors of creativity point out the meaning of the activation level, cognitive inhibition and prefrontal cortex. Divergent thinking differs from convergent thinking in terms of the neural level. Neurodegenerative processes and brain injuries sometimes influence the artistic output surprisingly or even launch it. Lesion studies contributing to understanding art experience will be explained. / Psychology / M.A. (Psychology)

Many neurodegenerative diseases are characterized by the accumulation of misfolded proteins that often share common morphological and biochemical features, and can similarly co-localize with several other proteins, including various chaperone proteins. Chaperone proteins, like heat shock protein 27 (HSP27), heme oxygenase 1 (HO-1) and clusterin, have been implicated as potent modulators of misfolded proteins, thus may play important roles in the pathogenesis of neurodegenerative diseases. The present study aims to investigate their roles in the pathogenesis of Frontotemporal lobar degeneration (FTLD), Alzheimer's disease (AD), Parkinson's disease (PD), and Motor neuron disease (MND) by determining their distribution and amount via immunohistochemical staining and western blotting in diseased and control subjects.There were distinct patterns of HSP27 and clusterin immunostaining in different brain regions. For HSP27, patients with AD and FTLD were in general more severely affected than were patients with MND and control subjects. For clusterin, patients with AD and FTLD were more severely affected than control subjects where neurons and glial cells were concerned, while patients with AD and control subjects were more severely affected than those with FTLD where diffuse and cored plaques were concerned. However, there were no obvious differences in the pattern of HO-1 immunostaining in various brain regions in patients with AD or FTLD relative to control subjects. Moreover, there was no association between HSP27, HO-1 and clusterin with disease or histological type, and the ‘classic’ neuropathological changes in FTLD, AD and MND were not immunoreactive to any of these proteins. There were significant correlations between the degrees of HO-1 and clusterin immunostaining in many brain areas for both AD and FTLD cases, and for all cases overall, but none between HSP27 and clusterin or HSP27 and HO-1. Present results suggest an involvement with ongoing cellular stress, misfolded or unfolded protein accumulation or the deficits/failure of other relevant protein quality control systems, in the pathogenesis of these neurodegenerative diseases. Present work may therefore have implications for the further development of ideas concerning the cause or treatment of neurodegenerative diseases where there is aberrant accumulation of misfolded, aggregated protein, and perhaps for conformational diseases in general. However, there are still many issues remain to be elucidated. Further research aimed at understanding the function and mechanisms of the chaperone system, and other protein quality control mechanisms, in the pathogenesis of neurodegenerative diseases is still needed.

The theoretical part deals with issues of dementia, memory, primacy effect, recency effect, and the Auditory-Verbal Learning Test. The empirical part consists of quantitative research. The research sample consists of patients with dementia who were tested for their performance in the Auditory-Verbal Learning Test in which I focused on the primacy and recency effects. The aim was to determine the differences between the primacy and recency effects among different groups of patients, as well as to detect the presence or absence of a primacy or recency effect in various populations. This study tries to describe a potential tool that focuses on how individuals with dementia remember new informations. This tool can serve to understand how people diagnosed with memory disorders of different etiology remember new infomation. Key words: Dementia, Alzheimer's Disease, vascular dementia, frontotemporal dementia, Auditory-Verbal Learning Test , primacy effect, recency effect

Progression and pattern of changes in different biomarkers of Alzheimer’s disease (AD) and frontotemporal lobar degeneration (FTLD) like [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) have been carefully investigated over the past decades. However, there have been substantially less studies investigating the potential of combining these imaging modalities to make use of multimodal information to further improve understanding, detection and differentiation of various dementia syndromes. Further the role of preprocessing has been rarely addressed in previous research although different preprocessing algorithms have been shown to substantially affect diagnostic accuracy of dementia. In the present work common preprocessing procedures used to scale FDG-PET data were compared to each other. Further, FDG-PET and MRI information were jointly analyzed using univariate and multivariate techniques. The results suggest a highly differential effect of different scaling procedures of FDG-PET data onto detection and differentiation of various dementia syndromes. Additionally, it has been shown that combining multimodal information does further improve automatic detection and differentiation of AD and FTLD.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19174号 / 医博第4016号 / 新制||医||1010(附属図書館) / 32166 / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 淳, 教授 村井 俊哉, 教授 渡邉 大 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Die Liquordiagnostik im Rahmen von Demenzerkrankungen ist trotz neuer diagnostischer Möglichkeiten im Bereich der PET(Positronen-Emissions-Tomographie)-Bildgebung weiterhin von hoher klinischer Relevanz. Insbesondere für die Alzheimer-Erkrankung existieren validierte Biomarker, die die Diagnose untermauern und bei der diagnostischen Abgrenzung anderer Demenzätiologien hilfreich sein können.Während unauffällige Liquorbefunde mit negativen Demenz- und Destruktionsmarkern die überwiegende Mehrzahl neurodegenerativer Demenzursachen mit hoher diagnostischer Sicherheit ausschließen, stellen in der klinischen Praxis vor allem überlappende Biomarkerprofile bei primär neurodegenerativen Demenzursachen ein substanzielles Problem bei der Befundinterpretation dar. Deshalb bedarf die Liquorbefundinterpretation stets einer kontextualisierten Betrachtung unter Würdigung der klinischen Symptomatik und Verlaufscharakteristika des entsprechenden demenziellen Syndroms. Außerdem stellen auchMischbefunde eine häufige diagnostische Herausforderung dar, ür deren Interpretation es profunder Kenntnisse im Bereich von Präanalytik, möglicher Liquorbefundkonstellationen und natürlich der verschiedenen in Betracht kommenden Demenzätiologien bedarf. Auch Liquorbiomarker für Synukleinopathien, Tauopathien sowie TDP43(Transactive response DNA binding protein 43 kDa)-Proteinopathien sind Gegenstand aktueller Untersuchungen, wenngleich diese noch nicht den Weg in die klinische Routinediagnostik gefunden haben.