Frontotemporal dementia subtyping using machine learning, multivariate statistics and neuroimaging

Frontotemporal dementia (FTD) is a prevalent form of early-onset dementia characterized by progressive neurodegeneration and encompasses a group of heterogeneous disorders. Due to overlapping symptoms, diagnosis of FTD and its subtypes still poses a challenge. Magnetic resonance imaging (MRI) is commonly used to support the diagnosis of FTD. Using machine learning and multivariate statistics, we tested whether brain atrophy patterns are associated with severity of cognitive impairment, whether this relationship differs between the phenotypic subtypes and whether we could use these brain patterns to classify patients according to their FTD variant. A total of 136 patients (70 behavioural variant FTD, 36 semantic variant primary progressive aphasia and 30 non-fluent variant primary progressive aphasia) from the frontotemporal lobar degeneration neuroimaging initiative (FTLDNI) database underwent brain MRI and clinical and neuropsychological examination. Deformation-based morphometry, which offers increased sensitivity to subtle local differences in structural image contrasts, was used to estimate regional cortical and subcortical atrophy. Atlas-based associations between atrophy values and performance across different cognitive tests were assessed using partial least squares. We then applied linear regression models to discern the group differences regarding the relationship between atrophy and cognitive decline in the three FTD phenotypes. Lastly, we assessed whether the combination of atrophy and cognition patterns in the latent variables identified in the partial least squares analysis could be used as features in a machine learning model to predict FTD subtypes in patients. Results revealed four significant latent variables that combined accounted for 86% of the shared covariance between cognitive and brain atrophy measures. Partial least squares-based atrophy and cognitive patterns predicted the FTD phenotypes with a cross-validated accuracy of 89.12%, with high specificity (91.46-97.15%) and sensitivity (84.19-93.56%). When using only MRI measures and two behavioural tests in the partial least squares and classification algorithms, ensuring clinical feasibility, our model was equally precise in the same participant sample (87.18%, specificity 76.14-92.00%, sensitivity 86.93-98.26%). Here, including only atrophy or behaviour patterns in the analysis led to prediction accuracies of 69.76% and 76.54%, respectively, highlighting the increased value of combining MRI and clinical measures in subtype classification. We demonstrate that the combination of brain atrophy and clinical characteristics and multivariate statistical methods can serve as a biomarker for disease phenotyping in FTD, whereby the inclusion of deformation-based morphometry measures adds to the classification accuracy in the absence of extensive clinical testing. Metz et al. report that machine learning can effectively differentiate frontotemporal dementia subtypes, combining brain atrophy patterns and cognitive performance. Using deformation-based morphometry and multivariate statistics, they achieved subtype classification with high accuracy, sensitivity and specificity. This approach demonstrates potential as a biomarker for phenotyping frontotemporal dementia in clinical settings.