<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04425148</url>
  </required_header>
  <id_info>
    <org_study_id>2021P003553</org_study_id>
    <nct_id>NCT04425148</nct_id>
  </id_info>
  <brief_title>Gamma-Induction in FrontoTemporal Dementia Trial</brief_title>
  <acronym>GIFTeD</acronym>
  <official_title>Non-invasive Brain Stimulation for Gamma-induction and Cognitive Enhancement in FTD (Gamma-Induction in FrontoTemporal Dementia, GIFTeD)</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Massachusetts General Hospital</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Alzheimer's Drug Discovery Foundation</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Massachusetts General Hospital</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>Yes</is_fda_regulated_device>
    <is_unapproved_device>Yes</is_unapproved_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      This is an interventional, sham controlled, double-blind study designed to investigate the&#xD;
      safety, tolerability and efficacy of 40 Hz transcranial alternating current stimulation&#xD;
      (tACS), a form of noninvasive brain stimulation, delivered for 6 weeks once daily in&#xD;
      frontotemporal dementia (FTD) patients. Cognition, gamma EEG activity and brain metabolism&#xD;
      via FDG-PET will be measured before and after the tACS intervention.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      This is an interventional, multi-site, randomized, double-blind, placebo-controlled study of&#xD;
      tACS in patients with FTD. The main aim of this study is to investigate the safety,&#xD;
      tolerability and efficacy of gamma-tACS in patients with behavioral variant (bv)-FTD,&#xD;
      demonstrating tACS potential mechanisms of action, target engagement, and thus informing the&#xD;
      design of larger clinical trials.&#xD;
&#xD;
      Participants will be screened at trial sites for determination of eligibility to enter the&#xD;
      study on the basis of diagnostic evaluations, according to current diagnostic criteria for&#xD;
      probable bv-FTD and safety assessments.&#xD;
&#xD;
      Baseline assessments will consist of behavioral/cognitive evaluations, blood biomarkers,&#xD;
      actigraphy, voice biomarkers, EEG and TMS-EEG and tACS with EEG measures, MRI, FDG-PET&#xD;
      imaging (5-8 visits). Once participants have met all inclusion and exclusion criteria, they&#xD;
      will be randomly assigned to either 6 weeks of daily tACS sessions or 6 weeks of daily Sham&#xD;
      tACS sessions.&#xD;
&#xD;
      Post-intervention visits will include FDG-PET scans, MRI, cognitive testing, tACS with EEG,&#xD;
      blood biomarkers and TMS-EEG (5-8 visits). A follow-up visit will occur 3 months after the&#xD;
      post-invention visit. This visit will include an EEG registration, cognitive testing and&#xD;
      behavioral markers.&#xD;
&#xD;
        -  tACS is a way of stimulating the brain externally using weak electric currents.&#xD;
&#xD;
             -  Electrodes are placed into a cap that you wear on your head.&#xD;
&#xD;
             -  A weak electrical current travels back and forth through the electrodes to your&#xD;
                head.&#xD;
&#xD;
        -  FDG-PET is a way of taking pictures of your brain using a special dye that is absorbed&#xD;
           into your body. In this study, the dye will help us to see the glucose uptake in your&#xD;
           brain. The PET scans for this study will be done at Massachusetts General Hospital&#xD;
           (MGH).&#xD;
&#xD;
        -  TMS is a noninvasive way of stimulating the brain and will be used in this study to&#xD;
           measure your brain's plasticity. Brain plasticity is the brain's ability to change and&#xD;
           learn through experience. TMS uses a magnetic field to cause changes in the brain&#xD;
           activity. The magnetic field is produced by a coil that is held next to your scalp. We&#xD;
           will measure how your brain responds to the TMS before and after the tACS treatment.&#xD;
&#xD;
        -  EEG is used in routine clinical care to measure the brain's electrical activity. EEG&#xD;
           involves placing a cap with electrodes onto your head.&#xD;
&#xD;
      The investigators will enroll a sample of 20 age-matched healthy controls, who will undergo&#xD;
      evaluations similar to the bv-FTD baseline assessment except for PET imaging. Healthy&#xD;
      subjects will not have the tACS intervention.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Recruiting</overall_status>
  <start_date type="Actual">December 30, 2020</start_date>
  <completion_date type="Anticipated">March 2024</completion_date>
  <primary_completion_date type="Anticipated">December 2023</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Attrition (withdrawal) rate</measure>
    <time_frame>up to 6 months</time_frame>
    <description>The rate of enrolled participants who withdraw from the study will be reported</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in Gamma activity</measure>
    <time_frame>up to 6 months</time_frame>
    <description>Changes in oscillatory activity in the EEG gamma band will be evaluated before and after the tACS sessions</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in Cognition</measure>
    <time_frame>up to 6 months</time_frame>
    <description>Change in Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) score will be reported. The score ranges from 0-85 with the higher score meaning greater cognitive impairment.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in Cognition</measure>
    <time_frame>up to 6 months</time_frame>
    <description>Change in Frontal Assessment Battery (FAB) score will be reported. The scores range from 0-18 with a higher score meaning less cognitive impairment.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in Brain Metabolism measured via FDG-PET</measure>
    <time_frame>up to 3 months</time_frame>
    <description>Change in brain glucose metabolism will be measured via FDG-PET after the daily tACS sessions</description>
  </primary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">70</enrollment>
  <condition>Frontotemporal Dementia</condition>
  <arm_group>
    <arm_group_label>tACS</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>40 Hz transcranial alternating current stimulation (tACS), 30 daily (Monday-Friday) 1-hour sessions</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Sham tACS</arm_group_label>
    <arm_group_type>Sham Comparator</arm_group_type>
    <description>Sham transcranial alternating current stimulation (tACS), 30 daily (Monday-Friday) 1-hour sessions</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Transcranial Alternating Current Stimulation (tACS)</intervention_name>
    <description>tACS is a noninvasive way of stimulating the brain externally using weak electric currents. Electrodes are placed into a cap that you wear on your head. A weak electrical current travels back and forth through the electrodes to your head.</description>
    <arm_group_label>tACS</arm_group_label>
    <other_name>Non-invasive Brain Stimulation</other_name>
    <other_name>Neuroelectrics Starstim</other_name>
  </intervention>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Sham Transcranial Alternating Current Stimulation (sham tACS)</intervention_name>
    <description>Sham (placebo) simulation of transcranial alternating current stimulation without receiving any real stimulation.</description>
    <arm_group_label>Sham tACS</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        FTD Participants&#xD;
&#xD;
        Inclusion Criteria:&#xD;
&#xD;
          -  Diagnosis of probable Frontotemporal dementia (bvFTD)&#xD;
&#xD;
          -  Mini Mental State Examination (MMSE) &gt; 18&#xD;
&#xD;
          -  FTLD-specific Clinical Dementia Rating (FTLD-CDR) total score of ≤1&#xD;
&#xD;
          -  On stable medications related to cognition or behavior for &gt;30 days such as&#xD;
             acetylcholinesterase inhibitors, memantine, anti-depressants, antipsychotic agents,&#xD;
             other mood stabilizers, benzodiazepines;&#xD;
&#xD;
          -  Age from 40 to 80 years;&#xD;
&#xD;
          -  Minimum of completed 8th grade education&#xD;
&#xD;
          -  No history of intellectual disability&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Current or past history of any significant neurodegenerative disorder of the central&#xD;
             nervous system other than FTD e.g. Alzheimer's disease, Lewy body dementia,&#xD;
             Parkinson's disease, multiple sclerosis, progressive supranuclear palsy, normal&#xD;
             pressure hydrocephalus, Huntington's disease, any condition directly or indirectly&#xD;
             caused by Transmissible Spongiform Encephalopathy (TSE), Creutzfeldt-Jakob Disease&#xD;
             (CJD), variant Creutzfeldt-Jakob Disease (vCJD), or new variant Creutzfeldt-Jakob&#xD;
             Disease (nvCJD);&#xD;
&#xD;
          -  Current or past history of stroke (cortical stroke), intracranial brain lesions,&#xD;
             previous neurosurgery or head trauma that resulted in residual neurologic impairment.&#xD;
&#xD;
               -  Non-cortical disease such as confluence white matter changes (including lacunar&#xD;
                  infarcts &lt; 1cm) and asymptomatic, subacute, cerebellar infarcts may be included&#xD;
                  upon review of a medically responsible neurologist.&#xD;
&#xD;
          -  Past or current history of major depression, bipolar disorder, psychotic disorders, or&#xD;
             any other major psychiatric condition will be evaluated by the study MD.&#xD;
&#xD;
          -  Current history of poorly controlled migraines including chronic medication for&#xD;
             migraine prevention&#xD;
&#xD;
          -  History of seizures with the exception of a single seizure of benign etiology (e.g.&#xD;
             febrile seizure) in the judgment of the investigator;&#xD;
&#xD;
          -  History of fainting spells of unknown or undetermined etiology that might constitute&#xD;
             seizures.&#xD;
&#xD;
          -  Chronic (particularly) uncontrolled medical conditions that may cause a medical&#xD;
             emergency in case of a provoked seizure (cardiac malformation, cardiac dysrhythmia,&#xD;
             asthma, etc.).&#xD;
&#xD;
          -  Metal implants in the head (except dental), pacemaker, medication pump, nerve&#xD;
             stimulator, TENS unit, ventriculo-peritoneal shunt, cochlear implant, unless cleared&#xD;
             by the study MD.&#xD;
&#xD;
          -  Contraindication for undergoing MRI or receiving TMS or tACS;&#xD;
&#xD;
          -  Any clinically significant hematological, endocrine, cardiovascular, renal, hepatic,&#xD;
             gastrointestinal or neurological disease. If the condition has been stable for at&#xD;
             least the past year and is judged by the investigator not to interfere with the&#xD;
             patient's participation in the study, the patient may be included;&#xD;
&#xD;
          -  &gt;50 mSv of radiation exposure for research within the past year (PET imaging&#xD;
             exclusion);&#xD;
&#xD;
          -  Substance abuse or dependence within the past six months;&#xD;
&#xD;
          -  Medications will be reviewed by the responsible MD and a decision about inclusion will&#xD;
             be made based on the following: The patient's past medical history, drug dose, history&#xD;
             of recent medication changes or duration of treatment, and combination of CNS active&#xD;
             drugs;&#xD;
&#xD;
          -  All female participants that are pre-menopausal will be required to have a pregnancy&#xD;
             test; any participant who is pregnant or breastfeeding will not be enrolled in the&#xD;
             study;&#xD;
&#xD;
          -  Subjects who, in the investigator's opinion, might not be suitable for the study;&#xD;
&#xD;
          -  A hair style or head dress that prevents electrode contact with the scalp or would&#xD;
             interfere with the stimulation (for example: thick braids, hair weave, afro, wig).&#xD;
&#xD;
        Healthy Volunteers&#xD;
&#xD;
        Inclusion Criteria:&#xD;
&#xD;
          -  Age: 40-80 years&#xD;
&#xD;
          -  Normal healthy volunteer&#xD;
&#xD;
          -  Right-handed (assessed by means of the Edinburgh Handedness Questionnaire)&#xD;
&#xD;
          -  MMSE &gt;27&#xD;
&#xD;
          -  Minimum of completed 8th grade education&#xD;
&#xD;
          -  No history of intellectual disability&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  History of fainting spells of unknown or undetermined etiology that might constitute&#xD;
             seizures&#xD;
&#xD;
          -  History of seizures, diagnosis of epilepsy, history of abnormal (epileptiform) EEG or&#xD;
             family history of treatment resistant epilepsy, with the exception of a single seizure&#xD;
             of benign etiology (e.g. febrile seizures) in the judgment of the investigator&#xD;
&#xD;
          -  History of head injury resulting in prolonged loss of consciousness&#xD;
&#xD;
          -  Any metal in the brain, skull or elsewhere unless approved by the responsible MD&#xD;
&#xD;
          -  Any medical devices (i.e. Cardiac pacemaker, deep brain stimulator, medication&#xD;
             infusion pump, cochlear implant, vagal nerve stimulator) unless otherwise approved by&#xD;
             the responsible MD&#xD;
&#xD;
          -  Past or current history of major depression, bipolar disorder or psychotic disorders,&#xD;
             or any other major psychiatric condition.&#xD;
&#xD;
          -  Neurological disorder or intracranial lesion (including an incidental finding on MRI)&#xD;
&#xD;
          -  Current history of poorly controlled migraines including chronic medication for&#xD;
             migraine prevention&#xD;
&#xD;
          -  Any unstable medical condition&#xD;
&#xD;
          -  Pregnancy&#xD;
&#xD;
          -  Medications will be reviewed by the responsible MD and a decision about inclusion will&#xD;
             be made based on the following:&#xD;
&#xD;
               -  The participant's past medical history, drug dose, history of recent medication&#xD;
                  changes or duration of treatment, and combination with other CNS active drugs.&#xD;
&#xD;
          -  Substance abuse or dependence within the past six months&#xD;
&#xD;
          -  Subjects who, in the investigator's opinion, might not be suitable for the study&#xD;
&#xD;
          -  Diseased or damaged skin over the face or scalp&#xD;
&#xD;
          -  A hair style or head dress that prevents electrode contact with the scalp (for&#xD;
             example: thick braids, hair weave, afro, wig)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>40 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Emiliano Santarnecchi, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Massachusetts General Hospital</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Julianne Reilly</last_name>
    <phone>617-667-9088</phone>
    <email>jrreilly@mgh.harvard.edu</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Andrea Norton</last_name>
    <email>acnorton@bidmc.harvard.edu</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Beth Israel Deaconess Medical Center</name>
      <address>
        <city>Boston</city>
        <state>Massachusetts</state>
        <zip>02215</zip>
        <country>United States</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Julianne Reilly</last_name>
      <phone>617-667-9088</phone>
      <email>jrreilly@mgh.harvard.edu</email>
    </contact>
    <investigator>
      <last_name>Lorella Battelli</last_name>
      <role>Principal Investigator</role>
    </investigator>
  </location>
  <location>
    <facility>
      <name>Fondazione Santa Lucia</name>
      <address>
        <city>Roma</city>
        <country>Italy</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Caterina Motta</last_name>
      <email>c.motta@hsantalucia.it</email>
    </contact>
    <investigator>
      <last_name>Giacomo Koch, MD</last_name>
      <role>Principal Investigator</role>
    </investigator>
  </location>
  <location_countries>
    <country>Italy</country>
    <country>United States</country>
  </location_countries>
  <verification_date>August 2023</verification_date>
  <study_first_submitted>June 1, 2020</study_first_submitted>
  <study_first_submitted_qc>June 8, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">June 11, 2020</study_first_posted>
  <last_update_submitted>August 29, 2023</last_update_submitted>
  <last_update_submitted_qc>August 29, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">August 30, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Massachusetts General Hospital</investigator_affiliation>
    <investigator_full_name>Emiliano Santarnecchi</investigator_full_name>
    <investigator_title>Associate Professor of Radiology</investigator_title>
  </responsible_party>
  <keyword>FTD</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Dementia</mesh_term>
    <mesh_term>Frontotemporal Dementia</mesh_term>
    <mesh_term>Aphasia, Primary Progressive</mesh_term>
    <mesh_term>Pick Disease of the Brain</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04425148
org study id: 2021P003553
nct id: NCT04425148
lead sponsor: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: Yes
is unapproved device: Yes
is us export: No
This is an interventional, sham controlled, double-blind study designed to investigate the
      safety, tolerability and efficacy of 40 Hz transcranial alternating current stimulation
      (tACS), a form of noninvasive brain stimulation, delivered for 6 weeks once daily in
      frontotemporal dementia (FTD) patients. Cognition, gamma EEG activity and brain metabolism
      via FDG-PET will be measured before and after the tACS intervention.
This is an interventional, multi-site, randomized, double-blind, placebo-controlled study of
      tACS in patients with FTD. The main aim of this study is to investigate the safety,
      tolerability and efficacy of gamma-tACS in patients with behavioral variant (bv)-FTD,
      demonstrating tACS potential mechanisms of action, target engagement, and thus informing the
      design of larger clinical trials.

      Participants will be screened at trial sites for determination of eligibility to enter the
      study on the basis of diagnostic evaluations, according to current diagnostic criteria for
      probable bv-FTD and safety assessments.

      Baseline assessments will consist of behavioral/cognitive evaluations, blood biomarkers,
      actigraphy, voice biomarkers, EEG and TMS-EEG and tACS with EEG measures, MRI, FDG-PET
      imaging (5-8 visits). Once participants have met all inclusion and exclusion criteria, they
      will be randomly assigned to either 6 weeks of daily tACS sessions or 6 weeks of daily Sham
      tACS sessions.

      Post-intervention visits will include FDG-PET scans, MRI, cognitive testing, tACS with EEG,
      blood biomarkers and TMS-EEG (5-8 visits). A follow-up visit will occur 3 months after the
      post-invention visit. This visit will include an EEG registration, cognitive testing and
      behavioral markers.

        -  tACS is a way of stimulating the brain externally using weak electric currents.

             -  Electrodes are placed into a cap that you wear on your head.

             -  A weak electrical current travels back and forth through the electrodes to your
                head.

        -  FDG-PET is a way of taking pictures of your brain using a special dye that is absorbed
           into your body. In this study, the dye will help us to see the glucose uptake in your
           brain. The PET scans for this study will be done at Massachusetts General Hospital
           (MGH).

        -  TMS is a noninvasive way of stimulating the brain and will be used in this study to
           measure your brain's plasticity. Brain plasticity is the brain's ability to change and
           learn through experience. TMS uses a magnetic field to cause changes in the brain
           activity. The magnetic field is produced by a coil that is held next to your scalp. We
           will measure how your brain responds to the TMS before and after the tACS treatment.

        -  EEG is used in routine clinical care to measure the brain's electrical activity. EEG
           involves placing a cap with electrodes onto your head.

      The investigators will enroll a sample of 20 age-matched healthy controls, who will undergo
      evaluations similar to the bv-FTD baseline assessment except for PET imaging. Healthy
      subjects will not have the tACS intervention.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
measure: Attrition (withdrawal) rate
time frame: up to 6 months
description: The rate of enrolled participants who withdraw from the study will be reported
measure: Change in Gamma activity
time frame: up to 6 months
description: Changes in oscillatory activity in the EEG gamma band will be evaluated before and after the tACS sessions
measure: Change in Cognition
time frame: up to 6 months
description: Change in Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) score will be reported. The score ranges from 0-85 with the higher score meaning greater cognitive impairment.
measure: Change in Cognition
time frame: up to 6 months
description: Change in Frontal Assessment Battery (FAB) score will be reported. The scores range from 0-18 with a higher score meaning less cognitive impairment.
measure: Change in Brain Metabolism measured via FDG-PET
time frame: up to 3 months
description: Change in brain glucose metabolism will be measured via FDG-PET after the daily tACS sessions
arm group label: tACS
arm group type: Experimental
description: 40 Hz transcranial alternating current stimulation (tACS), 30 daily (Monday-Friday) 1-hour sessions
arm group label: Sham tACS
arm group type: Sham Comparator
description: Sham transcranial alternating current stimulation (tACS), 30 daily (Monday-Friday) 1-hour sessions
intervention type: Device
intervention name: Transcranial Alternating Current Stimulation (tACS)
description: tACS is a noninvasive way of stimulating the brain externally using weak electric currents. Electrodes are placed into a cap that you wear on your head. A weak electrical current travels back and forth through the electrodes to your head.
arm group label: tACS
other name: Non-invasive Brain Stimulation
other name: Neuroelectrics Starstim
intervention type: Device
intervention name: Sham Transcranial Alternating Current Stimulation (sham tACS)
description: Sham (placebo) simulation of transcranial alternating current stimulation without receiving any real stimulation.
arm group label: Sham tACS
criteria: 
gender: All
minimum age: 40 Years
maximum age: 80 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Emiliano Santarnecchi, PhD
role: Principal Investigator
affiliation: Massachusetts General Hospital
last name: Julianne Reilly
phone: 617-667-9088
email: jrreilly@mgh.harvard.edu
last name: Andrea Norton
email: acnorton@bidmc.harvard.edu
facility: 
status: Recruiting
contact: 
investigator: 
facility: 
status: Recruiting
contact: 
investigator: 
country: Italy
country: United States
responsible party type: Principal Investigator
investigator affiliation: Massachusetts General Hospital
investigator full name: Emiliano Santarnecchi
investigator title: Associate Professor of Radiology
mesh term: Dementia
mesh term: Frontotemporal Dementia
mesh term: Aphasia, Primary Progressive
mesh term: Pick Disease of the Brain