Early diagnosis of the frontal variant of frontotemporal dementia: how sensitive are standard neuroimaging and neuropsychologic tests?
OBJECTIVE
To examine the role of structural (magnetic resonance imaging [MRI]) and functional (single photon emission computed tomography [SPECT]) imaging and neuropsychologic evaluation in the early diagnosis of frontal variant frontotemporal dementia (fvFTD).


BACKGROUND
Current criteria for FTD stress the need for neuropsychologic and functional neuroimaging abnormalities, yet caregivers report lengthy histories of behavioral change. It is not known when, in the course of the disease, these investigations become abnormal, because few longitudinal studies have been reported.


METHODS
Longitudinal study of two patients with serial neuropsychologic evaluation and MRI and HMPAO-SPECT scanning.


RESULTS
Both patients, men aged 49 and 50, had major changes in personality, behavior, and social conduct that progressed over 5 to 6 years in a way that conformed to the clinical picture of fvFTD. There was remarkably little abnormality on neuropsychologic testing, and MRI and HMPAO-SPECT findings initially were normal. Over time, however, abnormalities on SPECT, frontal atrophy on MRI, or a neuropsychologic profile more typical of fvFTD developed in both patients.


CONCLUSIONS
Standard neuropsychologic tests and conventional brain imaging techniques (MRI and SPECT) may not be sensitive to the early changes in fvFTD that occur in the ventromedial frontal cortex, and better methods of accurate early detection are required. These findings are relevant to the diagnostic criteria for FTD.
Gregory
C A
CA
Fulbourn Hospital, Cambridge, England.
Serra-Mestres
J
J
Hodges
J R
JR
D001284:Atrophy; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003704:Dementia / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007508:Irritable Mood; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010554:Personality Disorders / Q000150:complications; D012680:Sensitivity and Specificity; D012920:Social Behavior Disorders / Q000150:complications; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon
D019690:Technetium Tc 99m Exametazime