Initial complaints in frontotemporal lobar degeneration.
OBJECTIVE
Frontotemporal lobar degeneration (FTLD) is probably underrecognized. The goal of this study was to investigate initial complaints of both patients and their caregivers at first specialist referral. Also, we tried to assess whether misrecognition of symptoms contributed to diagnostic delay.


METHODS
The case notes of all patients diagnosed with FTLD at the VU University Medical Center, Alzheimer Center of Amsterdam, The Netherlands, since 1998 were retrospectively reviewed. Only patients of whom detailed information of first specialist referral was available were included. The diagnosis of FTLD was based on the clinical diagnostic criteria of Neary and Snowden, supported by ancillary investigations.


RESULTS
Forty-six patients with FTLD were included. Twenty-one patients had frontotemporal dementia (FTD), 17 semantic dementia (SD) and 8 progressive nonfluent aphasia (PA). The majority of the FTD patients presented without complaints or with somatic complaints and nearly a quarter of them expressed memory complaints. The presenting complaints of most of their caregivers differed from the patients' complaints and often consisted of cognitive complaints. In SD and PA, language problems but also forgetfulness were presented. Misrecognition of the initial symptoms in some cases seemed to have contributed to diagnostic delay.


CONCLUSIONS
Presenting complaints in FTLD can be misleading. In our cohort, memory complaints occurred relatively often. A multidisciplinary approach, including a structured behavioral interview, is important to recognize symptoms of FTLD.
Pijnenburg
Yolande A L
YA
Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands.
Gillissen
Freek
F
Jonker
Cees
C
Scheltens
Philip
P
D000368:Aged; D000369:Aged, 80 and over; D018888:Aphasia, Primary Progressive / Q000523:psychology; D017028:Caregivers; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D012649:Self Concept; D013997:Time Factors