title: Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort.
abstract: BACKGROUND
  The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease.
  
  
  OBJECTIVE
  We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF).
  
  
  METHODS
  We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change.
  
  
  RESULTS
  Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses.
  
  
  CONCLUSIONS
  Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.
authors.affiliation: Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Welmoed A
authors.initials: WA
authors.lastname: Krudop
authors.forename: Annemiek
authors.initials: A
authors.lastname: Dols
authors.forename: Cora J
authors.initials: CJ
authors.lastname: Kerssens
authors.forename: Niels D
authors.initials: ND
authors.lastname: Prins
authors.forename: Christiane
authors.initials: C
authors.lastname: Möller
authors.forename: Sigfried
authors.initials: S
authors.lastname: Schouws
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Bart N M
authors.initials: BN
authors.lastname: van Berckel
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Teunissen
authors.forename: Wiesje M
authors.initials: WM
authors.lastname: van der Flier
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.forename: Sietske A M
authors.initials: SA
authors.lastname: Sikkes
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.forename: Yolande A L
authors.initials: YA
authors.lastname: Pijnenburg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D003430:Cross-Sectional Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D057180:Frontotemporal Dementia / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D019788:Fluorodeoxyglucose F18