title: [Pathomechanisms and clinical aspects of frontotemporal lobar degeneration].
abstract: BACKGROUND
  Frontotemporal lobar degeneration (FTLD) includes a spectrum of heterogeneous clinical and neuropathological diseases. In a strict sense this includes the behavioral variant of frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA) and both variants can be associated with amyotrophic lateral sclerosis (FTD-ALS). In a broader sense FTLD also includes progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). In recent years the strong genetic component of FTLD has become increasingly clear.
  
  
  OBJECTIVE
  The association between clinical presentation, neuropathology, genetics and pathophysiological mechanisms of FTLD are presented.
  
  
  RESULTS
  The diagnostic criteria and tools for the clinical differential diagnosis of FTLD are presented. At autopsy patients show neuronal and glial inclusions of Tau, TDP-43 or FUS. While Tau pathology is often associated with extrapyramidal symptoms, patients with TDP-43 and FUS inclusions often also show signs of ALS. Pathogenic mutations directly increase the aggregation propensity of these proteins or impair protein degradation through autophagy or the proteasome. Pathogenic mutations in most FTLD genes trigger cytoplasmic missorting and aggregation of the RNA-binding protein TDP-43 and thus lead to a nuclear loss of TDP-43 function. Microgliosis and mutations in GRN and TREM2 suggest an important role of neuroinflammation in FTLD.
  
  
  CONCLUSIONS
  There is still no causal therapy for FTLD but preclinical studies focusing on pathogenic mutations in C9orf72, GRN and Tau may lead to clinical trials soon; therefore, establishing large well characterized patient cohorts is crucial for trial readiness.
authors.affiliation: Institut für Schlaganfall und Demenzforschung, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.|Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Bürger
authors.affiliation: Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland.|Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.|Zentrum für Neuropathologie und Prionforschung, Ludwig-Maximilians-Universität München, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Arzberger
authors.affiliation: Institut für Schlaganfall und Demenzforschung, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.|Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Stephan
authors.affiliation: Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland.|Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.affiliation: Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland. dieter.edbauer@dzne.de.|Munich Cluster of Systems Neurology (SyNergy), Ludwig-Maximilians-Universität München, München, Deutschland. dieter.edbauer@dzne.de.
authors.forename: D
authors.initials: D
authors.lastname: Edbauer
mesh_terms: D000368:Aged; D005260:Female; D057174:Frontotemporal Lobar Degeneration / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D020022:Genetic Predisposition to Disease / Q000453:epidemiology* / Q000235:genetics*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics; D009419:Nerve Tissue Proteins / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D009419:Nerve Tissue Proteins
keywords: Frontotemporal dementia; Neurodegenerative diseases; Primary progressive aphasia; TDP‑43 proteinopathies; Tauopathy