frontotemporal dementia

Frontotemporal dementia (FTD) is an early onset disorder that mostly occurs between the ages of 45 and 65,{{cite journal | vauthors = Snowden JS, Neary D, Mann DM | title = Frontotemporal dementia | journal = The British Journal of Psychiatry | volume = 180 | issue = 2 | pages = 140–143 | date = February 2002 | pmid = 11823324 | doi = 10.1192/bjp.180.2.140 | doi-access = free }} but can begin earlier, and in 20–25% of cases onset is later.{{cite journal | vauthors = Hofmann JW, Seeley WW, Huang EJ | title = RNA Binding Proteins and the Pathogenesis of Frontotemporal Lobar Degeneration | journal = Annual Review of Pathology | volume = 14 | pages = 469–495 | date = January 2019 | pmid = 30355151 | pmc = 6731550 | doi = 10.1146/annurev-pathmechdis-012418-012955 }}{{cite journal | vauthors = Rabinovici GD, Miller BL | title = Frontotemporal lobar degeneration: epidemiology, pathophysiology, diagnosis and management | journal = CNS Drugs | volume = 24 | issue = 5 | pages = 375–398 | date = May 2010 | pmid = 20369906 | pmc = 2916644 | doi = 10.2165/11533100-000000000-00000 }} Men and women appear to be equally affected.{{cite journal | vauthors = Finger EC | title = Frontotemporal Dementias | journal = Continuum | volume = 22 | issue = 2 Dementia | pages = 464–489 | date = April 2016 | pmid = 27042904 | pmc = 5390934 | doi = 10.1212/CON.0000000000000300 }} It is the most common early presenting dementia.{{cite web |title=Focus on Frontotemporal Dementia (FTD) | work = National Institute of Neurological Disorders and Stroke | publisher = U.S. National Institutes of Health |url=https://www.ninds.nih.gov/Current-Research/Focus-Disorders/Alzheimers-Related-Dementias/Focus-Frontotemporal-Dementia-FTD |access-date=3 March 2021 |archive-date=16 October 2021 |archive-url=https://web.archive.org/web/20211016052517/https://www.ninds.nih.gov/Current-Research/Focus-Disorders/Alzheimers-Related-Dementias/Focus-Frontotemporal-Dementia-FTD }} FTD is the second most prevalent type of early onset dementia after Alzheimer's disease.

The International Classification of Diseases recognizes the disease as causative to disorder affecting mental and behavioural aspects in humans. Dissociation from family, compulsive buying disorder (oniomania), vulgar speech characteristics, screaming, inability to control emotions, behavior, personality, and temperament are characteristic social display patterns.{{cite book | vauthors = Sartorius N, Henderson A, Strotzka H, Lipowski Z, Yu-cun S, You-xin X, Strömgren E, Glatzel J, Kühne G, Misès R, Soldatos C, Pull C, Giel R, Jegede R, Malt U, Nadzharov R, Smulevitch A, Hagberg B, Perris C, Scharfetter C, Clare A, Cooper J, Corbett J, Griffith Edwards J, Gelder M, Goldberg D, Gossop M, Graham P, Kendell R, Marks I, Russell G, Rutter M, Shepherd M, West D, Wing J, Wing L, Neki J, Benson F, Cantwell D, Guze S, Helzer J, Holzman P, Kleinman A, Kupfer D, Mezzich J, Spitzer R, Lokar J |author-link1 = Norman Sartorius |title=The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines |date = 1992 |url=https://cdn.who.int/media/docs/default-source/classification/other-classifications/9241544228_eng.pdf | publisher = World Health Organization |page=51 | isbn = 92-4-154422-8 }} A gradual onset and progression of changes in behavior or language deficits are reported to have begun several years prior to presentation to a neurologist.

The main subtypes of frontotemporal dementia are behavioral variant FTD (bvFTD), two variants of primary progressive aphasia – semantic dementia (svPPA) and progressive nonfluent aphasia (nfvPPA){{cite web |title=What is frontotemporal dementia |url=https://www.dementiauk.org/understanding-dementia/types-and-symptoms/frontotemporal-dementia/ |access-date=2020-10-19 |website=Dementia UK}} – as well as FTD associated with amyotrophic lateral sclerosis (FTD–ALS or FTD-MND). Two distinct rare subtypes are neuronal intermediate filament inclusion disease (NIFID), and basophilic inclusion body disease (BIBD). Related disorders are corticobasal syndrome (CBS or CBD), and progressive supranuclear palsy (PSP).

Behavioral variant frontotemporal dementia (BvFTD) was previously known as Pick's disease, and is the most common of the FTD types.{{cite web |title=What are the Different Types of Frontotemporal Disorders? |url=https://www.nia.nih.gov/health/types-frontotemporal-disorders |website=National Institute on Aging |access-date=1 November 2020 |language=en}} BvFTD is diagnosed four times as often as the PPA variants. Behavior can change in BvFTD in either of two ways—it can change to being impulsive and disinhibited, acting in socially unacceptable ways; or it can change to being listless and apathetic.{{cite web |title=Frontotemporal Dementia Information Page |url=https://www.ninds.nih.gov/Disorders/All-Disorders/Frontotemporal-Dementia-Information-Page | work = National Institute of Neurological Disorders and Stroke | publisher = U.S. National Institutes of Health }}{{cite journal | vauthors = Sleegers K, Cruts M, Van Broeckhoven C | title = Molecular pathways of frontotemporal lobar degeneration | journal = Annual Review of Neuroscience | volume = 33 | issue = 1 | pages = 71–88 | year = 2010 | pmid = 20415586 | doi = 10.1146/annurev-neuro-060909-153144 }} About 12–13% of people with bvFTD develop motor neuron disease.{{cite journal | vauthors = Bang J, Spina S, Miller BL | title = Frontotemporal dementia | journal = Lancet | volume = 386 | issue = 10004 | pages = 1672–1682 | date = October 2015 | pmid = 26595641 | pmc = 5970949 | doi = 10.1016/S0140-6736(15)00461-4 }}

The Pick bodies which are present in behavioral variant FTD are spherical inclusion bodies found in the cytoplasm of affected cells. They consist of tau fibrils as a major component together with a number of other protein products including ubiquitin and tubulin.{{cite web | vauthors = Gaillard F |title=Pick bodies | work = Radiology Reference Article | publisher = Radiopaedia |url=https://radiopaedia.org/articles/pick-bodies?lang=gb |access-date=12 March 2021}}

Semantic dementia (SD) is characterized by the loss of semantic understanding, resulting in impaired word comprehension. However, speech remains fluent and grammatical.

Progressive nonfluent aphasia (PNFA) is characterized by progressive difficulties in speech production.

Neuronal intermediate filament inclusion disease (NIFID) is a rare distinct variant. The inclusion bodies that are present in NIFID are cytoplasmic and made up of type IV intermediate filaments.{{cite journal | vauthors = Cairns NJ, Grossman M, Arnold SE, Burn DJ, Jaros E, Perry RH, Duyckaerts C, Stankoff B, Pillon B, Skullerud K, Cruz-Sanchez FF, Bigio EH, Mackenzie IR, Gearing M, Juncos JL, Glass JD, Yokoo H, Nakazato Y, Mosaheb S, Thorpe JR, Uryu K, Lee VM, Trojanowski JQ | title = Clinical and neuropathologic variation in neuronal intermediate filament inclusion disease | journal = Neurology | volume = 63 | issue = 8 | pages = 1376–1384 | date = October 2004 | pmid = 15505152 | pmc = 3516854 | doi = 10.1212/01.wnl.0000139809.16817.dd }} NIFID has an early age of onset between 23 and 56. Symptoms can include behavioural, and personality changes, memory and cognitive impairments, language difficulties, motor weakness, and extrapyramidal symptoms. NIFID is one of the frontotemporal lobar degeneration (FTLD)-FUS proteopathies.{{cite journal | vauthors = Armstrong RA, Gearing M, Bigio EH, Cruz-Sanchez FF, Duyckaerts C, Mackenzie IR, Perry RH, Skullerud K, Yokoo H, Cairns NJ | title = Spatial patterns of FUS-immunoreactive neuronal cytoplasmic inclusions (NCI) in neuronal intermediate filament inclusion disease (NIFID) | journal = Journal of Neural Transmission | volume = 118 | issue = 11 | pages = 1651–1657 | date = November 2011 | pmid = 21792670 | pmc = 3199334 | doi = 10.1007/s00702-011-0690-x }} Imaging commonly shows atrophy in the frontotemporal region, and in part of the striatum in the basal ganglia. Post-mortem studies show a marked reduction in the caudate nucleus of the striatum; frontotemporal gyri are narrowed, with widened intervening sulci, and the lateral ventricles are enlarged.

Another rare FTD variant, also a FTLD-FUS proteopathy, is basophilic inclusion body disease (BIBD).{{cite journal | vauthors = Ito H | title = Basophilic inclusions and neuronal intermediate filament inclusions in amyotrophic lateral sclerosis and frontotemporal lobar degeneration | journal = Neuropathology | volume = 34 | issue = 6 | pages = 589–595 | date = December 2014 | pmid = 24673472 | doi = 10.1111/neup.12119 | s2cid = 19275295 | doi-access = free }}{{cite journal | vauthors = Munoz DG, Neumann M, Kusaka H, Yokota O, Ishihara K, Terada S, Kuroda S, Mackenzie IR | title = FUS pathology in basophilic inclusion body disease | journal = Acta Neuropathologica | volume = 118 | issue = 5 | pages = 617–627 | date = November 2009 | pmid = 19830439 | doi = 10.1007/s00401-009-0598-9 | hdl-access = free | s2cid = 22541167 | hdl = 2429/54671 }}

In later stages of FTD, the clinical phenotypes may overlap. People with FTD tend to struggle with binge eating and compulsive behaviors.{{cite journal | vauthors = Piguet O | title = Eating disturbance in behavioural-variant frontotemporal dementia | journal = Journal of Molecular Neuroscience | volume = 45 | issue = 3 | pages = 589–593 | date = November 2011 | pmid = 21584651 | doi = 10.1007/s12031-011-9547-x | s2cid = 24125998 }} Binge eating habits are often associated with changes in food preferences (cravings for more sweets, carbohydrates), eating inedible objects and snatching food from others. Recent findings from structural MRI research have indicated that eating changes in FTD are associated with atrophy (wasting) in the right ventral insula, striatum, and orbitofrontal cortex.

People with FTD show marked deficiencies in executive functioning and working memory.{{cite journal | vauthors = Neary D, Snowden J, Mann D | title = Frontotemporal dementia | journal = The Lancet. Neurology | volume = 4 | issue = 11 | pages = 771–780 | date = November 2005 | pmid = 16239184 | doi = 10.1016/S1474-4422(05)70223-4 | s2cid = 17310802 }} Most become unable to perform skills that require complex planning or sequencing.{{cite journal | vauthors = Kramer JH, Jurik J, Sha SJ, Rankin KP, Rosen HJ, Johnson JK, Miller BL | title = Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease | journal = Cognitive and Behavioral Neurology | volume = 16 | issue = 4 | pages = 211–218 | date = December 2003 | pmid = 14665820 | doi = 10.1097/00146965-200312000-00002 | s2cid = 46800951 }} In addition to the characteristic cognitive dysfunction, a number of primitive reflexes known as frontal release signs are often able to be elicited. Usually the first of these frontal release signs to appear is the palmomental reflex which appears relatively early in the disease course whereas the palmar grasp reflex and rooting reflex appear late in the disease course.{{citation needed|date=December 2020}}

In rare cases, FTD can occur in people with amyotrophic lateral sclerosis (ALS), a motor neuron disease. {{As of|2005}}, the prognosis for people with ALS was worse when combined with FTD, shortening survival by about a year.{{cite journal | vauthors = Olney RK, Murphy J, Forshew D, Garwood E, Miller BL, Langmore S, Kohn MA, Lomen-Hoerth C | title = The effects of executive and behavioral dysfunction on the course of ALS | journal = Neurology | volume = 65 | issue = 11 | pages = 1774–1777 | date = December 2005 | pmid = 16344521 | doi = 10.1212/01.wnl.0000188759.87240.8b | s2cid = 11672234 }}

A higher proportion of frontotemporal dementias seem to have a familial component than other neurodegenerative diseases such as Alzheimer's disease. More and more mutations and genetic variants are being identified all the time, needing constant updating of genetic influences.

• Tau-positive frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) is caused by mutations in the MAPT gene on chromosome 17 that encodes the tau protein.{{cite journal | vauthors = Buée L, Delacourte A | title = Comparative biochemistry of tau in progressive supranuclear palsy, corticobasal degeneration, FTDP-17 and Pick's disease | journal = Brain Pathology | volume = 9 | issue = 4 | pages = 681–693 | date = October 1999 | pmid = 10517507 | pmc = 8098140 | doi = 10.1111/j.1750-3639.1999.tb00550.x | s2cid = 10711305 }} It has been determined that there is a direct relationship between the type of tau mutation and the neuropathology of gene mutations. The mutations at the splice junction of exon 10 of tau lead to the selective deposition of the repetitive tau in neurons and glia. The pathological phenotype associated with mutations elsewhere in tau is less predictable, with both typical neurofibrillary tangles (consisting of both 3-repeat and 4-repeat tau) and Pick bodies (consisting of 3-repeat tau) having been described. The presence of tau deposits within glia is also variable in families with mutations outside of exon 10. This disease is now informally designated FTDP-17T. FTD shows a linkage to the region of the tau locus on chromosome 17, but it is believed that there are two loci leading to FTD within megabases of each other on chromosome 17.{{cite journal | vauthors = Hardy J, Momeni P, Traynor BJ | title = Frontal temporal dementia: dissecting the aetiology and pathogenesis | journal = Brain | volume = 129 | issue = Pt 4 | pages = 830–831 | date = April 2006 | pmid = 16543401 | doi = 10.1093/brain/awl035 | doi-access = free }} The only other known autosomal dominant genetic cause of FTLD-tau is a hypomorphic mutation in VCP which is associated with a unique neuropathology called vacuolar tauopathy.{{cite journal | vauthors = Darwich NF, Phan JM, Kim B, Suh E, Papatriantafyllou JD, Changolkar L, Nguyen AT, O'Rourke CM, He Z, Porta S, Gibbons GS, Luk KC, Papageorgiou SG, Grossman M, Massimo L, Irwin DJ, McMillan CT, Nasrallah IM, Toro C, Aguirre GK, Van Deerlin VM, Lee EB | title = Autosomal dominant VCP hypomorph mutation impairs disaggregation of PHF-tau | journal = Science | volume = 370 | issue = 6519 | pages = eaay8826 | date = November 2020 | pmid = 33004675 | pmc = 7818661 | doi = 10.1126/science.aay8826 }}
• FTD caused by FTLD-TDP43 has numerous genetic causes. Some cases are due to mutations in the GRN gene, also located on chromosome 17. Others are caused by hypomorphic VCP mutations, although these patients present with a complex picture of multisystem proteinopathy that can include amyotrophic lateral sclerosis, inclusion body myopathy, Paget's disease of bone, and FTD. The most recent addition to the list ({{as of|2019|lc=y}}) was a hexanucleotide repeat expansion in intron 1 of C9ORF72.{{cite journal | vauthors = Convery R, Mead S, Rohrer JD | title = Review: Clinical, genetic and neuroimaging features of frontotemporal dementia | journal = Neuropathology and Applied Neurobiology | volume = 45 | issue = 1 | pages = 6–18 | date = February 2019 | pmid = 30582889 | doi = 10.1111/nan.12535 | s2cid = 58636022 | url = https://discovery.ucl.ac.uk/id/eprint/10068269/ }}{{cite journal | vauthors = van Blitterswijk M, DeJesus-Hernandez M, Rademakers R | title = How do C9ORF72 repeat expansions cause amyotrophic lateral sclerosis and frontotemporal dementia: can we learn from other noncoding repeat expansion disorders? | journal = Current Opinion in Neurology | volume = 25 | issue = 6 | pages = 689–700 | date = December 2012 | pmid = 23160421 | pmc = 3923493 | doi = 10.1097/WCO.0b013e32835a3efb }}{{cite journal | vauthors = Abugable AA, Morris JL, Palminha NM, Zaksauskaite R, Ray S, El-Khamisy SF | title = DNA repair and neurological disease: From molecular understanding to the development of diagnostics and model organisms | journal = DNA Repair | volume = 81 | pages = 102669 | date = September 2019 | pmid = 31331820 | doi = 10.1016/j.dnarep.2019.102669 | doi-access = free }} Only one or two cases have been reported describing TARDBP (the TDP-43 gene) mutations in a clinically pure FTD (FTD without ALS).{{citation needed|date=December 2020}}
• Several other genes have been linked to this condition. These include CYLD, OPTN, SQSTM1 and TBK1.{{cite journal | vauthors = Dobson-Stone C, Hallupp M, Shahheydari H, Ragagnin AM, Chatterton Z, Carew-Jones F, Shepherd CE, Stefen H, Paric E, Fath T, Thompson EM, Blumbergs P, Short CL, Field CD, Panegyres PK, Hecker J, Nicholson G, Shaw AD, Fullerton JM, Luty AA, Schofield PR, Brooks WS, Rajan N, Bennett MF, Bahlo M, Landers JE, Piguet O, Hodges JR, Halliday GM, Topp SD, Smith BN, Shaw CE, McCann E, Fifita JA, Williams KL, Atkin JD, Blair IP, Kwok JB | title = CYLD is a causative gene for frontotemporal dementia - amyotrophic lateral sclerosis | journal = Brain | volume = 143 | issue = 3 | pages = 783–799 | date = March 2020 | pmid = 32185393 | pmc = 7089666 | doi = 10.1093/brain/awaa039 }} These genes have been implicated in the autophagy pathway.
• No genetic causes of FUS pathology in FTD have yet been reported.{{citation needed|date=December 2020}}
• Major alleles of TMEM106B SNPs have been found to be associated with risk of FTLD.{{cite journal | vauthors = Feng T, Lacrampe A, Hu F | title = Physiological and pathological functions of TMEM106B: a gene associated with brain aging and multiple brain disorders | journal = Acta Neuropathologica | volume = 141 | issue = 3 | pages = 327–339 | date = March 2021 | pmid = 33386471 | pmc = 8049516 | doi = 10.1007/s00401-020-02246-3 }}

{{Main|Frontotemporal lobar degeneration}}

There are three main histological subtypes found at post-mortem: FTLD-tau, FTLD-TDP, and FTLD-FUS. In rare cases, patients with clinical FTD were found to have changes consistent with Alzheimer's disease on autopsy.{{cite journal | vauthors = Liscic RM, Storandt M, Cairns NJ, Morris JC | title = Clinical and psychometric distinction of frontotemporal and Alzheimer dementias | journal = Archives of Neurology | volume = 64 | issue = 4 | pages = 535–540 | date = April 2007 | pmid = 17420315 | doi = 10.1001/archneur.64.4.535 | doi-access = free }} The most severe brain atrophy appears to be associated with behavioral variant FTD, and corticobasal degeneration.{{cite journal | vauthors = Rohrer JD, Lashley T, Schott JM, Warren JE, Mead S, Isaacs AM, Beck J, Hardy J, de Silva R, Warrington E, Troakes C, Al-Sarraj S, King A, Borroni B, Clarkson MJ, Ourselin S, Holton JL, Fox NC, Revesz T, Rossor MN, Warren JD | title = Clinical and neuroanatomical signatures of tissue pathology in frontotemporal lobar degeneration | journal = Brain | volume = 134 | issue = Pt 9 | pages = 2565–2581 | date = September 2011 | pmid = 21908872 | pmc = 3170537 | doi = 10.1093/brain/awr198 | author20-link = Martin Rossor }}

With regard to the genetic defects that have been found, repeat expansion in the C9orf72 gene is considered a major contribution to FTLD, although defects in the GRN and MAPT genes are also associated with it.{{cite journal | vauthors = van der Zee J, Van Broeckhoven C | title = Dementia in 2013: frontotemporal lobar degeneration-building on breakthroughs | journal = Nature Reviews. Neurology | volume = 10 | issue = 2 | pages = 70–72 | date = February 2014 | pmid = 24394289 | doi = 10.1038/nrneurol.2013.270 }}

DNA damage and the defective repair of such damages have been etiologically linked to various neurodegenerative diseases including FTD.{{cite journal | vauthors = Wang H, Kodavati M, Britz GW, Hegde ML | title = DNA Damage and Repair Deficiency in ALS/FTD-Associated Neurodegeneration: From Molecular Mechanisms to Therapeutic Implication | journal = Frontiers in Molecular Neuroscience | volume = 14 | issue = | pages = 784361 | date = 2021 | pmid = 34975400 | pmc = 8716463 | doi = 10.3389/fnmol.2021.784361 | doi-access = free }}

FTD is traditionally difficult to diagnose owing to the diverse nature of the associated symptoms. Signs and symptoms are classified into three groups based on the affected functions of the frontal and temporal lobes:{{cite journal | vauthors = Cardarelli R, Kertesz A, Knebl JA | title = Frontotemporal dementia: a review for primary care physicians | journal = American Family Physician | volume = 82 | issue = 11 | pages = 1372–1377 | date = December 2010 | pmid = 21121521 | url = http://www.aafp.org/afp/2010/1201/p1372.html }} These are behavioural variant frontotemporal dementia, semantic dementia, and progressive nonfluent aphasia. An overlap between symptoms can occur as the disease progresses and spreads through the brain regions.

Structural MRI scans often reveal frontal lobe and/or anterior temporal lobe atrophy, but in early cases the scan may seem normal. Atrophy can be either bilateral or asymmetric. Registration of images at different points of time (e.g., one year apart) can show evidence of atrophy that otherwise at individual time points may be reported as normal. Many research groups have begun using techniques such as magnetic resonance spectroscopy, functional imaging, and cortical thickness measurements in an attempt to offer an earlier diagnosis to the FTD patient. Fluorine-18-fluorodeoxyglucose positron emission tomography scans classically show frontal and/or anterior temporal hypometabolism, which helps differentiate the disease from Alzheimer's disease, as the PET scan in Alzheimer's disease classically shows biparietal hypometabolism.

Meta-analyses based on imaging methods have shown that frontotemporal dementia mainly affects a frontomedial network discussed in the context of social cognition or "theory of mind".{{cite journal | vauthors = Schroeter ML, Raczka K, Neumann J, von Cramon DY | title = Neural networks in frontotemporal dementia--a meta-analysis | journal = Neurobiology of Aging | volume = 29 | issue = 3 | pages = 418–426 | date = March 2008 | pmid = 17140704 | doi = 10.1016/j.neurobiolaging.2006.10.023 | s2cid = 9039002 }} This is entirely in keeping with the notion that on the basis of cognitive neuropsychological evidence, the ventromedial prefrontal cortex is a major locus of dysfunction early on in the course of the behavioural variant of frontotemporal degeneration.{{cite journal | vauthors = Rahman S, Sahakian BJ, Hodges JR, Rogers RD, Robbins TW | title = Specific cognitive deficits in mild frontal variant frontotemporal dementia | journal = Brain | volume = 122 | issue = 8 | pages = 1469–1493 | date = August 1999 | pmid = 10430832 | doi = 10.1093/brain/122.8.1469 | doi-access = free }} The language subtypes of FTLD (semantic dementia and progressive nonfluent aphasia) can be regionally dissociated by imaging approaches in vivo.{{cite journal | vauthors = Schroeter ML, Raczka K, Neumann J, Yves von Cramon D | title = Towards a nosology for frontotemporal lobar degenerations-a meta-analysis involving 267 subjects | journal = NeuroImage | volume = 36 | issue = 3 | pages = 497–510 | date = July 2007 | pmid = 17478101 | doi = 10.1016/j.neuroimage.2007.03.024 | s2cid = 130161 }}

The confusion between Alzheimer's and FTD is justifiable due to the similarities between their initial symptoms. Patients do not have difficulty with movement and other motor tasks.{{cite journal | vauthors = Steinbart EJ, Smith CO, Poorkaj P, Bird TD | title = Impact of DNA testing for early-onset familial Alzheimer disease and frontotemporal dementia | journal = Archives of Neurology | volume = 58 | issue = 11 | pages = 1828–1831 | date = November 2001 | pmid = 11708991 | doi = 10.1001/archneur.58.11.1828 | doi-access = free }} As FTD symptoms appear, it is difficult to differentiate between a diagnosis of Alzheimer's disease and FTD. There are distinct differences in the behavioral and emotional symptoms of the two dementias, notably, the blunting of affect seen in FTD patients. In the early stages of FTD, anxiety and depression are common, which may result in an ambiguous diagnosis. However, over time, these ambiguities fade away as this dementia progresses and defining symptoms of apathy, unique to FTD, start to appear.{{citation needed|date=December 2020}}

Recent studies over several years have developed new criteria for the diagnosis of behavioral variant frontotemporal dementia (bvFTD). The confirmatory diagnosis is made by brain biopsy, but other tests can be used to help, such as MRI, EEG, CT, and physical examination and history.{{MedlinePlusEncyclopedia|000744|Frontotemporal dementia}} {{as of|2011}}, six distinct clinical features have been identified as symptoms of bvFTD.{{cite journal | vauthors = Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EG, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL | title = Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia | journal = Brain | volume = 134 | issue = Pt 9 | pages = 2456–2477 | date = September 2011 | pmid = 21810890 | pmc = 3170532 | doi = 10.1093/brain/awr179 }}

1. Disinhibition
2. Apathy / Inertia
3. Loss of Sympathy / Empathy
4. Perseverative / Compulsive behaviors
5. Hyperorality
6. Dysexecutive neuropsychological profile

Of the six features, three must be present in a patient to diagnose one with possible bvFTD. Similar to standard FTD, the primary diagnosis stems from clinical trials that identify the associated symptoms, instead of imaging studies. The above criteria are used to distinguish bvFTD from disorders such as Alzheimer's and other causes of dementia. In addition, the criteria allow for a diagnostic hierarchy distinguished possible, probable, and definite bvFTD based on the number of symptoms present.

A 2021 study, determined that using cerebrospinal fluid (CSF) biomarkers of pathologic amyloid plaques, tangles, and neurodegeneration, collectively called ATN, can be useful in diagnosing FTD.{{cite journal | vauthors = Cousins KA, Phillips JS, Irwin DJ, Lee EB, Wolk DA, Shaw LM, Zetterberg H, Blennow K, Burke SE, Kinney NG, Gibbons GS, McMillan CT, Trojanowski JQ, Grossman M | title = ATN incorporating cerebrospinal fluid neurofilament light chain detects frontotemporal lobar degeneration | journal = Alzheimer's & Dementia | volume = 17 | issue = 5 | pages = 822–830 | date = May 2021 | pmid = 33226735 | pmc = 8119305 | doi = 10.1002/alz.12233 }}

The progression of the degeneration caused by bvFTD may follow a predictable course. The degeneration begins in the orbitofrontal cortex and medial aspects such as ventromedial prefrontal cortex. In later stages, it gradually expands its area to the dorsolateral prefrontal cortex and the temporal lobe.{{cite journal | vauthors = Krueger CE, Bird AC, Growdon ME, Jang JY, Miller BL, Kramer JH | title = Conflict monitoring in early frontotemporal dementia | journal = Neurology | volume = 73 | issue = 5 | pages = 349–355 | date = August 2009 | pmid = 19652138 | pmc = 2725928 | doi = 10.1212/wnl.0b013e3181b04b24 }} Thus, the detection of dysfunction of the orbitofrontal cortex and ventromedial cortex is important in the detection of early stage bvFTD. As stated above, a behavioural change may occur before the appearance of any atrophy in the brain in the course of the disease. Because of that, image scanning such as MRI can be insensitive to the early degeneration and it is difficult to detect early-stage bvFTD.{{citation needed|date=December 2020}}

In neuropsychology, there is an increasing interest in using neuropsychological tests such as the Iowa gambling task or Faux Pas Recognition test as an alternative to imaging for the diagnosis of bvFTD.{{cite journal | vauthors = Torralva T, Roca M, Gleichgerrcht E, Bekinschtein T, Manes F | title = A neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia | journal = Brain | volume = 132 | issue = Pt 5 | pages = 1299–1309 | date = May 2009 | pmid = 19336463 | doi = 10.1093/brain/awp041 | doi-access = free }} Both the Iowa gambling task and the Faux Pas test are known to be sensitive to dysfunction of the orbitofrontal cortex.{{citation needed|date=December 2020}}

The Faux Pas Recognition test is intended to measure one's ability to detect faux pas types of social blunders (accidentally making a statement or an action that offends others). It is suggested that people with orbitofrontal cortex dysfunction show a tendency to make social blunders due to a deficit in self-monitoring.{{cite journal | vauthors = Beer JS, John OP, Scabini D, Knight RT | title = Orbitofrontal cortex and social behavior: integrating self-monitoring and emotion-cognition interactions | journal = Journal of Cognitive Neuroscience | volume = 18 | issue = 6 | pages = 871–879 | date = June 2006 | pmid = 16839295 | doi = 10.1162/jocn.2006.18.6.871 | s2cid = 13590871 | citeseerx = 10.1.1.527.3607 }} Self-monitoring is the ability of individuals to evaluate their own behavior to make sure that their behavior is appropriate in particular situations. The impairment in self-monitoring leads to a lack of social emotion signals. The social emotions such as embarrassment are important in the way that they alert the individual to adapt social behavior in an appropriate manner to maintain relationships with others. Though patients with damage to the OFC retain intact knowledge of social norms, they fail to apply it to actual behavior, because they fail to generate social emotions that promote adaptive social behavior.

The other test, the Iowa gambling task, is a psychological test intended to simulate real-life decision making. The underlying concept of this test is the somatic marker hypothesis. This hypothesis argues that when people have to make complex uncertain decisions, they employ both cognitive and emotional processes to assess the values of the choices available to them. Each time a person makes a decision, both physiological signals and evoked emotion (somatic markers) are associated with their outcomes, and this accumulates as experience. People tend to choose the choice which might produce the outcome reinforced with positive stimuli; thus it biases decision-making towards certain behaviors while avoiding others.{{cite journal | vauthors = Damasio AR | title = The somatic marker hypothesis and the possible functions of the prefrontal cortex | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 351 | issue = 1346 | pages = 1413–1420 | date = October 1996 | pmid = 8941953 | doi = 10.1098/rstb.1996.0125 | s2cid = 1841280 }} It is thought that somatic markers are processed in the orbitofrontal cortex.{{citation needed|date=December 2020}}

The symptoms observed in bvFTD are caused by dysfunction of the orbitofrontal cortex; thus these two neuropsychological tests might be useful in detecting early-stage bvFTD. However, as self-monitoring and somatic marker processes are so complex, it likely involves other brain regions. Therefore, neuropsychological tests are sensitive to the dysfunction of orbitofrontal cortex, yet are not specific to it. The weakness of these tests is that they do not necessarily show dysfunction of the orbitofrontal cortex.{{citation needed|date=December 2020}}

In order to solve this problem, some researchers have combined neuropsychological tests which detect the dysfunction of orbitofrontal cortex into one grouping, so that it increases its specificity to the degeneration of the frontal lobe, in order to detect early-stage bvFTD. They invented the Executive and Social Cognition Battery which comprises five neuropsychological tests:

• Faux Pas test
• Hotel task
• Iowa gambling task
• Mind in the Eyes
• Multiple Errands task

The result has shown that this combined test is more sensitive in detecting the deficits in early bvFTD.

Currently, there is no cure for FTD. Treatments are available to manage the behavioral symptoms. Rehabilitiation services supporting every day functioning have demonstrated some positive results, in particular the Tailored Activity Programme, which is occupational therapy based. Positive behavior support (PBS) has also been identified as potentially beneficial for people with bvFTD.{{cite journal | vauthors = Suárez-González A, Savage SA, Alladi S, Amaral-Carvalho V, Arshad F, Camino J, Caramelli P, Comas-Herrera A, Cook J, Cooper C, García Díaz L, Grasso SM, Jokel R, Lavoie M, León T, Priya T, Ramos Franco T, Taylor-Rubin C, Townsend R, Thöne-Otto A, Slachevsky A, Volkmer A, Weidner W, O'Connor CM | display-authors = 6 | title = Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low-Middle-Income Countries | journal = International Journal of Environmental Research and Public Health | volume = 21 | issue = 6 | pages = 790 | date = June 2024 | pmid = 38929036 | pmc = 11203756 | doi = 10.3390/ijerph21060790 | doi-access = free }} Disinhibition and compulsive behaviors can be controlled by selective serotonin reuptake inhibitors (SSRIs).{{cite journal | vauthors = Swartz JR, Miller BL, Lesser IM, Darby AL | title = Frontotemporal dementia: treatment response to serotonin selective reuptake inhibitors | journal = The Journal of Clinical Psychiatry | volume = 58 | issue = 5 | pages = 212–216 | date = May 1997 | pmid = 9184615 | doi = 10.4088/jcp.v58n0506 }}{{cite web|url=http://memory.ucsf.edu/ftd/overview/ftd/treatment/multiple/behavioral|title=Medications for behavioral symptoms| work = Weill Institute for Neurosciences | publisher = University of California San Francisco |access-date=30 October 2015}} Agitation can be controlled with small doses of atypical antipsychotics.{{cite journal | vauthors = Manoochehri M, Huey ED | title = Diagnosis and management of behavioral issues in frontotemporal dementia | journal = Current Neurology and Neuroscience Reports | volume = 12 | issue = 5 | pages = 528–536 | date = October 2012 | pmid = 22847063 | pmc = 3443960 | doi = 10.1007/s11910-012-0302-7 }} Although Alzheimer's and FTD share certain symptoms, they cannot be treated with the same pharmacological agents because the cholinergic systems are not affected in FTD.

Because FTD often occurs in relatively younger adults (i.e. in their 40s or 50s), it can severely affect families. Patients often still have children living in the home.{{citation needed|date=December 2020}}

Symptoms of frontotemporal dementia progress at a rapid, steady rate. Patients with the disease can survive for 2–20 years. Eventually patients will need 24-hour care for daily function.{{cite journal | vauthors = Kertesz A | title = Frontotemporal dementia/Pick's disease | journal = Archives of Neurology | volume = 61 | issue = 6 | pages = 969–971 | date = June 2004 | pmid = 15210543 | doi = 10.1001/archneur.61.6.969 }}

Cerebrospinal fluid leaks are a known cause of reversible frontotemporal dementia.{{Cite journal | vauthors = Samson K | title = Hypotension May Cause Frontotemporal Dementia | doi = 10.1097/00132985-200209000-00013 | journal = Neurology Today | volume = 2 | issue = 9 | pages = 35–36 | year = 2002 }}

Features of FTD were first described by the Czech psychiatrist Arnold Pick between 1892 and 1906.{{cite journal |vauthors=Mikol J |title=History of Pick's disease |journal=Revue Neurologique |date=2018 |volume=174 |issue=10 |pages=740–741 |doi=10.1016/j.neurol.2018.09.009 |s2cid=81923630 |url=https://www.sciencedirect.com/science/article/abs/pii/S0035378718308245#bib0130 |language=en |issn=0035-3787}}{{Cite journal| vauthors = Pick A |date=1892|title=Uber die Beziehungen der senilen Hirnatrophie zur Aphasie |url= https://ci.nii.ac.jp/naid/10021235320/amp/ja|journal=Prag Med Wochenschr|volume=17|pages=165–167}} The name Pick's disease was coined in 1922.{{cite journal | vauthors = Pearce JM | title = Pick's disease | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 74 | issue = 2 | pages = 169 | date = February 2003 | pmid = 12531941 | pmc = 1738259 | doi = 10.1136/jnnp.74.2.169 }} This term is now reserved only for behavioral variant FTD which shows the presence of the characteristic Pick bodies and Pick cells, which were first described by Alois Alzheimer in 1911.

In 1989, Snowden suggested the term semantic dementia to describe the patient with predominant left temporal atrophy and aphasia that Pick described. The first research criteria for FTD, "Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups", was developed in 1994. The clinical diagnostic criteria were revised in the late 1990s, when the FTD spectrum was divided into a behavioral variant, a nonfluent aphasia variant, and a semantic dementia variant.{{cite journal | vauthors = Olney NT, Spina S, Miller BL | title = Frontotemporal Dementia | journal = Neurologic Clinics | volume = 35 | issue = 2 | pages = 339–374 | date = May 2017 | pmid = 28410663 | pmc = 5472209 | doi = 10.1016/j.ncl.2017.01.008 }} The most recent revision of the clinical research criteria was by the International Behavioural Variant FTD Criteria Consortium in 2011.

People who have been diagnosed as having FTD (often referred to as Pick's disease in cases of the behavioral variant) include:

• John Berry (1963–2016), American hardcore punk musician and founding member of the Beastie Boys{{Cite web | vauthors = Oyebode J |date=31 May 2016 |title=Beastie Boy John Berry Died of Frontal Lobe Dementia – But What Is It? |url=https://scitechconnect.elsevier.com/beastie-boy-died-frontal-lobe-dementia/ |access-date=10 May 2022 |website=Elsevier}}
• Clancy Blair (born 1960), American developmental psychologist and professor{{Citation needed|date=April 2023}}
• Don Cardwell (1935–2008), Major League Baseball pitcher{{cite web | vauthors = Goldstein R | url = https://www.nytimes.com/2008/01/16/sports/baseball/16cardwell.html | title = Don Cardwell, 72, Pitcher for 1969 Mets, Is Dead | work = The New York Times | date = 16 January 2008 }}
• Charmian Carr (1942–2016), who played Liesl, from the Sound of Music, born Charmian Anne Farnon
• Jerry Corbetta (1947–2016), frontman, organist and keyboardist of American psychedelic rock band Sugarloaf{{Cite web|url=http://www.denverpost.com/2016/09/20/colorado-hitmaker-jerry-corbetta-dead-at-68/|title=Sugarloaf frontman Jerry Corbetta dead at 68 | work = The Denver Post|access-date=2016-10-29|date=2016-09-20}}
• Ted Darling (1935–1996), Buffalo Sabres television announcer
• Robert W. Floyd (1936–2001), computer scientist{{Cite journal | vauthors = Knuth DE | author-link = Donald Knuth | title = Robert W Floyd, In Memoriam | url = http://www-cs-faculty.stanford.edu/~uno/papers/floyd.ps.gz | doi = 10.1145/954092.954488 | journal = ACM SIGACT News | volume = 34 | issue = 4 | pages = 3–13 | date = December 2003 | s2cid = 35605565 | access-date = 2020-12-12 | archive-date = 2017-04-22 | archive-url = https://web.archive.org/web/20170422014927/http://www-cs-faculty.stanford.edu/~uno/papers/floyd.ps.gz | url-status = dead }}
• Lee Holloway (born 1982), computer scientist, co-founder of Cloudflare{{cite magazine | vauthors = Upson S | title = The Devastating Decline of a Brilliant Young Coder | url = https://www.wired.com/story/lee-holloway-devastating-decline-brilliant-young-coder/ | magazine = Wired | date = 15 April 2020 }}
• Colleen Howe (1933–2009), sports agent and ice hockey team manager, known as "Mrs. Hockey"{{cite web|url=http://www.freep.com/article/20090306/SPORTS05/90306069?imw=Y|title=Fans mourn loss of "Mrs. Hockey," Colleen Howe| vauthors = Sipple G |website=The Detroit Free Press|date=March 6, 2009|access-date=October 3, 2015|archive-url=https://web.archive.org/web/20151004110013/http://www.freep.com/article/20090306/SPORTS05/90306069?imw=Y|archive-date=October 4, 2015}}
• Kazi Nazrul Islam (1899–1976) national poet of Bangladesh{{Cite web | vauthors = Farooq MO |title=Kazi Nazrul Islam: Illness and Treatment |url=http://www.nazrul.org/nazrul_life/illness.htm |archive-url=https://web.archive.org/web/20150529083323/http://www.nazrul.org/nazrul_life/illness.htm |archive-date=29 May 2015 |access-date=26 March 2016 |website=nazrul.org |df=dmy-all}}
• Terry Jones (1942–2020), Welsh comedian (Monty Python) and director
• Ralph Klein (1942–2013), former premier of Alberta, Canada
• Kevin Moore (1958–2013), English footballer{{cite web|last=Sportsteam|title=Grimsby Town legend Kevin Moore passes away|url=http://www.thisisgrimsby.co.uk/Grimsby-Town-legend-Kevin-Moore-passes-away/story-18838049-detail/story.html#axzz2RsGaeCI7|access-date=2013-04-29|archive-url=https://web.archive.org/web/20130503011757/http://www.thisisgrimsby.co.uk/Grimsby-Town-legend-Kevin-Moore-passes-away/story-18838049-detail/story.html#axzz2RsGaeCI7|archive-date=2013-05-03}}
• Ernie Moss (1949–2021), English footballer{{cite news|title=Support for Valiants hero Ernie Moss after he is diagnosed with Pick's Disease|url=http://www.stokesentinel.co.uk/Port-Vale-Support-Valiants-hero-Ernie-Moss/story-23091273-detail/story.html|access-date=11 October 2014|work=The Sentinel|date=11 October 2014|archive-url=https://web.archive.org/web/20141102103942/http://www.stokesentinel.co.uk/Port-Vale-Support-Valiants-hero-Ernie-Moss/story-23091273-detail/story.html|archive-date=2 November 2014}}
• Nic Potter (1951–2013), British bassist for Van der Graaf Generator{{cite news| vauthors = Potter S |url= https://www.theguardian.com/music/2013/jan/22/nic-potter |title=Nic Potter obituary | Music | guardian.co.uk |publisher=Guardian |date= 22 January 2013|access-date=22 January 2013 |location=London}}
• Christina Ramberg (1946–1995), American painter associated with the Chicago Imagists{{cite web | vauthors = Cook G |url=https://www.wbur.org/artery/2014/02/27/the-sexy-proto-feminist-art-of-christina-rambergs-tragically-short-life|title=The Sexy, Proto-Feminist Art Of Christina Ramberg's Tragically Short Life|website=www.wbur.org|date=27 February 2014 }}
• David Rumelhart (1942–2011), American cognitive psychologist{{citation needed|date=December 2020}}
• Sir Nicholas Wall (1945–2017), English judge{{cite web | vauthors = Rayner G | url = https://www.telegraph.co.uk/news/2017/02/23/sir-nicholas-wall-britains-top-family-law-judge-commits-suicide/ | title = Sir Nicholas Wall, once Britain's top family law judge, commits suicide after dementia diagnosis | work = The Daily Telegraph | date = 23 February 2017 }}
• Wendy Williams (born 1964), American broadcaster{{Cite magazine | vauthors = Shah S |date= 22 February 2024 |title=Wendy Williams Diagnosed With Frontotemporal Dementia and Apahasia |url=https://time.com/6767929/wendy-williams-diagnosis-frontotemporal-dementia-aphasia/ |access-date=22 February 2024 |magazine=TIME |language=en}}
• Bruce Willis (born 1955), American actor{{Cite web | vauthors = Moreau J |date=2023-02-16 |title=Bruce Willis Diagnosed With Dementia After Retiring Due to Aphasia |url=https://variety.com/2023/film/news/bruce-willis-dementia-aphasia-retire-1235525599/ |access-date=2023-02-16 |website=Variety}}
• Mark Wirtz (1943–2020), pop musician, composer and producer{{cite web | title = Mark Wirtz, musician and producer who had a global hit with Excerpt from a Teenage Opera – obituary | url = https://www.telegraph.co.uk/obituaries/2020/08/12/mark-wirtz-musician-producer-had-global-hit-excerpt-teenage | archive-url = https://web.archive.org/web/20200827133924/https://www.telegraph.co.uk/obituaries/2020/08/12/mark-wirtz-musician-producer-had-global-hit-excerpt-teenage/ | archive-date = 27 August 2020 | work = The Daily Telegraph | date = 13 August 2020 }}

{{col div|colwidth=30em}}

• Alcoholic dementia
• Lewy body dementia
• Logopenic progressive aphasia
• Mini-SEA
• Proteopathy
• Transportin 1
• Vascular dementia

{{colend}}

{{Reflist}}

{{Refbegin}}

• {{Cite news |last=Hughes |first=Virginia |date=2024-12-22 |title=Fighting to Avoid Her Mother’s Fate, for Her Daughters’ Sake |url=https://www.nytimes.com/2024/12/22/health/frontotemporal-dementia-genetic-mutation-linde-jacobs.html |access-date=2025-03-02 |work=The New York Times}}
• {{cite journal | vauthors = Liu W, Miller BL, Kramer JH, Rankin K, Wyss-Coray C, Gearhart R, Phengrasamy L, Weiner M, Rosen HJ | title = Behavioral disorders in the frontal and temporal variants of frontotemporal dementia | journal = Neurology | volume = 62 | issue = 5 | pages = 742–748 | date = March 2004 | pmid = 15007124 | pmc = 2367136 | doi = 10.1212/01.WNL.0000113729.77161.C9 | series = 5 }}
• {{cite journal | vauthors = Nyatsanza S, Shetty T, Gregory C, Lough S, Dawson K, Hodges JR | title = A study of stereotypic behaviours in Alzheimer's disease and frontal and temporal variant frontotemporal dementia | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 74 | issue = 10 | pages = 1398–1402 | date = October 2003 | pmid = 14570833 | pmc = 1757381 | doi = 10.1136/jnnp.74.10.1398 }}
• {{Cite web | vauthors = Reynolds M |title='Til Death or Dementia Do us Part, a memoir |work=River Rock Books |url=https://www.riverrockbooks.com/prints/til-death-or-dementia-do-us-part-a-memoir-by-marilyn-reynolds |access-date=2018-02-19 |archive-date=2018-02-20 |archive-url=https://web.archive.org/web/20180220033626/https://www.riverrockbooks.com/prints/til-death-or-dementia-do-us-part-a-memoir-by-marilyn-reynolds }}
• {{Cite magazine | vauthors = Upson S |title=The Devastating Decline of a Brilliant Young Coder |magazine=Wired |date=15 April 2020 |access-date=17 September 2020 |url=https://www.wired.com/story/lee-holloway-devastating-decline-brilliant-young-coder/ }}

{{Refend}}

{{Medical resources

| DiseasesDB = 10034

| ICD11 = {{ICD11|6D83}}

| ICD10 = {{ICD10|G31.0}}

| ICD9 = {{ICD9|331.19}}

| ICDO =

| OMIM = 600274

| OMIM_mult = {{OMIM|105550||none}} {{OMIM|614260||none}}

| MedlinePlus =

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D003704

| GeneReviewsNBK = NBK1505

| GeneReviewsName = MAPT-Related Disorders

| geneReviewsNBK2 = NBK1371

| geneReviewsName2= GRN-Related Frontotemporal Dementia

}}

{{Mental and behavioural disorders|selected = neurological}}

{{CNS diseases of the nervous system}}

Category:Cognitive disorders

Category:Dementia

Category:Frontal lobe

Category:Temporal lobe

de:Frontotemporale Demenz