Accuracy of the Clinical Evaluation for Frontotemporal Dementia

Mendez, Mario F.; Shapira, Jill; McMurtray, Aaron; Licht, Eliot A.; Miller, Bruce L.

doi:10.1001/archneur.64.6.830

Cited by 183 publications

(152 citation statements)

References 35 publications

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“…Our cases were diagnosed after a multidisciplinary assessment at a subspecialty center. In the community, recognition of bvFTD is dependent on nonexpert clinicians, and diagnosis is often inaccurate 5, 6, 7. Techniques that are less dependent on subjective interpretation provide an important adjunct to clinical assessment.…”

Section: Discussionmentioning

confidence: 99%

“…FTLD can present with a variety of syndromes, including progressive supranuclear palsy, corticobasal degeneration, and progressive aphasia, but the most common presentation is progressive change in personality with abnormalities in socioemotional behavior, referred to as the behavioral variant of frontotemporal dementia (bvFTD) 4. Diagnosis of bvFTD remains difficult, with patients being erroneously diagnosed with Alzheimer's disease (AD) or psychiatric disorders 5, 6, 7. A large body of work has demonstrated that brain imaging, in particular structural magnetic resonance imaging (MRI) and functional imaging of cerebral blood flow (CBF) with SPECT or cerebral metabolic rate of glucose (CMRgl) with fluorodeoxyglucose (FDG) positron emission tomography (PET), can improve the accuracy of differential diagnosis in bvFTD 8, 9, 10, 11, 12, 13, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic utility of ASL‐MRI and FDG‐PET in the behavioral variant of FTD and AD

Tosun

Schuff

Rabinovici

et al. 2016

Ann Clin Transl Neurol

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ObjectiveTo compare the values of arterial spin‐labeled (ASL) MRI and fluorodeoxyglucose (FDG) PET in the diagnosis of behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD).MethodsPartial least squares logistic regression was used to identify voxels with diagnostic value in cerebral blood flow (CBF) and cerebral metabolic rate of glucose (CMRgl) maps from patients with bvFTD (n = 32) and AD (n = 28), who were compared with each other and with cognitively normal controls (CN, n = 15). Diagnostic values of these maps were compared with each other.ResultsRegions that differentiated each disorder from controls were similar for CBF and CMRgl. For differentiating AD from CN, the areas under the curve (AUC) for CBF (0.89) and CMRgl (0.91) were similar, with similar sensitivity (CBF: 86%, CMRgl: 78%) and specificity (CBF: 92%, CMRgl: 100%). Likewise, for differentiating bvFTD from CN performances of CBF (AUC = 0.83) and CMRgl (AUC = 0.85) were equivalent, with similar sensitivity (CBF: 78%, CMRgl: 79%) and specificity (CBF: 92%, CMRgl: 100%). In differentiating bvFTD from AD, classification was again similar for CBF (AUC = 0.87) and CMRgl (AUC = 0.79), as were sensitivity (CBF: 83%, CMRgl: 89%) and specificity (CBF: 93%, CMRgl: 78%). None of the differences in any performance measure were statistically significant.InterpretationASL‐MRI has similar diagnostic utility as FDG‐PET in the diagnosis of AD and bvFTD. Continued development of ASL‐MRI as a diagnostic tool for neurodegenerative dementias is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic utility of ASL‐MRI and FDG‐PET in the behavioral variant of FTD and AD

Tosun

Schuff

Rabinovici

et al. 2016

Ann Clin Transl Neurol

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“…A logistic regression showed that an optimal semantic index cutoff score of .552 correctly classified 92.3% of AD patients and 84.6% of FTD patients, for an overall correct discrimination rate of 89.7%. Mendez et al (2007) found that neuropsychological measures lacked sensitivity for accurate diagnosis of FTD at initial presentation. However, the pattern of progression on neuropsychological tests was helpful at establishing diagnosis over time, with worsening naming and executive functions and preserved constructional ability noted at follow-up.…”

Section: Differentiation Of Ftd From Admentioning

confidence: 98%

“…Mendez et al (2007), for example, concluded that neuroimaging, particularly functional brain studies, greatly increased the sensitivity of detecting FTD over what was possible with neuropsychological measures. Atrophy patterns in FTD are predominately frontal, but extend well beyond the frontal lobes and are more evident in some frontal regions than others.…”

Section: Differentiation Of Ftd From Admentioning

confidence: 99%

The Early Neuropsychological and Behavioral Characteristics of Frontotemporal Dementia

et al. 2008

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Frontotemporal lobe dementias (FTLD) represent a constellation of disorders that may be overlooked or misdiagnosed, despite being a fairly common presenile neurodegenerative diseases. Although the cognitive disorder can be difficult to document, particularly early in the dementia course, neuropsychological evaluation can assist in the diagnosis. Neuropsychologists are in an excellent position to draw from related disciplines like personality theory and social psychology to better assess the types of changes that characterize the prodromal and early phases of the disease. This review summarizes the current state of the field in the diagnosis of FTLD and discusses the emerging role of neuropsychology in elucidating the brain organization of complex processes including empathy, behavioral control and inhibition, reward systems, appetitive behaviors, emotional regulation, and goal-orientation. As this review underscores, FTD remains a powerful model for studying brain-behavior relationships.Frontotemporal lobar degeneration (FTLD) refers to a set of neurodegenerative disorders arising from relatively circumscribed frontal and temporal lobar atrophy. Characterized by troubling and progressive changes in behavior, personality, judgment, language, and cognition, the disorder compromises individuals while still in their productive years and may initially be mistaken as a psychiatric disorder. As with other degenerative dementias, a goal is to identify these disorders early with the intent of intervening before the disease has fully expressed in brain. Although no pharmacological treatments are yet available to prevent the disease progression, there are treatments that help alleviate symptoms and nonpharmacological interventions to deal with problem behaviors, coping, and adjustment. From a cognitive neuroscience perspective, the FTLD dementias with their effects on some of the core features of human personality and cognition offer an opportunity to better understand how these fundamental processes of human existence are functionally organized, both the processes involved as well as the brain systems that mediate them. This review article discusses the clinical presentation of the FTLD dementias with an emphasis on its early expression. We propose that by applying a theoretical framework of human behavior from social psychology and constructs from personality theory to the study of FTLD, neuropsychology is ideally positioned to elucidate some of the brain mechanisms underlying a range of complex human behaviors, emotions, and social cognition. Clinical and Neuropathological Expression of FTLDThe first mention of FTLD as a syndrome was in 1892 when Arnold Pick, a neurologist at the University of Prague, described the clinical and pathological features of one of his patients. He reported an aphasic presentation that progressed over three years in a 71-yearold individual. Upon autopsy, there was found to be significant frontal and temporal lobe atrophy in the diseased brain. Pick's clinical description of his patien...

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“…Apesar dos avanços recentes na caracterização da DFTvc, o diagnóstico desta síndrome permanece desafiador. Enquanto alguns pacientes são erroneamente considerados preservados, outros são diagnosticados com transtornos psiquiátricos ou (DA) (Mendez et al, 2007).…”

Section: Demência Frontotemporal Variante Comportamentalunclassified

Funcionalidade e desempenho cognitivo na demência frontotemporal variante comportamental

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AgradecimentosPrimeiramente à oportunidade concedida pelo grande mestre Prof. Ricardo Nitrini, coordenador da pós-graduação de Neurologia da Faculdade de Medicina da USP, pela oportunidade de realizar uma pesquisa com um tema tão desafiador e de poder estagiar e aprender com seu grupo de pesquisa, tão referenciado no país, nas questões de aprendizagem e assistência, o Grupo de Neurologia Cognitiva e do Comportamento-(GNCC). Minha sincera admiração a sua pessoa, um exemplo de ser humano, médico e líder de pesquisa. Poder conviver com você durante a pós graduação, foi um ganho ímpar a minha carreira como gerontóloga e cidadã. Também agradeço ao Prof. Ricardo, por possibilitar que meu estudo fosse de caráter colaborativo, contando com a parceria de centros liderados por neurologistas e psiquiatras renomados em nossa área, como Prof. Paulo Caramelli, Prof. Cássio Bottino, Prof. Benito Damasceno e Prof. Márcio Bathazar.A Profa Mônica Yassuda, pela possibilidade de tê-la como orientadora e amiga.Meu profundo reconhecimento ao seu caráter íntegro, a seu perfil decidido, justo e determinado de viver a vida e de fazer pesquisa, um grande exemplo e referencial a mim, de pesquisadora, de ética, uma mestra eterna na minha vida, são anos de convivência de troca de experiências e de muita aprendizagem ao seu lado. Agradeço pela confiança cedida como primeira orientanda sua no Programa de pós graduação em neurologia e por idealizar o tema do meu projeto de pesquisa. Meu atual investimento na área é resultado de uma parceria entre nós, desde minha graduação, me sinto uma pedra polida pela sua pessoa.Agradeço a Profa Valéria Bahia, pela oportunidade de tê-la como co orientadora, por toda a dedicação em me aprofundar no universo das demências precoces e da degeneração lobar frontotemporal, pela paciência e parceria em ajudar nos reajustes do trabalho, pelo encaminhamento dos pacientes. Por autorizar o acompanhamento intenso de seus atendimentos no ambulatório de Neurologia e pelos momentos de descontração no GNCC.Minha sincera admiração pela Profa Sônia Brucki, pessoa ao qual me espelho muito na pesquisa e nos ideais políticos, poder conhecê-la e tê-la como professora e amiga, foi uma honra. Agradeço pelo apoio nos momentos difíceis de saúde na família, por sempre estar disposta a ajudar qualquer ser humano, admiro muito seu jeito, uma pessoa muito querida, como sempre digo: um anjo.Todo reconhecimento a Dra Jerusa Smid, pelo profissionalismo, caráter e boa índole, pelo apoio nos momentos difíceis de saúde do meu pai e tio, por ser uma pessoa ímpar e colaborando sempre para as discussões de casos e estudos do GNCC, tornandoas mais enriquecedoras.Ao Prof. Paulo Caramelli pela oportunidade de parceria neste estudo, com seu grupo de Neurologia Cognitiva e do Comportamento da Universidade Federal de Minas Gerais. Um exemplo de liderança de pesquisa, uma pessoa querida por todos, foi uma aprendizagem incrível estar com sua equipe, me senti bem acolhida e me admirei com a atuação multiprofissional bem estabelecida, para atividades de p...

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Accuracy of the Clinical Evaluation for Frontotemporal Dementia

Cited by 183 publications

References 35 publications

Diagnostic utility of ASL‐MRI and FDG‐PET in the behavioral variant of FTD and AD

Diagnostic utility of ASL‐MRI and FDG‐PET in the behavioral variant of FTD and AD

The Early Neuropsychological and Behavioral Characteristics of Frontotemporal Dementia

Funcionalidade e desempenho cognitivo na demência frontotemporal variante comportamental

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