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Functional neuroimaging and presenting psychiatric features in frontotemporal dementia

¹ Department of Neurology, UCLA, Los Angeles, California, USA
² VA Greater Los Angeles Healthcare System, Los Angeles
³ Harbor-UCLA Medical Center, Los Angeles
⁴ The Department of Neurology, University of California at San Francisco, San Francisco, California, USA

Correspondence to:
Correspondence to:
Dr Mario F Mendez
Neurobehavior (116AF; Bldg 500, 3S), VA Greater Los Angeles Healthcare, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; mmendez{at}UCLA.edu

Background: Frontotemporal dementia (FTD) is a behavioural syndrome caused by degeneration of the frontal and anterior temporal lobes. Behavioural disturbances include psychiatric features. Whether patients with FTD present with psychiatric features varies with the initial neuroanatomical variability of FTD.

Objective: To identify presenting psychiatric changes not part of diagnostic criteria of FTD and contrast them with the degree of hemispheric asymmetry and frontal and temporal hypoperfusion on single photon emission computed tomography (SPECT) imaging.

Methods: 74 patients who met consensus criteria for FTD were evaluated at a two year follow up. All had brain SPECT on initial presentation. Results of an FTD psychiatric checklist were contrasted with ratings of regional hypoperfusion.

Results: The regions of predominant hypoperfusion did not correlate with differences on FTD demographic variables but were associated with presenting psychiatric features. Dysthymia and anxiety were associated with right temporal hypoperfusion. "Moria" or frivolous behaviour also occurred with temporal lobe changes, especially on the right. The only significant frontal lobe feature was the presence of a peculiar physical bearing in association with right frontal hypoperfusion.

Conclusions: Patients with FTD may present with psychiatric changes distinct from the behavioural diagnostic criteria for this disorder. Early temporal involvement is associated with frivolous behaviour and right temporal involvement is associated with emotional disturbances. In contrast, those with right frontal disease may present with alterations in non-verbal behaviour.

Abbreviations: FTD, frontotemporal dementia; MMSE, mini-mental state examination; SPECT, single photon emission computed tomography

Keywords: dementia; frontotemporal dementia; neuropsychiatry; personality

This article has been cited by other articles:

				M. F. Mendez, E. C. Lauterbach, S. M. Sampson, and ANPA Committee on Research An Evidence-Based Review of the Psychopathology of Frontotemporal Dementia: A Report of the ANPA Committee on Research J Neuropsychiatry Clin Neurosci, May 1, 2008; 20(2): 130 - 149. [Abstract] [Full Text] [PDF]

				M. F. Mendez, J. S. Shapira, A. McMurtray, E. Licht, and B. L. Miller Accuracy of the Clinical Evaluation for Frontotemporal Dementia Arch Neurol, June 1, 2007; 64(6): 830 - 835. [Abstract] [Full Text] [PDF]