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DIAGNOSING FRONTOTEMPORAL DEMENTIA IN OUTPATIENTS: AN AUDIT OF RADIOLOGICAL REPORTS AND REVIEW OF DIAGNOSTIC CRITERIA
  1. Bethan Dewer,
  2. Patrick Rogers,
  3. James Ricketts,
  4. William Mukonoweshuro,
  5. Adam Zeman

Abstract

Objective The Frontotemporal Dementias (FTDs) comprise a clinically and pathologically heterogeneous group of disorders which usually have in common selective degeneration of the frontal and temporal lobes. They account for 10–20% of cases of dementia occurring before the age of 65. On review, it was observed that subtle but relevant changes on initial brain imaging were often not mentioned in the initial radiological report and only came to light during the neuroradiology review meeting.

Method We audited a series of 39 consecutive patients seen by a single cognitive neurologist (AZ) in whom the initial diagnosis was of a form of FTD.

Results 38 sets of notes were available for review. Two patients progressed in a manner suggestive of Alzheimer's Disease and were excluded. 22 of the remaining 36 patients satisfied formal diagnostic criteria for forms of FTD (6 behavioural variant FTD (BvFTD), 5 semantic dementia (SD), 3 non-fluent primary progressive aphasia (PNFA), 4 progressive supra-nuclear palsy (PSP), 4 corticobasal syndrome (CBS). We compared the initial non-specialist radiological reports of the MRI scans performed in these 22 patients with the reports of a radiologist who specifically examined the scans with the possibility of an atypical dementia in mind. We found that 6/22 of the original reports provided a full and accurate description of the radiological findings, while 2/22 provided a fully accurate interpretation.

Conclusion We conclude that in this group of patients, with early-onset dementia, valuable diagnostic information may be missed unless clinicians and radiologists jointly review and discuss the brain imaging. We review the diagnostic criteria for this family of disorders and provide illustrative examples of the typical brain imaging findings. It may be advisable to apply standardised scales to facilitate the radiological reporting of scans performed to investigate cognitive disorder.

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