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Is pathology-specific diagnosis of the dementia possible in life?
  1. John R Hodges
  1. Correspondence to Professor John R Hodges, FRONTIER, Brain & Mind Centre, Level 1 M02F, 94 Mallett Street, Camperdown, New South Wales 2050, Australia; john.hodges{at}

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Young-onset and elderly-onset Alzheimer’s produce different patterns of brain atrophy while pathological subtypes of frontotemporal dementia remain largely indistinguishable

Establishing whether distinct pathological forms of dementia have anatomical signatures at presentation is monumental work involving the long-term follow-up of patients assessed sufficiently early in their course to allow MRI imaging, who are then enrolled into a brain bank with subsequent successful retrieval of their brains after death. Few places in the world are capable of this feat, and it is no surprise that the article by Harper et al 1 represents the collaborative effort of four dementia research centres in two countries. At the heart of the study are two fundamental questions: Is early-onset Alzheimer’s disease (AD) the same as later-onset AD but just in young people? And do the distinctive pathologies that underlie frontotemporal dementia have distinct anatomical signatures?

The former question is more straightforward and goes back to the early days of AD when it was regarded as a rare cause of dementia that affects young people, whereas the bulk of dementia in the elderly was due to simple ‘senility’. The later realisation …

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  • Contributors This editorial commentary was written entirely by JRH and expresses his opinions only.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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