Functional neuroimaging and presenting psychiatric features in frontotemporal dementia

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2006-01, Vol.77 (1), p.4-7
• Main Authors: Mendez, M F, McMurtray, A, Chen, A K, Shapira, J S, Mishkin, F, Miller, B L
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Anxiety; Anxiety - diagnosis; Anxiety - etiology; Apathy; Behavior; Biological and medical sciences; Cerebrovascular Circulation - physiology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - diagnostic imaging; Dementia - pathology; Dementia - psychology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Dysthymic Disorder - diagnosis; Dysthymic Disorder - etiology; Emotions; Female; Follow-Up Studies; Frontal Lobe - blood supply; Frontal Lobe - diagnostic imaging; Frontal Lobe - pathology; frontotemporal dementia; FTD; Functional Laterality - physiology; Hallucinations; Humans; Logistic Models; Magnetic Resonance Imaging; Male; Medical imaging; Medical sciences; Middle Aged; mini-mental state examination; MMSE; Nervous system (semeiology, syndromes); Neurology; neuropsychiatry; NMR; Nuclear magnetic resonance; Patients; personality; Psychosis; single photon emission computed tomography; SPECT; Studies; Temporal Lobe - blood supply; Temporal Lobe - diagnostic imaging; Temporal Lobe - pathology; Tomography, Emission-Computed, Single-Photon; Vitamin deficiency
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2005.072496

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.