Alzheimer disease and frontotemporal dementias: Behavioral distinctions

Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles School of Medicine, USA.
JAMA Neurology (Impact Factor: 7.42). 08/1996; 53(7):687-90.
Source: PubMed


Frontotemporal dementia (FTD) is a syndrome produced by lobar degeneration of the temporal and/or frontal lobes.
To quantify the behavioral disturbances of FTD and compare them with behavioral changes observed in Alzheimer disease (AD).
Cross-sectional comparison of 2 groups defined by research diagnostic criteria and single photon emission computed tomography. Behaviors were assessed using a standardized rating scale-Neuropsychiatric Inventory. Groups were matched for dementia severity.
Patients were seen at 2 university-based outpatient dementia clinics and a Veterans Affairs medical center.
Twenty-two patients with FTD and 30 patients with AD.
Patients with FTD had significantly greater total Neuropsychiatric Inventory scores than patients with AD and exhibited more apathy, disinhibition, euphoria, and aberrant motor behavior. The Neuropsychiatric Inventory accurately assigned 77% of patients with FTD and 77% of patients with AD to the correct diagnostic group using disinhibition, apathy, and depression. Patients with FTD had higher levels of disinhibition and apathy with relatively lower levels of depression compared with patients with AD.
The Neuropsychiatric Inventory provides a behavioral profile that differentiates patients with FTD from patients with AD. Patients with FTD are more behaviorally disturbed but are often less depressed than patients with AD relative to their level of apathy.

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    • "Author n Control Measurement Delusions Hallucinations Lopez et al., [29] 20 AD (n = 40) DSM-III-R and others 20% 0% Levy et al., [35] 22 AD (n = 30) NPI 7% 0% Swartz et al., [18] 19 AD (n = 19), late-life depression (n = 35) SCAN Occasional (bizarre, jealous, somatic), Rare (auditory) Hirono et al., [27] 24 AD (n = 240), DLB (n = 23) NPI 0% 0% Gregory et al., [26] "
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    ABSTRACT: Frontotemporal dementia (FTD) is a neurodegenerative disorder, associated with a progressive decline in behavior caused by focal degeneration of the frontal lobes. Psychosis was an underestimated symptom of FTD, however, recent genetic research has revealed a high prevalence of psychosis in certain genetic groups. The primary objective of this work is to review the literature on psychosis in FTD and to propose directions for future research, with reference to findings on psychosis in schizophrenia. A search was performed using PubMed, MEDLINE, and EMBASE. Search terms included "frontotemporal dementia", "psychosis", "schizophreni*", "psychotic symptoms", "hallucinations", and "delusions", and it identified 122 articles. Results revealed: 1) prevalence is approximately 10%, 2) TDP-43 type B and FUS pathologies might have relatively high frequency of psychosis, 3) psychosis in FTD is higher with genetic mutations of C9ORF72 and GRN, 4) imaging researches did not achieve conclusive results, and 5) no treatment for psychosis in FTD is currently available. A limitation of this systematic review is that it includes a small number of studies specifically examining psychosis in FTD. It is suggested that a possible overlap exists between FTD and schizophrenia. This potential overlap indicates a vulnerability to psychosis due to brain systems and pathways shared by these disorders.
    Journal of Alzheimer's disease: JAD 06/2014; 42(2). DOI:10.3233/JAD-140312 · 4.15 Impact Factor
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    • "3 FTD + 81 AD + 14 VaD Higher aberrant motor activity prevalence in FTD. Ikeda et al. (2002) 23 FTD + 25 SD + 43 AD Changes in eating behaviors more common in both FTLD groups compared with AD. Levy et al. (1996) 22 FTD + 30 AD Higher scores for disinhibition, apathy, aberrant motor behavior, and euphoria in patients with FTD compared with AD. Nyatsanza et al. (2003) 18 FTD + 13 SD + 28 AD Complex ritualized behaviors were significantly more frequent in patients with fvFTD and semantic dementia than in AD. "
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    ABSTRACT: Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long term hospitalization, misuse of medication and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BPS.
    Frontiers in Neurology 05/2012; 3. DOI:10.3389/fneur.2012.00073
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    • "Frequency and severity of apathy vary across different dementia subtypes; it is the most common behavioral symptom of behavioral variant of frontotemporal dementia (bvFTD), with reported prevalence ranging from 62 to 89% of patients [4]; the prevalence of apathy in AD ranges from 25 to 88% [5] [6] with a trend to increase with disease severity [7]. When severity was directly compared, higher levels of apathy have been reported in bvFTD than in AD [8] [9] [10] [11]. The functional and neuroanatomical substrates of apathy seem to differ between AD and bvFTD. "
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    ABSTRACT: Apathy is one of the most common behavioral symptoms of dementia; it is one of the salient features of behavioral variant of frontotemporal dementia (bvFTD) but is also very frequent in Alzheimer's disease. This preliminary investigation was aimed at assessing the type of apathy-related symptoms in a population of bvFTD and AD subjects showing comparable apathy severity. Each patient underwent a comprehensive neuropsychological assessment; behavioral changes were investigated by the neuropsychiatric inventory (NPI), using the NPI-apathy subscale to detect apathetic symptoms. At univariate analysis, bvFTD subjects showed lack of initiation (χ(2) = 4.602, p = 0.032), reduced emotional output (χ(2) = 6.493, p = 0.008), and reduced interest toward friends and family members (χ(2) = 4.898, p = 0.027), more frequently than AD subjects. BvFTD displayed higher scores than AD on NPI total score (p = 0.005) and on subscales assessing agitation (p = 0.004), disinhibition (p = 0.007) and sleep disturbances (p = 0.025); conversely, AD subjects were more impaired on memory, constructional abilities, and attention. On multivariate logistic regression, reduced emotional output was highly predictive of bvFTD (OR = 18.266; p = 0.008). Our preliminary findings support the hypothesis that apathy is a complex phenomenon, whose clinical expression is conditioned by the site of anatomical damage. Furthermore, apathy profile may help in differentiating bvFTD from AD.
    Current Gerontology and Geriatrics Research 04/2012; 2012:719250. DOI:10.1155/2012/719250
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