Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome

Background/Aims: We aimed to prospectively assess the diagnostic accuracy of the revised criteria for behavioural variant frontotemporal dementia (bvFTD) among subjects presenting with a frontal lobe syndrome in middle-late adulthood. Methods: Patients were included based on a predominant behavioural clinical presentation, a Frontal Behavioural Inventory (FBI) score of ≥11 and/or a Stereotypy Rating Inventory (SRI) score of ≥10. At baseline, the fulfilment of the international consensus criteria for behavioural variant FTD (FTDC) was systematically recorded. The 2-year follow-up consensus diagnosis was used as the gold standard to calculate sensitivity and specificity of the FTDC criteria for possible and probable bvFTD. Results: Two-year follow-up data were available for 116 patients (85%). Two-year follow-up consensus diagnoses consisted of probable/definite bvFTD (n = 27), other dementia (n = 30), psychiatric disorders (n = 46) and other neurological disorders (n = 13). Sensitivity for possible bvFTD was 85% (95% CI 70-95%) at a specificity of 27% (95% CI 19-37%). Sensitivity for probable bvFTD was 85% (95% CI 69-95%), whereas their specificity was 82% (95% CI 73-89%). Conclusions: We found a good diagnostic accuracy for FTDC probable bvFTD. However, the specificity for FTDC possible bvFTD was low. Our results reflect the symptomatic overlap between bvFTD, other neurological conditions and psychiatric disorders, and the relevance of adding neuroimaging to the diagnostic process.

Download Full-text

Identifying Specific Clinical Symptoms of Behavioral Variant Frontotemporal Dementia Versus Differential Psychiatric Disorders in Patients Presenting With a Late-Onset Frontal Lobe Syndrome

The Journal of Clinical Psychiatry ◽

10.4088/jcp.15m09844 ◽

2016 ◽

Vol 77 (10) ◽

pp. 1391-1395 ◽

Cited By ~ 13

Author(s):

Annemiek Dols ◽

Saskia van Liempt ◽

Flora Gossink ◽

Welmoed A. Krudop ◽

Sietske Sikkes ◽

...

Keyword(s):

Psychiatric Disorders ◽

Frontotemporal Dementia ◽

Frontal Lobe ◽

Clinical Symptoms ◽

Late Onset ◽

Behavioral Variant Frontotemporal Dementia ◽

Frontal Lobe Syndrome

Download Full-text

Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000441023 ◽

2015 ◽

Vol 41 (1-2) ◽

pp. 16-26 ◽

Cited By ~ 7

Author(s):

Welmoed A. Krudop ◽

Annemiek Dols ◽

Cora J. Kerssens ◽

Niels D. Prins ◽

Christiane Möller ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Frontotemporal Dementia ◽

Frontal Lobe ◽

Fdg Pet ◽

Late Onset ◽

Behavioral Variant Frontotemporal Dementia ◽

Diagnostic Certainty ◽

18F Fdg ◽

Frontal Lobe Syndrome ◽

The Impact

Background: The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease. Aims: We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF). Methods: We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change. Results: Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses. Conclusion: Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.

Download Full-text

O2-14-04: IDENTIFYING BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA AMONG PATIENTS WITH A LATE-ONSET FRONTAL LOBE SYNDROME: SUMMARY RESULTS OF THE LOF STUDY

Alzheimer s & Dementia ◽

10.1016/j.jalz.2018.06.2721 ◽

2006 ◽

Vol 14 (7S_Part_12) ◽

pp. P657-P658

Author(s):

Yolande A.L. Pijnenburg ◽

Everard Vijverberg ◽

Welmoed A. Krudop ◽

Flora T. Gossink ◽

Niels D. Prins ◽

...

Keyword(s):

Frontotemporal Dementia ◽

Frontal Lobe ◽

Late Onset ◽

Behavioral Variant Frontotemporal Dementia ◽

Frontal Lobe Syndrome

Download Full-text

Building a New Paradigm for the Early Recognition of Behavioral Variant Frontotemporal Dementia: Late Onset Frontal Lobe Syndrome Study

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2013.02.002 ◽

2014 ◽

Vol 22 (7) ◽

pp. 735-740 ◽

Cited By ~ 17

Author(s):

Welmoed A. Krudop ◽

Cora J. Kerssens ◽

Annemieke Dols ◽

Niels D. Prins ◽

Christiane Möller ◽

...

Keyword(s):

Frontotemporal Dementia ◽

Frontal Lobe ◽

Late Onset ◽

Early Recognition ◽

New Paradigm ◽

Behavioral Variant Frontotemporal Dementia ◽

Frontal Lobe Syndrome

Download Full-text

Predicting progression in the late onset frontal lobe syndrome

International Psychogeriatrics ◽

10.1017/s1041610218001242 ◽

2018 ◽

Vol 31 (5) ◽

pp. 743-748 ◽

Cited By ~ 2

Author(s):

Flora T. Gossink ◽

Everard Vijverberg ◽

Welmoed Krudop ◽

Philip Scheltens ◽

Max L. Stek ◽

...

Keyword(s):

Frontal Lobe ◽

Clinical Symptoms ◽

Late Onset ◽

Clinical Syndrome ◽

Clinical Markers ◽

Neuropsychological Profile ◽

Stereotypical Behavior ◽

Executive Deficits ◽

Magnetic Resonance Imaging Mri ◽

Frontal Lobe Syndrome

ABSTRACTA late onset frontal lobe syndrome (LOF) refers to a clinical syndrome with apathy, disinhibition, or stereotypical behavior arising in middle or late adulthood. Diagnostics are challenging, and both clinicians and patients need reliable predictors of progression to improve clinical guidance. In this longitudinal multicenter and genetically screened prospective study, 137 LOF patients with frontal behavior (FBI score≥11) and/or stereotypical behavior (SRI≥10) were included. Progression was defined as institutionalization, death, or progression of frontal or temporal atrophy at magnetic resonance imaging (MRI) after two years of follow up. Absence of progression at MRI in addition to stable or improved Mini Mental State Examination and Frontal Assessment Battery scores after two years was indicative for non-progression. The presence of stereotypy and a neuropsychological profile with executive deficits at baseline were found to be predictive for progression, while a history and family history with psychiatric disorders were predictors for non-progression. The combination of these clinical markers had a predictive value of 80.4% (p < 0.05). In patients presenting with late onset behavioral symptoms, an appraisal of the rate of deterioration can be made by detailed mapping of clinical symptoms. Distinction of progressive discourses from non-progressive or treatable conditions is to be gained.

Download Full-text

Frontotemporal dementia misdiagnosed as schizophrenia or other psychotic disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1575 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s812-s812

Author(s):

A. Giamarelou ◽

P. Polychronopoulos ◽

M. Skokou ◽

L. Messinis ◽

P. Gourzis

Keyword(s):

Psychiatric Disorders ◽

Frontotemporal Dementia ◽

Social Impact ◽

Age Of Onset ◽

Correct Diagnosis ◽

Executive Dysfunction ◽

Final Diagnosis ◽

Somatization Disorder ◽

International Consensus ◽

Neuropsychological Evaluations

IntroductionFrontotemporal dementia (FTD) encompasses a group of clinical features that include personality and behavior changes (disinhibition, social isolation, antisocial behavior, compulsion) and executive dysfunction (poor planning, loss of judgment and loss of insight). These features may lead to an incorrect diagnosis of a primary psychiatric disorder.ObjectivesTo emphasize the difficulties in making a clinical distinction between early frontotemporal dementia and other psychiatric diseases.MethodsWe describe 11 patients who suffered from FTD, while initially had diagnosed with primary psychiatric disorders. The correct diagnosis was achieved by psychiatric and neuropsychological evaluations (WAIS SCALE, ACE-R, MMSE), neuroimaging studies (MRI 7/11, SPECT 8/11) and applying the international consensus criteria for FTD.ResultsAll patients (5 males and 6 females) were initially diagnosed with psychiatric disorders: schizophrenia (2/11), bipolar disorders (4/11), depression (5/11), schizoaffective disorder (1/11), somatization disorder (1/11), personality disorders (2/11), malingering (1/11), alcohol dependence (1/11), while 5 patients had more than one diagnosis. The age of onset varied from 19 to 53 years old. Final diagnosis of FTD was delayed on average 6,5 years from the onset of symptoms.ConclusionClinicians should be familiar with the clinical entity of FTD and its difficult distinction from other psychiatric disorders. A possible hospitalization of a patient with FTD in a psychiatric department and the social impact that it brings may be avoided. On the other hand, the proper care of FTD patients (pharmacological and psychosocial) improves the quality of life of patients and their caregivers.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text