engleski

Clinical differentiation between Alzheimer's and frontotemporal dementia.

The clinical diagnosis of Alzheimer's disease (AD) is now reliant on the use of the National Institute of Neurological and Communicative Disorders and Stroke and AD and Related Disorders Association (NINCDS-ADRDA)1 criteria. Other diseases causing dementia, for example frontotemporal dementia, are being increasingly recognized. A proportion of patients who meet clinical criteria for AD have frontotemporal lobar degeneration (FTLD) confirmed at autopsy with or without neuropathological AD-type changes. Thus, more sensitive clinical diagnostic tools, including psychometric tests, are required to distinguish between these pathological phenotypes at initial presentation, considering that AD and FTLD have different prognoses and treatment. A retrospective review of 48 neuropathologically confirmed cases of FTLD according to clinicopathological consensus criteria of McKhann2 (70.6&#177; 9.5 years ; 27 had completed psychometric testing) yielded clinical and neuropsychological features for comparison with 27 age-, sex-, education-, and severity- matched individuals with AD. Neary3 clinical consensus criteria for FTLD were used and a standard battery of psychometric tests was administered. At first visit, those with FTLD demonstrated more disinhibition and impulsivity (p=0.0004, Fischer&#8217; s exact test), and less withdrawal (p=0.01) than those with AD. They also had more dysfluency (p=0.01), agrammatism (p=0.004), and speech hesitancy (p=0.03). The two clinical phenotypes had comparable executive dysfunction (p=0.33), but the AD group had more memory complaints (p=0.01). The FTLD individuals performed better than those with AD on a visual test of episodic memory but worse on word fluency (p<0.05) (performance correlated with aphasic features). 11/48 cases had additional AD-type pathology. Clinical and cognitive features of FTLD may overlap with AD, particularly for memory and executive function, although behavioral problems and language difficulties distinguish those with FTLD. Psychometric tests help distinguish FTLD from AD, especially word fluency task, sensitive to frontal lobe dysfunction. Compounding the overlap of FTLD and AD clinical phenotypes is the presence of AD-type pathology in one-fourth of FTLD individuals. References: 1. McKhann GM et al. Neurology. 1984 ; 34:939-944. 2. McKhann GM et al. Arch Neurol. 2001 ; 58:1803-1809. 3. Neary D et al. Neurology. 1998 ; 51:1546-1554.

Alzheimer's disease; frontoremporal dementia; clinical differentiation

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