A 45 year-old female has short-term memory loss, behavior changes, increased irritability/agitation/confusion, motor weakness, and coordination problems. MRI and PET were performed. What is the likely diagnosis?
FDG-PET showed decreased metabolic activity in both frontal lobes and temporal lobes. MRI imaging showed degenerative changes in both frontal lobes and anterior temporal lobes.
Froontotemporal lobar degeneration (FTD) is a heterogenous group of diseases involving the frontal and anterior temporal lobes leading to dementia in a younger group of patients. FTD has three types: Pick's disease, sementic dementia, and progressive non-fluent dementia. In the early stages, the patients have transient neurological, emotional, and behavioral changes with dementia at later stages. There is decreased FDG metabolism in the frontal and anterior temporal lobes on PET imaging. In majority of these patients, there is no amyloid deposit where it can be differentiated from Alzhimer's disease.
Dementias of Lewy body, Alzheimer's disease
Neurological exam and review of the treatable conditions such as depression, alcohol, and drug abuse and medical co-morbidities are the 1st line of therapy. Imaging such as carotid ultrasound and vascular flow to brain such as MRA are key for the structural changes of the brain. PET FDG and Tau imaging can differentiate different types of dementia.
Structural brain imaging in fronto temporal dementia, (BBA)-Molecular basis of disease, Vol 1822, March 2012
PET approaches for diagnosis of dementia, K. Ishii, AJNR, Am J Neuroradiology, 2014