Which physical findings are characteristic of frontotemporal dementia (FTD)?

Updated: Jun 14, 2018
  • Author: Howard S Kirshner, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Answer

Physical and neurologic examinations reflect mainly the mental status abnormalities described under Behavioral Changes. Characteristics of frontotemporal lobe dementia (FTD), as found on physical examination, can be further described as follows:

  • Speech - Many patients have a nonfluent speech pattern, and virtually all have some degree of difficulty in naming or word finding

  • Behavior - Behavioral alterations and frontal lobe symptoms have been previously outlined

  • Ideation - Ideation tends to be concrete, with poor abstraction and organization of responses and delayed shifting of cognitive sets

  • Visual and spatial functions and constructional tasks – These are much less affected, except as influenced by behavioral and organizational difficulties; motor skills usually are spared, except for perseverative or inattentive responses and difficulty with temporal sequencing of tasks

  • Specific ideomotor apraxia – Rare, except in patients with language difficulty associated with corticobasal degeneration (see below).

  • Memory - Memory is usually preserved for orientation, although information retrieval may be difficult. Short-term memory deficits may be present in some patients but are less characteristic and early than those associated with Alzheimer disease.

  • Frontal release signs - Frontal release signs, such as a positive glabellar sign, snout, grasp, and palmomental responses, may develop

In a minority of patients, extrapyramidal signs, such as rigidity or even a full-blown parkinsonian syndrome of rigidity, akinesia, and tremor, may develop. These cases may overlap with Lewy body dementia, in which fluctuating mental status, early visual hallucinations, and REM sleep behavior disorder (acting out of dreams) are characteristic, along with mild parkinsonian motor symptoms.

An overlap also exists with the syndrome of corticobasal degeneration, in which rigidity and apraxia of the upper limbs, typically starting in one arm and remaining asymmetric, may coexist with neurobehavioral symptoms much like those associated with the syndrome of primary progressive aphasia (PPA). [62, 63, 64]

Widespread muscle atrophy, weakness, fasciculations, bulbar signs, and hyperreflexia may ensue in patients with motor neuron disease. Muscle weakness is also seen in the rare variant with inclusion body myopathy.

As mentioned earlier, some patients may show artistic or musical talents, sometimes with greater expression than before the onset of the illness.


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