Frontotemporal Dementia: Identification and Management

Leah Wilfong, MS, AGPCNP-BC; Nancy E. Edwards, PhD, ANP-BC; Karen S. Yehle, PhD, FAHA; Karla Ross, MSN, ANP

Disclosures

Journal for Nurse Practitioners. 2016;12(4):277-282. 

In This Article

Diagnostic Testing

Along with a thorough history and physical examination, laboratory testing is beneficial in ruling out medical causes for impairment. Basic tests should include: thyroid-stimulating hormone and free thyroxine to rule out hypothyroidism; complete blood count with vitamin B12 and folate levels to rule out anemia and vitamin deficiencies; and a complete metabolic panel to rule out electrolyte imbalances and verify renal and hepatic function.

Neuropsychological testing should be performed to assess cognitive and functional ability. Instruments such as the Mini-Mental State Examination (MMSE)[11] and the Mini-Cog[12] are particularly valuable in clinical settings, especially when a reliable historian is not available to describe an individual's functional ability. Multiple assessments are available, but the more commonly used tool is the MMSE. Available under copyright, the MMSE can be administered in about 7 minutes to assess cognitive function in 7 areas: orientation; registration; attention and calculation; recall; language; repetition; and 3-dimensional skills.[11]

Alternatively, the Mini-Cog is an excellent instrument to use when there are patient barriers related to language or educational background.[12] This instrument takes approximately 3 minutes to complete and is comprised of a clock drawing test and word recall. Because FTD typically has preserved cognitive abilities, use of these tests may help rule out other dementias.[2]

Further testing may include brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT). Individuals with FTD may show atrophy of the frontal and/or anterior temporal lobes of the brain, in contrast to AD which may show widespread atrophy.[4] Structural alterations are variable in their presentation and typically not seen in the early disease state. With the possible lack of physiologic changes, patient history and presentation become vital to the nurse practitioner in early recognition of FTD.

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