Clinical, genetic, and pathological heterogeneity of frontotemporal dementia: a review

Harro Seelaar (1) , Jonathan D Rohrer (2) , Yolande A.L. Pijnenburg (3) , Nick C. Fox (2) , John C. van Swieten (2)

1 Erasmus MC - Erasmus University Medical Center [Rotterdam]
2 UCL Institute of Neurology, Queen Square [London]
3 VU University Medical Center [Amsterdam]

Frontotemporal dementia (FTD) is the second most common young-onset dementia, and is clinically characterized by progressive behavioural change, executive dysfunction and language difficulties. Three clinical syndromes, behavioural variant FTD, semantic dementia and progressive non-fluent aphasia, form part of a clinicopathological spectrum named frontotemporal lobar degeneration (FTLD). The classical neuropsychological phenotype of FTD has been enriched by tests exploring Theory of Mind, social cognition and emotional processing. Imaging studies have detailed the patterns of atrophy associated with different clinical and pathological subtypes. These patterns offer some diagnostic utility while measures of progression of atrophy may be of use in future trials. Between 30-50 percent of FTD is familial and mutations in two genes, MAPT and Progranulin (GRN), account for about half of these cases. Rare defects in VCP, CHMP2B, TARDP and FUS genes have been found in a small number of families. Linkage to chromosome 9p13.2-21.3 has been established in familial FTD with motor neuron disease, although the causative gene is yet to be identified. Recent developments in the immunohistochemistry of FTLD, and also in amyotrophic lateral sclerosis (ALS), have led to a new pathological nomenclature. The two major groups are those with tau-positive inclusions (FTLD-tau) and those with ubiquitin-positive and TDP-43 positive inclusions (FTLD-TDP). Recently a new protein involved in familial ALS, fused in sarcoma (FUS), has been found in FTLD patients with ubiquitin-positive and TDP-43-negative inclusions. In this review we discuss recent clinical, neuropsychological, imaging, genetic and pathological developments that have changed our understanding of FTD, its classification and criteria. The potential to establish an early diagnosis, predict underlying pathology during life and quantify disease progression will all be required for disease-specific therapeutic trials in the future.

Mots clés: BEHAVIOURAL DISORDER; DEMENTIA; FRONTAL LOBE; NEUROGENETICS; NEUROPATHOLOGY

Harro Seelaar, Jonathan D Rohrer, Yolande A.L. Pijnenburg, Nick C. Fox, John C. van Swieten. Clinical, genetic, and pathological heterogeneity of frontotemporal dementia: a review. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 82 (5), pp.476. ⟨10.1136/jnnp.2010.212225⟩. ⟨hal-00587974⟩