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From the Departments of Neurology (W. Liu, C. Wyss-Coray, R. Gearhart, and L. Phengrasamy, and Drs. Miller, Kramer, Rankin, Weiner, and Rosen) and Radiology (Dr. Weiner), University of California at San Francisco; USCF Memory and Aging Center (W. Liu, C. Wyss-Coray, R. Gearhart, and L. Phengrasamy, and Drs. Miller, Kramer, Rankin, and Rosen), San Francisco; and San Francisco Veterans Affairs Hospital Magnetic Resonance Imaging Unit (Dr. Weiner), CA.
Address correspondence and reprint requests to Dr. Howard J. Rosen, UCSF Department of Neurology, Memory and Aging Center, 350 Parnassus Ave., Box 1207, Suite 706, San Francisco, CA 94143-1207; e-mail: howie{at}itsa.ucsf.edu
Objective: To compare the behavioral features and to investigate the neuroanatomic correlates of behavioral dysfunction in anatomically defined temporal and frontal variants of frontotemporal dementia (tvFTD and fvFTD).
Methods: Volumetric measurements of the frontal, anterior temporal, ventromedial frontal cortical (VMFC), and amygdala regions were made in 51 patients with FTD and 20 normal control subjects, as well as 22 patients with Alzheimer disease (AD) who were used as dementia controls. FTD patients were classified as fvFTD or tvFTD based on the relative degree of frontal and anterior temporal volume loss compared with controls. Behavioral symptoms, cerebral volumes, and the relationship between them were examined across groups.
Results: Both variants of FTD showed significant increases in rates of elation, disinhibition, and aberrant motor behavior compared with AD. The fvFTD group also showed more anxiety, apathy, and eating disorders, and tvFTD showed a higher prevalence of sleep disturbances than AD. The only behaviors that differed significantly between fvFTD and tvFTD were apathy, greater in fvFTD, and sleep disorders, more frequent in tvFTD. FvFTD was associated with greater frontal atrophy and tvFTD was associated with more temporal and amygdala atrophy compared with AD, but both groups showed significant atrophy in the VMFC compared with AD, which was not associated with VMFC atrophy. In FTD, the presence of many of the behavioral disorders was associated with decreased volume in right-hemispheric regions.
Conclusion: FvFTD and tvFTD show many similarities in behavior, which appear to be associated with damage to right frontal and temporal structures.
Received January 23, 2003. Accepted in final form October 28, 2003.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 9 issue to find the title link for this article.
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