FFinalistSouthampton · 2027
Neurology
AKT · Neurology/Movement & neurodegenerationlow yield

Frontotemporal dementia

Frontotemporal lobar degeneration (tau/TDP-43; Pick bodies)

Overview

An early-onset dementia (often <65) from frontal/temporal lobar degeneration, presenting with EARLY personality/behavioural change or progressive language breakdown, with memory relatively preserved early on — the opposite emphasis to Alzheimer.

Recognise

  • Behavioural variant (Pick disease): disinhibition, apathy, loss of empathy, compulsive/repetitive behaviour, overeating
  • Primary progressive aphasia variants: non-fluent or semantic language breakdown
  • Younger onset (45–65), relatively preserved early memory; frontal/temporal atrophy

Red flags

  • Early-onset dementia with personality change — often misattributed to a psychiatric disorder

Differentials & how to tell them apart

Alzheimer's diseaseolder, amnesia-led, hippocampal atrophy — FTD spares early memory and hits behaviour/language
Primary psychiatric disorder (depression/mania/psychosis)behavioural FTD is frequently mistaken for this — imaging/progression distinguish
Lewy body dementiahallucinations + parkinsonism + fluctuation
Huntington diseasechorea + family history + CAG repeat

Investigations

Cognitive testing (frontal/executive + language); MRI (frontal/temporal atrophy); exclude reversible causes; specialist neuropsychology.

Management

Supportive + behavioural management (SSRIs for behaviour); cholinesterase inhibitors NOT used

  1. 1Specialist diagnosis; behavioural and environmental management, carer support and safety planning.Gate: Cholinesterase inhibitors are NOT recommended in FTD (may worsen it) — manage behaviour with SSRIs and non-drug strategies
  2. 2Address risk (driving, finances, safeguarding); SALT for language variants; genetic counselling where familial.
No disease-modifying drug — cholinesterase inhibitors NOT recommended; SSRIs may help behaviour
Supportive/behavioural management — safety, carer support

Key points

Early behaviour/personality or language change in a younger patient with spared memory = FTD. It is the great mimic of a new psychiatric illness in middle age.

Monitor & prognosis

Behaviour, language, safety, carer strain.

Progressive; shorter survival than Alzheimer.

Source: NICE NG97 (dementia)