Skip to main content

Advertisement

Log in

Frontotemporal Dementia and Primary Progressive Aphasia: An Update

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Frontotemporal dementias are syndromes of progressive dysfunction of the frontal and/or temporal lobes, either unilaterally or bilaterally. These syndromes were described clinically under the terms “primary progressive aphasia” in the United States and “frontotemporal dementia” in Europe and the United Kingdom. They are diagnosed by the clinical features of a frontal lobe neurobehavioral syndrome, or a language and cognitive deterioration. In recent years, molecular genetic findings in these syndromes, especially the tau and progranulin mutations on chromosome 17, have provided a molecular and genetic foundation for the understanding of frontotemporal dementia. These disorders are distinct from Alzheimer’s disease but have some overlap with the syndrome of corticobasal degeneration, and with motor neuron disease. Treatments remain very limited, mainly involving therapy for the mood and behavioral symptoms, but advances in the molecular and genetic understanding of these conditions will hopefully lead to more specific therapies in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. Pick A: On the relationship between aphasia and senile atrophy of the brain. In Neurological Classics in Modern Translation. Edited by Rottenberg DA, Hochberg FH. Hafner Press; 1977:35–40.

  2. Mesulam MM: Slowly progressive aphasia without generalized dementia. Ann Neurol 1982, 11:592–598.

    Article  CAS  PubMed  Google Scholar 

  3. Weintraub S, Rubin NP, Mesulam MM: Primary progressive aphasia. Longitudinal course, neuropsychological profile, and language features. Arch Neurol 1990, 47:1329–1335.

    CAS  PubMed  Google Scholar 

  4. Mesulam MM: Primary progressive aphasia. Ann Neurol 2001, 49:425–432.

    Article  CAS  PubMed  Google Scholar 

  5. Mesulam MM: Primary progressive aphasia—a language-based dementia. N Engl J Med 2003, 349:1535–1542.

    Article  CAS  PubMed  Google Scholar 

  6. Sonty SP, Mesulam MM, Thompson CK, et al.: Primary progressive aphasia: PPA and the language network. Ann Neurol 2003, 53:35–49.

    Article  PubMed  Google Scholar 

  7. Kirshner HS, Webb WG, Kelly MP, et al.: Language disturbance. An initial symptom of cortical degenerations and dementia. Arch Neurol 1984, 41:491–496.

    CAS  PubMed  Google Scholar 

  8. Green J, Morris JC, Sandson J, et al.: Progressive aphasia: a precursor of global dementia? Neurology 1990, 40:423–429.

    CAS  PubMed  Google Scholar 

  9. Edwards-Lee T, Miller BL, Benson DF, et al.: The temporal variant of frontotemporal dementia. Brain 1997, 120:1027–1040.

    Article  PubMed  Google Scholar 

  10. Josephs KA, Whitwell JL, Knopman DS, et al.: Two distinct subtypes of right temporal variant frontotemporal dementia. Neurology 2009, 73:1443–1450.

    Article  CAS  PubMed  Google Scholar 

  11. Neary D, Snowden J: Fronto-temporal dementia: nosology, neuropsychology, and neuropathology. Brain Cogn 1996, 31:176–187.

    Article  CAS  PubMed  Google Scholar 

  12. Neary D, Snowden JS, Gustafson L, et al.: Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998, 51:1546–1554.

    CAS  PubMed  Google Scholar 

  13. Snowden J, Neary D, Mann D: Frontotemporal lobar degeneration: clinical and pathological relationships. Acta Neuropathol 2007, 114:31–38.

    Article  PubMed  Google Scholar 

  14. Neary D, Snowden JS, Mann DM, et al.: Frontal lobe dementia and motor neuron disease. J Neurol Neurosurg Psychiatry 1990, 53:23–32.

    Article  CAS  PubMed  Google Scholar 

  15. Watts GD, Wymer J, Kovach MJ, et al.: Inclusion body myopathy associated with Paget disease of bone and frontotemporal dementia is caused by mutant valosin-containing protein. Nat Genet 2004, 36:377–381.

    Article  CAS  PubMed  Google Scholar 

  16. Miller BL, Cummings J, Mishkin F, et al.: Emergence of artistic talent in frontotemporal dementia. Neurology 1998, 51:978–982.

    CAS  PubMed  Google Scholar 

  17. Miller BL, Hou CE: Portraits of artists: emergence of visual creativity in dementia. Arch Neurol 2004, 61:842–844.

    Article  PubMed  Google Scholar 

  18. Snowden JS, Goulding PS, Neary D: Semantic dementia: a form of circumscribed cerebral atrophy. Behav Neurol 1989, 2:167–182.

    Google Scholar 

  19. Hodges JR, Patterson K, Oxbury S, et al.: Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy. Brain 1992, 115:1783–1806.

    Article  PubMed  Google Scholar 

  20. Hodges JR, Patterson K: Semantic dementia: a unique clinicopathological syndrome. Lancet Neurol 2007, 6:1004–1014.

    Article  CAS  PubMed  Google Scholar 

  21. Davies RR, Hodges JR, Kril JJ, et al.: The pathological basis of semantic dementia. Brain 2005, 128:1984–1995.

    Article  PubMed  Google Scholar 

  22. Gorno-Tempini ML, Brambati SM, Ginex V, et al.: The logopenic/phonological variant of primary progressive aphasia. Neurology 2008, 71:1227–1234.

    Article  CAS  PubMed  Google Scholar 

  23. Gorno-Tempini ML, Dronkers NF, Rankin KP, et al.: Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol 2004, 55:335–346.

    Article  PubMed  Google Scholar 

  24. Westbury C, Bub D: Primary progressive aphasia: a review of 112 cases. Brain Lang 1997, 60:381–406.

    Article  CAS  PubMed  Google Scholar 

  25. Graham NL, Bak T, Patterson K, et al.: Language function and dysfunction in corticobasal degeneration. Neurology 2003, 61:493–499.

    PubMed  Google Scholar 

  26. Sakurai Y, Hashida H, Uesugi H, et al.: A clinical profile of corticobasal degeneration presenting as primary progressive aphasia. Eur Neurol 1996, 36:134–137.

    Article  CAS  PubMed  Google Scholar 

  27. Josephs KA, Petersen RC, Knopman DS, et al.: Clinicopathologic analysis of frontotemporal and corticobasal degenerations and PSP. Neurology 2006, 66:41–48.

    Article  CAS  PubMed  Google Scholar 

  28. Grossman M, Mickanin J, Onishi K: Progressive nonfluent aphasia: language, cognitive, and PET measures contrasted with probable Alzheimer’s disease. J Cogn Neurosci 1996, 8:135–154.

    Article  Google Scholar 

  29. Alladi S, Xuereb J, Bak T, et al.: Focal cortical presentations of Alzheimer’s disease. Brain 2007, 130:2636–2645.

    Article  CAS  PubMed  Google Scholar 

  30. Black SE: Focal cortical atrophy syndromes. Brain Cogn 1996, 31:188–229.

    Article  CAS  PubMed  Google Scholar 

  31. Boxer AL, Miller BL: Clinical features of frontotemporal dementia. Alzheimer Dis Assoc Disord 2005, 19(Suppl 1):S3–S6.

    Article  PubMed  Google Scholar 

  32. Grossman M: Primary progressive aphasia: clinicopathological correlations. Nat Rev Neurol 2010, 6:88–97.

    Article  PubMed  Google Scholar 

  33. Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups [no authors listed]. J Neurol Neurosurg Psychiatry 1994, 57:416–418.

    Article  Google Scholar 

  34. Stevens M, van Duijn CM, Kamphorst W, et al.: Familial aggregation in frontotemporal dementia. Neurology 1998, 50:1541–1545.

    CAS  PubMed  Google Scholar 

  35. Seelaar H, Kamphorst W, Rosso SM, et al.: Distinct genetic forms of frontotemporal dementia. Neurology 2008, 71:1220–1226.

    Article  CAS  PubMed  Google Scholar 

  36. Abe K, Ukita H, Yanagihara T: Imaging in primary progressive aphasia. Neuroradiology 1997, 39:556–559.

    Article  CAS  PubMed  Google Scholar 

  37. Sinnatamby R, Antoun NA, Freer CE, et al.: Neuroradiological findings in primary progressive aphasia: CT, MRI and cerebral perfusion SPECT. Neuroradiology 1996, 38:232–238.

    Article  CAS  PubMed  Google Scholar 

  38. Whitwell JL, Jack CR Jr, Senjem ML, et al.: Patterns of atrophy in pathologically confirmed FTLD with and without motor neuron degeneration. Neurology 2006, 66:102–104.

    Article  PubMed  Google Scholar 

  39. Chawluk JB, Mesulam MM, Hurtig H, et al.: Slowly progressive aphasia without generalized dementia: studies with positron emission tomography. Ann Neurol 1986, 19:68–74.

    Article  CAS  PubMed  Google Scholar 

  40. Tyrrell PJ, Warrington EK, Frackowiak RS, et al.: Heterogeneity in progressive aphasia due to focal cortical atrophy. A clinical and PET study. Brain 1990, 113:1321–1336.

    Google Scholar 

  41. Diehl J, Grimmer T, Drzezga A, et al.: Cerebral metabolic patterns at early stages of frontotemporal dementia and semantic dementia. A PET study. Neurobiol Aging 2004, 25:1051–1056.

    Article  CAS  PubMed  Google Scholar 

  42. Holland AL, McBurney DH, Moossy J, et al.: The dissolution of language in Pick’s disease with neurofibrillary tangles: a case study. Brain Lang 1985, 24:36–58.

    Article  CAS  PubMed  Google Scholar 

  43. Wechsler AF, Verity MA, Rosenschein S, et al.: Pick’s disease. A clinical, computed tomographic, and histologic study with golgi impregnation observations. Arch Neurol 1982, 39:287–290.

    CAS  PubMed  Google Scholar 

  44. Graff-Radford NR, Damasio AR, Hyman BT, et al.: Progressive aphasia in a patient with Pick’s disease: a neuropsychological, radiologic, and anatomic study. Neurology 1990, 40:620–626.

    CAS  PubMed  Google Scholar 

  45. Kirshner HS, Tanridag O, Thurman L, et al.: Progressive aphasia without dementia: two cases with focal spongiform degeneration. Ann Neurol 1987, 22:527–532.

    Article  CAS  PubMed  Google Scholar 

  46. Knopman DS, Mastri AR, Frey WH 2nd, et al.: Dementia lacking distinctive histologic features: a common non-Alzheimer degenerative dementia. Neurology 1990, 40:251–256.

    CAS  PubMed  Google Scholar 

  47. Lippa CF, Cohen R, Smith TW, et al.: Primary progressive aphasia with focal neuronal achromasia. Neurology 1991, 41:882–886.

    CAS  PubMed  Google Scholar 

  48. Kertesz A, Hudson L, Mackenzie IR, et al.: The pathology and nosology of primary progressive aphasia. Neurology 1994, 44:2065–2072.

    CAS  PubMed  Google Scholar 

  49. Kertesz A, Martinez-Lage P, Davidson W, et al.: The corticobasal degeneration syndrome overlaps progressive aphasia and frontotemporal dementia. Neurology 2000, 55:1368–1375.

    CAS  PubMed  Google Scholar 

  50. Kertesz A, McMonagle P, Blair M, et al.: The evolution and pathology of frontotemporal dementia. Brain 2005, 128:1996–2005.

    Article  PubMed  Google Scholar 

  51. Heutink P, Stevens M, Rizzu P, et al.: Hereditary frontotemporal dementia is linked to chromosome 17q21-q22: a genetic and clinicopathological study of three Dutch families. Ann Neurol 1997, 41:150–159.

    Article  CAS  PubMed  Google Scholar 

  52. Hutton M, Lendon CL, Rizzu P, et al.: Association of missense and 5′-splice-site mutations in tau with the inherited dementia FTDP-17. Nature 1998, 393:702–705.

    Article  CAS  PubMed  Google Scholar 

  53. Poorkaj P, Bird TD, Wijsman E, et al.: Tau is a candidate gene for chromosome 17 frontotemporal dementia. Ann Neurol 1998, 43:815–825.

    Article  CAS  PubMed  Google Scholar 

  54. Wilhelmsen KC: Frontotemporal dementia is on the MAPtau. Ann Neurol 1997, 41:139–140.

    Article  CAS  PubMed  Google Scholar 

  55. Morris JC, Cole M, Banker BQ, et al.: Hereditary dysphasic dementia and the Pick-Alzheimer spectrum. Ann Neurol 1984, 16:455–466.

    Article  CAS  PubMed  Google Scholar 

  56. Lendon CL, Lynch T, Norton J, et al.: Hereditary dysphasic disinhibition dementia. A frontotemporal dementia linked to 17q21-22. Neurology 1998, 50:1546–1555.

    CAS  PubMed  Google Scholar 

  57. Forman MS, Farmer J, Johnson JK, et al.: Frontotemporal dementia: clinicopathological correlations. Ann Neurol 2006, 59:952–962.

    Article  PubMed  Google Scholar 

  58. Forman MS, Mackenzie IR, Cairns NJ, et al.: Novel ubiquitin neuropathology in frontotemporal dementia with valosin-containing protein gene mutations. J Neuropathol Exp Neurol 2006, 65:571–581.

    Article  CAS  PubMed  Google Scholar 

  59. Baker M, Mackenzie IR, Pickering-Brown SM, et al.: Mutations in progranulin cause tau-negative frontotemporal dementia linked to chromosome 17. Nature 2006, 442:916–919.

    Article  CAS  PubMed  Google Scholar 

  60. Cruts M, Gijselinck I, van den Zee J, et al.: Null mutations in progranulin cause ubiquitin positive frontotemporal dementia linked to chromosome 17q21. Nature 2006, 442:920–924.

    Article  CAS  PubMed  Google Scholar 

  61. Yu CE, Bird TD, Bekris LM, et al.: The spectrum of mutations in progranulin: a collaborative study screening 545 cases of neurodegeneration. Arch Neurol 2010, 67:161–170.

    Article  PubMed  Google Scholar 

  62. •• Bigio EH: Update on recent molecular and genetic advances in frontotemporal lobar degeneration. J Neuropathol Exp Neurol 2008, 67:635–648. This paper summarizes the recent neurochemical, neuropathologic, and molecular genetic findings in FTD.

    Article  CAS  PubMed  Google Scholar 

  63. • Josephs KA: Frontotemporal dementia and related disorders: deciphering the enigma. Ann Neurol 2008, 64:4–14. This paper is another excellent overview of recent advances in the FTD family of disorders.

    Article  CAS  PubMed  Google Scholar 

  64. Hosler BA, Siddique T, Sapp PC, et al.: Linkage of familial amyotrophic lateral sclerosis with frontotemporal dementia to chromosome 9q21-q22. JAMA 2000, 284:1664–1669.

    Article  CAS  PubMed  Google Scholar 

  65. Skibinski G, Parkinson NJ, Brown JM, et al.: Mutations in the endosomal ESCRTIII-complex subunit CHMP2B in frontotemporal dementia. Nat Genet 2005, 37:806–808.

    Article  CAS  PubMed  Google Scholar 

  66. Schymick JC, Yang Y, Andersen PM, et al.: Progranulin mutations and amyotrophic lateral sclerosis or amyotrophic lateral sclerosis-frontotemporal dementia phenotypes. J Neurol Neurosurg Psychiatry 2007, 78:754–756.

    Article  CAS  PubMed  Google Scholar 

  67. Hodges JR, Davies RR, Xuereb JH, et al.: Clinicopathological correlates in frontotemporal dementia. Ann Neurol 2004, 56:399–406.

    Article  PubMed  Google Scholar 

  68. Josephs KA, Whitwell JL, Duffy JR, et al.: Progressive aphasia secondary to Alzheimer disease vs FTLD pathology. Neurology 2008, 70:25–34.

    Article  CAS  PubMed  Google Scholar 

  69. Mesulam MM, Johnson N, Grujic Z, et al.: Apolipoprotein E genotypes in primary progressive aphasia. Neurology 1997, 49:51–55.

    CAS  PubMed  Google Scholar 

  70. Geschwind D, Karrim J, Nelson SF, et al.: The apolipoprotein E epsilon4 allele is not a significant risk factor for frontotemporal dementia. Ann Neurol 1998, 44:134–138.

    Article  CAS  PubMed  Google Scholar 

  71. Pickering-Brown SM, Owen F, Isaacs A, et al.: Apolipoprotein E epsilon4 allele has no effect on age at onset or duration of disease in cases of frontotemporal dementia with pick- or microvacuolar-type histology. Exp Neurol 2000, 163:452–456.

    Article  CAS  PubMed  Google Scholar 

  72. Gustafson L, Abrahamson M, Grubb A, et al.: Apolipoprotein-E genotyping in Alzheimer’s disease and frontotemporal dementia. Dement Geriatr Cogn Disord 1997, 8:240–243.

    Article  CAS  PubMed  Google Scholar 

  73. Lehmann DJ, Smith AD, Combrinck M, et al.: Apolipoprotein E epsilon2 may be a risk factor for sporadic frontotemporal dementia. J Neurol Neurosurg Psychiatry 2000, 69:404–405.

    Article  CAS  PubMed  Google Scholar 

  74. Rohrer JD, Ridgway GR, Modat M, et al.: Distinct profiles of brain atrophy in frontotemporal lobar degeneration caused by progranulin and tau mutations. Neuroimage 2010 Jan 4 [Epub ahead of print].

  75. Huey ED, Putnam KT, Grafman J: A systematic review of neurotransmitter deficits and treatments in frontotemporal dementia. Neurology 2006, 66:17–22.

    Article  CAS  PubMed  Google Scholar 

  76. Albert ML, Bachman DL, Morgan A, Helm-Estabrooks N: Pharmacotherapy for aphasia. Neurology 1988, 38:877–879.

    CAS  PubMed  Google Scholar 

  77. Gupta SR, Mlcoch AG, Scolaro C, Moritz T: Bromocriptine treatment of nonfluent aphasia. Neurology 1995, 45:2170–2173.

    CAS  PubMed  Google Scholar 

  78. Sabe L, Salvarezza F, Garcia Cuerva A, et al.: A randomized, double-blind, placebo-controlled study of bromocriptine in nonfluent aphasia. Neurology 1995, 45:2272–2274.

    CAS  PubMed  Google Scholar 

  79. Ashtary F, Janghorbani M, Chitsaz A, et al.: A randomized, double-blind trial of bromocriptine efficacy in nonfluent aphasia after stroke. Neurology 2006, 66:914–916.

    Article  CAS  PubMed  Google Scholar 

  80. Reed DA, Johnson NA, Thompson C, et al.: A clinical trial of bromocriptine for treatment of primary progressive aphasia. Ann Neurol 2004, 56:750.

    Article  PubMed  Google Scholar 

  81. Swartz JB, Miller BL, Lesser IM, Darby AL: Frontotemporal dementia: treatment response to serotonin selective reuptake inhibitors. J Clin Psychiatry 1997, 58:212–216.

    CAS  PubMed  Google Scholar 

  82. Moretti R, Torre P, Antonello RM, et al.: Frontotemporal dementia: paroxetine as a possible treatment of behavior symptoms. A randomized, controlled, open 14-month study. Eur Neurol 2003, 49:13–19.

    Article  CAS  PubMed  Google Scholar 

  83. Deakin JB, Rahman S, Nestor PJ, et al.: Paroxetine does not improve symptoms and impairs cognition in frontotemporal dementia: a double-blind randomized controlled trial. Psychopharmacology (Berl) 2004, 172:400–408.

    Article  CAS  Google Scholar 

  84. Lebert F, Stekke W, Hasenbroekx C, Pasquier F: Frontotemporal dementia: a randomised, controlled trial with trazodone. Dement Geriatr Cogn Disord 2004, 17:355–359.

    Article  CAS  PubMed  Google Scholar 

  85. Kaye ED, Petrovic-Poljak A, Verheoff NP, Freedman M: Frontotemporal dementia and pharmacologic interventions. J Neuropsychiatry Clin Neurosci 2010, 22:19–29.

    CAS  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Howard S. Kirshner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirshner, H.S. Frontotemporal Dementia and Primary Progressive Aphasia: An Update. Curr Neurol Neurosci Rep 10, 504–511 (2010). https://doi.org/10.1007/s11910-010-0145-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-010-0145-z

Keywords

Navigation