Frontotemporal Dementia ☺️

Question 1

Epidemiology

Presentation

Answer 1

Most common in U65s
OKA Pick Disease

Insidious onset
Memory and executive functions preserved
Personality changes and social disinhibition
Self neglect of hobbies and social contacts
Progressive loss of language fluency, comprehension

Question 2

Pathophysiology

• macroscopic changes
• nicroscopic changes

Answer 2

Atrophy of frontotemporal lobes

Pick bodies
Neurofibrillary tau tangles

Question 3

Investigations to rule out reversible causes of dementia

Answer 3

Drugs - medication review (BZ, opioids, anticholinergics, antipsychotics, antidepressants, alcohol)

Endocrine - hyperthyroidism, Addisons

Mental - depression

Nutritional - B12 (ataxia, memory loss, gait abnormalities), thiamine deficiency (Wernicke’s enceph, Korsakoff psychosis)

Trauma - subdural haemorrhage

Malignancy - brain tumour

Infection - syphillis

Question 4

Management - medical

Answer 4

Do not use ACh/memantine

Irritability, agitation - lorazepam
Compulsions - SSRIs (citalopram)
Restless - amantadine

Pharmacological management when conservative measures have failed

Question 5

Types

Answer 5

50% - Behavioural variant (executive cognitive dysfunction)

• early disinhibition, loss of empathy, impusivity
• hyperorality, dietary change
• other cognitive areas :)

50% - Language variant
Semantic dementia
-problems with matching names to objects

Non fluent aphasia

• motor speech issue but preserved single word knowledge
• agrammatism
• more nouns than verbs