Brain Advance Access originally published online on January 5, 2005
Brain 2005 128(3):597-605; doi:10.1093/brain/awh348
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Pathologically proven frontotemporal dementia presenting with severe amnesia
1 MRC Cognition and Brain Sciences Unit, 2 University Department of Neurology, Addenbrooke's Hospital and 3 Department of Neuropathology, Addenbrooke's Hospital, Cambridge, UK, 4 Prince of Wales Medical Research Institute, University of New South Wales, Randwick, New South Wales, Australia and 5 Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Concord, New South Wales, Australia
Correspondence to: Professor John Hodges, MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 2EF, UK E-mail: john.hodges{at}mrc-cbu.cam.ac.uk
Early and severe memory impairment is generally held to be an exclusion criterion for the clinical diagnosis of frontotemporal dementia (FTD). However, clinical experience suggests that some patients with otherwise typical FTD can be amnesic from presentation, or even present solely with amnesia. A review of severe amnesia at presentation in patients with pathologically proven FTD is therefore warranted. The present study examined the records of all patients in the joint Cambridge–Sydney neuropathological series of patients with dementia and a pathological diagnosis of FTD to identify those for whom memory complaints were dominant at presentation. Eight of 71 patients met these criteria. For two patients, memory loss was the only complaint; for one patient, memory loss was accompanied by personality change; for two patients, memory loss was accompanied by prominent dysexecutive symptoms; and for three patients, memory loss was accompanied by apathy but no other behavioural changes. In seven patients local specialist teams initially diagnosed Alzheimer's disease; four patients entered anticholinesterase drug trials. All eight later developed behavioural features: in four, the diagnosis was revised to FTD, while in four the diagnosis of FTD was made only on neuropathological examination after death. In conclusion, severe amnesia at presentation in FTD is commoner than previously thought and the clinical consensus criteria for the diagnosis of FTD may need to be revised. The underlying basis of the memory impairments in patients with FTD may be heterogeneous, with different explanations in different subgroups.
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