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Brain Advance Access published online on March 18, 2009
Brain, doi:10.1093/brain/awp037
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© The Author (2009). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The clinical profile of right temporal lobe atrophy

Dennis Chan1, Valerie Anderson1, Yolande Pijnenburg2, Jennifer Whitwell1, Jo Barnes1, Rachael Scahill1, John M. Stevens3, Frederik Barkhof2, Philip Scheltens2, Martin N. Rossor1,4 and Nick C. Fox1

1 Dementia Research Centre, Department of Clinical Neurology, Institute of Neurology, London, UK 2 Alzheimer Centre, VU Medical Centre, Amsterdam, Netherlands 3 The National Hospital for Neurology and Neurosurgery, London, UK 4 Division of Neurosciences, Faculty of Medicine, Imperial College, London, UK

Correspondence to: Dr Dennis Chan, Department of Neurology, Royal Sussex County Hospital, BN2 5BE Brighton, UK E-mail: d.chan{at}bsms.ac.uk

Frontotemporal lobar degeneration is currently associated with three syndromic variants. Disorders of speech and language figure prominently in two of the three variants, and are associated with left-sided frontotemporal atrophy. The detailed characterization of these syndromes contrasts with the relative paucity of information relating to frontotemporal lobar degeneration primarily affecting the right cerebral hemisphere. The objective of this study was to identify the clinical profile associated with asymmetrical, predominantly right-sided, temporal lobe atrophy. Twenty patients with predominant right temporal lobe atrophy were identified on the basis of blinded visual assessment of the MRI scans. The severity of right temporal lobe atrophy was quantified using volumetric analysis of the whole temporal lobes, the amygdala and the hippocampus. Profiles of cognitive function, behavioural and personality changes were obtained on each patient. The pattern of atrophy and the clinical features were compared with those observed in a group of patients with semantic dementia and predominant left-sided temporal lobe atrophy. The mean right temporal lobe volume in the right temporal lobe atrophy group was reduced by 37%, with the mean left temporal lobe volume reduced by 19%. There was marked atrophy of the right hippocampus and right amygdala, with mean volumes reduced by 41 and 51%, respectively (left hippocampus and amygdala volumes were reduced by 18 and 33%, respectively). The most prominent cognitive deficits were impairment of episodic memory and getting lost. Prosopagnosia was a symptom in right temporal lobe atrophy patients. These patients also exhibited a variety of behavioural symptoms including social disinhibition, depression and aggressive behaviour. Nearly all behavioural disorders were more prevalent in the right temporal lobe atrophy patient group than the semantic dementia group. Symptoms particular to the right temporal lobe atrophy patient group included hyper-religiosity, visual hallucinations and cross-modal sensory experiences. The combination of clinical features associated with predominant right temporal lobe atrophy differs significantly from those associated with the other syndromes associated with focal degeneration of the frontal and temporal lobes and it is, therefore, proposed that this right temporal variant should be considered a separate syndromic variant of frontotemporal lobar degeneration.

Key Words: dementia; frontotemporal lobar degeneration; frontotemporal dementia; right temporal lobe

Abbreviations: DRC, Dementia Research Centre; FTLD, frontotemporal lobar degeneration; NHNN, National Hospital for Neurology and Neurosurgery; RTLA, right temporal lobe atrophy; VUMC, VU University Medical Centre

Received October 8, 2008. Revised December 9, 2008. Accepted February 5, 2009.


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