RESIDENT & FELLOW SECTION Section Editor Mitchell S.V. Elkind, MD, MS
D.L. Perez, MD M. Larvie, MD D. Acar, MD K. Daffner, MD
Teaching NeuroImages: Apathetic variant of frontotemporal dementia
Figure
Structural-functional correlates of apathetic variant frontotemporal dementia
Address correspondence and reprint requests to Dr. David L. Perez, Brigham and Women’s Hospital, Department of Neurology, 75 Francis Street, Boston, MA 02115
[email protected]
(A–C) Sulcal prominence and atrophy were identified on axial T1-weighted MRI, particularly in dorsolateral and dorsomedial prefrontal regions. Mild periventricular/subcortical nonspecific white matter changes were also noted. (D–F) Fluorodeoxyglucose PET imaging revealed prefrontal (including dorsolateral, anterior cingulate, and ventromedial cortices), insular, and anterior temporal pole hypometabolism.
A 68-year-old man displayed 3 years of progressive deterioration in behavior/personality. Previously gregarious, he developed reduced social and empathic interactions, diminished (though fluent) spontaneous speech, and indifference to personal hygiene. He denied depression, lacked insight into his predicament, and was not disinhibited, impulsive, or socially inappropriate. Cognitive examination showed reduced vigilance on a continuous-performance task, perseveration on alternating-sequences testing, impaired phonemic greater than semantic fluency, and poor planning and organization. MRI and fluorodeoxyglucose PET revealed bilateral frontal atrophy and prefrontal, insular, and anterior-temporal hypometabolism, respectively
(figure).1 Frontotemporal dementia, apathetic variant, may result from anterior cingulate and dorsolateral prefrontal hypofunction.2 AUTHOR CONTRIBUTIONS Dr. Perez: case identification and manuscript/image preparation. Dr. Larvie: image/manuscript preparation. Dr. Acar: case identification and manuscript preparation. Dr. Daffner: case identification and manuscript/image preparation.
REFERENCES 1. Ishii K, Sakamoto S, Sasaki M, et al. Cerebral glucose metabolism in patients with frontotemporal dementia. J Nucl Med 1998;39:1875–1878. 2. Caycedo AM, Miller B, Kramer J, Rascovsky K. Early features in frontotemporal dementia. Curr Alzheimer Res 2009;6:337–340.
From the Departments of Neurology (D.L.P., D.A., K.D.) and Psychiatry (D.L.P.), Brigham and Women’s Hospital, Boston; and the Departments of Neurology (D.L.P.) and Radiology (M.L.), Massachusetts General Hospital, Boston. Disclosure: Dr. Perez reports no disclosures. Dr. Larvie performs brain PET examinations (10% effort) at MGH Divisions of Neuroradiology and Nuclear Medicine and receives research support from the NIH. Dr. Acar reports no disclosures. Dr. Daffner receives research support from the NIH and provides neurologic consultation on forensic cases. Copyright © 2011 by AAN Enterprises, Inc.
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Teaching NeuroImages: Apathetic variant of frontotemporal dementia D.L. Perez, M. Larvie, D. Acar, et al. Neurology 2011;77;e117 DOI 10.1212/WNL.0b013e3182377e4c This information is current as of November 14, 2011 Updated Information & Services
including high resolution figures, can be found at: http://www.neurology.org/content/77/20/e117.full.html
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This article cites 2 articles, 1 of which you can access for free at: http://www.neurology.org/content/77/20/e117.full.html##ref-list-1
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This article, along with others on similar topics, appears in the following collection(s): All Cognitive Disorders/Dementia http://www.neurology.org//cgi/collection/all_cognitive_disorders_deme ntia Frontotemporal dementia http://www.neurology.org//cgi/collection/frontotemporal_dementia MRI http://www.neurology.org//cgi/collection/mri PET http://www.neurology.org//cgi/collection/pet
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