1. How Alzheimer’s Disease Differs from Frontal Temporal Lobe Dementia (Pick’s Disease)
Josepha A. Cheong, MD
University of Florida Departments of Psychiatry and Neurology
McKnight Brain Institute
Institute on Aging
This module describes the features of other dementia disorders that may be associated with Alzheimer’ disease (AD)

2. Review the different kind of dementia
[Mild Cognitive Impairment (MCI)]
Frontotemporal Lobe Dementia (FTD)
Dementia Lewy Body Type (DLB)
Vascular Dementia (VaD)

3. Language, visuospatial skill, executive abilities, and emotion
DEMENTIA
Clinical syndrome which is acquired and represents a deterioration from previous function in at least 3 of the following functions:
Language, visuospatial skill, executive abilities, and emotion

4. Dementia Type—Total Population
Overall, Alzheimer’s disease accounts for just over half of all dementia— significantly more than any other form. About two fifths of all patients are in each of the mild and moderate stages, and the remaining fifth are in the severe stage
Distribution of Dementia Types 1%
Mild cognitive impairment
22%
13%
Dementia with Lewy bodies
Vascular
Mixed
14%
Other
55%
Alzheimer’s disease
22% 2%
Alzheimer’s—mild
Alzheimer’s—moderate
15%
Alzheimer’s—severe
11%
Source: Icon and Landis, Fall 2000

5. Mild Cognitive Impairment (MCI)
Patients who are memory impaired but are otherwise functioning well and do not meet clinical criteria for dementia are classified as having MCI
Symptoms include
Memory complaint, preferably with corroboration
Objective memory impairment
Normal general cognitive function
Intact activities of daily living
Not demented
Patients with MCI should be recognized and monitored for cognitive and functional decline due to their increased risk for subsequent dementia
There are currently no recommended treatments for MCI
Petersen RC. Neurology. 2001;56: Petersen RC et al. Arch Neurol. 1999;56:

6. Frontotemporal Dementia (FTD)
FTD is the most common of the neurodegenerative syndromes produced by frontotemporal lobar degeneration, and is less common than AD, VaD, and DLB
Perry RJ. Neurology. 2001;56: Perry RJ. Neurology. 2000;54: Morris JC. Neurology. 2001;57:

7. Frontotemporal Dementia (FTD)
Clinical features of FTD include decline in personal hygiene and grooming, mental rigidity and inflexibility, distractibility and impersistence, hyperorality and dietary changes, perseverative and stereotyped behavior, and utilization behavior
Perry RJ. Neurology. 2001;56: Perry RJ. Neurology. 2000;54: Morris JC. Neurology. 2001;57:

8. Frontotemporal Dementia (FTD)
Current treatment options only address symptomatic management, as there is no evidence for the use of AChEIs in this condition
Perry RJ. Neurology. 2001;56: Perry RJ. Neurology. 2000;54: Morris JC. Neurology. 2001;57:

9. Dementia With Lewy Bodies (DLB)
Presence of dementia, gait/balance disorder, prominent hallucinations and delusions, sensitivity to traditional antipsychotics, and fluctuations in alertness
Heyman A et al. Neurology. 1999;52: Ballard CG et al. Dement Geriatr Cogn Disord. 1999;10: Barber R et al. Neurology. 1999;52:

10. Vascular Dementia
VaD and AD can be difficult to distinguish, due to overlaps in symptomatology, pathophysiology, and comorbidity

11. Room for improved criteria for these patients
Vascular Dementia
A number of patients may have AD with concomitant CVD (“mixed” dementia)
Room for improved criteria for these patients

12. Relationship Between VaD and AD
Cholinergic dysfunction (central to AD) is seen in VaD
Togashi H et al. Neurosci Lett. 1994;166: Saito H et al. Clin Exp Pharmacol Physiol ;22(suppl 1):S257-S259. Kalaria RN, Ballard C. Alzheimer Dis Assoc Disord. 1999;13(suppl 3):S115-S Wallin A et al. Acta Neurol Scand. 1989;80: Gottfries CG et al. Dementia. 1994;5: Tohgi H et al. J Neural Transm. 1996;103:

13. Frontotemporal Dementia
aka Pick’s Disease because of the neuropathology of specific inclusion bodies (Pick bodies) in the neurons
Atrophy of the frontal and/or temporal lobe
Asymmetric atrophy
Miller BL, Cummings JL, et al: Neurology 41: , 1991

14. Frontotemporal Dementia
Clinical Syndromes
Disinhibition with tactlessness and impulsiveness
Primary progressive aphasia with nonfluent verbal output and early mutism
Semantic aphasia and visual agnosia
Miller BL, Cummings JL, et al: Neurology 41: , 1991

15. Frontotemporal Dementia
Genetic Considerations
40% are inherited in an autosomal dominant pattern
20% involve a mutation of the Chr 17
Miller BL, Cummings JL, et al: Neurology 41: , 1991

16. Frontotemporal Dementia
Clinical Considerations:
Usually begins between 50 – 70 yrs of age
Very slow onset with prominent change in personality or language
Memory, copying, and calculations are spared until mid-late stages of disease – used to differentiate with AD
Miller BL, Cummings JL, et al: Neurology 41: , 1991

17. Frontotemporal Dementia
Behavioral Changes:
Disinhibition
Impulsiveness
Tactlessness
Impaired social judgment
Apathy
Depression
Miller BL, Cummings JL, et al: Neurology 41: , 1991

18. FTD AD Specific atrophy Apraxia – late
Marked personality change – early in the disease
Memory impairment – late in the disease
Little response to ACHase Inhibitors
Pick inclusion bodies on pathology AD
Diffuse atrophy
Apraxia – early
Subtle personality changes
Memory Impairment – early in the disease
Good response to ACHase inhibitors
Neurofibrillary plaques and tangles

19. Clinical Trials Program ALZonline Caregiver Network
SHANDS at UF
Geriatric Psychiatry Inpatient Unit
Intake and Referral Line
Clinical Trials Program
STUDY
ALZonline Caregiver Network
UF Memory Disorder Clinic

20. GO GATORS !!!