Alzheimer disease vs Frontotemporal dementia
How to tell Alzheimer disease and Frontotemporal dementia apart when a board question makes them look alike.
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Early personality or language change with preserved recent-memory recall favors frontotemporal dementia over Alzheimer disease.
Side by side
Insidious episodic memory loss after age 65 with progressive impairment in instrumental activities of daily living and preserved social comportment early.
Earlier-onset behavioral disinhibition or progressive language dysfunction with relatively spared episodic memory in the initial stage.
Alzheimer disease is driven by cortical beta-amyloid deposition and tau-mediated neurodegeneration, most prominent in hippocampal networks.
Frontotemporal dementia reflects frontal and anterior temporal lobar degeneration with tau or TDP-43 pathology affecting behavior and language circuits.
Screen with MoCA or MMSE plus reversible-cause labs (TSH, vitamin B12); MRI typically shows medial temporal and hippocampal atrophy, and CSF profile often has low A-beta42 with elevated total tau or p-tau.
Neuropsychology shows executive or language-predominant deficits with relative memory sparing early; MRI or FDG-PET demonstrates frontal and anterior temporal atrophy or hypometabolism, often asymmetric in language variants.
The trap
Patients in their late 50s with workplace decline are often mislabeled as depression or early Alzheimer disease. Marked disinhibition, loss of empathy, compulsive eating, or progressive aphasia with frontal-predominant imaging redirects to frontotemporal dementia.
The repair move
Next best step: obtain formal neuropsychologic testing and brain MRI to define the dementia pattern, then start safety and caregiver planning. If Alzheimer pattern is confirmed and symptoms are mild to moderate, begin donepezil 5 mg nightly and increase to 10 mg after 4 to 6 weeks as tolerated; if frontotemporal dementia is confirmed, avoid cholinesterase inhibitors and treat disinhibition with an SSRI such as sertraline 25 to 50 mg daily.
Try a free question
CoreA 72-year-old woman has 2 years of progressive forgetfulness, getting lost while driving, and missed bill payments. BP 134/82 mm Hg, HR 70/min, temp 36.7 C. She is socially appropriate, recalls 0 of 3 objects at 5 minutes, and MRI shows hippocampal atrophy. What is the most likely diagnosis?
Show answer and explanation
Answer: A. Alzheimer disease. Prominent delayed-memory loss with hippocampal atrophy and gradual decline in an older patient is most consistent with Alzheimer disease.
Why the other choices are tempting
- B. Frontotemporal dementia is less likely because behavior or language changes usually precede severe amnestic deficits.
- C. Normal-pressure hydrocephalus would emphasize gait disturbance and urinary urgency with ventriculomegaly.
- D. Lewy body dementia would feature visual hallucinations, fluctuating cognition, and parkinsonism early.
- E. Depression can mimic cognitive symptoms, but objective progressive memory impairment with structural atrophy favors neurodegeneration.
Flashcards
Tap a card to flip it.
Which early cognitive domain usually fails first in Alzheimer disease?
Recent episodic memory, especially delayed recall, fails first in typical Alzheimer disease.
Which early behavioral clue points toward frontotemporal dementia rather than Alzheimer disease?
Disinhibition, apathy, loss of empathy, or compulsive behavior with relatively preserved memory suggests frontotemporal dementia.
Quick answers
What is the fastest way to tell Alzheimer disease from Frontotemporal dementia?
Early personality or language change with preserved recent-memory recall favors frontotemporal dementia over Alzheimer disease.
What is the key clue for Alzheimer disease?
Insidious episodic memory loss after age 65 with progressive impairment in instrumental activities of daily living and preserved social comportment early.
What is the key clue for Frontotemporal dementia?
Earlier-onset behavioral disinhibition or progressive language dysfunction with relatively spared episodic memory in the initial stage.
What is the common trap with Alzheimer disease vs Frontotemporal dementia?
Patients in their late 50s with workplace decline are often mislabeled as depression or early Alzheimer disease. Marked disinhibition, loss of empathy, compulsive eating, or progressive aphasia with frontal-predominant imaging redirects to frontotemporal dementia.