3. Objectives
• Describe the illnesses within the
frontotemporal lobar degeneration
(FTLD) spectrum
• Characterize the common types of
FTLD
• Illustrate case examples of FTLD
16. Memantine
• Increases brain FDG-PET metabolism in
FTD and SD (Chow 2011, 2012)
• No improvement in behavior/cognition
(Diehl-Schmid 2008, Vercelletto 2011)
• Transient improvement in neuropsych
symptoms in FTD and PPA (Swanberg
2007, Boxer 2009)
• Currently in multisite RCT
17. Antipsychotics
• Often used because of behavioral
symptoms
• Mounting evidence of hypersensitivity
to EPS in FTD (Mendez 2001,
Pijnenburg 2003, Czarnecki 2008)
• Think of overlap of FTLD with
“Parkinson’s-Plus” disorders
19. Antidepressants
• Loss of serotonergic neurons->replete
with serotonergic drugs
• Trazodone (Lebert 2004)
• SSRIs (Swartz 1997, Moretti 2003,
Herrmann 2011)
• Paroxetine: no effect, worsened
cognition (Deakin 2004)
20. Non-Pharmacological
Interventions
• Environment (locked behavioral
dementia unit)
• Caregiver support (FTD support
groups)
• SSDI Compassionate Allowances
• Elder care lawyer involvement early
• Driving (different concerns)
• Travel letters
21. Case #1
• 58 y.o. AAM attorney with h/o dyslexia
with a 2 yr h/o cognitive decline and
personality change
• Distracted, poor concentration, low
mood, fatigued
• Only reads comic books and watches
cartoons, often the same ones
repeatedly
22. Exam
General: Asked to leave room several
times to walk around. Buccal
stereotypies (i.e., blowing)
Speech: Sparse, poverty of content
Affect: Flat, no brightening
MMSE: 19/30
Brain MRI: Mild generalized atrophy
24. Case #2
• 60 y.o. WM with no past neuropsych hx
• Initial complaint is
stuttering/stammering
• Phonemic paraphrasic errors on exam
• MoCA=28/30
• “f”=2 words, “animals”=18
• At next visit, has complaints of poor
concentration and distractibility
25. Case #3
• 60 y.o. WF with h/o rheumatic fever,
GERD, vit D def, osteopenia, and
liver/brain hemangiomas
• 1 yr h/o progressive strabismus with
diplopia (repaired with return 1 mo
later), parkinsonism, dysarthria, and
short-term amnesia, fatigue, anxiety,
panic attacks
27. Case #4
• 50 y.o. female from Spain with 4 yr h/o
gradual executive dysfxn, short-term
amnesia, progressive non-fluent
aphasia, parkinsonism, and myoclonus
• Paces frequently, apathetic, crying
when frustrated, seen responding to
internal stimuli, and sometimes thinks
others are stealing from her
28. Exam
Gait: slow, shuffling, leans to left
Speech: Effortful, paraphrasic errors
MMSE: 5/30
3MS: 17/100
Clock: 1/5
UPDRS II: 44
•Myoclonus with speech and action
•Left-sided neglect, finger agnosia