Frontotemporal Dementia

Diagnosis

No test can detect frontotemporal dementia. Instead, the disorder is diagnosed by excluding other conditions that might be causing the signs and symptoms. There are numerous tests and questions for each patient that can help exclude other conditions. Because behavior changes are associated with the disorder, a psychiatrist may make the initial evaluation.

The patient will first have a complete physical exam, along with a detailed history of symptoms and medical history, including medications. Examination by neurology specialists will help identify signs of Parkinson's disease, strokes, tumors and other medical conditions that may impair memory and thinking, as well as physical function. Tests may include:

Mental Status and Neuropsychological Assessments

To determine which thinking and memory functions may be affected and to what degree, the patient will be asked questions to measure cognitive functions for attention, learning, recall, language and visuospatial abilities. Test results are compared to results for other patients of similar age and education.

The patient and people familiar with him or her will be interviewed about the patient's emotional state and day-to-day routines. They will also be asked about possible alcohol or drug abuse, head trauma and other causes for memory loss. Family members or close friends can provide valuable information about how the patient's behavior and personality have changed.

Speech and Language Assessments

To determine which communication abilities may be affected and to what degree, the ability to speak and understand speech, and read and write can be assessed. The patient and people familiar with the patient will be interviewed to establish the impact that difficulties with communication may be having on work and other daily activities.

Psychiatric Assessments

In addition, the patient may have a psychiatric assessment to uncover possible depression or other mental illness.

Blood Tests

The patient will need to provide a blood sample to be checked for infections or conditions such as vitamin deficiency, anemia, medication levels, disorders of the thyroid, kidneys or liver, and other factors that can cause memory loss.

Brain Imaging

Internal images of the brain help detect strokes, tumors or other conditions that may have affected the brain, and may show changes to structures in the brain that are associated with memory, such as the hippocampus. Brain imaging techniques offered at Mayo Clinic include:

• Computed tomography (CT scan) — In this test, an X-ray machine rapidly rotates around the brain using a series of thin X-ray beams to produce two-dimensional images of the brain.
• Magnetic resonance imaging (MRI) — This test uses powerful magnets and radio waves to produce a detailed, three-dimensional view of the brain.
• Positive emission tomography (PET) or Single-photon emission computerized tomography (SPECT) — These two fairly new techniques may be needed for clinical-related or research-related study. For both tests, a small amount of radioactive material is injected into the patient and then detectors are placed on the brain to capture emissions. PET provides visual images of metabolic activity in the brain. SPECT is used to measure blood flow to regions of the brain.
• Magnetic resonance imaging — Most patients will be asked to undergo an MRI scan, though some patients may undergo a different type of scan.

Other Tests

Other tests that sometimes provide important diagnostic information include electroencephalogram (EEG), electromyogram (EMG), urine tests, and tests on cerebrospinal fluid (CSF) obtained by a lumbar puncture. The physicians discuss with the patient and his or her family which tests are most appropriate to establish the correct diagnosis.