The Japanese journal of neuropsychology

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ArticleTitle	Clinical classification of dementia: with a special reference to anterior-type dementia
Language	J
AuthorList	Toshiya Fukui
Affiliation	Department of Neurology, Showa University School of Medicine
Publication	Japanese Journal of Neuropsychology: 16 (2), 117-124, 2000
Received
Accepted
Abstract	Pick complex (PiC) or frontotemporal lobar degeneration (FTLD) refers to a group of anterior-type dementia that is characterised by focal atrophy of the anterior portion of the brain and absence of Alzheimer pathology. Cardinal clinical presentations include frontotemporal dementia (FTD), progressive aphasia (PA), semantic dementia (SD), and progressive apraxia, anarthria or prosopagnosia. Common pathological pictures include non-specific spongiform degeneration as well as Pick pathology with and without Pick bodies. We address currently debatable issues regarding terminology, brain atrophy patterns, qualitative aspects of dementia and clinical diagnosis of anterior-type dementia. One of the difficulties hindering a proper understanding of anterior-type dementia is a nosological complexity: FTLD that represents the holistic concept of anterior-type dementia is likely to be mistaken for FTD, one of the major clinical presentations, and frontal lobe degeneration (FLD), representing a spongiform pathology. In contrast, the term Alzheimer represents the entire conceptuo-clinico-pathological facets of Alzheimer's disease (AD). Care should be taken not to confuse the highest concept of PiC and FTLD with the subordinate clinical and pathological terms. A quantitative volumetry using brain MRI and a computer program showed that brain atrophy of anterior-type dementia is not necessarily confined to the frontotemporal lobes, but may involve the basal ganglia and parietal lobes. These results support the concept of PiC more favourably than that of FTLD, which by definition precludes anatomical involvement of the basal ganglia and posterior brain structures. Results of formal cognitive and language tests were generally worse in 24 patients with AD than in 11 with FTD. The arithmetic tasks in WAIS-R differentiated AD from FTD statistically and the scores for the Frontal Behavioral Inventory were significantly higher in FTD. These results suggest a difference in the quality of dementia between FTD and AD. Whatever the initial symptoms, anterior-type dementia is likely to converge upon the typical symptoms of FTD in late stages, thus the name dementia. Therefore, a diagnosis of each clinical entity in PiC should be made on the basis of initial presenting or most disabling symptom.
Keywords	Pick complex, frontotemporal lobar degeneration, frontotemporal dementia, progressive aphasia, semantic dementia, Alzheimer's disease, focal cerebral atrophy