Frontotemporal dementia: A review for primary care physicians

Frontotemporal dementia (FTD) is one of the most common forms of dementia in persons younger than 65 years. Variants include behavioral variant FTD, semantic dementia, and progressive nonfluent aphasia. Behavioral and language manifestations are core features of FTD, and patients have relatively preserved memory, which differs from Alzheimer disease. Common behavioral features include loss of insight, social inappropriateness, and emotional blunting. Common language features are loss of comprehension and object knowledge (semantic dementia), and nonfluent and hesitant speech (progressive nonfluent aphasia). Neuroimaging (magnetic resonance imaging) usually demonstrates focal atrophy in addition to excluding other etiologies. A careful history and physical examination, and judicious use of magnetic resonance imaging, can help distinguish FTD from other common forms of dementia, including Alzheimer disease, dementia with Lewy bodies, and vascular dementia. Although no cure for FTD exists, symptom management with selective serotonin reuptake inhibitors, antipsychotics, and galantamine has been shown to be beneficial. Primary care physicians have a critical role in identifying patients with FTD and assembling an interdisciplinary team to care for patients with FTD, their families, and caregivers.