TY - JOUR
T1 - Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia
AU - Rascovsky, Katya
AU - Hodges, John R.
AU - Knopman, David
AU - Mendez, Mario F.
AU - Kramer, Joel H.
AU - Neuhaus, John
AU - Van Swieten, John C.
AU - Seelaar, Harro
AU - Dopper, Elise G.P.
AU - Onyike, Chiadi U.
AU - Hillis, Argye E.
AU - Josephs, Keith A.
AU - Boeve, Bradley F.
AU - Kertesz, Andrew
AU - Seeley, William W.
AU - Rankin, Katherine P.
AU - Johnson, Julene K.
AU - Gorno-Tempini, Maria Luisa
AU - Rosen, Howard
AU - Prioleau-Latham, Caroline E.
AU - Lee, Albert
AU - Kipps, Christopher M.
AU - Lillo, Patricia
AU - Piguet, Olivier
AU - Rohrer, Jonathan D.
AU - Rossor, Martin N.
AU - Warren, Jason D.
AU - Fox, Nick C.
AU - Galasko, Douglas
AU - Salmon, David P.
AU - Black, Sandra E.
AU - Mesulam, Marsel
AU - Weintraub, Sandra
AU - Dickerson, Brad C.
AU - Diehl-Schmid, Janine
AU - Pasquier, Florence
AU - Deramecourt, Vincent
AU - Lebert, Florence
AU - Pijnenburg, Yolande
AU - Chow, Tiffany W.
AU - Manes, Facundo
AU - Grafman, Jordan
AU - Cappa, Stefano F.
AU - Freedman, Morris
AU - Grossman, Murray
AU - Miller, Bruce L.
N1 - Funding Information:
We are grateful to M. Zoumarou-Wallis, the owner of the two orchards where this study was done at Korobororou village. We would also like to thank the anonymous reviewers for their useful comments. This study was supported by the project ?Increasing value of African Mango and Cashew production?. DANIDA (DFC No. 10 ? 025AU).
PY - 2011/9
Y1 - 2011/9
N2 - Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86) met 'possible' criteria, and 104 (76) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53) met previously established criteria for the syndrome (P<0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.
AB - Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86) met 'possible' criteria, and 104 (76) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53) met previously established criteria for the syndrome (P<0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.
KW - FTD
KW - behavioural variant frontotemporal dementia
KW - diagnostic criteria
KW - frontotemporal lobar degeneration
KW - pathology
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U2 - 10.1093/brain/awr179
DO - 10.1093/brain/awr179
M3 - Article
C2 - 21810890
AN - SCOPUS:80052938441
SN - 0006-8950
VL - 134
SP - 2456
EP - 2477
JO - Brain
JF - Brain
IS - 9
ER -