Frontotemporal dementia

Last reviewed: 2 Sep 2023
Last updated: 08 Nov 2022



History and exam

Key diagnostic factors

  • coarsening of personality, social behavior, and habits
  • progressive loss of language fluency or comprehension
  • development of memory impairment, disorientation, or apraxias
  • progressive self-neglect and abandonment of work, activities, and social contacts
More key diagnostic factors

Other diagnostic factors

  • early age at onset
  • family history of FTD
  • altered eating habits
  • inattentiveness, puerile preoccupations, economy of effort, impulsive responding, and compulsive behaviors
  • signs of amyotrophic lateral sclerosis (ALS)
  • parkinsonian symptoms
  • fasciculations, atrophy, hyperreflexia, and other signs of motor neuron disease
  • glabellar, snout, sucking, rooting, or grasp reflex
  • loss of bladder and bowel control
Other diagnostic factors

Risk factors

  • mutations in MAPT gene
  • mutations in GRN gene
  • mutations in C9orf72 gene
  • traumatic brain injury
More risk factors

Diagnostic investigations

1st investigations to order

  • formal cognitive testing
  • brain MRI
  • brain CT
  • CBC
  • serum CRP
  • serum thyroid-stimulating hormone (TSH)
  • free thyroxine (T4)
  • metabolic panel
  • serum BUN
  • serum creatinine
  • LFTs
  • serum vitamin B12 levels
  • serum folate levels
  • syphilis serology
  • HIV testing
  • serum enzyme-linked immunosorbent assay
More 1st investigations to order

Investigations to consider

  • brain fluorodeoxyglucose (FDG)-PET
  • brain single-photon emission computed tomography (SPECT)
  • brain biopsy
  • genetic testing
  • connective tissue panel
  • serum erythrocyte sedimentation rate
More investigations to consider

Emerging tests

  • cerebrospinal fluid analysis

Treatment algorithm


all patients



Raghava Kurup Radhakrishnan, DPM(NIMHANS), DNB(Psych), MRCPsych

Consultant Psycho-geriatrician

Waitemata District Health Board


New Zealand


RKR declares that he has no competing interests.

Sachin Jauhari, DMH, MRCPsych, FRANZCP

Consultant Psycho-geriatrician

Waitemata District Health Board

Honorary Senior Lecturer in Old Age Psychiatry

University of Auckland


New Zealand


SJ declares that he has no competing interests.


Dr Raghava Kurup Radhakrishnan and Dr Sachin Jauhari would like to gratefully acknowledge Dr Lawrence Whalley and Dr Chiadi Onyike, the previous contributors to this topic, and colleagues Dr Ann Boston (clinical psychologist), Dr Zara Godinovich (clinical psychologist), and Diane Ellis (clinical nurse specialist) for their suggestions.


LW, CO, AB, ZG, and DE declare that they have no competing interests.

Peer reviewers

Daniel Kaufer, MD


Memory Disorders Program

Department of Neurology

University of North Carolina at Chapel Hill



DK has received research support, speaking honoraria, and consulting fees from Eisai, Forest Laboratories, Johnson & Johnson, Medivation, Novartis, Ortho-McNeil, and Pfizer.

Bruce L. Miller, MD

Professor of Neurology

University of California

San Francisco



BLM declares that he has no competing interests.

Philip Scheltens, MD, PhD

Professor of Neurology

Department of Neurology/Alzheimer Center

VU University Medical Center


The Netherlands


PS declares that he has no competing interests.

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