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Frontotemporal lobar degeneration
Classification and external resources
A human brain showing frontotemporal lobar degeneration causing frontotemporal dementia.
OMIM	600274
DiseasesDB	10034
MeSH	D003704

Frontotemporal lobar degeneration (FTLD) is the name for a group of clinically, pathologically and genetically heterogeneous disorders associated with atrophy in the frontal lobe and temporal lobe of the brain, with sparing of the parietal and occipital lobes.

In the over 65 age group, FTLD is probably the fourth most common cause of dementia after Alzheimer's disease, Dementia with Lewy bodies and vascular dementia. In the below 65 age group, it is the second most common cause after Alzheimer's disease. In some patients the symptoms of FTLD and Alzheimer's may overlap ^[1]

There are three clinical subtypes described:

• frontotemporal dementia
• semantic dementia
• progressive nonfluent aphasia.

History

There are 3 main histological subtypes found at post-mortem:

• tau inclusions ( Pick's disease, MAPT mutations, corticobasal degeneration, progressive supranuclear palsy)
• ubiquitin positive (tau-negative) inclusions - in the majority of cases that have this type of pathology the ubiquitinated inclusions contain a protein called TDP-43. There are four subtypes of this type of pathology described in the recent consensus criteria by Cairns et al.: type 1 with neurites predominantly, type 2 with cytoplasmic inclusions predominantly; type 3 with intranuclear inclusions and type 4 associated with VCP mutations. It should be noted that not all ubiquitin-positive, tau negative cases stain for TDP-43 e.g. the CHMP2B cases but also other cases: many of these have been very recently recognized to contain the protein FUS.
• Dementia lacking distinctive histology (DLDH) - a rare and controversial entity - new analyses have allowed many cases to be reclassified into one of the positively-defined subgroups.

Genetics

Many cases (possibly up to 40%) of FTLD are genetic rather than sporadic. There are 2 major genes in which mutations cause FTLD:

• Mutations in the Tau gene (on chromosome 17q21 - known as MAPT or Microtubule Associated Protein Tau) can cause FTLD and there are over 40 known mutations at present.
• A series of new mutations associated with FTLD has been recently described in the progranulin gene which is remarkably also on chromosome 17q21. Patients with progranulin mutations have type 3 ubiquitin-positive, TDP-43 positive, tau-negative pathology at post-mortem. Progranulin is associated with tumorgenesis when overproduced, however the mutations seen in the progranulin gene associated with FTLD suggests a deficit in progranulin may be the problem.

There are currently 2 other known genes that can cause FTLD:

• CHMP2B (on chromosome 3) which is associated with a behavioural syndrome (mainly in a large Jutland cohort)
• VCP (valosin-containing protein, on chromosome 9) which is associated with the IBMPFD syndrome (inclusion body myopathy, Paget's disease and frontotemporal dementia).

These 2 genes only account for a tiny proportion of cases.

A locus on chromosome 9 is associated with FTD-MND (or FTD-ALS) i.e. frontotemporal dementia associated with motor neurone disease (or amyotrophic lateral sclerosis) - the hunt for this gene is currently the focus of a number of research labs around the world.

Examples

United States Senator Pete Domenici (R-NM) is a known sufferer of FTLD, and the illness is the main reason behind his October 4, 2007 announcement of retirement at the end of his term.

See also

• Corticobasal degeneration
• Proteopathy

References

• 1. ^ Rajka M. Liscic, MD, PhD; Martha Storandt, PhD; Nigel J. Cairns, PhD; John C. Morris, MD Clinical and Psychometric Distinction of Frontotemporal and Alzheimer Dementias
• Mackenzie IR, Baborie A, Pickering-Brown S, et al. (November 2006). "Heterogeneity of ubiquitin pathology in frontotemporal lobar degeneration: classification and relation to clinical phenotype". Acta Neuropathologica 112 (5): 539–49. doi:10.1007/s00401-006-0138-9. PMID 17021754. 
• Davidson Y, Kelley T, Mackenzie IR, et al. (May 2007). "Ubiquitinated pathological lesions in frontotemporal lobar degeneration contain the TAR DNA-binding protein, TDP-43". Acta Neuropathologica 113 (5): 521–33. doi:10.1007/s00401-006-0189-y. PMID 17219193. 
• Neary D, Snowden JS, Gustafson L, et al. (December 1, 1998). "Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria". Neurology 51 (6): 1546–54. PMID 9855500. http://www.neurology.org/cgi/content/abstract/51/6/1546. Retrieved 2009-06-20. 
• Pickering-Brown SM (July 2007). "The complex aetiology of frontotemporal lobar degeneration". Experimental Neurology 206 (1): 1–10. doi:10.1016/j.expneurol.2007.03.017. PMID 17509568. 

Further reading

• Hodges, John R. The Frontotemporal Dementia Syndromes. Cambridge University Press. 2007 ISBN 978-0-521-85477-1

External links

• FTD Support Forum
• The Association for Frontotemporal Dementias
• UCSF Memory and Aging Center and FTD videos
• Mayo Clinic - [1]
• Pick's Disease Support Group Online
• Frontotemporal Dementia Caregiver Support Center
• Frontotemporal Dementia Caregiver Support Center
• FRONTIER The Frontotemporal Dementia Research Group at POWMRI Sydney Australia