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Last reviewed: 19 Sep 2025
Last updated: 19 Sep 2025

Summary

Definition

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

Other diagnostic factors

  • early age at onset
  • family history of frontotemporal dementia (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

Risk factors

  • mutations in MAPT gene
  • mutations in GRN gene
  • mutations in C9orf72 gene
  • other mutations
  • traumatic brain injury
  • post-traumatic stress disorder (PTSD)

Diagnostic tests

1st tests to order

  • 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

Tests to consider

  • brain fluorodeoxyglucose (FDG)-PET/CT
  • brain perfusion single-photon emission computed tomography (SPECT)
  • brain amyloid PET/CT
  • brain biopsy
  • genetic testing
  • connective tissue panel
  • serum erythrocyte sedimentation rate
  • electroencephalogram (EEG)
  • electromyogram (EMG)

Treatment algorithm

Contributors

Authors

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

Consultant Psycho-geriatrician

Waitemata District Health Board

Auckland

New Zealand

Disclosures

RKR serves as an advisory board member for the Australian and New Zealand Journal of Psychiatry.

Rommel Dawith, MBChB, FRANZCP, FFPOA

Psychiatrist of Old Age

Waitemata District Health Board

Auckland

New Zealand

Disclosures

RD declares that he has no competing interests.

Acknowledgements

Dr Raghava Kurup Radhakrishnan and Dr Rommel Dawith would like to gratefully acknowledge Dr Sachin Jauhari, 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.

Disclosures

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

Peer reviewers

Daniel Kaufer, MD

Director

Memory Disorders Program

Department of Neurology

University of North Carolina at Chapel Hill

NC

Disclosures

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

CA

Disclosures

BLM declares that he has no competing interests.

Philip Scheltens, MD, PhD

Professor of Neurology

Department of Neurology/Alzheimer Center

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

PS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011 Sep;134(Pt 9):2456-77.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: dementia. 2024 [internet publication].Full text

Buoli M, Serati M, Caldiroli A, et al. Pharmacological management of psychiatric symptoms in frontotemporal dementia: a systematic review. J Geriatr Psychiatry Neurol. 2017 May;30(3):162-9. Abstract

Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016 May 1;173(5):543-6.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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