Abstract
A meta-analysis of the extent, nature and pattern of memory performance in behavioral variant frontotemporal dementia (bvFTD). Multiple observational studies have challenged the relative sparing of memory in bvFTD as stated in the current diagnostic criteria. We performed a meta-analytic review covering the period 1967 to February 2017 of case-control studies on episodic memory in bvFTD versus control participants (16 studies, 383 patients, 603 control participants), and patients with bvFTD versus those with Alzheimer's disease (AD) (20 studies, 452 bvFTD, 874 AD). Differences between both verbal and non-verbal working memory, episodic memory learning and recall, and recognition memory were examined. Data were extracted from the papers and combined into a common metric measure of effect, Hedges' d. Patients with bvFTD show large deficits in memory performance compared to controls (Hedges' d -1.10; 95% confidence interval [CI] [-1.23, -0.95]), but perform significantly better than patients with AD (Hedges' d 0.85; 95% CI [0.69, 1.03]). Learning and recall tests differentiate best between patients with bvFTD and AD (p<.01). There is 37-62% overlap in test scores between the two groups. This study points to memory disorders in patients with bvFTD, with performance at an intermediate level between controls and patients with AD. This indicates that, instead of being an exclusion criterion for bvFTD diagnosis, memory deficits should be regarded as a potential integral part of the clinical spectrum. (JINS, 2018, 24, 593-605).
Highlights
Frontotemporal dementia (FTD) is an early-onset dementia characterized by a heterogeneous clinical presentation including behavioral changes, frontal-executive deficits, and/or language disorders (Seelaar, Rohrer, Pijnenburg, Fox, & van Swieten, 2011), caused by pathophysiological damage in the frontal and temporal lobes (McKhann et al, 2001; Rohrer & Rosen, 2013)
Systematic investigations of episodic memory functioning in patients with Behavioral variant FTD (bvFTD) are scarce (Hornberger & Piguet, 2012) and inconsistent, with some studies revealing no differences between bvFTD and Alzheimer’s disease (AD) memory performance (e.g., Gregory, Orrell, Sahakian, & Hodges, 1997; Hodges et al, 1999; Walker, Meares, Sachdev, & Brodaty, 2005), and others demonstrating a relative sparing of memory performance in bvFTD compared to AD (e.g., Frisoni et al, 1995; Pachana, Boone, Miller, Cummings, & Berman, 1996; Thompson, Stopford, Snowden, & Neary, 2005)
By quantifying the nature and extent of bvFTD memory impairment, we provide insights into how memory performance in clinical evaluation can help in differential diagnostics between patients with bvFTD and AD
Summary
Frontotemporal dementia (FTD) is an early-onset dementia characterized by a heterogeneous clinical presentation including behavioral changes, frontal-executive deficits, and/or language disorders (Seelaar, Rohrer, Pijnenburg, Fox, & van Swieten, 2011), caused by pathophysiological damage in the frontal and temporal lobes (McKhann et al, 2001; Rohrer & Rosen, 2013). Studies showing memory impairment in patients with bvFTD suggest poor organization and a lack of efficient learning and retrieval strategies as causes (i.e., dysexecutive syndrome), rather than deficits in memory consolidation per se (Blumenfeld & Ranganath, 2007; Pasquier, Grymponprez, Lebert, & Van der Linden, 2001; Wang & Miller, 2007). In line with the latter, there are indications that patients with bvFTD and AD will not differ on delayed memory testing, but that they will benefit more from cued or recognition memory formats (e.g., Glosser, Gallo, Clark, & Grosmann, 2002). The authors argue that amnesic patients with FTD might represent an anatomical subtype of FTD, with prominent right temporal lobe involvement
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