Dementia: Update for the Practitioner

Neuropsychology of Mild Cognitive Impairment,
Alzheimer's Disease, Dementia with Lewy Bodies,
and Frontotemporal Dementia
Penne Sims, Ph.D.

Protocol for FTLD

As Dr. Honig pointed out, there are various forms of frontotemporal lobe dementia, all of which have a predominant language component and relatively preserved visual-spatial skills. There are also deficits in executive skills, including abstract reasoning, decision making, judgment, organization, and problem solving, and these can affect other domains of cognitive functioning, such as memory.

The neuropsychological profile for someone with frontotemporal lobe dementia may look more severe and more diffuse than for some other dementing disorders. This is for two reasons. The first is that language is a big component in frontotemporal lobe dementia, so if a patient has comprehension problems or expressive language problems, there will be difficulty with the other components of the evaluation that require language to complete. Even understanding the test instructions will be difficult, and that will impair performance. For example, deficits on the SRT may not necessarily suggest a primary deficit with memory but rather, perhaps the patient did not understand the test instructions. Usually FTLD does not cause a primary memory problem, but an encoding problem, and what is encoded is encoded inefficiently and is unusable. This will show up as significantly impaired word list learning performance and poor visual memory, not a primary memory problem.


	Neuropsychological profile of FTLD (PC)
	Similarities	3 (Sc. Score)
	SRT-LTS CLTR Trial 6 Delay Recog	<1%ile <1%ile 4/12 0/12 3/12
	VRI	1%ile
	VRII	1%ile
	CFL Fluency	1%ile
	Category Fluency	1%ile
	Naming	50/60 z=-2.21
	Trails A	unable to do
	Trails B	unable to do
	Orientation	4/10
	Motor Programming	bimanual unable to do
	Motor Inhibition	unable to do
	Language Testing difficulty writing the alphabet (took two tries) spelling: com from come writing numbers : 10093 for 193 100 800 65 for 1865 difficulty writing numbers 1–20 (four times)

	The neuropsychological profile of patient PC, diagnosed with frontotemporal lobe dementia. Courtesy of Penne Sims, Ph.D.

Someone with FTLD will also have trouble with executive skills, for example, with drawing, Rosen figures, and copying geometric figures. In the case of JC, his particular performance was not due to a visual-spatial problem, but rather trouble with stimulus-bound behavior. That is, he tended to incorporate his drawing with the stimulus drawing, suggesting that he needs structure and guidance to draw the figures; he cannot draw them on his own. JC also had significant difficulties with language, and he fell neatly into the particular category of FTLD.

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