Behavior changes

• Inappropriate behavior
• Compulsive behaviors (for example, overeating or only eating one type of food)
• Repetitive behavior
• Withdrawal from social interaction
• Inability to function or interact in social or personal situations
• Can't keep a job
• Problems with personal hygiene

Emotional changes

• Abrupt mood changes
• Does not show emotional warmth, concern, empathy, sympathy
• Indifference to events or environment (apathy)
• Does not recognize behavioral changes
• Inappropriate mood
• Decreased interest in daily living activities

Language changes

• Echolalia (person repeats anything spoken to them)
• Aphasia (decreased language ability, difficulty speaking or understanding speech)
• Difficulty finding a word
• Shrinking vocabulary
• Weak, uncoordinated speech sounds
• Can't speak (mutism)
• Decreased ability to read or write

Neurological problems

• Weakness
• Increased muscle tone (rigidity)
• Movement/coordination difficulties (apraxia)
• Memory loss that gets worse

Other problems

• Urinary incontinence

The doctor will ask you about your medical history and symptoms.

Tests may be ordered to help rule out other causes of dementia, including dementia due to metabolic causes. A neurological examination can help reveal what part of the brain is affected. Psychological studies and tests of sensation, cognitive function, and motor function may be abnormal.

• Neuropsychological assessment shows a pattern of mental decline that suggests selective loss of cognitive function that can be localized to the frontal and/or temporal lobes of the brain.
• An EEG (electroencephalogram) shows nonspecific changes in electrical activity of the brain.
• A head CT scan shows loss of tissue mass of affected lobes of the brain.
• A brain MRI can detect mild degrees of frontal and temporal atrophy missed by the head CT scan.
• Cerebrospinal fluid examination after a lumbar puncture is usually normal.

It is important to note that the definitive diagnosis can only be made with a brain biopsy. However, ongoing efforts are directed at developing a biological marker that would allow a firm diagnosis without the need for such an invasive procedure.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, MO: Mosby; 2004.

Pierce JM. Pick's disease. J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):169.

Grossman M. Frontotemporal dementia: a review. J Intl Neuropsychol Soc. 2002;8:566-583.

Grossman M. Progressive aphasic syndromes: clinical and theoretical advances. Curr Opin Neurol. 2002;15:1-5.

McKhann G, Albert M, Grossman M, Miller B, Dickson D, Trojanowski J. Clinical and pathological diagnosis of frontotemporal dementia. Arch Neurology. 2001;58:1803-1809.