Differential Diagnosis for Frontal Temporal Dementia
Single Most Likely Diagnosis
- Frontotemporal Dementia (FTD): This is the most likely diagnosis given the frontal and temporal involvement, as FTD is characterized by progressive damage to the frontal and/or temporal lobes of the brain, leading to significant changes in personality, behavior, and language.
Other Likely Diagnoses
- Alzheimer's Disease: While Alzheimer's typically presents with memory impairments, some variants can have prominent frontal and temporal features, making it a consideration in the differential diagnosis.
- Vascular Dementia: If the patient has a history of vascular risk factors, vascular dementia could be a possibility, especially if the cognitive decline is stepwise and accompanied by focal neurological signs.
- Lewy Body Dementia: Characterized by fluctuations in cognitive function, visual hallucinations, and parkinsonian motor symptoms, Lewy Body Dementia could be considered if these features are present.
Do Not Miss Diagnoses
- Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can present with rapid cognitive decline, myoclonus, and other neurological signs. It's crucial to consider due to its fatal outcome and the need for prompt diagnosis.
- Normal Pressure Hydrocephalus (NPH): Presents with the triad of gait disturbance, dementia, and urinary incontinence. It's treatable with shunting, making it a critical diagnosis not to miss.
- Chronic Subdural Hematoma: Especially in the elderly, even minor trauma can lead to a chronic subdural hematoma, which can cause cognitive decline and is treatable with surgery.
Rare Diagnoses
- Huntington's Disease: An autosomal dominant disorder that causes progressive damage to the brain, leading to cognitive, motor, and psychiatric disturbances. It's rare but should be considered, especially with a family history.
- Prion Diseases (other than Creutzfeldt-Jakob Disease): Such as Fatal Familial Insomnia or Gerstmann-Sträussler-Scheinker disease, which are extremely rare but have distinct clinical features.
- Inherited Forms of FTD: Such as those caused by mutations in the GRN, C9ORF72, or MAPT genes, which can have specific clinical and pathological features.