Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia

Katya Rascovsky*, John R. Hodges, David Knopman, Mario F. Mendez, Joel H. Kramer, John Neuhaus, John C. Van Swieten, Harro Seelaar, Elise G.P. Dopper, Chiadi U. Onyike, Argye E. Hillis, Keith A. Josephs, Bradley F. Boeve, Andrew Kertesz, William W. Seeley, Katherine P. Rankin, Julene K. Johnson, Maria Luisa Gorno-Tempini, Howard Rosen, Caroline E. Prioleau-LathamAlbert Lee, Christopher M. Kipps, Patricia Lillo, Olivier Piguet, Jonathan D. Rohrer, Martin N. Rossor, Jason D. Warren, Nick C. Fox, Douglas Galasko, David P. Salmon, Sandra E. Black, Marsel Mesulam, Sandra Weintraub, Brad C. Dickerson, Janine Diehl-Schmid, Florence Pasquier, Vincent Deramecourt, Florence Lebert, Yolande Pijnenburg, Tiffany W. Chow, Facundo Manes, Jordan Grafman, Stefano F. Cappa, Morris Freedman, Murray Grossman, Bruce L. Miller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3667 Scopus citations


Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86) met 'possible' criteria, and 104 (76) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53) met previously established criteria for the syndrome (P<0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.

Original languageEnglish (US)
Pages (from-to)2456-2477
Number of pages22
Issue number9
StatePublished - Sep 2011


  • FTD
  • behavioural variant frontotemporal dementia
  • diagnostic criteria
  • frontotemporal lobar degeneration
  • pathology

ASJC Scopus subject areas

  • Clinical Neurology


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