0:00

This next patient, case number eight,

0:02

is a 71-year-old woman with personality

0:05

changes and memory loss.

0:07

And what we see here is the patient had

0:10

an initial amyloid PET study in 2017.

0:13

The CT portion of this amyloid study showed

0:16

moderate cerebral atrophy with a

0:18

right temporal predilection.

0:19

This is what the CT looks like here.

0:22

And this is the amyloid study.

0:25

So this amyloid study was actually negative.

0:28

You see a tree and branch type pattern

0:32

and so that's a negative amyloid.

0:34

The patient then went on in 2018 to have an FDG

0:38

brain PET CT and look at the dramatic difference

0:41

in the amount of atrophy here.

0:43

Just one year later,

0:45

we now have moderately severe to severe

0:48

atrophy in the right temporal lobe,

0:50

moderate atrophy in the left temporal lobe.

0:53

Again, here's in comparison to the prior,

0:56

we have moderate atrophy also in

0:58

the bilateral frontal lobes,

1:00

and this has significantly progressed since

1:03

the prior as well. So, for example,

1:06

take a look at here at the size of the superior

1:09

frontal sulcus compared to this prior

1:12

exam just one year earlier.

1:15

There also is some atrophy in

1:17

the parietal lobes as well.

1:18

But the frontal lobes and the temporal

1:20

lobes really stand out.

1:22

This is the FDG brain PET

1:24

CT portion of this exam.

1:26

And this demonstrates statistically significant

1:31

hypometabolism in the bilateral frontal lobes as

1:35

well as within the bilateral temporal lobes.

1:38

Look how prominent this is in the

1:39

bilateral temporal lobes. So,

1:42

case number eight was again a 74-year-old with

1:44

personality changes and memory loss.

1:46

This was the FDG brain PET CT in 2018.

1:49

And we see the cortical hypometabolism in the

1:54

bilateral temporal lobes and bilateral

1:56

frontal lobes. By the way,

1:58

I've mentioned the MIM neuroanalysis

1:59

software several times,

2:01

which is what I use to judge statistical

2:03

significance for patient age.

2:06

the MIM neuroanalysis software.

2:08

You see here that these values,

2:10

these z score values, are in the temporal lobes,

2:14

2.51 on the left and 4.9 on the right,

2:18

and in the frontal lobes, that's negative.

2:20

These are negative values.

2:21

And in the frontal lobes,

2:23

2.98 below the mean and 2.88 on the right side.

2:28

And then the metabolism was within normal limits

2:31

in the parietal and occipital lobes.

2:33

So this type of pattern you see here should

2:36

raise red flags to what this might be.

2:39

Again, the amyloid PET CT was negative.

2:42

And here's another example here where we're

2:45

looking at the atrophy and the marked

2:47

progression in atrophy between 2017 and 2018.

2:51

Here's again the frontal the appearance

2:54

of the frontal in 2017 versus 2018.

2:58

Significant progression in frontal lobe.

2:59

Atrophy.

3:00

So this patient has frontotemporal dementia.

3:03

There are three subtypes of frontotemporal

3:05

dementia. The behavioral variant,

3:08

which manifests as personality and behavioral

3:10

changes, which is what this patient had.

3:12

And this is by far the most common subtype

3:15

of frontotemporal dementia.

3:17

You can also have primary progressive aphasias,

3:20

a nonfluent PPA,

3:21

which is hesitant or labored

3:23

or agrammatic speech,

3:25

and a semantic primary progressive aphasia,

3:27

which is loss of ability to understand

3:29

or formulate words.

3:31

And so the 30% of FTD cases are hereditary,

3:37

most commonly the behavioral variant,

3:39

and it's autosomal dominant.

3:42

And there are several genetic mutations

3:44

that can be seen with FTD.

3:48

It's a younger onset than Alzheimer's disease.

3:50

So 45 to 60 year olds is sort of the common

3:53

age bracket for initial presentation.

3:56

It's much less common than Alzheimer's disease.

3:58

So, for example,

3:59

there's 55,000 people living with FTD in the US

4:03

versus, again, 6 million with Alzheimer's.

4:06

But it is the most common dementia in

4:08

young patients under the age of 60.

4:10

The survival rate is typically six

4:12

to eight years after diagnosis.

4:15

They should have a negative amyloid PET.

4:18

And there are other diseases that are part of

4:20

the FTD spectrum that can primarily

4:23

involve motor changes,

4:24

and these would include ALS and corticobasal

4:28

degeneration and progressive supranuclear palsy.