Acta Neuropathologica

, Volume 114, Issue 1, pp 31–38 | Cite as

Frontotemporal lobar degeneration: clinical and pathological relationships

  • Julie SnowdenEmail author
  • David Neary
  • David Mann


Frontotemporal lobar degeneration (FTLD) encompasses a heterogeneous group of clinical syndromes that include frontotemporal dementia (FTD), frontotemporal dementia with motor neurone disease (FTD/MND), progressive non-fluent aphasia (PNFA), semantic dementia (SD) and progressive apraxia (PAX). Clinical phenotype is often assumed to be a poor predictor of underlying histopathology. Advances in immunohistochemistry provide the opportunity to re-examine this assumption. We classified pathological material from 79 FTLD brains, blind to clinical diagnosis, according to topography of brain atrophy and immunohistochemical characteristics. There were highly significant relationships to clinical syndrome. Atrophy was predominantly frontal and anterior temporal in FTD, frontal in FTD/MND, markedly asymmetric perisylvian in PNFA, asymmetric bitemporal in SD and premotor, parietal in PAX. Tau pathology was found in half of FTD and all PAX cases but in no FTD/MND or SD cases and only rarely in PNFA. FTD/MND, SD and PNFA cases were ubiquitin and TDP-43 positive. SD cases were associated with dystrophic neurites without neuronal cytoplasmic or intranuclear inclusions (FTLD-U, type 1), FTD/MND with numerous neuronal cytoplasmic inclusions (FTLD-U, type 2 ) and PNFA with neuronal cytoplasmic inclusions, dystrophic neurites and neuronal intranuclear inclusions (FTLD-U, type 3). MAPT mutations were linked to FTD and PGRN mutations to FTD and PNFA. The findings demonstrate predictable relationships between clinical phenotype and both topographical distribution of brain atrophy and immunohistochemical characteristics. The findings emphasise the importance of refined delineation of both clinical and pathological phenotype in furthering understanding of FTLD and its molecular substrate.


Frontotemporal dementia Progressive non-fluent aphasia Semantic dementia TDP-43 proteinopathy Tauopathy 


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Clinical Neurosciences Research Group, School of Translational MedicineUniversity of Manchester and Greater Manchester Neurosciences Centre, Salford Royal Foundation TrustSalfordUK
  2. 2.Cerebral Function Unit, Greater Manchester Neuroscience CentreHope HospitalSalfordUK

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