What are the key clinical features that differentiate frontotemporal dementia (FTD) from other types of dementia in a primary care setting?

Key clinical features that differentiate frontotemporal dementia (FTD) from other types of dementia in primary care include prominent early changes in behaviour and personality, language difficulties, and relative preservation of memory in the initial stages. Patients with FTD often present with marked behavioural variant symptoms such as disinhibition, apathy, loss of empathy, compulsive behaviours, and changes in social conduct, which are less typical in Alzheimer's disease or vascular dementia NICE NG97. Language variants of FTD, including progressive non-fluent aphasia and semantic dementia, manifest as progressive difficulties in speech production or word comprehension, distinguishing them from the predominant memory impairment seen in Alzheimer's disease Cardarelli et al. 2010.

In contrast to Alzheimer's disease, where verbal episodic memory impairment is a hallmark early feature, FTD patients may have relatively preserved episodic memory initially, with cognitive decline more focused on executive function and social cognition NICE NG97. Neuropsychological testing can help clarify these differences when the diagnosis is uncertain NICE NG97.

Additionally, FTD tends to have an earlier age of onset compared to other dementias and may have a stronger genetic component, which should be considered during assessment NICE NG97. Structural imaging may show frontal and/or temporal lobe atrophy, but imaging alone cannot definitively diagnose FTD and should be interpreted alongside clinical features NICE NG97.

Overall, in primary care, the key differentiators for FTD are early and prominent behavioural changes and language impairments with less early memory loss, which contrasts with the typical presentation of other dementias such as Alzheimer's disease or vascular dementia NICE NG97; Cardarelli et al. 2010. Emerging research also highlights the importance of detailed neuropsychological and neuroimaging assessments to refine diagnosis, especially in semantic dementia, a subtype of FTD Ding et al. 2024.