Which diagnostic tools and assessments are recommended for confirming a diagnosis of frontotemporal dementia in adults?

To confirm a diagnosis of frontotemporal dementia (FTD) in adults, a comprehensive specialist assessment is recommended, typically conducted in a dementia diagnostic service such as a memory clinic or community old age psychiatry service. This assessment should include a detailed history focusing on cognitive, behavioural, and psychological symptoms, ideally supplemented by information from someone who knows the person well. A physical examination and appropriate blood and urine tests should be performed to exclude reversible causes of cognitive decline. Cognitive testing using validated instruments is also essential, although normal scores do not exclude dementia ¹.

For subtype diagnosis, including FTD, the use of validated clinical criteria is advised, such as the International Frontotemporal Dementia Consortium criteria for behavioural variant FTD and the International FTD criteria for progressive non-fluent aphasia and semantic dementia ¹.

Structural brain imaging (CT or MRI) should be offered to rule out reversible causes and assist with subtype diagnosis, unless the dementia is well established and the subtype is clear. If the diagnosis remains uncertain and FTD is suspected, further functional imaging with FDG-PET or perfusion SPECT is recommended to support the diagnosis ¹. However, it is important not to rule out FTD solely based on imaging results, as these can be inconclusive ¹.

Neuropsychological testing may be considered when it is unclear whether cognitive impairment is present, whether it is due to dementia, or to clarify the subtype diagnosis ¹.

Genetic testing should be considered in some cases, as FTD has a known genetic component in a subset of patients ¹.

Recent literature emphasizes the diagnostic complexity of FTD and the importance of distinguishing behavioural variant FTD from psychiatric disorders, recommending a multidisciplinary approach that integrates clinical, neuropsychological, and imaging data to improve diagnostic accuracy (Ducharme et al., 2020; Antonioni et al., 2025). This supports the guideline recommendations for comprehensive specialist assessment and the use of specific diagnostic criteria and imaging modalities.