Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort

Dement Geriatr Cogn Disord. 2016;41(1-2):16-26. doi: 10.1159/000441023. Epub 2015 Oct 17.


Background: The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease.

Aims: We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF).

Methods: We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change.

Results: Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses.

Conclusion: Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / cerebrospinal fluid*
  • Cross-Sectional Studies
  • Female
  • Fluorodeoxyglucose F18
  • Frontal Lobe / diagnostic imaging
  • Frontal Lobe / pathology*
  • Frontotemporal Dementia / cerebrospinal fluid
  • Frontotemporal Dementia / diagnosis*
  • Frontotemporal Dementia / psychology
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neuroimaging* / methods
  • Neuropsychological Tests
  • Positron-Emission Tomography*
  • Prospective Studies


  • Biomarkers
  • Fluorodeoxyglucose F18