Frontotemporal Dementia

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Presentation transcript:

Frontotemporal Dementia Thomas G. Bowers, Ph.D. 11/24/2018

Frontal Lobes Executive functions Include attention, problem solving, hypothesis testing, social cognition and judgment Relatively recent evolutionary development Last structure to mature and develop (~25 years old) 11/24/2018

Pineas Gage 11/24/2018

Other Views of Gage 11/24/2018

Gages Actual Skull 11/24/2018

Impact of Frontal Lesion Gage’s behavior became socially very inappropriate Displayed consistently poor social judgment 11/24/2018

Basic Gross Anatomy Motor, Premotor and Prefrontal regions Many projections to premotor from other cortical regions Extensive limbic projections to the premotor region 11/24/2018

Frontal Organization From anterior 1. Prefrontal 2. Premotor 3. Motor 11/24/2018

Frontal Organization Prefrontal Does not receive any primary sensory input except olfactory stimuli Extensive projections from other cortical regions Extensive projections from the limbic system Reciprocating projections 11/24/2018

Frontal Organization Premotor Broca’s Area Critical convergence zone 11/24/2018

Frontal Organization Motor Linked with the premotor cortex, sensory cortex, and the basal ganglia Gives rise to pyramidal tacts that descend subcortically 11/24/2018

Frontal Organization Prefrontal – Limbic Links Includes amygdala, hippocampus, thalamus, temporal lobe pole Involves social processing as empathy, moral emotions, interpersonal judgment 11/24/2018

Frontal Organization Prefrontal – Subcortical Links Thalamofrontal Frontial-striatal Difficulties here can include disinhibition, perserveration, loss of motivation, attentional disorders, hemispatial neglect 11/24/2018

Vulnerable to Impairment Traumatic brain injury Axonal shearing, contusions, laceration, hemorrhage Stroke ACA, rostral aspects of MCA Aneurysm Neurodegenerative disease Pick’s Frontotemporal dementia 11/24/2018

Vulnerable to Impairment Psychiatric disorders Hydroencephalus Brain tumors Orbitofrontal meningioma 11/24/2018

Frontal Region is Vulnerable Frontal pole and anterior horn of the temporal lobe in particular are sensitive to lesions Coup injury Contrecoup Shearing injuries Small petechial hemorrhage 11/24/2018

Degenerative Disorders Pick’s Disease Atrophy has an affinity for the frontotemporal region Development of Pick’s bodies Frontotemporal dementia Not frequent, but 10% of degenerative dementias 11/24/2018