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Behavioural Variant FTD — RACP Adult Medicine MCQ

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ModerateNeurologyBehavioural Variant FTDRACP Adult Medicine

A 58-year-old man presents with progressive personality change over 2 years: social disinhibition, apathy, loss of empathy, compulsive behaviours (hoarding), and hyperorality (eating non-food items). His memory is relatively preserved. He has no parkinsonism. MRI shows frontal and anterior temporal lobe atrophy. What is the most likely dementia subtype?

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Correct answer: B — Frontotemporal dementia (behavioural variant)

Progressive behavioural change (disinhibition, apathy, loss of empathy, compulsive/repetitive behaviours, hyperorality/dietary changes) with relatively preserved memory and frontal/anterior temporal atrophy is behavioural variant frontotemporal dementia (bvFTD). It typically presents younger than AD (45-65). FTLD can be caused by tau (MAPT), TDP-43, or FUS pathology. No proven pharmacotherapy exists. Management is supportive with behavioural strategies and caregiver support.

Reference: Rascovsky 2011 bvFTD Criteria; eTG Neurology 2024