Background: Frontotemporal dementia (FTD) represents the second most frequent early
onset of dementia in people younger than 65 years. The main syndromes encompassed by the term
FTD are behavioral variant of Frontotemporal dementia (bvFTD), non-fluent variant primary progressive
aphasia (nfvPPA) and semantic variant (SD).
Aims: To assess the bvFTD and SD, which represent the most common subtypes of FTD, using
visual rating scales.
Methods: Brain MRI exams of 77 patients either with bvFTD (n=43) or SD (n=34) were evaluated.
The rating scales used were: Global cortical atrophy (GCA), Fazekas Scale: periventricular (PV)
and white matter (WM) changes, Koedam rating scale and visual scales regarding specific cortical
regions: dorsofrontal (DF), orbitofrontal (OF), anterior cingulate (AC), basal ganglia (BG), anterior-
temporal (AT), insula, lateral-temporal (LT), entorhinal (ERC), perirhinal (PRC), anterior fusiform(
AF), anterior hippocampus (AHIP) and posterior hippocampus (PHIP). Both Left (L) and
Right (R) hemispheres were evaluated.
Results: R-OF (p=0.059), L-OF (p<0.0005), L-AT (p=0.047) and L-AHIP (p=0.007) have a statistically
significant effect on the variable occurrence of SD compared to bvFTD. The indicators with
the highest value of the area under the curve (AUC) were R-AC (0.829), L-OF (0.808), L-AC
(0.791) and L-AF (0.778). Highest sensitivity was achieved by R-OF (97%) and L-AF (75%).
Highest specificity was achieved by L-OF (95%), L-AT (91%) followed by R-AC (84%). Best
combination of sensitivity and specificity was achieved by L-AF (74%-79%), L-OF (56%-95%)
and R-OF (97%-42%). Best combination of PPV and NPV was achieved by L-OF (90%-73%), LAT
(83%-72%) and R-AC (77%-77%).
Conclusion: Visual rating scales can be a practical diagnostic tool in the characterization of patterns
of atrophy in FTLD and may be used as an alternative to highly technical methods of quantification.