Confusable diagnoses · PANCE / PANRE

Alzheimer Disease vs Frontotemporal Dementia

Alzheimer Disease and Frontotemporal Dementia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Alzheimer Disease vs Frontotemporal Dementia at a glance

  • Alzheimer Disease: Most common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology.
  • Frontotemporal Dementia: Early-onset dementia syndromes characterized by frontal-temporal degeneration; presents as behavioral change or progressive aphasia.
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Side-by-side comparison

FeatureAlzheimer DiseaseFrontotemporal Dementia
At a glanceMost common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology.Early-onset dementia syndromes characterized by frontal-temporal degeneration; presents as behavioral change or progressive aphasia.
Classic presentationProfound short-term memory loss with relatively preserved older memories and intact remote procedural memory; hippocampal/medial temporal atrophy on MRI.; Insidious onset, gradual progression over years; Early: episodic short-term memory loss (forgetting recent conversations, repeating questions, misplacing items), word-finding…Mid-50s patient with new socially inappropriate behavior, apathy, or progressive nonfluent speech, with disproportionate frontal/temporal atrophy on MRI.; Behavioral variant: disinhibition, apathy, loss of empathy, perseverative/compulsive behavior, hyperorality and dietary changes (sweet tooth), executive dysfunction;…
Workup / key labsNIA-AA: probable AD dementia = insidious onset, progressive cognitive decline, predominant memory or non-amnestic syndrome, exclusion of other causes. Biomarker-supported (CSF or imaging) AD if available.; Reversible-cause screen: CBC, BMP, calcium, LFTs, TSH, B12, folate; consider HIV, RPR, heavy metals if risk factors; Depression…Rascovsky 2011 (bvFTD): ≥3 of 6 behavioral features (disinhibition, apathy, loss of sympathy/empathy, perseverative/compulsive behavior, hyperorality, dysexecutive cognitive profile) + functional decline. Gorno-Tempini 2011 criteria for PPA variants. Imaging or genetic evidence supports diagnosis.; TSH, B12, HIV, RPR, ANA, ceruloplasmin…
ImagingMRI brain (or CT if MRI contraindicated): generalized and disproportionate medial temporal/hippocampal atrophy; excludes vascular disease, NPH, masses, subdural; FDG-PET: temporoparietal hypometabolism; Amyloid PET (florbetapir, florbetaben, flutemetamol): positive cortical amyloid; required for anti-amyloid therapy candidacy; Tau PET…MRI brain — frontal and/or anterior temporal atrophy (often asymmetric; left perisylvian in nfvPPA, anterior temporal in svPPA); FDG-PET — frontal and temporal hypometabolism; Amyloid PET (if available) — typically negative; helps distinguish from AD
First-line treatmentCholinesterase inhibitor (AChE inhibitor) — donepezil, rivastigmine (oral or transdermal patch), galantamine; modest symptomatic benefit for mild-to-moderate AD; rivastigmine and galantamine require BID dosing; side effects include nausea, diarrhea, anorexia, bradycardia, vivid dreams, urinary urgency; NMDA receptor antagonist —…No disease-modifying therapy approved; SSRIs (sertraline, citalopram, escitalopram, trazodone) — first-line for disinhibition, compulsive behaviors, irritability, and overeating; Atypical antipsychotics (quetiapine, olanzapine) — reserved for agitation/aggression refractory to non-pharmacologic strategies; caution due to extrapyramidal…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.