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Yıl:2017; Cilt: 10; Sayı: 1>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2017;10(1):9-21
Major ve Minor Nörokognitif Bozukluklar: Frontotemporal Demans
EG Öğüten
İstanbul Bilim Üniversitesi, İstanbul
Frontotemporal demans (FTD), hastanın sosyal ve mesleki ilişkilerinde ciddi sorunlara yol açan, belirgin davranış ve kişilik değişiklikleri ve/veya çeşitli dil işlev bozuklukları ile giden bir grup sendromun ortak adıdır. Alzheimer Hastalığı'ndan sonra en sık görülen erken başlangıçlı nörodejeneratif demanstır. Tüm demansların %10-20'sini oluşturduğu belirtilmektedir. Olguların %30-50'sinin ailesel olduğu gösterilmiştir. Ailesel geçişten sorumlu tutulan başlıca genetik mutasyonlar mikrotübülle ilişkili protein tau (MAPT), progranulin (PGRN), C9orf72 (Chromosome 9 open reading frame 72), valosin içeren protein (VCP) ve yüklü multiveziküler protein 2B (CHMP2B) genlerinde görülür. İlişkili nöropatolojik bulgular heterojendir ve FTD başlıca 5 nöropatolojik alt tipe sınıflandırılmıştır. Ayrıca FTD'nin tanımlanan 4 klinik alt tipi davranışsal varyant FTD, akıcı olmayan/tutuk, semantik ve logopenik dilsel varyant FTD'dir. Genellikle orta yaşlarda başlar. Klinik seyri değişkenlik gösterir. Çoğu zaman işlevselliği belirgin derecede etkiler. Sağ kalım ortalama olarak hastalığın ilk belirtileri ortaya çıkmaya başladıktan sonra 6-8yıldır. FTD'ye özgü bir tedavi henüz yoktur. Bu gözden geçirmede uluslararası yeni sınıflandırma sistemlerine göre FTD ile ilgili tanımlamalar ve kriterler, DSM-5'teki yenilikler, sendromların klinik görünümleri, altta yatan moleküler patoloji ve genetik mutasyonlarla ilgili gelişmeler ve son olarak da hastalığın seyri ve ayırıcı tanıda önemli olan noktaların ele alınması amaçlanmıştır.
Major and Minor Neurocognitive Disorders: Frontotemporal Dementia
Frontotemporal Dementia (FTD) is a common name for a group of syndroms that impairment in social and occupational functions of patients is prominent as a result of significant change in personality and behaviour and/or impairment in various language functions. It is the second most common cause of early onset neurodegenerative dementias following Alzheimer Disease (AD). FTD is responsible 10-20% of all dementia types. 30-50% of cases are known to be famial. Major genetic mutations found to be related with this famial penetrance are seen in the genes microtubule associated protein tau (MAPT), progranulin (PGRN), C9orf72 (Chromosome 9 open reading frame 72), valocin containing protein (VCP) and charged multivesicular protein 2B (CHMP2B). FTD is pathologically heterogenous and is classified into 5 pathological subtypes. On the other hand it is classified into 4 clinical subtypes named behavioral variant, nonfluent variant, semantic variant and logopenic variant FTD. Onset is typically in the middle years of life, progression of the disease is variable, and most of the time functionality if effected obviously. Survival is about 6-8 years after the onset of symptoms. There has not found a spesific treatment for FTD yet. In this review the aim is to present new descriptions and international consensus criteria, novelty in DSM-5, clinical presentations of the syndroms, developments in neuropatology and genetics of FTD and finally clinical progression of the disease and the distinctive features in differential diagnosis.

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