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Yıl:2004; Cilt: 5; Sayı: 2>> Özet
Türkiye Klinikleri Psikiyatri Dergisi; 2004;5(2):116-121
Frontotemporal demanslar
S Demirci, D Kuzugüdenlioğlu
Süleyman Demirel Üniversitesi Tıp Fakültesi Psikiyatri AD, ISPARTA
Frontotemporal demans Alzheimer Hastalığından sonra en sık görülen dejeneratif demans tipidir. Semptomlar presenil dönemde ortaya çıkar. Sıklıkla familyaldir. Klinik bulguları oldukça heterojendir. Anatomik lokalizasyona göre başlıca iki klinik tipten sözedilebilir: esas olarak kişilik değişikliği ve yönetici işlev bozukluğu ile karakterli frontal tip (fv-FTD) ve ilerleyici lisan bozukluğu ile karakterli temporal tip (tv-FTD). Frontal tipte semptomlar geniş bir yelpaze içinde dağılım gösterir. Apati ve abuli gözlenen hastalarda dorsolateral prefrontal kortekste, dizinhibisyon ve dürtüsel davranışın ön planda olduğu hastalarda orbitomedial frontal lobdaki etkilenme daha belirgindir. Primer progresif afazide (PPA) başlangıç sıklıkla transkortikal motor afazi şeklindedir. Semantik demansda ise PPA'dan farklı olarak ilerleyici akıcı bir afazi mevcuttur. Frontotemporal demansın familyal geçiş gösterdiği bilinmekle birlikte hastalığa özgül bir mutasyon saptanamamıştır. 17'nci kromozomda tau proteininin kodlandığı bölgeyle bir ilişkiden sözedilmektedir. FTD'da hastalığın erken dönemlerde psikopatolojik tabloları taklit ediyor olması tanıda gecikmelere yol açmaktadır. Bu hastalıkta, nöroloji ve psikiyatri kliniklerinin işbirliği içinde çalışması gereklidir. Ancak bu şekilde, diğer olası nedenler dışlandıktan sonra nöropsikolojik değerlendirme ile daha erken dönemde doğru tanıya ulaşılabilecektir.
Frontotemporal Dementias
Frontotemporal dementia is the most common neurodegenerative dementia after Alzheimer's disease. Clinical features of the disease has an onset in presenium. It is highly familial. Clinical findings are heterogenous. There are mainly two clinical presentations according to anatomic localization: frontal variant characterized by progressive personality change and dysexecutive function and temporal variant characterized by progressive [language] disorder. The frontal variant involves a wide spectrum of behavioral symptoms. Among the frontal variant patients, those with symptoms of apathy and abulia exhibit dorsolateral prefrontal cortex atrophy; while the patients with disinhibition and impulsive behavior reveal an orbitomedial frontal lobe pathology. Generally, the initiation of progressive primary aphasia is in the form of transcortical motor aphasia. On the contrary, progressive fluent aphasia is observed in semantic dementia. Although we know that FTD shows a familial transmission, no specific mutation has been shown to be responsible. A possible relationship with the region coding the tau protein on the 17th chromosome has been suggested. The diagnosis of the disorder is generally delayed since it generally mimics psychopathological disorders. Neurologists and psychiatrists should perform an integrative approach in this disorder. Only with this co-operation will it be possible to reach an absolute diagnosis via neuropsychological tests applied relatively early in the disease.

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