FRONTOTEMPORAL DEMENTIA (FTD), PICK'S DISEASE -
Type A - Adult
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ALTERNATE NAMES
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Frontotemporal Lobar Degeneration; Dementia with Lobar Atrophy and Neuronal Cytoplasmic
Inclusions; Diffuse Degenerative Cerebral Disease; Lobar Atrophy of the brain; Pick
Disease of the brain-Type 1; Wilhelmsen-Lynch Disease; FTD
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DESCRIPTION
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Frontotemporal Dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal
anterior lobes of the brain. Originally known as Pick's disease, the name and classification of FTD has been a topic of discussion for over a century.
The current designation of the syndrome groups together Pick's disease, primary progressive
aphasia, and semantic dementia as FTD. The presence of abnormalities in the nerve
cells of the brain, called Pick bodies, distinguishes frontal lobe dementia from other
types of dementia. There is a strong genetic component to the disease; FTD often runs
in families.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing:
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Clinical assessment and blood tests;
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Neurological exam that checks awareness and responsiveness, vital signs, reflexes,
sensory responses and coordination;
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Neuropsychological testing, which assesses memory, ability to reason and judge, problem-solving
skills and language skills;
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Brain imagining, such as MRI and CT, may demonstrate shrinkage of the frontal and
temporal lobes and also help exclude other causes of dementia such as strokes and
brain tumors; and
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PET and SPEC tomography testing may be used to evaluate brain activity.
Physical findings: The symptoms of FTD depend on the areas of the brain affected. Most can be divided
into one of two categories: behavior or language.
Common behavioral symptoms of FTD may include:
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Apathy, or lack of interest or enthusiasm in activities;
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Lack of inhibition or restraint;
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Neglect of personal hygiene and care; and
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Common language-related symptoms of FTD include:
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Difficulty speaking or understanding speech;
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Language recall problems;
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Loss of reading and writing skills; and
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Difficulty with social interactions.
ICD-9: 331.1
ICD-10:G31.0
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PROGRESSION
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The outcome for individuals with FTD is poor. The disease progresses steadily and
often rapidly, ranging from less than 2 years in some individuals to more than 10
years in others. Eventually some individuals with FTD will need 24-hour care and monitoring
at home or in an institutionalized care setting.
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TREATMENT
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No treatment has been shown to slow the progression of FTD. Behavior modification
may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous
behaviors could require medication. Anti-depressants and tranquilizers have been shown
to improve some symptoms.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Brain imagining, such as MRI and CT, may demonstrate shrinkage of the frontal and
temporal lobes and also help exclude other causes of dementia such as strokes and
brain tumors;
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PET and SPEC tomography testing may be used to evaluate brain activity;
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Clinical evidence describing general physical and blood tests to rule out thyroid
disease, vitamin B12 deficiency, and syphilis;
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Consideration of family history is appropriate as there is often a strong family predisposition
for FTD;
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Documentation of a clinically appropriate medical history;
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Neurological findings consistent with the diagnosis of FTD; and
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The results of any electrophysiological and neuroimaging testing may be considered.
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Suggested Listings for
Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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11.17
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12.02
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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