Frontotemporal Lobar Degeneration (Ftld) is an important component in the neurobiology of neurodegenerative diseases. This page provides detailed information about its structure, function, and role in disease processes.
Frontotemporal Lobar Degeneration (FTLD) is a pathological term encompassing the group of neurodegenerative diseases that primarily affect the frontal and temporal lobes of the brain. FTLD is the neuropathological substrate underlying [Frontotemporal Dementia (FTD)[/diseases/[ftd[/diseases/[ftd[/diseases/[ftd--TEMP--/diseases)--FIX--, which is the second most common cause of early-onset dementia after [Alzheimer's disease[/diseases/[alzheimers[/diseases/[alzheimers[/diseases/[alzheimers--TEMP--/diseases)--FIX-- in individuals under 65. Whereas FTD describes clinical syndromes, FTLD refers specifically to the underlying molecular pathology characterized by abnormal protein inclusions in [neurons[/entities/[neurons[/entities/[neurons[/entities/[neurons--TEMP--/entities)--FIX-- and glial cells.
FTLD is classified into major subtypes based on the predominant protein aggregation: tau (FTLD-tau, [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- (FTLD-TDP), and [FUS[/entities/[fus[/entities/[fus[/entities/[fus--TEMP--/entities)--FIX-- (FTLD-FUS). This molecular classification has revolutionized the understanding of Frontotemporal Dementia spectrum disorders and has critical implications for therapeutic development, genetic counseling, and clinical trial design. Approximately 40% of FTLD cases are familial, making it one of the most heritable forms of neurodegenerative disease. The three most commonly mutated genes—[MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX--, [GRN[/genes/[grn[/genes/[grn[/genes/[grn--TEMP--/genes)--FIX--, and [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX--—together account for the majority of familial cases and each maps onto specific FTLD pathological subtypes.
FTLD-tau encompasses diseases in which the primary pathological protein is hyperphosphorylated tau. [Tau[/entities/[tau-protein[/entities/[tau-protein[/entities/[tau-protein--TEMP--/entities)--FIX-- is a [microtubule-associated protein] that stabilizes the cytoskeleton. In FTLD-tau, abnormal tau aggregates form neurofibrillary tangles, Pick bodies, tufted [astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes--TEMP--/cell-types)--FIX--, and other inclusion types depending on the specific tauopathy.
Tauopathies are further subclassified based on the predominant tau isoform:
- [Pick's Disease[/diseases/[pick-disease[/diseases/[pick-disease[/diseases/[pick-disease--TEMP--/diseases)--FIX--: The prototypical 3R tauopathy, characterized by Pick bodies—round, circumscribed, silver-staining intraneuronal inclusions—predominantly in the frontal and temporal cortices, [hippocampus[/brain-regions/[hippocampus[/brain-regions/[hippocampus[/brain-regions/[hippocampus--TEMP--/brain-regions)--FIX--, and dentate gyrus. Clinically presents as behavioral variant FTD (bvFTD) or progressive nonfluent aphasia.
- [Progressive Supranuclear Palsy (PSP)[/diseases/[progressive-supranuclear-palsy[/diseases/[progressive-supranuclear-palsy[/diseases/[progressive-supranuclear-palsy--TEMP--/diseases)--FIX--: Characterized by tufted [astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes--TEMP--/cell-types)--FIX--, globose neurofibrillary tangles, and tau-positive threads. Primarily affects the [basal ganglia[/brain-regions/[basal-ganglia[/brain-regions/[basal-ganglia[/brain-regions/[basal-ganglia--TEMP--/brain-regions)--FIX--, [brainstem[/brain-regions/[brainstem[/brain-regions/[brainstem[/brain-regions/[brainstem--TEMP--/brain-regions)--FIX--, and [cerebellum[/brain-regions/[cerebellum[/brain-regions/[cerebellum[/brain-regions/[cerebellum--TEMP--/brain-regions)--FIX--.
- [Corticobasal Degeneration (CBD)[/diseases/[corticobasal-degeneration[/diseases/[corticobasal-degeneration[/diseases/[corticobasal-degeneration--TEMP--/diseases)--FIX--: Features astrocytic plaques, tau-positive threads, and ballooned [neurons[/entities/[neurons[/entities/[neurons[/entities/[neurons--TEMP--/entities)--FIX-- (achromatic [neurons). Affects cortical and [subcortical structures] asymmetrically.
- [Argyrophilic Grain Disease (AGD)[/diseases/[argyrophilic-grain-disease[/diseases/[argyrophilic-grain-disease[/diseases/[argyrophilic-grain-disease--TEMP--/diseases)--FIX--: Characterized by spindle-shaped argyrophilic grains in medial temporal structures. Often presents as late-onset amnestic syndrome.
- Chronic traumatic encephalopathy (CTE): Associated with repetitive [traumatic brain injury[/diseases/[traumatic-brain-injury[/diseases/[traumatic-brain-injury[/diseases/[traumatic-brain-injury--TEMP--/diseases)--FIX--; features unique perivascular tau deposits at the depths of cortical sulci.
- [Primary Age-Related Tauopathy (PART)[/diseases/[primary-age-related-tauopathy[/diseases/[primary-age-related-tauopathy[/diseases/[primary-age-related-tauopathy--TEMP--/diseases)--FIX--: Medial temporal neurofibrillary tangles in the absence of significant [amyloid-beta[/entities/[amyloid-beta[/entities/[amyloid-beta[/entities/[amyloid-beta--TEMP--/entities)--FIX-- deposits.
Mutations in the [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- gene] (chromosome 17q21.31) cause autosomal dominant FTLD-tau. Over 50 pathogenic [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- mutations have been identified, affecting either tau splicing (altering the 3R/4R ratio) or the propensity of tau to aggregate. Common mutations include P301L, V337M, R406W, and N279K.
FTLD-TDP is the most common pathological subtype, characterized by inclusions of hyperphosphorylated, ubiquitinated, and abnormally cleaved [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- (TAR DNA-binding protein 43 kDa). [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- is normally a nuclear protein involved in [RNA metabolism[/mechanisms/[rna-metabolism[/mechanisms/[rna-metabolism[/mechanisms/[rna-metabolism--TEMP--/mechanisms)--FIX--; in FTLD-TDP, it is mislocalized to the cytoplasm where it forms pathological aggregates.
FTLD-TDP is subdivided into five types (A–E) based on the morphology and distribution of [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX---immunoreactive inclusions:
- Morphology: Abundant neuronal cytoplasmic inclusions (NCIs), short dystrophic neurites (DNs), and moderate neuronal intranuclear inclusions (NIIs).
- Distribution: Superficial cortical layers (layer II) of frontal and temporal cortices.
- Genetics: Strongly associated with [GRN (progranulin)[/genes/[GRN[/genes/[GRN[/genes/[GRN[/genes//genes/[GRN--TEMP--/genes/)--FIX-- mutations. Also seen in some [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- expansion carriers.
- Clinical: Most often presents as progressive nonfluent aphasia or behavioral variant FTD.
- Morphology: Moderate NCIs with few DNs and very rare NIIs. Granular, diffuse cytoplasmic staining.
- Distribution: All cortical layers, with subcortical involvement including [hippocampus[/brain-regions/[hippocampus[/brain-regions/[hippocampus[/brain-regions/[hippocampus--TEMP--/brain-regions)--FIX--, [brainstem[/brain-regions/[brainstem[/brain-regions/[brainstem[/brain-regions/[brainstem--TEMP--/brain-regions)--FIX--, and [spinal cord[/brain-regions/[spinal-cord[/brain-regions/[spinal-cord[/brain-regions/[spinal-cord--TEMP--/brain-regions)--FIX--.
- Genetics: Strongly associated with [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- repeat expansions. Also seen in sporadic [ALS[/diseases/[als[/diseases/[als[/diseases/[als--TEMP--/diseases)--FIX---FTD.
- Clinical: Behavioral variant FTD, FTD-ALS, or Motor [Neuron[/entities/[neurons[/entities/[neurons[/entities/[neurons--TEMP--/entities)--FIX-- Disease.
- Morphology: Long, thick dystrophic neurites with few NCIs; NIIs are rare.
- Distribution: Superficial cortical layers, especially temporal [cortex[/brain-regions/[cortex[/brain-regions/[cortex[/brain-regions/[cortex--TEMP--/brain-regions)--FIX--.
- Genetics: Usually sporadic (no known genetic associations).
- Clinical: [Semantic dementia[/diseases/[semantic-dementia[/diseases/[semantic-dementia[/diseases/[semantic-dementia--TEMP--/diseases)--FIX-- (semantic variant PPA) is the hallmark clinical presentation.
- Prognosis: Slowest disease progression among FTLD-TDP subtypes (mean duration ~9.7 years).
- Morphology: Abundant lentiform NIIs and short DNs with few NCIs.
- Distribution: Neocortex.
- Genetics: Exclusively associated with [VCP[/genes/[vcp[/genes/[vcp[/genes/[vcp--TEMP--/genes)--FIX-- mutations.
- Clinical: Inclusion body myopathy with Paget disease and Frontotemporal Dementia (IBMPFD).
- Morphology: Granulofilamentous NCIs with abundant fine granular neuritic pathology across all cortical layers.
- Distribution: Widespread cortical and subcortical involvement.
- Clinical: Rapidly progressive frontotemporal degeneration with remarkably short disease duration (~2.1 years).
[FUS[/entities/[fus[/entities/[fus[/entities/[fus--TEMP--/entities)--FIX-- pathology accounts for a minority of FTLD cases but has distinctive clinicopathological features (Mackenzie et al., 2011):
- FUS protein: FUS is an RNA-binding protein involved in transcription, splicing, and DNA repair; cytoplasmic aggregation impairs these nuclear functions
- Subtypes: Three histological patterns — NIFID (neuronal intermediate filament inclusion disease), aFTLD-U (atypical FTLD with ubiquitin inclusions), and BIBD (basophilic inclusion body disease)
- Clinical presentation: Typically young-onset behavioral variant FTD (often before age 40), frequently with prominent psychiatric features
- Genetics: Most FTLD-FUS cases are sporadic; familial FUS mutations more commonly cause [ALS[/diseases/[als[/diseases/[als[/diseases/[als--TEMP--/diseases)--FIX-- than pure FTD
- Key distinction from FTLD-TDP: FUS inclusions are immunoreactive for all FET family proteins (FUS, EWSR1, TAF15), unlike [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- inclusions (Neumann et al., 2011)
¶ FTLD-UPS and FTLD-no
Rare cases of FTLD lack identifiable tau, [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX--, or FUS pathology:
- FTLD-[UPS] (ubiquitin proteasome system): Ubiquitin-positive, [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX--/FUS-negative inclusions. Associated with CHMP2B mutations.
- FTLD-no (no inclusions): Characterized by neuronal loss and gliosis without detectable protein inclusions. Extremely rare.
FTLD is among the most heritable neurodegenerative diseases. Approximately 30–50% of patients have a family history of dementia, psychiatric disease, or [ALS[/diseases/[als[/diseases/[als[/diseases/[als--TEMP--/diseases)--FIX--, and about 10–20% show autosomal dominant inheritance.
| Gene |
Chromosome |
Protein |
FTLD Subtype |
Clinical Phenotype |
| [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- |
17q21.31 |
Tau |
FTLD-tau |
bvFTD, PSP-like, CBS-like |
| [GRN[/genes/[grn[/genes/[grn[/genes/[grn--TEMP--/genes)--FIX-- |
17q21.32 |
[progranulin[/entities/[grn[/entities/[grn[/entities/[grn--TEMP--/entities)--FIX-- |
FTLD-TDP Type A |
bvFTD, nfvPPA, CBS-like |
| [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- |
9p21.2 |
[C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- |
FTLD-TDP Type A/B |
bvFTD, FTD-ALS, ALS |
The hexanucleotide repeat expansion (GGGGCC) in [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- is the most common genetic cause of both FTD and [ALS[/diseases/[als[/diseases/[als[/diseases/[als--TEMP--/diseases)--FIX--, accounting for ~25% of familial FTD and ~40% of familial ALS. Pathogenic expansions typically exceed 30 repeats (often hundreds to thousands). The expansion causes disease through multiple mechanisms:
- Loss of function: Reduced [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- protein expression, affecting [autophagy[/entities/[autophagy[/entities/[autophagy[/entities/[autophagy--TEMP--/entities)--FIX-- and lysosomal function.
- RNA toxicity: Sense and antisense RNA foci sequester RNA-binding proteins.
- [RAN translation[/mechanisms/[ran-translation[/mechanisms/[ran-translation[/mechanisms/[ran-translation--TEMP--/mechanisms)--FIX--: Repeat-associated non-AUG translation produces toxic dipeptide repeat proteins (DPRs): poly-GA, poly-GP, poly-GR, poly-PA, and poly-PR.
[GRN mutations] cause FTLD through haploinsufficiency—loss-of-function mutations reduce progranulin levels by ~50%, which is sufficient to cause disease. Progranulin is a secreted growth factor involved in [lysosomal function], [neuroinflammation[/mechanisms/[neuroinflammation[/mechanisms/[neuroinflammation[/mechanisms/[neuroinflammation--TEMP--/mechanisms)--FIX--, and neuronal survival. Over 70 pathogenic GRN mutations have been identified.
[MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- mutations] alter the 3R/4R tau ratio or increase tau aggregation propensity. Over 50 mutations have been described, most in exons 9–13 (the microtubule-binding repeat region). [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- mutations were the first genetic cause of FTLD identified (1998).
- TBK1: Loss-of-function mutations associated with FTLD-TDP and ALS.
- VCP: Mutations cause FTLD-TDP type D with inclusion body myopathy.
- CHMP2B: Rare mutations linked to FTLD-[UPS].
- TARDBP: Mutations in the gene encoding [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX--; primarily cause ALS with occasional FTLD.
- FUS: Mutations primarily cause ALS rather than FTLD, despite the FTLD-FUS neuropathological category.
- OPTN, SQSTM1 ([p62), UBQLN2: Rare causes of FTD-ALS spectrum.
FTLD is characterized by selective and often asymmetric atrophy of the frontal and temporal lobes. The pattern of atrophy correlates with the clinical syndrome:
- Behavioral variant FTD: Bilateral orbitofrontal, dorsolateral prefrontal, and anterior temporal atrophy with anterior cingulate involvement.
- Semantic variant PPA: Left-predominant anterior and inferior temporal lobe atrophy, including the [amygdala[/brain-regions/[amygdala[/brain-regions/[amygdala[/brain-regions/[amygdala--TEMP--/brain-regions)--FIX-- and temporal pole.
- Nonfluent variant PPA: Left-predominant inferior frontal (Broca area) and insular atrophy.
- FTD-ALS: Frontal atrophy with motor [cortex[/brain-regions/[cortex[/brain-regions/[cortex[/brain-regions/[cortex--TEMP--/brain-regions)--FIX-- involvement and [spinal cord[/brain-regions/[spinal-cord[/brain-regions/[spinal-cord[/brain-regions/[spinal-cord--TEMP--/brain-regions)--FIX-- anterior horn cell loss.
All FTLD subtypes share common features of neuronal loss, superficial cortical spongiosis (microvacuolation), and astrocytic gliosis. The distinguishing features are the protein-specific inclusions:
- Tau inclusions: Neurofibrillary tangles, Pick bodies, tufted [astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes[/cell-types/[astrocytes--TEMP--/cell-types)--FIX--, astrocytic plaques, coiled bodies.
- [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- inclusions: Neuronal cytoplasmic inclusions, dystrophic neurites, neuronal intranuclear inclusions; require immunohistochemistry for detection.
- FUS inclusions: Neuronal cytoplasmic and intranuclear inclusions; basophilic inclusions visible on H&E.
The relationship between clinical FTD syndromes and underlying FTLD pathology is probabilistic rather than deterministic:
| Clinical Syndrome |
Most Common Pathology |
Other Possible Pathologies |
| Behavioral variant FTD |
FTLD-tau, FTLD-TDP (equal) |
FTLD-FUS, AD |
| Semantic variant PPA |
FTLD-TDP Type C (>80%) |
FTLD-tau (rare) |
| Nonfluent variant PPA |
FTLD-tau (~60%) |
FTLD-TDP Type A, AD |
| FTD-ALS |
FTLD-TDP Type B (~95%) |
Rare exceptions |
| [CBS] |
FTLD-tau (CBD, PSP) (~50%) |
AD, FTLD-TDP |
| [PSP syndrome] |
FTLD-tau (PSP) (~90%) |
CBD, other |
¶ Protein Aggregation and Prion-Like Spreading
Evidence supports [prion-like propagation] of pathological proteins in FTLD. Both tau and [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- exhibit cell-to-cell transmission and templated misfolding:
- Tau propagation: Well-characterized trans-synaptic spread following anatomically connected networks, as demonstrated in tau propagation] studies.
- [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- propagation: More recently demonstrated; [TDP-43[/entities/[tdp-43[/entities/[tdp-43[/entities/[tdp-43--TEMP--/entities)--FIX-- seeds can induce aggregation in recipient cells.
[microglial[/cell-types/[microglia[/cell-types/[microglia[/cell-types/[microglia--TEMP--/cell-types)--FIX--/cell-types/microglia
- [CSF biomarkers[/diagnostics/[csf-biomarkers[/diagnostics/[csf-biomarkers[/diagnostics/[csf-biomarkers--TEMP--/diagnostics)--FIX--: Negative AD biomarkers (normal Aβ42/40 ratio) help distinguish FTLD from AD.
- Genetic testing: Recommended for patients with family history; panels include [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX--, GRN, [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX--.
- [Neuroimaging[/diagnostics/[neuroimaging[/diagnostics/[neuroimaging[/diagnostics/[neuroimaging--TEMP--/diagnostics)--FIX--: MRI patterns of atrophy and FDG-PET hypometabolism can suggest the underlying FTLD subtype.
Definitive diagnosis of FTLD requires neuropathological examination, as clinical syndromes do not reliably predict the underlying proteinopathy (Mackenzie et al., 2010):
- Neuropathological classification: Based on the predominant inclusion protein — FTLD-tau, FTLD-TDP, FTLD-FUS, or FTLD-[UPS] (rare)
- Brain biopsy: Rarely performed ante-mortem; may be considered when the differential includes treatable conditions (e.g., lymphoma, vasculitis)
- Autopsy: The gold standard; brain bank programs (NACC, Queen Square) provide standardized neuropathological assessment
- Immunohistochemistry: Panels including anti-tau, anti-TDP-43, anti-FUS, anti-ubiquitin, and anti-p62 antibodies classify the proteinopathy
- Emerging biomarkers: Seed amplification assays for tau and TDP-43 in CSF or tissue may eventually enable ante-mortem molecular diagnosis without biopsy
Understanding FTLD molecular subtypes is critical for therapeutic development:
- FTLD-tau: Tau-targeted therapeutics[/treatments/[tau-targeted-therapeutics[/treatments/[tau-targeted-therapeutics[/treatments/[tau-targeted-therapeutics--TEMP--/treatments)--FIX-- including tau immunotherapy, tau aggregation inhibitors, and [MAPT[/genes/[mapt[/genes/[mapt[/genes/[mapt--TEMP--/genes)--FIX-- antisense oligonucleotides ([ASOs[/treatments/[antisense-oligonucleotide-therapy[/treatments/[antisense-oligonucleotide-therapy[/treatments/[antisense-oligonucleotide-therapy--TEMP--/treatments)--FIX--).
- FTLD-TDP (GRN): Progranulin replacement strategies including gene therapy, progranulin-enhancing small molecules, and sortilin inhibitors (latozinemab).
- FTLD-TDP ([C9orf72): ASOs targeting the [C9orf72[/genes/[c9orf72[/genes/[c9orf72[/genes/[c9orf72--TEMP--/genes)--FIX-- repeat expansion; clinical trials underway.
- General: Anti-inflammatory approaches targeting [microglial activation] and lysosomal enhancement strategies.
- [Antisense Oligonucleotide Therapy[/treatments/[antisense-oligonucleotide-therapy[/treatments/[antisense-oligonucleotide-therapy[/treatments/[antisense-oligonucleotide-therapy--TEMP--/treatments)--FIX--
- [Csf Biomarkers[/diagnostics/[csf-biomarkers[/diagnostics/[csf-biomarkers[/diagnostics/[csf-biomarkers--TEMP--/diagnostics)--FIX--
- [Neuroimaging[/diagnostics/[neuroimaging[/diagnostics/[neuroimaging[/diagnostics/[neuroimaging--TEMP--/diagnostics)--FIX--
- [All Diseases[/[diseases[/[diseases[/[diseases[/[diseases[/diseases
The study of Frontotemporal Lobar Degeneration (Ftld) has evolved significantly over the past decades. Research in this area has revealed important insights into the underlying mechanisms of neurodegeneration and continues to drive therapeutic development.
Historical context and key discoveries in this field have shaped our current understanding and will continue to guide future research directions.
- FTLD refers to the neuropathologic umbrella (for example FTLD-TDP, FTLD-tau, and FTLD-FET) defined by proteinopathy and tissue pathology.
- FTD refers to the clinical syndrome domain (behavioral variant FTD, primary progressive aphasia variants, and overlap syndromes).
- A single clinical syndrome can map to multiple FTLD pathologies, and one pathology class can produce distinct clinical phenotypes.
Canonical split used in NeuroWiki:
-
Use this FTLD page for pathology-first classification and molecular substrates.
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Use [frontotemporal dementia[/diseases/[ftd[/diseases/[ftd[/diseases/[ftd--TEMP--/diseases)--FIX-- for syndrome-level diagnosis, trajectories, and patient-facing clinical framing.\n\n## FTLD vs FTD: Canonical Boundaries\n\n[Frontotemporal Lobar Degeneration (FTLD)[/diseases/[frontotemporal-lobar-degeneration[/diseases/[frontotemporal-lobar-degeneration[/diseases/[frontotemporal-lobar-degeneration--TEMP--/diseases)--FIX-- and [Frontotemporal Dementia[/diseases/[ftd[/diseases/[ftd[/diseases/[ftd--TEMP--/diseases)--FIX-- are related but not interchangeable terms:
-
FTLD refers to the neuropathologic umbrella (for example FTLD-TDP, FTLD-tau, and FTLD-FET) defined by proteinopathy and tissue pathology.
-
FTD refers to the clinical syndrome domain (behavioral variant FTD, primary progressive aphasia variants, and overlap syndromes).
-
A single clinical syndrome can map to multiple FTLD pathologies, and one pathology class can produce distinct clinical phenotypes.
Canonical split used in NeuroWiki:
-
Use this FTLD page for pathology-first classification and molecular substrates.
-
Use [Frontotemporal Dementia[/diseases/[ftd[/diseases/[ftd[/diseases/[ftd--TEMP--/diseases)--FIX-- for syndrome-level diagnosis, trajectories, and patient-facing clinical framing.\n\n## External Links
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PubMed - Biomedical literature
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Alzheimer's Disease Neuroimaging Initiative - Research data
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Allen Brain Atlas - Brain gene expression data
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- [Cairns NJ, et al. Neuropathologic diagnostic and nosologic criteria for frontotemporal lobar degeneration: consensus of the Consortium for Frontotemporal Lobar Degeneration. Acta Neuropathol. 2007;114(1]:5-22. DOI
- [Mackenzie IR, Neumann M. Molecular neuropathology of Frontotemporal Dementia: insights into disease mechanisms from postmortem studies. J Neurochem. 2016;138(Suppl 1]:54-70. DOI
- [Rohrer JD, et al. The genetics and neuropathology of frontotemporal lobar degeneration. Acta Neuropathol. 2012;124(3]:353-372. DOI
- [Greaves CV, Rohrer JD. An update on genetic Frontotemporal Dementia. J Neurol. 2019;266(8]:2075-2086. DOI
- [Neumann M, et al. Ubiquitinated TDP-43 in frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Science. 2006;314(5796]:130-133. DOI
- [Lee EB, et al. Expansion of the classification of FTLD-TDP: distinct pathology associated with rapidly progressive frontotemporal degeneration. Acta Neuropathol. 2017;134(1]:65-78. DOI
- [Rademakers R, Neumann M, Mackenzie IR. Advances in understanding the molecular basis of Frontotemporal Dementia. Nat Rev Neurol. 2012;8(8]:423-434. DOI
- [Josephs KA, et al. Frontotemporal lobar degeneration: pathogenesis, pathology and pathways to phenotype. Brain Pathol. 2021;31(2]:e12913. DOI
- [Baker M, et al. Mutations in progranulin cause tau-negative Frontotemporal Dementia linked to chromosome 17. Nature. 2006;442(7105]:916-919. DOI
- [Hutton M, et al. Association of missense and 5'-splice-site mutations in tau with the inherited dementia FTDP-17. Nature. 1998;393(6686]:702-705. DOI