Frontotemporal Dementia Case Study

Using MRI Brain Volumetrics to Differentiate FTD from Alzheimer’s Disease

Clinical Overview

This case study highlights how automated MRI brain volumetrics can support the differentiation of frontotemporal dementia (FTD) from Alzheimer’s disease (AD) by objectively quantifying regional brain atrophy.

The patient is a 66-year-old man presenting with a gradual onset of personality changes and memory loss, a clinical profile that raises concern for a neurodegenerative process and often overlaps between FTD and Alzheimer’s disease.

Using a 3D volumetric T1-weighted MRI and a Neuroreader® volumetric analysis report, clinicians were able to identify a distinct pattern of brain volume loss consistent with frontotemporal dementia.

MRI Volumetric Findings

Disproportionate Frontal and Temporal Lobe Atrophy

Neuroreader® volumetric analysis revealed severe volume loss in the frontal and temporal lobes, with additional involvement of the hippocampus and amygdala.

Key findings included:

• Frontal lobe volume at the 0.6th percentile compared to age-matched normative data
• Marked temporal lobe atrophy, with volumes in the low percentiles
• Hippocampal volume loss, which can be seen in both FTD and Alzheimer’s disease
• Ventricular expansion, reflecting diffuse brain volume loss

Crucially, the frontal lobes were the most severely affected structures, a hallmark feature of frontotemporal dementia.

Preserved Parietal Lobes Support FTD Diagnosis

In contrast to the frontal and temporal lobes, the parietal lobes were relatively preserved.

This finding is clinically significant because:

• In Alzheimer’s disease, parietal lobe atrophy is typically prominent and often precedes or parallels temporal lobe involvement
• In frontotemporal dementia, frontal and temporal atrophy predominate, while parietal regions are often spared in earlier stages

Visual inspection of the MRI corroborated the quantitative findings. Regions such as the posterior cingulate and parietal-occipital cortex did not demonstrate abnormal atrophy, while the frontal lobes showed widened cerebrospinal fluid spaces and shrunken gyri.

Neuroreader® heat maps further reinforced this pattern, clearly highlighting frontal and temporal lobes as the most severely affected regions.

Differentiating FTD from Alzheimer’s Disease with Volumetrics

Although hippocampal atrophy can occur in both Alzheimer’s disease and frontotemporal dementia, the regional distribution of atrophy is critical for accurate interpretation.

In this case:

• Frontal lobe atrophy was disproportionately severe
• Temporal lobe volumes were significantly reduced
• Parietal lobes remained comparatively preserved

This volumetric profile favors frontotemporal dementia over Alzheimer’s disease, where parietal involvement would be expected alongside temporal degeneration.

Clinical Value of Neuroreader® in Dementia Evaluation

This case illustrates how quantitative brain volumetrics add diagnostic confidence beyond visual MRI assessment alone.

Neuroreader® enables clinicians to:

• Objectively quantify regional brain volume loss
• Compare patient data against an age- and sex-adjusted normative database
• Identify disease-specific atrophy patterns
• Support differential diagnosis in clinically overlapping dementias

By delivering a standardized volumetric report in under 10 minutes, Neuroreader® integrates seamlessly into routine MRI workflows and supports evidence-based neurodegenerative disease assessment.

Conclusion

In patients with overlapping cognitive and behavioral symptoms, MRI brain volumetrics play a critical role in differentiating frontotemporal dementia from Alzheimer’s disease.

In this case, the combination of:

• Severe frontal and temporal lobe atrophy
• Preserved parietal lobes
• Quantitative percentile analysis

strongly supported a diagnosis of frontotemporal dementia.

Automated volumetric tools like Neuroreader® provide clinicians with objective, reproducible insights that enhance diagnostic accuracy and clinical confidence in dementia care.