Mendelian forms of disease and age at onset affect survival in frontotemporal dementia

Frontotemporal dementia (FTD) is a common cause of young onset dementia. Very few reports on disease duration are currently available and predictors of survival are still undefined. The aim of the present study was to assess the natural history of FTD and to define predictors of survival.

Four hundred amd eleven FTD patients, including 294 with behavioural variant FTD, 77 with agrammatic variant primary progressive aphasia (PPA) and 40 with semantic variant PPA, were consecutively enrolled and demographic and clinical variables carefully recorded. Each patient underwent genetic screening for monogenic disease.

The mean survival time from onset of the symptoms was 7.8 ± 4.0 years. The presence of a pathogenic mutation (GRN, C9orf72 or MAPT) (Hazard ratio [HR] = 1.85, 95% CI 1.04-3.31, p = 0.037) and older age at disease onset (HR = 1.04, 95% CI 1.02-1.07, p = 0.002) were associated with shorter life expectancy. However, a significant negative interaction between age at onset and genetic mutation was found, suggesting that the effect of age is different in patients with and without a genetic mutation (p = 0.028). Gender, clinical phenotype or education and occupation were not associated with survival risk.

Our findings suggest that monogenic disease and age at onset are independent predictors of survival and should be considered in future clinical intervention trials and in patients' and caregivers' counselling.