Accuracy of clinical diagnosis of behavioral variant frontotemporal dementia: A systematic review and meta-analysis

Accurate diagnosis of behavioral variant frontotemporal dementia (bvFTD) remains difficult due to overlapping symptoms with other conditions. We aimed to evaluate the diagnostic accuracy of bvFTD clinical criteria and whether it has improved over time.

We systematically reviewed studies assessing the Lund-Manchester (1994), Neary (1998), and Rascovsky (2011) criteria, using pathology or follow-up diagnosis as reference standards. A Bayesian bivariate model was used to estimate pooled sensitivity and specificity.

Nine studies (1130 participants) were included. Sensitivity increased from 0.70 (95% confidence interval [CI], 0.41-0.89; Lund-Manchester) to 0.80 (95% CI, 0.48-0.95; Neary) and 0.90 (95% CI, 0.81-0.95; Rascovsky, probable diagnosis), at the cost of a decreased specificity (0.94, 0.95, and 0.85, respectively).

The diagnostic sensitivity of bvFTD criteria has improved over time, though specificity has declined. Ongoing refinement and biomarker development are needed to enhance diagnostic accuracy, especially in early disease stages.