Hans Förstl


Pick Disease / Lobar Atrophy / Frontotemporal  Degeneration:

Behaviour, EEG, volumetry



J Neural Transm Suppl. 1996;47:169-81. Links
Quantitative EEG in frontal lobe dementia.
•    Besthorn C,
•    Sattel H,
•    Hentschel F,
•    Daniel S,
•    Zerfass R,
•    Forstl H.
Central Institute of Mental Health, Mannheim, Federal Republic of Germany.
A study on quantitative EEG in 14 patients with frontal lobe dementia (FLD), 14 patients with Alzheimer's disease (AD), and 14 healthy controls was conducted using a complete set of EEG parameters: band power, coherence and fractal dimension. Contrary to earlier studies, we observed higher theta power and sagittal interactions in higher frequency bands in the FLD than in the control group. Lateral interactions of coherence and two indices of fractal dimension were lower in FLD than in controls. There was greater electrophysiological resemblance between the control group and FLD than between any of these groups and AD. This was documented by the results of a discriminant analysis which led to a correct overall classification of 66% of the subjects with misclassifications occurring primarily between control and FLD group.
PMID: 8841964 [PubMed - indexed for MEDLINE]



Dementia. 1996 Jan-Feb;7(1):27-34. Links
Frontal lobe degeneration and Alzheimer's disease: a controlled study on clinical findings, volumetric brain changes and quantitative electroencephalography data.
•    Forstl H,
•    Besthorn C,
•    Hentschel F,
•    Geiger-Kabisch C,
•    Sattel H,
•    Schreiter-Gasser U.
Central Institute of Mental Health, Mannheim, Germany.
Ten patients with a clinical diagnosis of frontal lobe degeneration (FLD) were compared with a group of patients with probable Alzheimer's disease (AD) and with nondemented controls matched for gender and age. In comparison with AD, the duration of illness was slightly shorter and cognitive performance was better in patients with FLD. The greatest enlargement of cerebrospinal fluid volumes was found in FLD and this effect was most pronounced in the anterior fissure and lateral ventricles. Estimates of EEG band-power and EEG coherence in FLD were not remarkably different from nondemented controls, whereas delta- and theta-power were significantly increased in AD. These observations may indicate different disease processes with a dissociation of volumetric computed tomography and quantitative EEG changes, which may be of differential diagnostic value.
PMID: 8788079 [PubMed - indexed for MEDLINE]


Nervenarzt. 1994 Sep;65(9):611-8. Links
[Frontal and temporal onset of brain atrophy. Clinical and instrumental findings]
[Article in German]
•    Forstl H,
•    Hentschel F,
•    Besthorn C,
•    Geiger-Kabisch C,
•    Sattel H,
•    Schreiter-Gasser U,
•    Bayerl JR,
•    Schmitz F,
•    Schmitt HP.
Psychiatrische Klinik, Zentralinstitut fur Seelische Gesundheit, Mannheim.
We report the cases of a 70-year old man with left temporal brain atrophy and of a 39-year-old man with neuropathologically verified frontal lobe degeneration (FLD) of Non-Alzheimer type. 10 patients with FLD collected during a prospective study on degenerative dementia had more severe volumetric brain changes and less severe quantitative band power changes than a group of matched patients with clinically diagnosed Alzheimer's disease.
PMID: 7991007 [PubMed - indexed for MEDLINE]


Eur Arch Psychiatry Clin Neurosci. 1995;245(6):299-305. Links
Frontal lobe degeneration of non-Alzheimer type and Pick's atrophy: lumping or splitting?
•    Schmitt HP,
•    Yang Y,
•    Forstl H.
Institut fur Neuropathologie, Universitat Heidelberg, Germany.
We report six cases of presenile (five) and senile (one) progressive dementia with a mild-to-marked frontal or frontotemporal atrophy and ventricular dilation (Frontal Lobe Degeneration [FLD]). The most prominent microscopic features were layer-dependent neuronal depletion of the cortex, spongiosis, and cortical and subcortical gliosis. Five cases showed additional degeneration of the S. nigra, and two also had motor neuron disease. Despite the absence of Pick cells and bodies, such cases have many features in common with Pick atrophy. Because Pick cells and bodies are inconstantly occurring features in otherwise typical cases of Pick atrophy, they cannot be regarded as inevitable markers of the latter. In our opinion, cases with mild frontal or frontotemporal atrophy as described herein and by others match the grades 1 and 2 in terms of Schneider's classification of Pick atrophy [37]. As long as the etiology of both Pick atrophy and the so-called FLD is unknown, and we finally have to follow morphological criteria for classification, there is apparently no convincing reason to introduce a separate category, such as FLD or FTA, for the cases with moderate or mild frontal atrophy and dementia of frontal lobe type, which can be sufficiently classified with the Pick spectrum of lobar atrophy.
PMID: 8527466 [PubMed - indexed for MEDLINE]


Fortschr Neurol Psychiatr. 1994 Sep;62(9):345-55. Links
[Pick and focal brain atrophy]
[Article in German]
•    Forstl H,
•    Baldwin B.
Psychiatrische Klinik, Zentralinstitut fur Seelische Gesundheit, Mannheim.
In 1892 Arnold Pick presented the case of an elderly demented patient with severe aphasia and global brain atrophy most accentuated at the left temporal lobe. Picks main interest was the relationship between focally accentuated brain degeneration and focally accentuated neuropsychological deficits, and this was what he wanted to demonstrate. He made no effort to describe a new form of dementia. The term "Pick's disease" which was introduced 30 years later implies the existence of a nosological entity with characteristic clinical features, localisation and histology. The neuropathological causes of focally accentuated brain atrophies are varied. Neocortical pyramidal cell loss with or without spongiform changes, cortical and subcortical gliosis have commonly been described. Achromatic neuronal ballooning ("Pick's cells") and intraneuronal argentophilic inclusion bodies ("Pick's bodies"), Alzheimer type plaques and tangles and other features were found in a smaller number of cases. Several authors confirmed an association between the localisation of brain atrophy and its clinical manifestations, but no convincing relationship has been demonstrated between the clinical symptoms and the underlying histology. In several studies frontal lobe degeneration was found in 10% to 20% of the demented patients, whereas aphasia, apraxia and other pronounced deficits in the context of focally accentuated brain atrophy were described less frequently. An early clinical distinction between atypical early stages of Alzheimer's disease and other forms of slowly progressive dementing disorders is virtually impossible in these cases. Prospective studies documenting the clinical and anatomical findings are needed to examine the reliability of these surmised brain-behaviour relationships in degenerative brain diseases more reliably. A descriptive approach offers a better basis for data collection than the premature diagnosis of a poorly defined disease like "Pick's".
PMID: 7959518 [PubMed - indexed for MEDLINE]