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Johnson et al¹ provided convincing neuropsychological evidence for a frontal lobe pattern of dementia in patients with pathologically confirmed Alzheimer disease (AD), and were able to correlate this pattern with anatomical evidence of increased frontal lobe burden of neurofibrillary tangles compared with that found in "typical" cases of AD. I have a similar case of a 64-year-old man with a striking progressive frontal lobe syndrome marked by perseverative, retentive, hoarding behavior, radiologically evident bifrontal atrophy (the left side worse than the right side), and an apolipoprotein E (APOE) genotype of APOE3/4 suggesting he may have AD rather than Pick disease (although we presently lack tissue confirmation).

Johnson et al underscore a point I tried to make, in a 1992 article titled "Asymmetric Cortical Degeneration Syndromes,"² that the cognitive profile of degenerative cortical dementia is dictated by the topography of pathology more than by its histology. This is true . . . [Full Text of this Article]