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Abbreviations: CBD, corticobasal degeneration; DLB, dementia with Lewy bodies; MSA, multiple system atrophy; PD, Parkinson's disease; PSP, progressive supranuclear palsy.

Abbreviations: CBD, corticobasal degeneration; DLB, dementia with Lewy bodies; MSA, multiple system atrophy; PD, Parkinson's disease; PSP, progressive supranuclear palsy.

may be prominent and strongly suggests CBD, however, some patients with PSP may also have asymmetric limb dystonia (24). Patients with CBD do not benefit from levodopa and the course is relentlessly progressive.

Rare cases of a parietal form of Pick's disease may be confused with CBD (65). The clinical spectrum of CBD has recently been expanded to include early onset dementia and aphasia (66); however, in general, these patients have a conspicuous absence of cognitive deficits. MRI in CBD shows focal atrophy, especially in the parietal areas (67), and PET scans show asymmetric decrease of regional cerebral metabolic rates for glucose utilization (68). Tables 5 and 6 summarize some of the differential diagnostic features.

Frontotemporal Dementia with Parkinsonism

FTD is characterized by profound behavioral changes and an alteration in personality and social conduct with relative preservation of memory (69-70). Extrapyramidal symptoms are common, and parkinsonism occurs in 40% of patients (71). Akinesia, rigidity, and a shuffling gait are the most common with typical tremor being rare (72). The PET scan reveals an equal decrease in the beta CFT uptake in the caudate and the putamen, as opposed to PD where putamen is preferentially involved (72). This disorder is generally easy to distinguish from PD, but may be confused with DLB and other disorders causing dementia and parkinsonism.

TABLE 6 Magnetic Resonance Imaging Features of Some Cases of Parkinsonism

TABLE 6 Magnetic Resonance Imaging Features of Some Cases of Parkinsonism

Cortical atrophy

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Putaminal atrophy

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