What findings might you expect to see on this patient's MRI?
Fronto-temporal lobar degeneration (FTLD).
Given the clinical information, what is the likely lobar predominance?
FTLD is typically asymmetric. This patient is most likely to exhibit left-predominant atrophy given the prominence of langauge impairment in the clinical phenotype and the left-hemispheric language domanance suggested his right-handedness.
Neuropsychology testing:
Strengths: performs within expected premorbid limits on hands-on, performance-based, perceptual-based skills in the domains of problem solving, visual reasoning and visuo-spatial reconstruction.
Weaknesses: severe impairment of expressive and receptive language skills with significant and severe loss of conceptual semantic word meaning. Severely impaired information processing speed.
No evidence of classic executive function impairment.