Skip to main content Accessibility help
×
Hostname: page-component-74656f9884-6grmk Total loading time: 0 Render date: 2026-11-04T08:00:29.919Z Has data issue: false hasContentIssue false

Chapter 11 - The Behavioral Variant of Frontotemporal Dementia: Preclinical to Advanced Dementia

from Section 2 - The Dementias

Published online by Cambridge University Press:  17 November 2025

By
Ignacio Illán-Gala  and
Bruce L. Miller
Edited by
Bruce L. Miller  and
Bradley F. Boeve
Bruce L. Miller
Affiliation:
University of California, San Francisco
Bradley F. Boeve
Affiliation:
Mayo Clinic, Minnesota
Get access

Summary

The behavioral variant of frontotemporal dementia (bvFTD) is a clinical syndrome characterized by progressive deterioration of social behavior and cognitive functions. It is one of the most common causes of early-onset dementia and is associated with frontotemporal lobar degeneration (FTLD). The diagnosis of bvFTD can be challenging due to its overlap with other psychiatric disorders, but obtaining a detailed clinical history from a reliable informant is essential. Diagnostic criteria for bvFTD include behavioral and cognitive features such as loss of motivation, social disinhibition, lack of empathy, repetitive behaviors, changes in eating habits, and executive dysfunction. Biomarkers such as brain imaging and genetic testing can help increase diagnostic certainty. Disease progression in bvFTD leads to disability and functional deterioration. Future research aims to improve early recognition, diagnostic accuracy, and the development of disease-modifying treatments.

Keywords

neuropsychiatrydiagnosisprognosisgeneticpathologydementiafrontotemporal dementiafrontotemporal lobar degenerationearly-onset dementiabiomarkers

Information

Type
Chapter
Information
The Behavioral Neurology of Dementia , pp. 165 - 179
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Elahi, FM, Miller, BL. A clinicopathological approach to the diagnosis of dementia. Nat Rev Neurol 2017;13:457–476. https://doi.org/10.1038/nrneurol.2017.96.CrossRefGoogle Scholar
Rascovsky, K, Hodges, JR, Knopman, D, et al. Sensitivity of revised diagnostic criteria for the behavioral variant of frontotemporal dementia. Brain 2011;134:2456–2477. https://doi.org/10.1093/brain/awr179.CrossRefGoogle Scholar
Gorno-Tempini, ML, Hillis, AE, Weintraub, S, et al. Classification of primary progressive aphasia and its variants. Neurology 2011;76:1006–1014. https://doi.org/10.1212/WNL.0b013e31821103e6.CrossRefGoogle ScholarPubMed
Neary, D, Snowden, JS, Gustafson, L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51:1546–1554. https://doi.org/10.1212/WNL.51.6.1546.CrossRefGoogle ScholarPubMed
Harris, JM, Gall, C, Thompson, JC, et al. Sensitivity and specificity of FTDC criteria for behavioral variant frontotemporal dementia. Neurology 2013;80:1881–1887. https://doi.org/10.1212/WNL.0b013e318292a342.CrossRefGoogle ScholarPubMed
Coyle-Gilchrist, ITS, Dick, KM, Patterson, K, et al. Prevalence, characteristics, and survival of frontotemporal lobar degeneration syndromes. Neurology 2016;86:1736–1743.10.1212/WNL.0000000000002638CrossRefGoogle ScholarPubMed
Logroscino, G, Piccininni, M, Binetti, G, et al. Incidence of frontotemporal lobar degeneration in Italy: the Salento-Brescia Registry study. Neurology 2019;92:e2355–e2363.10.1212/WNL.0000000000007498CrossRefGoogle ScholarPubMed
Onyike, CU, Diehl-Schmid, J. The epidemiology of frontotemporal dementia. Int Rev Psychiatry 2013;25:130–137.10.3109/09540261.2013.776523CrossRefGoogle ScholarPubMed
Marelli, C, Gutierrez, L-A, Menjot de Champfleur, N, et al. Late-onset behavioral variant of frontotemporal lobar degeneration versus Alzheimer’s disease: interest of cerebrospinal fluid biomarker ratios. Alzheimers Dement (Amst) 2015;1:371–379.10.1016/j.dadm.2015.06.004CrossRefGoogle ScholarPubMed
Woolley, JD, Khan, BK, Murthy, NK, Miller, BL, Rankin, KP. The diagnostic challenge of psychiatric symptoms in neurodegenerative disease: rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. J Clin Psychiatry 2011;72:126–133. https://doi.org/10.4088/JCP.10m06382oli.CrossRefGoogle ScholarPubMed
Seo, SW, Thibodeau, M-P, Perry, DC, et al. Early vs late age at onset frontotemporal dementia and frontotemporal lobar degeneration. Neurology 2018;90:e1047–e1056.10.1212/WNL.0000000000005163CrossRefGoogle ScholarPubMed
Murley, AG, Coyle-Gilchrist, I, Rouse, MA, et al. Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes. Brain 2020;143:1555–1571. https://doi.org/10.1093/brain/awaa097.CrossRefGoogle ScholarPubMed
Kansal, K, Mareddy, M, Sloane, KL, et al. Survival in frontotemporal dementia phenotypes: a meta-analysis. Dement Geriatr Cogn Disord 2016;41:109–122. https://doi.org/10.1159/000443205.CrossRefGoogle ScholarPubMed
Agarwal, S, Ahmed, RM, D’Mello, M, et al. Predictors of survival and progression in behavioural variant frontotemporal dementia. Eur J Neurol 2019;26:774–779. https://doi.org/10.1111/ene.13887.CrossRefGoogle ScholarPubMed
Garcin, B, Lillo, P, Hornberger, M, et al. Determinants of survival in behavioral variant frontotemporal dementia. Neurology 2009;73:1656–1661.10.1212/WNL.0b013e3181c1dee7CrossRefGoogle ScholarPubMed
Caswell, C, McMillan, CT, Xie, SX, et al. Genetic predictors of survival in behavioral variant frontotemporal degeneration. Neurology 2019;93:e1707–e1714. https://doi.org/10.1212/WNL.0000000000008387.CrossRefGoogle ScholarPubMed
Mauvais-Jarvis, F, Bairey Merz, N, Barnes, PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet 2020;396:565–582. https://doi.org/10.1016/S0140-6736(20)31561-0.CrossRefGoogle ScholarPubMed
Perry, DC, Brown, JA, Possin, KL, et al. Clinicopathological correlations in behavioural variant frontotemporal dementia. Brain 2017;140:3329–3345. https://doi.org/10.1093/brain/awx254.CrossRefGoogle ScholarPubMed
O’Connor, CM, Landin-Romero, R, Clemson, L, et al. Behavioral-variant frontotemporal dementia: distinct phenotypes with unique functional profiles. Neurology 2017;89:570–577. https://doi.org/10.1212/WNL.0000000000004215.CrossRefGoogle ScholarPubMed
Illan-Gala, I, Montal, V, Borrego-Ecija, S, et al. Cortical microstructure in the behavioural variant of frontotemporal dementia: looking beyond atrophy. Brain 2019;142:1121–1133. https://doi.org/10.1093/brain/awz031.CrossRefGoogle ScholarPubMed
Spinelli, EG, Mandelli, ML, Miller, ZA, et al. Typical and atypical pathology in primary progressive aphasia variants. Ann Neurol 2017;81:430–443.10.1002/ana.24885CrossRefGoogle ScholarPubMed
Illán-Gala, I, Casaletto, KB, Borrego-Écija, S, et al. Sex differences in the behavioral variant of frontotemporal dementia: a new window to executive and behavioral reserve. Alzheimers Dement 2021 Aug;17(8):1329–1341. https://doi.org/1002/alz.12299.CrossRefGoogle ScholarPubMed
Miller, BL. Frontotemporal Dementia. Oxford University Press, 2014.10.1093/med/9780195380491.001.0001CrossRefGoogle ScholarPubMed
Karageorgiou, E, Miller, BL. Frontotemporal lobar degeneration: a clinical approach. Semin Neurol 2014;34:189–201.10.1055/s-0034-1381735CrossRefGoogle ScholarPubMed
Miller, BL, Seeley, WW, Mychack, P, et al. Neuroanatomy of the self: evidence from patients with frontotemporal dementia. Neurology 2001;57:817–821. https://doi.org/10.1212/wnl.57.5.817.CrossRefGoogle ScholarPubMed
Ducharme, S, Dols, A, Laforce, R, et al. Recommendations to distinguish behavioural variant frontotemporal dementia from psychiatric disorders. Brain 2020;143:1632–1650. https://doi.org/10.1093/brain/awaa018.CrossRefGoogle ScholarPubMed
Perry, DC, Datta, S, Sturm, VE et al. Reward deficits in behavioural variant frontotemporal dementia include insensitivity to negative stimuli. Brain 2017;140:3346–3356. https://doi.org/10.1093/brain/awx259.CrossRefGoogle ScholarPubMed
Liljegren, M, Naasan, G, Temlett, J, et al. Criminal behavior in frontotemporal dementia and Alzheimer disease. JAMA Neurol 2015;72:295–300.10.1001/jamaneurol.2014.3781CrossRefGoogle ScholarPubMed
Liljegren, M, Landqvist Waldö, M, Frizell Santillo, A, et al. Association of neuropathologically confirmed frontotemporal dementia and Alzheimer disease with criminal and socially inappropriate behavior in a Swedish cohort. JAMA Netw Open 2019;2:e190261. https://doi.org/10.1001/jamanetworkopen.2019.0261.CrossRefGoogle Scholar
Lansdall, CJ, Coyle-Gilchrist, ITS, Vázquez Rodríguez, P, et al. Prognostic importance of apathy in syndromes associated with frontotemporal lobar degeneration. Neurology 2019;92:e1547–e1557. https://doi.org/10.1212/WNL.0000000000007249.CrossRefGoogle ScholarPubMed
Perry, DC, Sturm, VE, Seeley, WW, et al. Anatomical correlates of reward-seeking behaviours in behavioural variant frontotemporal dementia. Brain 2014;137:1621–1626.10.1093/brain/awu075CrossRefGoogle ScholarPubMed
Piguet, O, Petersén, A, Yin Ka Lam, B, et al. Eating and hypothalamus changes in behavioral-variant frontotemporal dementia. Ann Neurol 2011;69:312–319.10.1002/ana.22244CrossRefGoogle ScholarPubMed
Ahmed, RM, Ke, YD, Vucic, S, et al. Physiological changes in neurodegeneration – mechanistic insights and clinical utility. Nat Rev Neurol 2018;14:259–271. https://doi.org/10.1038/nrneurol.2018.23.CrossRefGoogle ScholarPubMed
Ranasinghe, KG, Rankin, KP, Lobach, IV, et al. Cognition and neuropsychiatry in behavioral variant frontotemporal dementia by disease stage. Neurology 2016;86:6006–10. https://doi.org/10.1212/WNL.0000000000002373.CrossRefGoogle ScholarPubMed
Henry, JD, von Hippel, W, Molenberghs, P, Lee, T, Sachdev, PS. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol 2016;12:28–39.10.1038/nrneurol.2015.229CrossRefGoogle ScholarPubMed
Rowe, JB. Parkinsonism in frontotemporal dementias. Int Rev Neurobiol 2019;149:249–275. https://doi.org/10.1016/bs.irn.2019.10.012.Google ScholarPubMed
Baborie, A, Griffiths, TD, Jaros, E, et al. Frontotemporal dementia in elderly individuals. Arch Neurol 2012;69:1052–1060.10.1001/archneurol.2011.3323CrossRefGoogle ScholarPubMed
Illán-Gala, I, Falgàs, N, Friedberg, A, et al. Diagnostic utility of measuring cerebral atrophy in the behavioral variant of frontotemporal dementia and association with clinical deterioration. JAMA Netw Open. 2021;4(3):e211290. https://doi.org/10.1001/jamanetworkopen.2021.1290CrossRefGoogle Scholar
Harper, L, Fumagalli, G G, Barkhof, F, et al. MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Brain 2016;139:1211–1225, https://doi.org/10.1093/brain/aww005CrossRefGoogle ScholarPubMed
McCarthy, J, Collins, DL, Ducharme, S. Morphometric MRI as a diagnostic biomarker of frontotemporal dementia: a systematic review to determine clinical applicability. NeuroImage Clin 2018;20:685–696. https://doi.org/10.1016/j.nicl.2018.08.028.CrossRefGoogle ScholarPubMed
Chételat, G, Arbizu, J, Barthel, H, et al. Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer’s disease and other dementias. Lancet Neurol 2020;19:951–962. https://doi.org/10.1016/S1474-4422(20)30314-8.CrossRefGoogle Scholar
Zimmer, ER, Parent, MJ, Souza, DG, et al. [18F]FDG PET signal is driven by astroglial glutamate transport. Nat Neurosci 2017;20:393–395. https://doi.org/10.1038/nn.4492.CrossRefGoogle ScholarPubMed
Ranasinghe, KG, Rankin, KP, Pressman, PS, et al. Distinct subtypes of behavioral variant frontotemporal dementia based on patterns of network degeneration. JAMA Neurol 2016;73:1078. https://doi.org/10.1001/jamaneurol.2016.2016.CrossRefGoogle ScholarPubMed
Kertesz, A, McMonagle, P, Blair, M, Davidson, W, Munoz, DG. The evolution and pathology of frontotemporal dementia. Brain 2005;128:1996–2005. https://doi.org/10.1093/brain/awh598.CrossRefGoogle ScholarPubMed
Devenney, E, Swinn, T, Mioshi, E, et al. The behavioural variant frontotemporal dementia phenocopy syndrome is a distinct entity – evidence from a longitudinal study. BMC Neurol 2018;18:56. https://doi.org/10.1186/s12883-018-1060-1.CrossRefGoogle ScholarPubMed
Ossenkoppele, R, Pijnenburg, YAL, Perry, DC, et al. The behavioural/dysexecutive variant of Alzheimer’s disease: clinical, neuroimaging and pathological features. Brain 2015;138:2732–2749. https://doi.org/10.1093/brain/awv191.CrossRefGoogle ScholarPubMed
Meeter, LH, Kaat, LD, Rohrer, JD, van Swieten, JC. Imaging and fluid biomarkers in frontotemporal dementia. Nat Rev Neurol 2017;13:406–419. https://doi.org/10.1038/nrneurol.2017.75.CrossRefGoogle ScholarPubMed
Leuzy, A, Smith, R, Ossenkoppele, R, et al. Diagnostic performance of RO948 F 18 Tau positron emission tomography in the differentiation of Alzheimer disease from other neurodegenerative disorders. JAMA Neurol 2020;77:955–965. https://doi.org/10.1001/jamaneurol.2020.0989.CrossRefGoogle ScholarPubMed
Palmqvist, S, Janelidze, S, Quiroz, YT, et al. Discriminative accuracy of plasma phospho-tau217 for Alzheimer disease vs other neurodegenerative disorders. JAMA 2020;324:772. https://doi.org/10.1001/jama.2020.12134.CrossRefGoogle ScholarPubMed
Illán-Gala, I, Lleo, A, Karydas, A, et al. Plasma tau and neurofilament light in frontotemporal lobar degeneration and Alzheimer’s disease. Neurology 2020;96:e671–e683. https://doi.org/10.1212/WNL.0000000000011226.Google Scholar
van der Ende, EL, Meeter, LH, Poos, JM, et al. Serum neurofilament light chain in genetic frontotemporal dementia: a longitudinal, multicentre cohort study. Lancet Neurol 2019;18:1103–1111. https://doi.org/10.1016/S1474-4422(19)30354-0.CrossRefGoogle ScholarPubMed
Al Shweiki, MR, Steinacker, P, Oeckl, P, et al. Neurofilament light chain as a blood biomarker to differentiate psychiatric disorders from behavioural variant frontotemporal dementia. J Psychiatr Res 2019;113:137–140. https://doi.org/10.1016/j.jpsychires.2019.03.019.CrossRefGoogle ScholarPubMed
Whitwell, JL, Przybelski, SA, Weigand, SD, et al. Distinct anatomical subtypes of the behavioural variant of frontotemporal dementia: a cluster analysis study. Brain 2009;132:2932–2946. https://doi.org/10.1093/brain/awp232.CrossRefGoogle ScholarPubMed
Seeley, WW. Behavioral variant frontotemporal dementia. Continuum (Minneap Minn) 2019;25:76–100.CrossRefGoogle ScholarPubMed
Ulugut Erkoyun, H, Groot, C, Heilbron, R, et al. A clinical-radiological framework of the right temporal variant of frontotemporal dementia. Brain 2020;143:2831–2843. https://doi.org/10.1093/brain/awaa225.CrossRefGoogle ScholarPubMed
Illán-Gala, I, Montal, V, Pegueroles, J, et al. Cortical microstructure in the amyotrophic lateral sclerosis–frontotemporal dementia continuum. Neurology 2020;95:e2565–e2576. https://doi.org/10.1212/WNL.0000000000010727.CrossRefGoogle ScholarPubMed
Cortes-Vicente, E, Turon-Sans, J, Gelpi, E, et al. Distinct clinical features and outcomes in motor neuron disease associated with behavioural variant frontotemporal dementia. Dement Geriatr Cogn Disord 2018;45:220–231. https://doi.org/10.1159/000488528.CrossRefGoogle ScholarPubMed
Brown, RH, Al-Chalabi, A. Amyotrophic lateral sclerosis. N Engl J Med 2017;377:162–172. https://doi.org/10.1056/NEJMra1603471.CrossRefGoogle ScholarPubMed
Goldstein, LH, Abrahams, S. Changes in cognition and behaviour in amyotrophic lateral sclerosis: nature of impairment and implications for assessment. Lancet Neurol 2013;12:368–380. https://doi.org/10.1016/S1474-4422(13)70026-7.CrossRefGoogle ScholarPubMed
Höglinger, GU, Respondek, G, Stamelou, M, et al. Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria. Mov Disord 2017;32:853–864.10.1002/mds.26987CrossRefGoogle ScholarPubMed
Walker, Z, Possin, KL, Boeve, BF, Aarsland, D. Lewy body dementias. Lancet 2015;386:1683–1697.10.1016/S0140-6736(15)00462-6CrossRefGoogle ScholarPubMed
Bologna, M, Paparella, G, Fasano, A, Hallett, M, Berardelli, A. Evolving concepts on bradykinesia. Brain 2020;143:727–750. https://doi.org/10.1093/brain/awz344.CrossRefGoogle ScholarPubMed
Lesman-Segev, OH, Edwards, L, Rabinovici, GD. Chronic traumatic encephalopathy: a comparison with Alzheimer’s disease and frontotemporal dementia. Semin Neurol 2020;40:394–410. https://doi.org/10.1055/s-0040-1715134.Google ScholarPubMed
Wicklund, MR, Mokri, B, Drubach, DA, et al. Frontotemporal brain sagging syndrome: an SIH-like presentation mimicking FTD. Neurology 2011;76:1377–1382. https://doi.org/10.1212/WNL.0b013e3182166e42.CrossRefGoogle ScholarPubMed
Ducharme, S, Price, BH, Larvie, M, Dougherty, DD, Dickerson, BC. Clinical approach to the differential diagnosis between behavioral variant frontotemporal dementia and primary psychiatric disorders. Am J Psychiatry 2015;172:827–837.10.1176/appi.ajp.2015.14101248CrossRefGoogle Scholar
Ducharme, S, Pearl-Dowler, L, Gossink, F, et al. the frontotemporal dementia versus primary psychiatric disorder (FTD versus PPD) checklist: a bedside clinical tool to identify behavioral variant FTD in patients with late-onset behavioral changes. J Alzheimers Dis 2019;67:113–124. https://doi.org/10.3233/JAD-180839.CrossRefGoogle ScholarPubMed
Mackenzie, IRA, Neumann, M. Molecular neuropathology of frontotemporal dementia: insights into disease mechanisms from postmortem studies. J Neurochem 2016;138 Suppl 1:54–70.10.1111/jnc.13588CrossRefGoogle ScholarPubMed
Mioshi, E, Kipps, CM, Dawson, K, et al. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077–2084.10.1212/01.wnl.0000264897.13722.53CrossRefGoogle ScholarPubMed
Mioshi, E, Hsieh, S, Savage, S, Hornberger, M, Hodges, JR. Clinical staging and disease progression in frontotemporal dementia. Neurology 2010;74:1591–1597.10.1212/WNL.0b013e3181e04070CrossRefGoogle ScholarPubMed
Miyagawa, T, Brushaber, D, Syrjanen, J, et al. Utility of the global CDR® plus NACC FTLD rating and development of scoring rules: data from the ARTFL/LEFFTDS Consortium. Alzheimers Dement 2020;16:106–117. https://doi.org/10.1002/alz.12033.CrossRefGoogle ScholarPubMed
Rohrer, JD, Nicholas, JM, Cash, DM, et al. Presymptomatic cognitive and neuroanatomical changes in genetic frontotemporal dementia in the Genetic Frontotemporal dementia Initiative (GENFI) study: a cross-sectional analysis. Lancet Neurol 2015;14:253–262.10.1016/S1474-4422(14)70324-2CrossRefGoogle ScholarPubMed
Rosen, HJ, Boeve, BF, Boxer, AL. Tracking disease progression in familial and sporadic frontotemporal lobar degeneration: recent findings from ARTFL and LEFFTDS. Alzheimers Dement 2020;16:71–78. https://doi.org/10.1002/alz.12004.CrossRefGoogle ScholarPubMed
Staffaroni, AM, Ljubenkov, PA, Kornak, J, et al. Longitudinal multimodal imaging and clinical endpoints for frontotemporal dementia clinical trials. Brain 2019;142:443–459. https://doi.org/10.1093/brain/awy319.CrossRefGoogle ScholarPubMed

Accessibility standard: WCAG 2.1 AA

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

The HTML of this chapter complies with version 2.1 of the Web Content Accessibility Guidelines (WCAG), covering newer accessibility requirements and improved user experiences and achieves the intermediate (AA) level of WCAG compliance, covering a wider range of accessibility requirements.

Content Navigation

Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.

Reading Order & Textual Equivalents

Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.

Visual Accessibility

Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.

Structural and Technical Features

ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×