Adam M. Staffaroni et al ascertained if an atrophy-based risk score could be developed to anticipate the onset of dementia. Dementia risk scores were created in 268 familial frontotemporal lobar degeneration family members by entering covariate-adjusted standardized estimates of brain atrophy into a logistic regression to classify asymptomatic vs demented candidates. Good separation of asymptomatic vs demented patients was accomplished by cross-validated logistic regression. Atrophy scores forecast conversion to dementia from asymptomatic or mildly/questionably symptomatic. With 90% accuracy, quantification of the unique atrophy pattern of each individual can separate those with dementia from those without symptoms. A promising predictor of progression in asymptomatic familial frontotemporal lobar degeneration mutation carriers is the individualized quantification of baseline brain atrophy.