Patients with Bipolar Disorder (BD) usually display cognitive deficits with
aging. However, the correlation between BD and dementia syndromes is
inconclusive, despite the similarity with behavioral variant frontotemporal
dementia. We report a 78-year-old female patient who had bipolar type 1 disorder
since adolescence. Her symptoms ranged from apathy to psychotic mania. She had
had three hospitalizations, and since her last stay 10 years ago, her symptoms
had remained stable. However, in the past 2 years, she displayed different
symptoms, such as irritability manifested as verbal and physical aggression,
cognitive impairment, repetitive pattern of behavior, perambulation, persecutory
delusions, disorientation, and hyporexia. Treatment with anticholinesterases or
mood stabilizers promoted no improvement. She scored 17/30 points on the
Mini-Mental State Examination. Neuropsychological assessment suggested deficits
in executive function, attention, and memory. Neuroimaging tests revealed
frontotemporal degeneration and hypoperfusion. Diagnostic and therapeutic
approaches for this type of patient represent a significant challenge for
clinicians.
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