Early-onset of psychiatric features in mild frontotemporal dementia with impaired memory test: a case report and neuropsychological evaluation

Abstract

Dear eDitor,Frontotemporal dementia (FTD) is characterized by behavioral changes which may precede cognitive decline, being mainly a presenile disturbance with an insidious onset and high fa milial incidence 1 . Degeneration affects mainly prefrontal and temporal anterior brain areas; ex ecutive functions (EFs) and language deficits are commonly found. Changes in eating habits and psychosis have being recently studied as earliest symptoms. We present a FTD case start ing with mood symptoms, psychosis and compulsions to discuss differential diagnosis. CaSeA., male, 61 yearsold, righthanded, graduated, recently retired after working as a manager of a company. Relatives reported first mood changes when he was 56, presenting depressive and hippomaniac episodes of brief duration. A change of eating habits followed and the patient lost almost 10 kg in 3 months. A. believes his neighbors will sue him, despite the lack of reasons. He is spending hours a day organizing documents he believes will be necessary for the legal process; he started presenting fixed idea for cleaning, washing his hands many times a day. A.'s wife reported difficulties to return home after going to the church because he needs to ensure that people will not gather to speak at his back. There is a current though of bankruptcy, despi te his high income; he sold his car because of this fear -even after checking his bank balance. He had no history of psychiatric disorders. He was afraid of taking his medicines because of the risk of being "poisoned".Neuropsychological evaluation: A. presented difficulties to initiate behavior, such as telling the examiner when he finished the task. Performance in memory was below expected for age, both for visual and verbal material. Verbal memory was evaluated through a prose memory test, with weak performance in immediate recall, but a very similar performance in delayed re call -corresponding to normal ranges. The performance in Complex Figure was impaired after a 5 minute delay. Results revealed cognitive inflexibility, planning difficulties, impaired verbal fluency and formulation hypothesis ability and also perseveration. Language was normal. Re sults are in tables 1 and 2.