Identifying Specific Clinical Symptoms of Behavioral Variant Frontotemporal Dementia Versus Differential Psychiatric Disorders in Patients Presenting With a Late-Onset Frontal Lobe Syndrome

Dols, Annemiek; Liempt, Saskia van; Gossink, Flora; Krudop, Welmoed; Sikkes, Sietske A.M.; Pijnenburg, Yolande A.L.; Stek, Max L.

doi:10.4088/jcp.15m09844

Cited by 26 publications

(24 citation statements)

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“…Our results suggest that positive symptoms, such as inappropriateness, hyper-orality, aggression, and stereotyped behaviour are present in the early phase of bvFTD, as positive FBI scores at the initial visit have been previously shown to be different between diagnostic groups (Dols et al, 2016;) -but may not change any further over the time period studied in this study, the diagnostic stage. Since our follow-up duration was 2 years, I cannot be excluded that an increase of positive symptoms occurs in later stages of bvFTD.…”

Section: Discussionsupporting

confidence: 47%

“…Negative symptoms decreased in psychiatric cases, potentially related to treatment. Previous studies have shown that increased FBI positive symptoms at the initial visit have a relatively high potential to discriminate bvFTD from psychiatric diagnoses, (Boutoleau-Bretonniere et al, 2012;Dols et al, 2016;. Conversely, the distinctive trajectory for the FBI in bvFTD, psychiatric and other neurodegenerative disorders was predominantly driven by negative symptoms rather than positive symptoms.…”

Section: Discussionmentioning

confidence: 87%

“…For the FBI, MMSE, FAB and Faux pas test, a fixed intercept and a random slope with time were assumed, meaning that the model accounted for individual variation of change in the scale of interest over time, whereas baseline measures were not allowed to vary between patients. For the SRI and Ekman faces test a random intercept was assumed, as baseline values for these questionnaires have previously been found differ between diagnostic groups, (Dols et al, 2016;Gossink et al, 2017;.…”

Section: Discussionmentioning

confidence: 99%

“…We have set up the late-onset frontal lobe syndrome (LOF) study, including individuals who presented with behavioural changes during middle to late adulthood at a memory clinic setting (Krudop et al, 2014). In earlier studies using baseline data from this cohort we have shown that impaired emotion recognition and the presence of stereotypy are suggestive of a diagnosis of bvFTD, while theory of mind and cognitive performances did not discriminate bvFTD from other disorders presenting with late-onset behavioural change, (Dols et al, 2016;Gossink et al, 2017;).…”

Section: Introductionmentioning

confidence: 99%

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Disease trajectories in behavioural variant frontotemporal dementia, primary psychiatric and other neurodegenerative disorders presenting with behavioural change

Reus

Vijverberg

Tijms

et al. 2018

Journal of Psychiatric Research

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Behavioural variant frontotemporal dementia (bvFTD) is characterized by behavioural and social cognitive disturbances, while various psychiatric and neurodegenerative disorders may have similar clinical symptoms. Since neurodegenerative disorders are eventually progressive, whereas primary psychiatric disorders are not, this study aimed to investigate whether the change in clinical symptoms over time differed between groups and which biomarkers predicted rate of decline. Disease trajectories (median follow-up = 3 years) of frontal and stereotyped behaviour, general and frontal cognitive functioning, and social cognition were examined in bvFTD (n = 34), other neurodegenerative (n = 28) and primary psychiatric disorders (n = 43), all presenting with late-onset frontal lobe syndrome (45-75 years), using linear mixed models. To gain more insight in underlying pathological processes driving disease progression, we studied the association of baseline cerebrospinal fluid (CSF) (neurofilament light (NfL) and YKL-40 levels, phosphotau to total tau ratio) and neuroimaging markers with disease trajectories. Frontal behavioural symptoms (e.g., disinhibition, apathy) worsened over time in bvFTD, whereas they improved in psychiatric disorders and remained stable in other neurodegenerative disorders. General and frontal cognitive decline was observed in bvFTD and other neurodegenerative disorders, but not in psychiatric disorders. None of the groups showed change in stereotypy and social cognition. For all diagnostic groups, higher CSF NfL levels were associated with faster frontal cognitive decline. A modest association was observed between caudate volume and stereotyped behaviour. Tracking frontal behavioural symptoms and cognition has potential to distinguish bvFTD from other disorders. CSF NfL levels seem to be associated with decline in frontal cognitive functioning.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disease trajectories in behavioural variant frontotemporal dementia, primary psychiatric and other neurodegenerative disorders presenting with behavioural change

Reus

Vijverberg

Tijms

et al. 2018

Journal of Psychiatric Research

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“…Although the distinction between bvFTD and psychiatric disorders is a major diagnostic dilemma, especially in the early stages of disease,3,5,21 knowledge on psychotic symptoms in bvFTD based on this common broad definition of psychosis cannot be ignored. In one of the previous papers,22 the authors of the present study found that a positive history of psychiatric illness, male gender, lower Stereotypy Rating Inventory (SRI) scores, and higher Montgomery–Asberg Depression Scale scores were predictors of the diagnosis of a psychiatric disorder versus bvFTD, but a systematic prospective study on the broad definition of psychosis in bvFTD has not been published yet. Whether specific psychotic symptoms of bvFTD are unique and they can distinct bvFTD from psychiatric disorders, and vice versa, would help the clinician considerably in daily practice from a diagnostic perspective.…”

Section: Introductionmentioning

confidence: 52%

Psychosis in behavioral variant frontotemporal dementia

Gossink¹,

Vijverberg²,

Krudop³

et al. 2017

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BackgroundDementia is generally characterized by cognitive impairment that can be accompanied by psychotic symptoms; for example, visual hallucinations are a core feature of dementia with Lewy bodies, and delusions are often seen in Alzheimer’s disease. However, for behavioral variant of frontotemporal dementia (bvFTD), studies on the broad spectrum of psychotic symptoms are still lacking. The aim of this study was to systematically and prospectively subtype the wide spectrum of psychotic symptoms in probable and definite bvFTD.MethodsIn this study, a commonly used and validated clinical scale that quantifies the broad spectrum of psychotic symptoms (Positive and Negative Symptom Scale) was used in patients with probable and definite bvFTD (n=22) and with a primary psychiatric disorder (n=35) in a late-onset frontal lobe cohort. Median symptom duration was 2.8 years, and the patients were prospectively followed for 2 years.ResultsIn total, 22.7% of bvFTD patients suffered from delusions, hallucinatory behavior, and suspiciousness, although the majority of the patients exhibited negative psychotic symptoms such as social and emotional withdrawal and blunted affect (95.5%) and formal thought disorders (81.8%). “Difficulty in abstract thinking” and “stereotypical thinking” (formal thought disorders) differentiated bvFTD from psychiatric disorders. The combined predictors difficulty in abstract thinking, stereotypical thinking, “anxiety”, “guilt feelings,” and “tension” explained 75.4% of variance in the diagnosis of bvFTD versus psychiatric diagnoses (P<0.001).ConclusionDelusions, hallucinatory behavior, and suspiciousness were present in one-fifth of bvFTD patients, whereas negative psychotic symptoms such as social and emotional withdrawal, blunted affect, and formal thought disorders were more frequently present. This suggests that negative psychotic symptoms and formal thought disorders have an important role in the psychiatric misdiagnosis in bvFTD; misdiagnosis in bvFTD might be reduced by systematically exploring the broad spectrum of psychiatric symptoms.

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Clinical Assessment of Older Adults with Bipolar Disorder

Dols

Chen

Jurdi³

et al. 2017

Bipolar Disorder in Older Age Patients

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Identifying Specific Clinical Symptoms of Behavioral Variant Frontotemporal Dementia Versus Differential Psychiatric Disorders in Patients Presenting With a Late-Onset Frontal Lobe Syndrome

Abstract: In daily clinical practice, specific subtyping of clinical symptoms in patients with late-onset frontal lobe syndrome may aid in differentiating bvFTD patients from psychiatric patients and may provide guidance in patient management.

Cited by 26 publications

References 15 publications

Disease trajectories in behavioural variant frontotemporal dementia, primary psychiatric and other neurodegenerative disorders presenting with behavioural change

Disease trajectories in behavioural variant frontotemporal dementia, primary psychiatric and other neurodegenerative disorders presenting with behavioural change

Psychosis in behavioral variant frontotemporal dementia

Clinical Assessment of Older Adults with Bipolar Disorder

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