Psychiatric Symptoms and Their Psychosocial Consequences in Frontotemporal Dementia

Passant, Ulla; Elfgren, Christina; Englund, Elisabet; Gustafson, Lars

doi:10.1097/01.wad.0000183084.22562.5a

Cited by 70 publications

(74 citation statements)

References 16 publications

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“…55 A recent study assessing the specific psychosocial consequences of bvFTD outlined marital discord, criminal behavior, child endangerment, and driving violations as some of the products of behaviors related to the disorder, outlining the need for appropriate psychosocial education and support. 4 Weintraub and Morhardt 54 recently outlined a prescription for tailored care and education for patients with FTD and PPA and their caregivers. The present study indicates that it may be appropriate to educate families dealing with PPA that similar problems to those seen early in bvFTD are likely to emerge over time, and that they should address financial/legal affairs and health care proxy decisions while patients are still aware of their condition, and their symptoms are still restricted to language impairments.…”

Section: Discussionmentioning

confidence: 99%

“…2 These symptoms include mood disturbances, psychoses, compulsions, anxiety, and agitation, symptoms that constitute a major source of morbidity and caregiver burden. 3,4 Neuropsychiatric symptoms are more prevalent in certain types of dementia. Frontotemporal dementia (FTD) is an umbrella term for a group of dementia syndromes that present clinically without amnesia, especially in the early stages.…”

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confidence: 99%

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Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

Banks

Weıntraub

2008

J Geriatr Psychiatry Neurol

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Neuropsychiatric symptoms are well defined in behavioral variant frontotemporal dementia but are not as well studied in primary progressive aphasia. This study compared caregiver reported neuropsychiatric symptoms in these 2 forms of dementia at short and long disease duration. Patients with behavioral variant frontotemporal dementia had more symptoms than patients with primary progressive aphasia. However, when divided by duration of disease, patients with primary progressive aphasia with long duration had a similar number of symptoms to patients with behavioral variant frontotemporal dementia at either duration. Furthermore, this group of patients with primary progressive aphasia had more symptoms typical of behavioral variant frontotemporal dementia and less mood-related symptoms which were more common in patients with primary progressive aphasia with shorter duration. This study illustrates the emergence of neuropsychiatric symptoms as primary progressive aphasia progresses and highlights the increasing overlap with behavioral variant frontotemporal dementia because the disease affects areas outside of the language network. Keywords dementia; neuropsychiatric symptoms; primary progressive aphasia; frontotemporal dementia Neuropsychiatric symptoms are common in the neurodegenerative dementias 1 and are related to specific biochemical and anatomical changes that occur with these diseases. 2 These symptoms include mood disturbances, psychoses, compulsions, anxiety, and agitation, symptoms that constitute a major source of morbidity and caregiver burden. 3,4 Neuropsychiatric symptoms are more prevalent in certain types of dementia. Frontotemporal dementia (FTD) is an umbrella term for a group of dementia syndromes that present clinically without amnesia, especially in the early stages. FTD affects between 4% and 20% of patients presenting to dementia clinics 5 and is found to be most prevalent in individuals below 60 years of age. 6-8 FTD can be broadly divided into 2 clinical categories 9 : a behavioral variant frontotemporal dementia (bvFTD) and an aphasic variant known as primary progressive aphasia (PPA). Neuropsychiatric symptoms are the earliest manifestation in bvFTD and may occur in isolation or in addition to executive dysfunction. Different symptoms of aphasia occur early in PPA 10-13 and remain most prominent over the course of illness. Although the postmortem neuropathological findings are varied in both PPA and bvFTD, they typically affect the prefrontal and anterolateral temporal areas of the brain and are therefore subsumed under the rubric of frontotemporal lobar degeneration (FTLD). PPA refers to the class of clinical dementia syndromes in which aphasia is the earliest and most salient symptom, especially within the first 2 years of symptoms onset. Any type of aphasia can be manifested. 12 PPA has recently been classified into subtypes based on distinctive clinical and neuroimaging features: labelled agrammatic or nonfluent, semantic dementia (SD), and logopenic. [14][15][16][17] Prior t...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

Banks

Weıntraub

2008

J Geriatr Psychiatry Neurol

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“…Clinicopathologic studies report a wide range (0-71%) of clinical accuracy for diagnosing VaD and FTD [13,15,18,19]. During the first few years of their disease, these patients may see many different doctors and undergo extensive medical evaluations with significant delays in diagnosis of 3-4 years or more [17,18]. Yet, the accurate diagnosis of EODs has management consequences [2,20].…”

Section: The Misdiagnosis Of Eodmentioning

confidence: 99%

“…Despite the importance, clinicians misdiagnose many if not most patients with EOD early in their course [2,5,10,[15][16][17]. Although clinical criteria exist for the most common EODs, misdiagnosis is common even at tertiary centers [2].…”

Section: The Misdiagnosis Of Eodmentioning

confidence: 99%

The Accurate Diagnosis of Early-Onset Dementia

Mendez

2006

Int J Psychiatry Med

155

144

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Early-onset dementia (EOD, <65 years at onset) is a relatively common and frequently misdiagnosed condition. One reason for misdiagnosis is that EOD has a more varied differential diagnosis than late-onset dementia (LOD). For example, Alzheimer's disease (AD), the preponderant LOD, makes up only about one-third of EODs; the rest are due to vascular dementias, frontotemporal lobar degenerations, traumatic head injury, alcohol-related dementia, and a great many other conditions. Another reason for misdiagnosis is that early-onset AD may have predominant cognitive deficits other than memory loss and a potential familial inheritance with spastic paraparesis, seizures, or myoclonus. A third reason is that EOD often presents with neuropsychiatric features out-of-proportion to any cognitive deficits. Despite these obstacles, it is important to accurately diagnose EODs, particularly because they differ in management and course. Clinicians can successfully diagnose most EODs with careful cognitive and family histories, mental status and neurological examinations, and neuroimaging.

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“…As the correct diagnosis is the cornerstone of patient's management, misdiagnosis should be avoided to prevent treatment delay. Furthermore, a correct diagnosis of bvFTD has direct implications for heritability, prognosis and patient management [34,35]. …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome

Vijverberg

Dols

Krudop

et al. 2016

Dement Geriatr Cogn Disord

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Background/Aims: We aimed to prospectively assess the diagnostic accuracy of the revised criteria for behavioural variant frontotemporal dementia (bvFTD) among subjects presenting with a frontal lobe syndrome in middle-late adulthood. Methods: Patients were included based on a predominant behavioural clinical presentation, a Frontal Behavioural Inventory (FBI) score of ≥11 and/or a Stereotypy Rating Inventory (SRI) score of ≥10. At baseline, the fulfilment of the international consensus criteria for behavioural variant FTD (FTDC) was systematically recorded. The 2-year follow-up consensus diagnosis was used as the gold standard to calculate sensitivity and specificity of the FTDC criteria for possible and probable bvFTD. Results: Two-year follow-up data were available for 116 patients (85%). Two-year follow-up consensus diagnoses consisted of probable/definite bvFTD (n = 27), other dementia (n = 30), psychiatric disorders (n = 46) and other neurological disorders (n = 13). Sensitivity for possible bvFTD was 85% (95% CI 70-95%) at a specificity of 27% (95% CI 19-37%). Sensitivity for probable bvFTD was 85% (95% CI 69-95%), whereas their specificity was 82% (95% CI 73-89%). Conclusions: We found a good diagnostic accuracy for FTDC probable bvFTD. However, the specificity for FTDC possible bvFTD was low. Our results reflect the symptomatic overlap between bvFTD, other neurological conditions and psychiatric disorders, and the relevance of adding neuroimaging to the diagnostic process.

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Psychiatric Symptoms and Their Psychosocial Consequences in Frontotemporal Dementia

Cited by 70 publications

References 16 publications

Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

The Accurate Diagnosis of Early-Onset Dementia

Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome

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