Frontotemporal dementia: A diagnostic challenge

Introduction Frontotemporal dementia (FTD), the second commonest cause of degenerative dementia after Alzheimer's disease in patients aged 65 years or less is characterized clinically by progressive changes in social, behavioural, and language function. Objectives To do a complete psychiatric and neurological examination of a case with pick dementia. Aims This case report wants to highlight the combination of psychiatric and neurological symptoms in FTD in order to improve the early diagnosis and therapeutical management. Methods We report the case of a 62-years-old male who was admitted in psychiatric clinic, I Cluj-Napoca after he was transferred from neurology clinic I for distractibility, impersistence, apathy, loss of interest, emotional blunting, hyperorality, dietary changes, stereotyped behaviour, decline in personal hygiene. The delay in diagnosis was approximately 3 years, probably because his MMSE total score was 30 points and because he presented behavioural and verbal disinhibition, irritability, inappropriate emotional reacting and a CT with minimal changes. Results Psychometric evaluations revealed: Frontal Assessment Batery (13/18), Frontotemporal Dementia Rating Scale (50% impairment, moderate severity level), ADL (activities of daily living) (Katz score = 4/7, moderate dependence, low self-care) and IADL (instrumental activities of daily living) (2/8 = high dependency level, low self-maintenance). MRI: fronto-temporal atrophy. The anamnesis, heteroanamnesis, para-clinical investigations led us to a diagnosis of FTD (Pick dementia). Conclusions We should acknowledge that behavioural changes progress whatever the presentation, that cognitive decline occurs later and that FTD is a disease with a longer delay in onset of cognitive symptoms and diagnosis.