Dementia or mania? A case report

In the clinical practice, we encounter situations that require precise differential diagnosis and special treatment. This poster reviews diagnosis and pharmacotherapy of two cases that point out how likely is to confuse the diagnosis of two apparently different pathologies: bipolar disorder and frontotemporal dementia. The first case presents a 75-year-old man that presented behavioural changes and insomnia without previous known psychiatric history other than alcoholism. The family explained a history of episodes of mood changes going from depression to mania, compatible with a bipolar disorder never diagnosed, and the neuropsychological exam performed did not show any cognitive impairments, finally receiving a diagnosis of bipolar disorder after good response to lithium treatment. The second case presents a 58-year-old man with behavioural disturbances and mood fluctuation that changed from short periods of hypomania with disinhibition and insomnia to a predominance of hypothymia, apathy and self-care negligence, which received at the beginning a diagnosis of bipolar disorder and after the proper complementary tests was shown to be a frontotemporal dementia. When facing behavioural and mood changes in advance age, we should take into account the considerable percentage of patients with a final diagnosis of frontotemporal dementia that received previously a mistaken diagnosis of bipolar disorder and vice versa. Even though in our practice age can point to a disorder, we should not forget the importance of a good clinical history and anamnesis to reach a correct diagnosis as well a organized and carefully planned treatment approach for each individual patient.