Fronto-Temporal Dementia: A Case Report

          http://austinpublishinggroup.com/molecular-biology/fulltext/jmbmi-v3-id1023.php

Fronto-temporal dementia (FTD) is the most common form of primary degenerative dementia after Alzheimer’s disease that affects middle age with an estimated prevalence at 15 per 100,000 in the population aged between 45 – 65 years. FTD is often misdiagnosed due to its early onset, clinical and pathological heterogeneity. Neuroimaging is known to assist in early diagnosis of these disorders. We present a case of a 59 year old woman with FTD.

A 59 year old female was diagnosed with major depressive disorder and borderline personality disorder of about a year’s duration. There were continued behavioral changes, with periods of aggression and impulsiveness at times. Also, there was ongoing worsening of memory with poor concentration. She later developed irritable mood and poor appetite. Examination on her last hospital visit showed a well groomed, alert, calm and cooperative patient. She had normal speech and normal psychomotor activity. Her mood was labile; she was however coherent and relevant showing reactive affects. She was a suicidal however objectively hallucinating.

The patient’s medications included fluoxetine 20mg daily, sodium valproate 200mg twice daily, clonazepam 0.5mg when necessary. She underwent magnetic resonance imaging (MRI) of the brain in view of her worsening memory and concentration. This showed evidence of mild frontotemporal lobe involution (Figure 1). Incidentally, there was also an enlarged anterior pituitary gland (1.02 x 1.3 cm) seen.

She was also referred to the nuclear medicine department for brain perfusion imaging – this forms part of molecular imaging and was done byacquiring SPECT images of the brain using Tc-99m HMPAO (Exametazime) injected into a pre-inserted IV line in a quiet dimly lit room. The scan showed a relatively decreased perfusion in the frontotemporal region, involving the anterior cingulate and anterior temporal cortices seen in Figure 2. These findings were in agreement with the findings of MRI and together with the clinical history and signs, consistent with frontotemporal dementia with a diagnosis of Pick’s disease most likely.

The concept of frontotemporal dementia includes a group of primary degenerative dementia disorders that presents with predominant frontal lobe and /or temporal lobe symptoms. These include Pick’s disease (often referred to in broader term of frontotemporal dementia), frontotemporal lobar degeneration (FTLD) also called dementia lacking distinctive histological features (DLDH), frontotemporal lobar degeneration with motor neuron disease, corticobasal degeneration, progressive supranuclear palsy, frontotemporal dementia with parkinsonism linked to chromosome 17 and others.