An autopsy case of dementia with Lewy bodies clinically diagnosed to have a behavioral variant of frontotemporal dementia.

We herein report the case of a 75-year-old male who had shown many psychiatric symptoms, but whose autopsy disclosed the presence of dementia with Lewy bodies (DLB). When he was 70 years old, the patient had presented with stereotyped behavior, dietary changes, and a decline in social interpersonal conduct in clinical settings, and it was thought that these symptoms were consistent with a behavioral variant of frontotemporal dementia (bvFTD), and he lacked the core features of DLB. Nevertheless, this case was pathologically defined as the limbic type of DLB after he died at the age of 75 years. Looking retrospectively at the clinical course, it was considered that the following features were suggestive or supportive of DLB: neuroleptic sensitivity, autonomic symptoms, and psychiatric symptoms. It can be presumed that the bvFTD-like behavioral disturbances were caused by the severe Lewy pathology of the locus ceruleus (LC) and left anterior temporal region. The clinical symptoms of DLB might be more multifarious than has conventionally been thought, because the symptoms can be modified by the pathological spread of DLB within the brain. It is important to be aware of these possible symptoms of DLB so as not to overlook the diagnosis in the clinical setting.
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