Gossink Flora T, Vijverberg Everard Gb, Krudop Welmoed, Scheltens Philip, Stek Max L, Pijnenburg Yolande Al, Dols Annemiek
Department of Old Age Psychiatry, GGZinGeest.
Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam.
Neuropsychiatr Dis Treat. 2017 Apr 13;13:1099-1106. doi: 10.2147/NDT.S127863. eCollection 2017.
Dementia is generally characterized by cognitive impairment that can be accompanied by psychotic symptoms; for example, visual hallucinations are a core feature of dementia with Lewy bodies, and delusions are often seen in Alzheimer's disease. However, for behavioral variant of frontotemporal dementia (bvFTD), studies on the broad spectrum of psychotic symptoms are still lacking. The aim of this study was to systematically and prospectively subtype the wide spectrum of psychotic symptoms in probable and definite bvFTD.
In this study, a commonly used and validated clinical scale that quantifies the broad spectrum of psychotic symptoms (Positive and Negative Symptom Scale) was used in patients with probable and definite bvFTD (n=22) and with a primary psychiatric disorder (n=35) in a late-onset frontal lobe cohort. Median symptom duration was 2.8 years, and the patients were prospectively followed for 2 years.
In total, 22.7% of bvFTD patients suffered from delusions, hallucinatory behavior, and suspiciousness, although the majority of the patients exhibited negative psychotic symptoms such as social and emotional withdrawal and blunted affect (95.5%) and formal thought disorders (81.8%). "Difficulty in abstract thinking" and "stereotypical thinking" (formal thought disorders) differentiated bvFTD from psychiatric disorders. The combined predictors difficulty in abstract thinking, stereotypical thinking, "anxiety", "guilt feelings," and "tension" explained 75.4% of variance in the diagnosis of bvFTD versus psychiatric diagnoses (<0.001).
Delusions, hallucinatory behavior, and suspiciousness were present in one-fifth of bvFTD patients, whereas negative psychotic symptoms such as social and emotional withdrawal, blunted affect, and formal thought disorders were more frequently present. This suggests that negative psychotic symptoms and formal thought disorders have an important role in the psychiatric misdiagnosis in bvFTD; misdiagnosis in bvFTD might be reduced by systematically exploring the broad spectrum of psychiatric symptoms.
痴呆症通常以认知障碍为特征，可能伴有精神病性症状；例如，视幻觉是路易体痴呆的核心特征，而妄想在阿尔茨海默病中较为常见。然而，对于行为变异型额颞叶痴呆（bvFTD），关于广泛精神病性症状的研究仍然缺乏。本研究的目的是对可能的和确诊的bvFTD患者的广泛精神病性症状进行系统且前瞻性的亚型分类。
在本研究中，一种常用且经过验证的临床量表（阳性和阴性症状量表）被用于可能的和确诊的bvFTD患者（n = 22）以及晚发性额叶队列中的原发性精神障碍患者（n = 35）。症状持续时间的中位数为2.8年，对患者进行了为期2年的前瞻性随访。
总体而言，22.7%的bvFTD患者患有妄想、幻觉行为和猜疑，尽管大多数患者表现出阴性精神病性症状，如社交和情感退缩、情感迟钝（95.5%）以及形式思维障碍（81.8%）。“抽象思维困难”和“刻板思维”（形式思维障碍）可将bvFTD与精神障碍区分开来。抽象思维困难、刻板思维、“焦虑”、“内疚感”和“紧张”这些综合预测因素解释了bvFTD与精神障碍诊断差异的75.4%的方差（<0.001）。
五分之一的bvFTD患者存在妄想、幻觉行为和猜疑，而社交和情感退缩、情感迟钝以及形式思维障碍等阴性精神病性症状更为常见。这表明阴性精神病性症状和形式思维障碍在bvFTD的精神科误诊中起重要作用；通过系统地探索广泛的精神症状，可能会减少bvFTD的误诊。
