Tondo Giacomo, De Marchi Fabiola, Terazzi Emanuela, Sacchetti Marta, Cantello Roberto
Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
Cogn Behav Neurol. 2017 Jun;30(2):62-67. doi: 10.1097/WNN.0000000000000122.
Behavioral variant frontotemporal dementia, the most common form of frontotemporal dementia, is characterized by executive dysfunction and changes in personality and behavior, sometimes with associated psychiatric disorders. We report a man who suddenly developed a gambling disorder when he was 55 years old. A year later he developed personality changes of agitation, euphoria, and disinhibition, along with binge eating and dysthymia. He did not improve on paroxetine 40 mg/day. Two years after the onset of his symptoms, he came to our clinic for evaluation. Neuropsychological testing showed deficits in cognitive control, planning, and attention. Brain magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography scans showed predominant frontal and temporal alterations, worse in the right hemisphere than the left. Cerebrospinal fluid analysis was not compatible with Alzheimer disease. On the basis of current criteria, we gave him a diagnosis of probable behavioral variant frontotemporal dementia presenting with a psychiatric symptom. Our findings in this unusual patient confirm the importance of close clinical monitoring in people who have a psychiatric disorder with atypical features, because the condition may mask an underlying neurodegenerative disease.
行为变异型额颞叶痴呆是额颞叶痴呆最常见的形式，其特征为执行功能障碍以及人格和行为改变，有时还伴有相关的精神障碍。我们报告一名55岁男性突然患上了赌博障碍。一年后，他出现了易激惹、欣快和脱抑制等人格改变，同时伴有暴饮暴食和心境恶劣。他服用每日40毫克的帕罗西汀后病情并未改善。症状出现两年后，他来到我们诊所进行评估。神经心理学测试显示其在认知控制、计划和注意力方面存在缺陷。脑磁共振成像和18F-氟脱氧葡萄糖正电子发射断层扫描显示主要为额叶和颞叶改变，右侧半球比左侧更严重。脑脊液分析与阿尔茨海默病不符。根据当前标准，我们诊断他为可能的行为变异型额颞叶痴呆并伴有精神症状。我们在这名不寻常患者身上的发现证实了对具有非典型特征的精神障碍患者进行密切临床监测的重要性，因为这种情况可能掩盖潜在的神经退行性疾病。
