Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil.
Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil.
Arq Neuropsiquiatr. 2022 May;80(5 Suppl 1):7-14. doi: 10.1590/0004-282X-ANP-2022-S140.
Due to the early and prominent behavioral changes which characterize behavioral variant frontotemporal dementia (bvFTD), patients are more likely to seek psychiatric help and are often initially diagnosed with a primary psychiatric disorder (PPD). Differentiating these conditions is critical because of the dramatically different outcomes, differences in patient management, family counseling and caregiver education.
To propose a practical guide to distinguish between bvFTD and PDD.
We conducted a non-systematic review of the published manuscripts in the field, including some previous investigations from our own group and work on which we have collaborated, and summarized the main findings and proposals that may be useful for neurological practice.
The reviewed literature suggests that a comprehensive clinical history, brief cognitive and neuropsychological evaluations, detailed neurological examination with special attention to motor alterations related to bvFTD, structural and functional neuroimaging evaluation, genetic investigation in selected cases, and assistance from a multidisciplinary team, including a neurologist and a psychiatrist with expertise in bvFTD, are very helpful in differentiating these conditions.
Although the clinician may commonly face great difficulty in differentiating between bvFTD and PPD, the use of appropriate tools in a systematic way and the availability of a well-trained multidisciplinary group can significantly increase diagnostic accuracy.
由于行为变异型额颞叶痴呆（bvFTD）具有早期且突出的行为改变，患者更有可能寻求精神科帮助，并且通常最初被诊断为原发性精神障碍（PPD）。区分这些病症至关重要，因为它们的预后、患者管理、家庭咨询和护理人员教育存在显著差异。
提出一种实用的指南来区分 bvFTD 和 PPD。
我们对该领域已发表的文献进行了非系统性回顾，包括我们自己小组的一些先前调查结果以及我们合作的研究，并总结了可能对神经科实践有用的主要发现和建议。
综述文献表明，全面的临床病史、简短的认知和神经心理学评估、详细的神经检查，特别注意与 bvFTD 相关的运动改变、结构和功能神经影像学评估、有选择地进行遗传研究以及多学科团队的协助，包括具有 bvFTD 专业知识的神经科医生和精神科医生，对于区分这些病症非常有帮助。
尽管临床医生通常在区分 bvFTD 和 PPD 方面可能会遇到很大的困难，但系统使用适当的工具以及有经过良好训练的多学科团队的支持，可以显著提高诊断准确性。
