Titta Korhonen1, Kasper Katisko1, Antti Cajanus1, Päivi Hartikainen2, Anne M Koivisto2, Annakaisa Haapasalo3, Anne M Remes1,2,4,5, Eino Solje6,7. 1. Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland. 2. Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland. 3. A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland. 4. Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland. 5. Medical Research Center, Oulu University Hospital, Oulu, Finland. 6. Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland, eino.solje@uef.fi. 7. Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland, eino.solje@uef.fi.
Abstract
INTRODUCTION: Behavioral variant frontotemporal dementia (bvFTD) is the most common clinical subtype of frontotemporal lobar degeneration. bvFTD is often characterized by changes in behavior and personality, frequently leading to psychiatric misdiagnoses. On the other hand, substantial clinical overlap with other neurodegenerative diseases, such as Alzheimer disease (AD), further complicates the diagnostics. OBJECTIVE: Our aim was to identify the main differences in early symptoms of bvFTD and AD in the prodromal stages of the diseases. In addition, patients with bvFTD were analyzed separately according to whether they carry the C9orf72repeat expansion or not. METHODS: Patient records of bvFTD (n = 75) and AD (n = 83) patients were analyzed retrospectively for memory and neuropsychiatric symptoms, sleeping disorders, and somatic complaints before the setting of the accurate diagnosis. RESULTS: A total of 84% of bvFTD patients (n = 63) and 98.8% of AD patients (n = 82) reported subjective memory disturbances in the prodromal phases of the disease. bvFTD patients presented significantly more often with sleeping disorders, headache, inexplicable collapses, transient loss of consciousness, somatization, delusions, and hallucinations, suicidality, changes in oral behaviors, and urinary problems. In addition, poor financial judgement was frequently detected in patients with prodromal bvFTD. Aberrant sensations in the nose and throat without any physical explanation, regarded as somatizations, emerged only in bvFTD patients with the C9orf72 repeat expansion. CONCLUSIONS: Subjective reporting of impaired episodic memory is a poor indicator in differentiating bvFTD from AD. Sleeping disturbances, delusions, hallucinations, and unexplained somatic complaints in a patient with cognitive disturbances should prompt the clinicians to consider bvFTD as a possible diagnostic option behind these symptoms. The spectrum of symptoms in the prodromal stages of bvFTD may be more diverse than the latest criteria suggest.
INTRODUCTION: Behavioral variant frontotemporal dementia (bvFTD) is the most common clinical subtype of frontotemporal lobar degeneration. bvFTD is often characterized by changes in behavior and personality, frequently leading to psychiatric misdiagnoses. On the other hand, substantial clinical overlap with other neurodegenerative diseases, such as Alzheimer disease (AD), further complicates the diagnostics. OBJECTIVE: Our aim was to identify the main differences in early symptoms of bvFTD and AD in the prodromal stages of the diseases. In addition, patients with bvFTD were analyzed separately according to whether they carry the C9orf72repeat expansion or not. METHODS:Patient records of bvFTD (n = 75) and AD (n = 83) patients were analyzed retrospectively for memory and neuropsychiatric symptoms, sleeping disorders, and somatic complaints before the setting of the accurate diagnosis. RESULTS: A total of 84% of bvFTD patients (n = 63) and 98.8% of ADpatients (n = 82) reported subjective memory disturbances in the prodromal phases of the disease. bvFTD patients presented significantly more often with sleeping disorders, headache, inexplicable collapses, transient loss of consciousness, somatization, delusions, and hallucinations, suicidality, changes in oral behaviors, and urinary problems. In addition, poor financial judgement was frequently detected in patients with prodromal bvFTD. Aberrant sensations in the nose and throat without any physical explanation, regarded as somatizations, emerged only in bvFTD patients with the C9orf72 repeat expansion. CONCLUSIONS: Subjective reporting of impaired episodic memory is a poor indicator in differentiating bvFTD from AD. Sleeping disturbances, delusions, hallucinations, and unexplained somatic complaints in a patient with cognitive disturbances should prompt the clinicians to consider bvFTD as a possible diagnostic option behind these symptoms. The spectrum of symptoms in the prodromal stages of bvFTD may be more diverse than the latest criteria suggest.
Authors: Eino Solje; Alberto Benussi; Emanuele Buratti; Anne M Remes; Annakaisa Haapasalo; Barbara Borroni Journal: Diagnostics (Basel) Date: 2021-04-27
Authors: Megan S Barker; Reena T Gottesman; Masood Manoochehri; Silvia Chapman; Brian S Appleby; Danielle Brushaber; Katrina L Devick; Bradford C Dickerson; Kimiko Domoto-Reilly; Julie A Fields; Leah K Forsberg; Douglas R Galasko; Nupur Ghoshal; Jill Goldman; Neill R Graff-Radford; Murray Grossman; Hilary W Heuer; Ging-Yuek Hsiung; David S Knopman; John Kornak; Irene Litvan; Ian R Mackenzie; Joseph C Masdeu; Mario F Mendez; Belen Pascual; Adam M Staffaroni; Maria Carmela Tartaglia; Bradley F Boeve; Adam L Boxer; Howard J Rosen; Katherine P Rankin; Stephanie Cosentino; Katya Rascovsky; Edward D Huey Journal: Brain Date: 2022-04-29 Impact factor: 15.255