Frontotemporal dementia (FTD) is, next to Alzheimer disease, the most frequently encountered form of primary degenerative dementia among middle-aged subjects. It generally begins insidiously between the ages of 45 and 65 years, and is seen in both genders with equal frequency. It is characterized by changes in personality, behavior, and affect, in addition to loss of insight, perseverative and stereotypical behaviours, and changes in eating habits. These patients appear normal upon neurological examination and routine electroencephalography (EEG), but brain imaging reveals focal abnormalities in the frontotemporal lobes. There is significant deficiency in executive functions. This study describes a male patient with FTD that had began insidiously in his fifties, and in whom the changes in personality and impairment in behavior were the striking symptoms (loss of insight, hyperorality, and dietary changes; compulsive and stereotypical behaviours; blunted affect, decrease in the amount of speech and retardation in expressional behaviours; impairment in personal hygiene; urinary and fecal incontinence) along with a family history of dementia. The neurological examination and routine electroencephalogram (EEG) of the patient were normal. His cranial magnetic resonance imaging (MRI) revealed asymmetric atrophy, particularly in the right hemisphere at the dorsolateral and orbitofrontal regions. Tc-99 HMPAO single photon emission tomography (SPECT) detected asymmetric hypoperfusion within an extended region, including the right frontal and parietal lobes. There was deficiency in frontal executive functions. Partial improvement in behavioral symptoms was achieved by treating the patient with quetiapine 300 mg/day. The present case study showed that detailed history, as well as medical examination including physical and neurological examination and brain imaging, must be performed in the case of middle-aged patients with insidious onset of psychiatric symptoms.
Frontotemporal dementia, middle ages, executive functions, brain imaging