CASES OF FRONTO TEMPORAL DEMENTIA PRESENTING WITH PSYCHOSIS

Abstract

Introduction Fronto Temporal Dementia presents in varied clinical situations, here we are presenting 2 cases that presented to Neurologist with Behavioural symptoms with No cognitive decline and symptoms suggestive of Psychosis. Both the cases were treated with neuroleptics and were considered to be Psychosis. MRI of the brain and Labs were normal. Only PET CT Scan of the brain showed probable Fronto Temporal Dementia. Methods Report of case series Results CASE 1 • 62 Year old female from middle socio economic status, Homemaker with Family history of psychiatric illness in brother was referred by the neurology team with behavioural manifestations, Initially presented with irrelevant talk, talking to self since last 2 years. She gradually started becoming withdrawn, but managed to be independent in her Activities of Daily Living till few months back.Since the last couple of months she was not interested to her house hold chores, confining herself to indoors, and reduced self care. Since couple of months predominantly silent, occasionally responds to what family says and at times does the opposite. No hallucinations and delusions. No history of clear cognitive decline except for occasionally misplacing things which was felt normal. On examination: she was able to walk, mute, active and passive negativism. Labs and MRI brain done were within normal limits. No other significant medical history was present. A Diagnosis of “Catatonia” was made, Trial of lorazepam was given with mild improvement in speech and communication, food intake was better, obeying simple commands better. In discussion with neurologist and a trial of ECT was considered. AS the improvement was marginal a PET CT Scan was done which was Suggestive of Fronto Temporal Dementia. CASE 2 • A 60 year old lady, divorced in a couple of years after marriage, coping well worked as a teacher, Pre-morbidly stubborn and demanding, Family history of depressive disorder in first degree relative Behavioural changes noted at the age of 50 years manifested by being withdrawn, reduced involvement in regular activities, increased food consumption reduced self care, would pass urine stools at inappropriate places and be unmindful. Admitted at general hospital-diagnosed to have Hypertension, Diabeted Mellitus, Hypothyroidism and Irritable Bowel Syndrome. She occasionally mentioned people were talking about her but difficult to elicit other psychotic Symptoms. She was shifted to old age home at Hyderabad where she had leg pains and diagnosed as RLS and responded to treatment. MRI of the brain was normal. During subsequent follow up with the Neurologist she was noted to be “depressed” and started on Escitalopram-unclear response. In the next few months the episodes of passing stools inappropriately came down, hyperphagia persisted and would occasionally report of apprehension that someone may harm her and could see some vague shadows. This prompted her to be started on Amsulpride but stopped in few days as developed EPS at about 200mg/day. Despite stopping medications she started having significant increase in appetite, would start intruding into other peoples rooms and take whatever food items were there. She was subsequently told not to come into the common mess as she would consume large proportions of food from others plate as well. She was threatened to be thrown out of the old age home and they only agreed if she will be restricted to room. Being off all medications, noted to have occasional forgetfulness. Her “hyperphagia” continued and started developing involuntary Right upper limb choreo-athetotic movements. She also was noted to have repeated touching and rubbing of the face. A PET CT scan of the Brian was suggestive of Fronto Temporal Dementia. Conclusions A diagnosis of Fronto temporal Dementia should be suspected in all cases presenting with late onset psychosis and mild cognitive disturbances. Implication of the the diagnosis and treatment will be discussed. This research was funded by NIL