Mild Behavioral Impairment

Abstract

The concept and significance of Mild Behavioral Impairment (MBI) as the prodromal condition of frontotemporal lobar degeneration (FTLD) and the possibilities of symptomatic treatment is described. Three community-residing patients, who were all normal functioning persons with gradual and persistent changes in behavior, no serious memory complaints, not demented and normal activities of daily living, met the clinical criteria for MBI.After a one year follow up period one of them had turned into FTLD and one had progressive memory impairment. FTLD frequently presents with psychiatric symptoms. Diagnosis is difficult when symptoms are still mild and atypical. By separating clinical and preclinical stages, the importance of the disease course is emphasized, which makes it possible to describe various stages of the same disease or alternatively, to describe one disease-related syndrome that is changing its features over time as the disease process continues. In case of mild psychiatric symptoms, especially disinhibition, the diagnosis MBI as a prodromal stage of FTLD should be considered. If frontal hypoperfusion in cerebral SPECT scanning is present, the risk of conversion to FTD within one to three years is high. Symptomatic treatment with a Serotonin Selective Reuptake Inhibitor or possibly a cholinesterase inhibitor may provide a therapeutic option in case of distressing behavioral symptoms. Symptomatic medication can improve quality of life. Awareness of the concept MBI prevents stigmatization of the patient and may reduce patient and caregiver stress.