Our Panel of Experts Highlight the Most Important Research Articles Across the Spectrum of Topics Relevant to the Field of Neurodegenerative Disease Management

Abstract

Neuroscience Research Australia, Sydney, Australia School of Medical Sciences, the University of New South Wales, Sydney, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK *Author for correspondence: f.kumfor@neura.edu.au Landqvist Waldo M, Gustafson L, Passant U, Englund E. Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma? Int. Psychogeriatr. doi:10.1017/S1041610214002580 (2014) (Epub ahead of print). Early diagnosis of frontotemporal dementia (FTD) remains difficult despite an accumulation of research in recent years. Given the clinical and pathological heterogeneity, misdiagnosis is not uncommon and has implications for the management of these patients. In this study published in International Psychogeriatrics, Waldo and colleagues conducted a retrospective analysis of 97 patients with pathological confirmation of FTD and reviewed the presence of psychotic symptoms, initial diagnosis and family history for psychiatric disorders. They found that fewer than 15% of patients were initially diagnosed with FTD and 25% never received a correct diagnosis in life. At presentation, 41 patients were diagnosed with a psychiatric disorder and 33 with another dementia. Patients diagnosed with psychiatric disorders were significantly younger than the other patients. Psychotic symptomatology was present in 31 patients (∼33%) and was strongly associated with right-sided brain atrophy. In addition, over 75% of cases with psychotic symptoms were found to have non-tau pathology, predominantly TDP-43 protein deposition. This study confirms the difficulty in establishing an early diagnosis of FTD, particularly in young individuals who are more likely to be diagnosed with a psychiatric disorder. Importantly, presence of psychotic symptoms in FTD patients appears to provide clues to the underlying pathology (i.e., non-tau). While genetic status of the patients was not provided, frequency of psychotic features is in line with recent investigations of FTD patients with the C9orf72 gene expansion, who also show abnormal TDP-43 protein deposition. These findings provide further support to consider psychotic symptoms as part of the diagnostic criteria for FTD. – Written by Olivier Piguet