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Psychiatric symptoms in the early detection and differential diagnosis of FTD
Author(s) -
Ducharme Simon
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.045848
Subject(s) - frontotemporal dementia , prodrome , psychiatry , neuroimaging , dementia , medicine , disease , clinical psychology , psychology , psychosis , pathology
Background The early symptoms of behavioral‐variant frontotemporal dementia (bvFTD) have considerable overlap with the common primary psychiatric disorders like major depression and psychotic disorders. Consequently, about 50% are diagnosed with a psychiatric disorder before the identification of bvFTD. While this can be due to inadequate recognition of bvFTD features and lack of expertise, the diagnostic effort is also complicated by the fact that psychiatric symptoms like delusions and hallucinations are sometimes the prodrome to bvFTD—particularly in familial cases. Whereas the reliability of Alzheimer’s disease diagnoses has improved with the advent of molecular biomarkers, the diagnosis of bvFTD remains primarily based on clinical assessment and neuroimaging. The need for a systematic approach to distinguish bvFTD from psychiatric disorders is addressed in recommendations recently developed by an internal panel of experts, the Neuropsychiatric International Consortium for FTD, and are reviewed in this presentation. Method The Neuropsychiatric International Consortium for FTD was convened to develop recommendations for a diagnosis approach for identifying bvFTD in individuals with midlife‐onset (>45 years) behavior change. The consensus process included a systematic review of the literature to identify best practices, effective clinical measures and the utility of brain imaging. Result Differential diagnosis of bvFTD from psychiatric disorders is facilitated by comprehensive and chronologically‐ordered history, family history of neurodegenerative or neuromuscular disease, use of formal diagnostic criteria for bvFTD and for psychiatric disorders, use of bedside measures of general cognition and social behavior, psychiatric scales and brain imaging. These have been incorporated into an algorithm to facilitate use of the recommendations. Conclusion A systematic approach to the clinical examination can be facilitate the differential of bvFTD from primary psychiatric disorders. This is valuable for providing timely diagnosis, and early counseling and treatment planning to patients, for facilitating testing of novel treatments in clinical trials—and will also facilitate proper treatment for patients with primary and secondary psychiatric states.