Dados do Trabalho

Título

A late presentation of Frontotemporal Dementia (FTD) associated with Psychiatric symptoms: a case report.

RESUMO

Presentation: A 73-years-old patient, male, from Manaus, Amazonas, arrived to our service with a long-standing sleep disorder, and about 2 years ago the clinical condition was associated with anterograde amnesia, in addition to episodes of disorientation and mental confusion, according to his wife. He progressively evolved with behavioral changes, characterized by agitation, akathisia, constant speech of persecutory content and worsening of sleep disorders, followed by episodes of visual hallucination. He denies a history of neurological or psychiatric diseases in the family, and at the time of the first consult was using Risperidone and Rivastigmine. On the neurological examination was slightly disoriented in time, space, person and situation. CGS 14, restless, with constant talk of self-destructive content, echolalia and akathisia. Osteotendinous reflexes abolished in upper limbs, Patellar present, Achilles absent and Glabellar tap was fatiguable. Cognitive tests were distorted, with MMSE score of 15 out of 30 and clock test score of 1. MRI showed moderate atrophy, without hippocampal predominance and without signal changes or ventricular dilatation, leading to the probable diagnosis of Frontotemporal dementia (FTD). After discussion by the neurologic team, Periciazine and Olanzapine were introduced and Risperidone was suspended. In the following months, patient returned with support of the clinical picture, in addition to the appearance of essential tremor in upper limbs, maintenance of sleep disorder and he became dependent on family members for basic-life activities around 6 months since the first consult, and Citalopram was added to the prescription for symptomatic control. The follow-up continued at our service to assess the progression of the cognitive-behavioral status, and he died at home in 2022 after approximately 3 years of follow-up. Discussion: The case reveals a late presentation of FTD, since the most affected age group is under 65 years, and helps to emphasize that the presence of this condition in older ages should not be ignored. The presence of hallucinations and sleep disorders are not as common as behavioral and language changes, fact that may have directed examiners to hypothesis such as Lewy-body dementia in this case. Final comments: Healthcare providers should order routine tests and deep examination to rule out other conditions that cause similar symptoms and advised on the reserved prognosis of this disease.