Frontotemporal dementia patient with bipolar disorder: A case report

Abstract

Background: Frontotemporal dementias constitute 5% of all irreversible dementias. FTD is the third common major neurocognitive disorder after Alzheimer's Dementia and Vascular Dementia. Early stages of the disease is often characterised by personality and behavioural changes which may lead to misdiagnosis of psychiatric disorders. The condition can mimic psychiatric disorders and often misdiagnosed especially in a patient with previous history of psychiatric disorder. Objective: To describe the case of a 75yr old woman with previous history of bipolar disorder whose current presentation was consistent with Bipolar disorder. But the duration of illness was prolonged and symptoms remained refractory to medications and was diagnosed as Frontotemporal dementia. Case Report: 75 year old married female from a upper middle socioeconomic backgroundpresented with inappropriate behaviour, increased irritability and anger, over talkativeness and asking things repeatedly, disinterest in household work since past 2years with past history of T2DM with Peripheral Neuropathy and Hypertension and h/o psychiatric illness s/o Manic episode following 1st delivery 54yrs back, took psychiatric treatment, reached PML and continued medications for 2years.Family history revealed episodic psychiatric illness in elder son and h/o suicide in elder brother.Patient was admitted and started on Sodium Valproate 750mg and Quetiapine 100mg.Even though symptoms were consistent with Bipolar disorder, considering the longer duration and refractory symptoms, we proceeded with brain imaging and neurocognitive testing and Frontotemporal dementia was diagnosed. Result: This case demonstrates the need to identify differential diagnoses in psychiatric disorders with atypical presentation and thoseresistant to medications Conclusion: It is diffcult to establish a differential diagnosis between Frontotemporal Dementia and Bipolar Disorder especially in patients with history of Bipolar Disorder.Evaluating a patient from a neuropsychiatric perspective is important rather than having psychiatric approach alone.