The Clinical Challenges of Diagnosing Behavioral Variant Frontotemporal Dementia vs Other Psychiatric Disorders

This is a case of stark behavior change in a 59-year-old female intended to highlight the clinical care to be taken in diagnosing early-stage behavioral variant frontotemporal dementia against other primary psychiatric disorders. Frontotemporal dementia is considered to be the second most common dementia in those under the age of 65 behind early onset Alzheimer’s disease. Of frontotemporal dementia variants, the behavioral variant has the highest risk of resembling or being misdiagnosed as another psychiatric disorder in part because of symptomatic crossover. The patient in this case presented initially with assumed symptoms of major depressive disorder with catatonic features; however on deeper analysis a strong argument can be made for early stage frontotemporal dementia. Aspects such as family history of dementia, negative personal history of psychiatric disorder, later age of onset, strict use of diagnostic criteria and signs of a progressive course can all be useful in directing a clinician towards a diagnosis of behavioral variant frontotemporal dementia. Furthermore, the challenges of diagnosing the behavioral variant against other primary psychiatric disorders in the acute care setting will continue to require clinicians to take a step back in regards to patient history and the mental status exam. This case report will hopefully bring light to some of the areas of difficulty for this diagnosis and towards research that has been done to make the diagnosis of behavioral variant Frontotemporal dementia slightly less challenging on clinicians.