Analysis on early clinical features of behavioral variant frontotemporal dementia

Abstract

Background Although the early behavioral symptoms of behavioral variant frontotemporal dementia (bvFTD) are prominent, early diagnosis for bvFTD is difficult due to confusion with other mental disorders, and lack of sensitivity and specificity of diagnostic criteria, etc. In this paper, we summarized the important reviews in recent years and analyzed the clinical characteristics of bvFTD patients to improve the detection of early symptoms in bvFTD.  Methods Twenty-three possible or probable bvFTD patients were diagnosed according to International Behavioral Variant Frontotemporal Dementia Criteria Consortium (FTDC). Self-designed questionnaires designed by Shanghai Mental Health Center were used to collect sociodemographic data and general information of patients. Their clinical characteristics were summarized, including abnormal behaviors, cognitive impairment, psychotic symptoms and other symptoms. Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL) and Clinical Dementia Rating Scale (CDR) were used to make neuropsychological tests and compare with similar overseas studies (control group, N = 66).  Results Eleven male patients and 12 female patients were included in our study. Compared with control group, the average age of onset [(50.83 ± 11.55) years vs. (57.00 ± 10.00) years; t = 3.863, P = 0.000] and average age of diagnosis [(53.22 ± 11.55) years vs. (61.00 ± 9.00) years; t = 13.423, P = 0.000] of bvFTD patients were smaller. The study showed that bvFTD patients had more apathy or indolence [95.65% (22/23) vs. 65.15% (43/66); χ² = 8.057, P = 0.005], loss of sympathy or empathy [95.65% (22/23) vs. 33.33% (22/66); χ² = 26.499, P = 0.000], while patients in control group showed more derepression behavior [98.48% (65/66) vs. 52.17% (12/23); χ² = 27.514, P = 0.000] and continuous, stiff, obsessive and/or ritualized behavior [95.45% (63/66) vs. 30.43% (7/23); adjusted χ² = 39.159, P = 0.000]. For cognitive impairment, bvFTD patients presented apraxia [69.56% (16/23) vs. 22.73% (15/66); χ² = 16.484, P = 0.000] and executive dysfunction [82.61% (19/23) vs. 59.09% (39/66); χ² = 4.156, P = 0.041]. In psychotic symptoms, patients in control group showed hallucination and delusion [33.33% (22/66) vs. 4.35% (1/23); χ² = 7.477, P = 0.006].  Conclusions While the behavioral symptoms of bvFTD patients are varied, memory disorder can be one of the primal symptoms. Compared with similar foreign studies, the different composition of behavior symptoms of our bvFTD patients may be caused by cultural differences among evaluators in the understanding of some clinical symptoms in patients.

DOI: 10.3969/j.issn.1672-6731.2017.11.010