The Use of Quantitative EEG for Differentiating Frontotemporal Dementia From Late-Onset Bipolar Disorder

IntroductionEspecially the behavioral variant of Frontotemporal Dementia (FTD) may present with impulsivity, social disinhibition or depressive symptoms and these symptoms may create a clinical profile very similar to Bipolar Disorder (BD). In clinical practice, this similarity at symptom level creates substantial diagnostic confusion and often errors. As the treatment approach to the two disorders differ significantly, it is essential to make a reliable differential diagnosis.AimIn this study we aimed to identify EEG differences between FTD and BD.MethodsFor this aim we recruited 22 patients with FTD and 32 patients with BD. Patients in both groups were evaluated with a standardized neuropsychological battery and structural MRI. All patients were evaluated with resting EEG. There were no significant age and gender differences between groups.ResultsEEG power analysis showed that FTD group had increased frontal and temporal theta as compared to the BD group. There were no consistent group differences for other bands.ConclusionBased on this result we conclude that quantitative EEG may help differentiating BD from FTD and may eliminate diagnostic uncertainty.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1173 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S335-S336 ◽

Cited By ~ 1

Author(s):

P. Oliveira ◽

C. Roque ◽

V. Santos ◽

N. Madeira

Keyword(s):

Bipolar Disorder ◽

Frontotemporal Dementia ◽

Psychiatric Symptoms ◽

Late Onset ◽

Single Photon ◽

Photon Emission ◽

Interpersonal Behavior ◽

Psychotic Symptoms ◽

Emission Computed Tomography ◽

Global Pattern

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Late onset bipolar disorder and frontotemporal dementia with mutation in progranulin gene: a case report

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration ◽

10.1080/21678421.2017.1339716 ◽

2017 ◽

Vol 18 (7-8) ◽

pp. 624-626 ◽

Cited By ~ 6

Author(s):

Elisa Rubino ◽

Alessandro Vacca ◽

Salvatore Gallone ◽

FLORA Govone ◽

Milena Zucca ◽

...

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Frontotemporal Dementia ◽

Late Onset

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A Case of Late-Onset Bipolar Disorder With Severely Abnormal Behavior and Neuroimaging Observations Very Similar to Those of Frontotemporal Dementia

Journal of Neuropsychiatry ◽

10.1176/appi.neuropsych.13020031 ◽

2014 ◽

Vol 26 (1) ◽

pp. E35-E35 ◽

Cited By ~ 7

Author(s):

Akira Monji ◽

Keisuke Motomura ◽

Yoshito Mizoguchi ◽

Tomoyuki Ohara ◽

Shingo Baba ◽

...

Keyword(s):

Bipolar Disorder ◽

Frontotemporal Dementia ◽

Late Onset ◽

Abnormal Behavior

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Frontotemporal Dementia and Late-Onset Bipolar Disorder: The Many Directions of a Busy Road

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.768722 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mari N. Maia da Silva ◽

Fábio Henrique de Gobbi Porto ◽

Pedro Maranhão Gomes Lopes ◽

Catarina Sodré de Castro Prado ◽

Norberto Anízio Ferreira Frota ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorder ◽

Frontotemporal Dementia ◽

Late Onset ◽

Current Knowledge ◽

Severe Depression ◽

First Episode ◽

Considerable Proportion ◽

Clinical Genetic ◽

Increased Risk

It is a common pathway for patients with the behavioral variant of frontotemporal dementia (bvFTD) to be first misdiagnosed with a primary psychiatric disorder, a considerable proportion of them being diagnosed with bipolar disorder (BD). Conversely, not rarely patients presenting in late life with a first episode of mania or atypically severe depression are initially considered to have dementia before the diagnosis of late-onset BD is reached. Beyond some shared features that make these conditions particularly prone to confusion, especially in the elderly, the relationship between bvFTD and BD is far from simple. Patients with BD often have cognitive complaints as part of their psychiatric disorder but are at an increased risk of developing dementia, including FTD. Likewise, apathy and disinhibition, common features of depression and mania, respectively, are among the core features of the bvFTD syndrome, not to mention that depression may coexist with dementia. In this article, we take advantage of the current knowledge on the neurobiology of these two nosologic entities to review their historical and conceptual interplay, highlighting the clinical, genetic and neuroimaging features that may be shared by both disorders or unique to each of them.

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