OBJECTIVE: Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia with progressive nerve cell loss in the frontal and anterior temporal lobes. Clinically, there are two major subtypes. Personality disorder and behavior change are evident in one of these: apathy, lack of empathy, perseverative and stereotypic behaviors, disinhibition, social maladaptation can be seen. Non-fluent, fast speech and grammatical errors, or problems word-to-word and word-to-object matching can be seen in the type that goes with impairments in language functions. These cases may be misdiagnosed as psychotic disorder or late onset bipolar affective disorder. Here we’ll present a patient diagnosed with FTD who is admitted to our clinic with a manic episode pre-diagnosis.

CASE: A fifty-five-year-old woman was admitted to our clinic, complaints with social indifference, impairments in decision-making, functioning and self-care, and forgetting the names of some objects for one year, and with additive complaints which are increased mobility, insomnia and increased money spending for last three months. There was no specific finding in her biography and no dementia history in her family. During her examination, her mood was elevated; content of the speech was poor and she was repeating the same things in a perseverative manner. She didn’t answer the questions and she had difficulty in finding the right words. Her score of the mini-mental test was 12 (N24–30). In neuropsychological tests, impairment in the ability to maintain attention, psychomotor speed, and stability was found to be moderate impairment and impulsivity, loss of insight, difficulty coping with challengers, impairment in abstraction, simple and complex attention, planning and organizational disruption in frontal executive functions were detected. The routine laboratory analysis were as usual. In EEG, general disorder in the main activities and primer subcortical discharge were detected. MR showed prominent and moderate-to-severe atrophy in the perisylvian extraaxial CSF distance continuing on the frontotemporal, frontoparietal plane. After detailed neuropsychometric examinations and tests performed, the patient was diagnosed with FTD. for the controlling of behavioral symptoms, quetiapine tablet treatment was started and it was increased up to 600 mg / day. With this treatment, the patient's mobility, insomnia, perseverative speech complaints decreased and social adjustment improved.

DISCUSSION: FTD is should be one of the first diagnosis to come to mind for disorganized behaviors and mood changes, especially starting after the age of 50s. In addition, euphoria - one of the behavioral symptoms - improper jokes, increase in self-confidence and irritability may lead to misdiagnose the patient as bipolar disorder (manic episode) at the initial stage. It is a fact that the recognition of similar phenomena will become more evident after better
identification of this dementia-like picture and the establishment of clinical diagnostic criteria and widespread use of neuropsychological assessment.