Hello doctor, My mother has recently received a diagnosis of frontotemporal dementia. Here is a history of her: She had what we believed to be a nervous breakdown four years back. This was after a year of stress from a pending court case. After this breakdown, she displayed some psychotic symptoms. Would constantly go to the toilet to wash her hands. Had obsessive thoughts that were very strong. She was placed on an antipsychotic, sleeping aid Zoplicone and Lithium. After a month, she was stabilized and came home. The obsessive thinking continued but not so much in the form of compulsions. Over the next four years, she was quite up and down and tried to take her life a few times. One becoming close and ended up in an intensive scar. She had taken a large amount of Lithium and was taken off this and antipsychotics. After recovery, she became extremely maniac but obsessions disappeared and then went into a depression where the obsessions started again. Then she displayed some psychotic thinking around my father not to be trusted and would send her back to the initial mental hospital. We then managed to have her admitted to an OCD center. In here she very quickly declined and became very delusional. They then decided to test her for biological causes. They conducted neuropsychological testing and diagnosed the FTD. I have done a lot of reading on this condition and really have not noticed the majority of the symptoms and the way she is displaying in this institution is very similar to the previous occasion four years ago. She also had an MRI done 1.5 years ago due to some seizures and they did not find any issues on the frontal or temporal lobes. These findings were not reviewed by the neurologist that recently diagnosed the FTP. He was also unable to access any information from her first admission. Does this warrant a secondary opinion.
Hi. I read carefully your question and would explain that fronto-temporal diagnosis is a very challenging diagnosis, which is determined by the neuro-psychological tests and the progression of the disease. Sometimes, the radiological findings are not typical of this disorder, so I am not very surprised to learn that her MRI findings are not compatible with the diagnosis. Did she perform any MRI four years back? Some changes between the two MRI would help determine the diagnosis. Does she have memory problems or speech problems? Anyway, you should know that sometimes the first signs in frontotemporal dementia are just depression or psychosis. Memory problems or speech problems come next (in the next years). So, if there is a progression of the disease, the diagnosis of FTD would be more probable. Does she have any family history for dementia? If her symptoms are completely reversible from antidepressants or antipsychotic therapy, the diagnosis of FTD would not stand. So, there is not too much to be done, besides treat her symptoms and wait to see for possible further progression. Genetic test for FTD can be done too.