title: Impairment of decision-making cognition in a case of frontotemporal lobar degeneration (FTLD) presenting with pathologic gambling and hoarding as the initial symptoms.
abstract: OBJECTIVE
  The aim of this study was to use the Iowa Gambling Task (IGT) to examine decision-making cognition in a patient with mild frontal variant of frontotemporal dementia (fv-FTD).
  
  
  BACKGROUND
  Although fv-FTD may present with bizarre and dramatic behavioral changes, traditional executive tasks are sometimes preserved in patients with mild fv-FTD. Some evidence suggests that tasks assessing decision-making cognition, such as the IGT, may be sensitive to detect cognitive dysfunction in patients with mild fv-FTD. Here, we report a patient with fv-FTD who presented with bizarre behavior including hoarding, pathologic gambling, and abnormal sexual behavior.
  
  
  METHODS
  A 54-year-old man who had been diagnosed as having fv-FTD was examined using a behavioral assessment, a wide range of neuropsychologic tasks, and the IGT. Brain magnetic resonance imaging and brain 99mTc-ethylcysteinate dimer single-photon emission computed tomography examinations were also performed.
  
  
  RESULTS
  Although the patient's cognitive abilities were almost fully preserved for a number of traditional neuropsychologic tasks (memory, executive function), the IGT suggested that his decision-making cognition was impaired. The 99mTc-ethylcysteinate dimer single-photon emission computed tomography examination revealed hypometabolism in bilateral medial frontal and orbitofrontal regions of the cerebral cortex, and also in the cingulate gyri.
  
  
  CONCLUSIONS
  Our findings suggest that the IGT may be a sensitive tool for assessing patients with mild fv-FTD before the development of severe dementia. We speculate that the deficit in decision-making cognition observed in the present case was associated with hypometabolism in the neural networks of the frontal lobe and involving both the bilateral medial frontal and orbitofrontal regions of the cerebral cortex.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. hzi05510@nifty.com
authors.forename: Shutaro
authors.initials: S
authors.lastname: Nakaaki
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Murata
authors.forename: Junko
authors.initials: J
authors.lastname: Sato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shinagawa
authors.forename: Jin
authors.initials: J
authors.lastname: Hongo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tatsumi
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
mesh_terms: D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D003192:Compulsive Behavior; D003657:Decision Making; D003704:Dementia / Q000175:diagnosis / Q000523:psychology*; D005715:Gambling / Q000523:psychology*; D005717:Games, Experimental; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D012720:Severity of Illness Index