Frontotemporal dementia presenting as pathological gambling.
BACKGROUND
A 69 year-old woman presented to an interdisciplinary medical group with pathological gambling, and went on to develop disinhibition, loss of empathy, and perseverative, stereotyped and ritualistic behavior. An initial neuropsychological evaluation showed selective impairment on the Iowa Gambling Task similar to that of patients with behavioral variant frontotemporal dementia, despite normal performance on standard neuropsychological tasks. MRI scans showed frontal lobe atrophy, which was consistent with findings on hexamethylpropyleneamine oxime single photon emission CT (HMPAO-SPECT).


METHODS
Physical examination, neuropsychiatric and neuropsychological assessments, MRI brain scan, HMPAO-SPECT.


METHODS
Behavioral variant frontotemporal dementia.


RESULTS
Pharmacological treatment with the selective serotonin reuptake inhibitor paroxetine for impulsive behavior and carbamazepine to stabilize mood. The patient and her family also received counseling to advise on behavioral and legal issues.
Manes
Facundo F
FF
Institute of Cognitive Neurology (INECO), Favaloro University, Castex 3293 (1425), Buenos Aires, Argentina. fmanes@neurologiacognitiva.org
Torralva
Teresa
T
Roca
María
M
Gleichgerrcht
Ezequiel
E
Bekinschtein
Tristan A
TA
Hodges
John R
JR
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009483:Neuropsychological Tests; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods