"Fantastic thinking" in pathologically proven Pick disease.
BACKGROUND
Reports of false beliefs may be a unique feature of behavioral variant frontotemporal dementia (bvFTD) but the nature of these experiences is unclear.


OBJECTIVE
To report a case of pathologically verified Pick disease in a patient presenting with prominent and recurrent fantasies.


METHODS
We describe the clinical, neuroradiologic, and neuropathologic findings of a 53-year-old woman presenting with fantasies and meeting Clinical Consensus Criteria for bvFTD.


RESULTS
Early in her course, she reported interactions with different actors, having torrid affairs with them, and other related fantasies. When confronted with her false beliefs, she admitted that these relationships were imaginary. Autopsy revealed Pick disease with tau-immunoreactive Pick bodies in the frontal and temporal cortices, and in the hippocampi.


CONCLUSIONS
Fantastic thinking, or vividly experienced imagination, may be a manifestation of bvFTD that is distinct from delusions and confabulations and could be the source of previously reported delusions and confabulations in bvFTD.
Neurobehavior Unit, Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. skremen@ucla.edu
Sarah A
SA
Kremen
Orestes E
OE
Solis
Jill S
JS
Shapira
Harry V
HV
Vinters
Mario F
MF
Mendez
D001284:Atrophy / Q000523:psychology; D002540:Cerebral Cortex / Q000473:pathology*; D018450:Disease Progression; D005201:Fantasy; D005260:Female; D006801:Humans; D008875:Middle Aged; D020774:Pick Disease of the Brain / Q000473:pathology* / Q000523:psychology*; D013850:Thinking