title: Frontotemporal lobar degeneration with motor neurone disease (FTLD/MND): Presentations in psychiatric practice.
abstract: Background. Concurrence of frontotemporal lobar degeneration with clinical features of motor neurone disease (FTLD/MND) is a recognised cause of dementia with widely accepted diagnostic criteria, but it is not mentioned in DSM-IV-TR. Aim. To draw attention to cases of FTLD/MND referred by psychiatrists, or already under the care of psychiatrists at time of referral, to a dedicated Cognitive Function Clinic. Methods. Prospective study of FTLD/MND cases, 1999-2007 inclusive; case note review. Results. Nine of 13 cases of FTLD/MND were either referred by or already under the care of a psychiatrist. Although most had been identified as having a dementia, in none had the correct diagnosis been made. All patients had signs of motor neurone pathology on clinical examination, sometimes subtle, in addition to cognitive and psychiatric features. A wide variety of drugs had been prescribed including antidepressants, antipsychotics, cholinesterase inhibitors, and memantine. Conclusions. A high index of clinical suspicion is required to identify cases of possible FTLD/MND, and thereby initiate appropriate investigations and management and avoid inappropriate medication. Absence of FTLD/MND in DSM-IV-TR may further handicap psychiatrists in making this diagnosis.
authors.affiliation: Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sathasivam
authors.forename: M
authors.initials: M
authors.lastname: Doran
authors.forename: A J
authors.initials: AJ
authors.lastname: Larner
keywords: DSM-IV-TR; Frontotemporal lobar degeneration with motor neurone disease (FTLD/MND); diagnosis; psychiatric symptoms