title: Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?
abstract: BACKGROUND
  Frontotemporal dementia (FTD) constitutes a spectrum of neurodegenerative disorders associated with degeneration of, predominantly, the frontal and temporal lobes. The clinical heterogeneity is evident, and early diagnosis is a challenge. The primary objectives were to characterize psychotic symptoms, initial clinical diagnoses and family history in neuropathologically verified FTD-patients and to analyze possible correlations with different neuropathological findings.
  
  
  METHODS
  The medical records of 97 consecutive patients with a neuropathological diagnosis of frontotemporal lobar degeneration (FTLD) were reevaluated. Psychotic symptoms (hallucinations, delusions, paranoid ideas), initial diagnosis and family history for psychiatric disorders were analyzed.
  
  
  RESULTS
  Psychotic symptoms were present in 31 patients (32%). There were no significant differences in age at onset, disease duration or gender between patients with and without psychotic symptoms. Paranoid ideas were seen in 20.6%, and hallucinations and delusions in 17.5% in equal measure. Apart from a strong correlation between psychotic symptoms and predominantly right-sided brain degeneration, the majority of patients (77.4%) were tau-negative. Only 14.4% of the patients were initially diagnosed as FTD, while other types of dementia were seen in 34%, other psychiatric disorders in 42%, and 9.2% with other cognitive/neurological disorders. The patients who were initially diagnosed with a psychiatric disorder were significantly younger than the patients with other initial clinical diagnoses. A positive heredity for dementia or other psychiatric disorder was seen in 42% and 26% of the patients respectively.
  
  
  CONCLUSIONS
  Psychotic symptoms, not covered by current diagnostic criteria, are common and may lead to clinical misdiagnosis in FTD.
authors.affiliation: Section of Geriatric Psychiatry,Department of Clinical Sciences,Lund University,Klinikgatan 22,Lund SE-221 85,Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Landqvist Waldö
authors.affiliation: Section of Geriatric Psychiatry,Department of Clinical Sciences,Lund University,Klinikgatan 22,Lund SE-221 85,Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Gustafson
authors.affiliation: Section of Geriatric Psychiatry,Department of Clinical Sciences,Lund University,Klinikgatan 22,Lund SE-221 85,Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Passant
authors.affiliation: Section of Oncology and Pathology,Department of Clinical Sciences,Lund University,Lund,SE-221 85,Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Englund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D005260:Female; D057180:Frontotemporal Dementia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology
keywords: first clinical diagnosis