title: Identifying Specific Clinical Symptoms of Behavioral Variant Frontotemporal Dementia Versus Differential Psychiatric Disorders in Patients Presenting With a Late-Onset Frontal Lobe Syndrome.
abstract: OBJECTIVE
  Early differentiation between psychiatric disorders and behavioral variant frontotemporal dementia (bvFTD) is of paramount importance in patients with the late-onset frontal lobe syndrome. As bvFTD in patients will deteriorate, psychiatric disorders are treatable. To date, misdiagnosis often occurs due to an overlap of symptoms and lack of specific biomarkers. The aim of our study was to investigate whether specific symptoms could separate bvFTD from psychiatric disorders.
  
  
  METHODS
  In a naturalistic, prospective, multicenter study, 137 patients (aged 45-75 years, 72% male) with a late-onset frontal lobe syndrome were included based on their scores on the Frontal Behavioral Inventory (FBI) and the Stereotypy Rating Inventory (SRI) from April 2011 to June 2013. In a multidisciplinary consensus meeting, diagnoses were established based on elaborate neuropsychological testing, magnetic resonance imaging, fludeoxyglucose F 18 positron emission tomography, cerebrospinal fluid biomarkers, and clinical examination by a neurologist and a psychiatrist based on the International bvFTD Criteria Consortium for bvFTD and DSM-IV-TR criteria for psychiatric disorders.
  
  
  RESULTS
  Forty-four subjects (32.8%) were diagnosed with a psychiatric disorder, 10 (7.3%) with possible bvFTD, and 45 (32.8%) with probable bvFTD. A logistic regression analysis was performed with "psychiatry or bvFTD" as dependent variable and clinical variables (Montgomery-Asberg Depression Rating Scale [MADRS], SRI, FBI) and demographics as independent variables. A positive history of psychiatric illness, male gender, lower SRI scores and higher MADRS scores were predictive of psychiatric disorders, explaining 65.2% of the variance in diagnosis of psychiatry versus bvFTD (χ²₅ = 60.04, P < .001). On the FBI, symptom level verbal apraxia/aphasia and impulsivity were predictive of bvFTD, whereas irritability was predictive of psychiatric disorders.
  
  
  CONCLUSIONS
  In daily clinical practice, specific subtyping of clinical symptoms in patients with late-onset frontal lobe syndrome may aid in differentiating bvFTD patients from psychiatric patients and may provide guidance in patient management.
authors.affiliation: Department of Old Age Psychiatry, GGZinGeest, Amstelveenseweg 589, 1081JC, Amsterdam, the Netherlands. a.dols@ggzingeest.nl.|Department of Old Age Psychiatry, GGZinGeest, Amsterdam, the Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Dols
authors.affiliation: Department of Old Age Psychiatry, GGZinGeest, Amsterdam, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: van Liempt
authors.affiliation: Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Flora
authors.initials: F
authors.lastname: Gossink
authors.affiliation: Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Welmoed A
authors.initials: WA
authors.lastname: Krudop
authors.affiliation: Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Sietske
authors.initials: S
authors.lastname: Sikkes
authors.affiliation: Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Yolande A L
authors.initials: YA
authors.lastname: Pijnenburg
authors.affiliation: Department of Old Age Psychiatry, GGZinGeest, Amsterdam, the Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
mesh_terms: D000367:Age Factors; D000368:Aged; D057565:Apathy; D015897:Comorbidity; D003192:Compulsive Behavior / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D057180:Frontotemporal Dementia / Q000175:diagnosis* / Q000523:psychology*; D006778:Hospitals, Psychiatric; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D013239:Stereotyped Behavior