Item

Abstract

Behavioral variant frontotemporal dementia (bvFTD) is characterized by severe changes in personality/behavior. Recent studies have provided evidence that a decrease in serotonin receptors and neuronal loss in the raphe nuclei play a role in bvFTD’s pathology. Serotonergic antidepressants have been reported to diminish behavioral disturbances in bvFTD, in particular repetitive behaviors, disinhibition, apathy, sexually inappropriate behaviors, and hyperorality. Here we present the case of a 80-year-old Caucasian male patient with clinically and biomarker supported bvFTD (“probable” bvFTD; disease-specific alterations in [18F]fluorodesoxyglucose positron emission tomography and magnetic resonance imaging). The patient exhibited behavioral disinhibition, apathy, a loss of empathy, perseverative behavior during testing, hyperorality, changes in diet, and executive deficits in neuropsychological testing. Remarkably, he failed in solving crosswords by systematically filling in the blanks by letters in alphabetical order (A, B, C, D etc.) indicating obsessive-compulsive behavior. One year later the patient visited the clinic again for a follow up investigation. He had taken 20 mg of citalopram per day for one consecutive year. Remarkably, he had regained the ability to fill in cross-word puzzles correctly, although the neuropsychiatric inventory showed overall only small improvement in behavioral impairment. A regiment of 20 mg citalopram per day over the course of one year led to a specific improvement in one of bvFTD’s core symptoms – obsessive-compulsive behavior – most pronounced in solving cross-word puzzles. This case contributes to the understanding of the neuropharmacological correlates of bvFTD, and supports treatment of bvFTD’s behavioral symptoms with selective serotonin reuptake inhibitors.