Disordered behaviour

The Lund-Manchester consensus on clinical criteria for FTD is summarized in Table- The early stage of FLD and Pick's disease is characterized by changes of personality and behaviour, affective symptoms, and a progressive reduction of expressive speech, revealing the dysfunction of frontotemporal brain structures. The clinical onset is insidious with slow progression without ictal events. Therefore the duration of the disease may easily be underestimated. The changes of personality and behaviour are mainly non-specific and easily misinterpreted as expressions of non-organic mental disease such as mood disorder, hypochondriasis, schizophrenia, or other psychotic reaction. Other explanations of the patient's behaviour such as a reaction to problems in the family may also be suggested, especially by people lacking previous knowledge of the patient. Loss of insight concerning the mental changes and their consequences is an early and alarming manifestation of the disease. Although most patients deny any awareness of mental change or illness, several patients ask for medical xamination referring to symptoms such as anxiety, tiredness, and strange somatic complaints combined with bizarre hypochondriacal ideas. The hypochondriasis may sometimes be secondary to hallucinations or sensory distortion.

Table 2 The Lund-Manchester clinical criteria for frontotemporal dementias

The early loss of personal and social awareness is seen as neglect of personal hygiene and grooming, and tactlessness and antisocial behaviour. The impaired control and modulation of emotions are seen as increased sentimentality, inadequate smiling, inappropriate joking, irritability, and acts of aggressiveness, leading to conflicts at home and at work. Craving for affection and sexual contact may be easily provoked, but usually expressions of sexual disinhibition are rather childish and innocent, and possible to divert. Impulse buying, shoplifting, indecency, and other disinhibited behaviour may, however, lead to rejection by the family and society. Such unpredictable and pseudopsychopathic behaviour imposes severe strain on the patient's family, leading in some cases to economic problems, divorce, and even suicide in the family. Complications of this type are uncommon in families with an Alzheimer patient. Traffic accidents may also result from the patient's impaired regulation of conduct. FTD patients tend to become inattentive and careless; although using the correct traffic lane they may neglect traffic lights, speed limits, and other regulations. The typical Alzheimer patient is more self-critical and anxiously aware of the difficulties in driving. Changes in drinking behaviour are sometimes reported. Patients with previous restricted alcohol consumption start to drink more frequently and in larger quantities than before. The alcohol is probably sometimes used to reduce anxiety and depressed mood. The pathological drinking behaviour, which may lead to misdiagnosis of alcohol-induced dementia, can often be controlled by a firm attitude from relatives.

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