Late life bipolar disorder evolving into frontotemporal dementia mimic

Annemiek Dols, Welmoed Krudop, Christiane Möller, Kenneth Shulman, Martha Sajatovic, Yolande Al Pijnenburg

Research output: Contribution to journalArticleAcademicpeer-review

27 Citations (Scopus)

Abstract

OBJECTIVES: Although bipolar disorder has been understood classically as a cyclic disease with full recovery between mood episodes, in the last decade, evidence has accumulated supporting progressive features. The clinical picture of advanced or end-stage bipolar disorder is heterogeneous with possible deficits in cognition and behavior, as illustrated by our case series.

CASES: From our neuropsychiatric outpatient clinic, we describe four cases with bipolar disorder gradually developing a clinical syndrome, including apathy, disinhibition, loss of empathy, stereotypical behavior, and compulsiveness, fulfilling the criteria for possible behavioral variant frontotemporal dementia. All cases were diagnosed with bipolar 1 disorder at least 10 years before the onset of the current symptoms, which were not due to recent mood episodes or switches of medication. In all cases, 3-7 years of follow-up yielded no progression. Repeated neuroimaging was within normal limits. Cerebrospinal fluid biomarker studies were not supportive of underlying neurodegenerative pathology. C9orf72 mutation status was negative in all cases.

CONCLUSION: Symptoms fitting the criteria for possible behavioral variant frontotemporal dementia may be present in end-stage of bipolar disorder. An alternative neurodegenerative nature seems unlikely based on repeated normal neuroimaging and the absence of clinical progression. Functional involvement of the frontal-subcortical networks might play a role.

Original languageEnglish
Pages (from-to)2207-12
Number of pages6
JournalNeuropsychiatric Disease and Treatment
Volume12
DOIs
Publication statusPublished - 2016

Keywords

  • Journal Article

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