Frontotemporal demans ve psikiyatrik belirtiler

Frontotemporal demans (FTD), erken başlangıçlı demanslar içinde ikinci sıklıkta görülmektedir; ilerleyici davranış değişiklikleri, yürütücü işlevlerdeki bozukluklar ve lisan problemleri ile karakterizedir. FTD, sıklıkla Alzheimer hastalığı ve psikiyatrik hastalıklarla karışır. Klinik olarak, kişilik değişiklikleri, huzursuzluk, inhibisyon kaybı, apati, sosyal geri çekilme ve impuls kontrolünde bozukluk görülür. Frontotemporal demanslı birçok hastada uygunsuz sosyal davranışlar, kompulsiyon benzeri hareketler, içgörü kaybı ve psikiyatrik hastalıklarda görülebilen varsanılar ve paranoid sanrılar gibi belirtiler nedeniyle hastalar sıklıkla psikiyatrik bozukluk tanısı alırlar. Sporadik FTD’nin etiyolojisi bilinmemektedir. Herediter FTD’de 17. kromozomda, tau geninde mutasyonlar olduğu saptanmıştır. Üç klinik FTD sendromu tanımlanmıştır: Davranış varyantı, semantik demans ve ilerleyici tutuk afazi. Günümüzde “FTD” terimi klinik sendromları kapsarken, “frontotemporal lob dejenerasyonu” ise altta yatan patolojiyi tanımlamak için kullanılır. Ayrıntılı öykü, psikiyatrik ve nörolojik muayene, manyetik rezonans görüntüleme FTD’yi diğer sık görülen demanslardan ve psikiyatrik bozukluklardan ayırt etmeye yardım eder. Frontotemporal demansın etkin bir tedavisi olmamasına karşın, serotonin geri alım inhibitörlerinin davranışsal belirtilerin kontrolünde yararlı olduğu gösterilmiştir.

Frontotemporal demantia and psychiatric symptoms

Frontotemporal dementia (FTD) is the second most common cause of early onset dementia and is clinically characterized by progressive behavioural change, executive dysfunctions, and language difficulties. FTD is frequently confused with Alzheimer’s disease and psychiatric disorders. Clinical features of FTD include changes of personality, restlessness, loss of inhibition, apathy, social withdrawal and impulsiveness. Most patients with FTD display socially inappropriate behaviours, compulsive-like acts, poor insight and psychiatric features including hallucinations and paranoid delusions. These symptoms can lead to misdiagnosing FTD as a psychiatric disorder. The etiology of sporadic FTD is unknown. In hereditary FTD, a causative mutation in the tau gene has been identified. Three clinical FTD syndromes has been described; a behavioural variant of FTD, semantic dementia and progressive non-fluent aphasia. At the present time the term “FTD” is used to define clinical syndromes while “frontotemporal lobar degeneration” refers to underlying pathologies. A detailed history and psychiatric and neurologic examination with the usage of magnetic resonance imaging can help to distinguish FTD from other common forms of dementia and psychiatric disorders. Although no effective treatment for FTD exists, serotonin reuptake inhibitor drugs have been shown to improve behavioural symptoms.

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