Frontotemporal dementia presenting as pathological gambling

Institute of Cognitive Neurology (INECO), Favaloro University, Castex 3293 (1425), Buenos Aires, Argentina.
Nature Reviews Neurology (Impact Factor: 15.36). 06/2010; 6(6):347-52. DOI: 10.1038/nrneurol.2010.34
Source: PubMed


A 69 year-old woman presented to an interdisciplinary medical group with pathological gambling, and went on to develop disinhibition, loss of empathy, and perseverative, stereotyped and ritualistic behavior. An initial neuropsychological evaluation showed selective impairment on the Iowa Gambling Task similar to that of patients with behavioral variant frontotemporal dementia, despite normal performance on standard neuropsychological tasks. MRI scans showed frontal lobe atrophy, which was consistent with findings on hexamethylpropyleneamine oxime single photon emission CT (HMPAO-SPECT).
Physical examination, neuropsychiatric and neuropsychological assessments, MRI brain scan, HMPAO-SPECT.
Behavioral variant frontotemporal dementia.
Pharmacological treatment with the selective serotonin reuptake inhibitor paroxetine for impulsive behavior and carbamazepine to stabilize mood. The patient and her family also received counseling to advise on behavioral and legal issues.

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Available from: Teresa Torralva
    • "In addition, also the semantic variant of FTD may present at onset with obsessive–compulsive disorder as unique feature for several years [10]. As regard to ICD, few reports have described the presence of pathological gambling as isolated symptom [11] [12] or in association with abnormal sexual behavior and hoarding [13] as early "
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    ABSTRACT: Objective To describe a patient with behavioral frontotemporal dementia (bvFTD) presenting with impulse control disorders (ICDs) which responded to fluvoxamine and topiramate. Case report A 64 year-old woman was affected by complained of several ICDs. At disease onset she complained suffered fromof impulsive smoking and overeating that which caused 20 kg increase ofa body weight increase of 20 kg in 6 months. Later on she manifested binge-eating behavior and skin picking disordercompulsion. Presence ofA progressive frontal disexecutive cognitive impairment (MMSE 24/30) and evidence of hypoperfusion of the anterior cingulate cortex and dorsolateral frontal cortex detected with brain SPECT scan contributed to the diagnosis of bvFTD. Use of combination treatment with SSRI drugs and topiramate as add-on therapy could control improved all these symptoms. Conclusion This case extends the clinical phenotype of repetitive and compulsive habits in bvFTD to encompass symptoms suggestive of ICDs. It is proposed that fluvoxamine and topiramate may be considered as treatment options in these conditions.
    No preview · Article · Nov 2014 · General Hospital Psychiatry
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    • "There are three similar cases of FTD presenting with PG in the literature.7-9 The first case was a 49-year-old male patient with disinhibited, overactive subtype of FTD whose initial symptom was PG.7 Nakaaki et al.8 reported a similar patient whose cognitive functions were fully preserved, except decision making as assessed by the IGT. "
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    ABSTRACT: Pathological gambling (PG), which is characterized by consistent, repetitive gambling and unsuccessful quitting attempts, is classified as an impulse control disorder. PG has also been reported in patients with Parkinson's disease, frontotemporal dementia, and amyotrophic lateral sclerosis. A 53-year-old male visited the outpatient clinic due to excessive gambling and personality changes. Based on electrophysiological findings and neuropsychiatric assessment, he was diagnosed as frontotemporal dementia-amyotrophic lateral sclerosis. This case report underlines that PG can also be seen in patients with neurological disorders involving the orbitofrontal cortex.
    Full-text · Article · Apr 2013 · Journal of Clinical Neurology
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    • "Overall, very few studies have looked at IGT performance in groups of bvFTD patients. These studies found that bvFTD patients prefer cards from disadvantageous decks (Nakaaki et al., 2007; Torralva et al., 2007) and risky decision making behaviour on the IGT has even been shown in mild bvFTD patients with otherwise unaffected executive functioning (Manes et al., 2010, 2011). The sensitivity of the IGT in the detection of cognitive dysfunction in bvFTD patients has prompted suggestions to use the test as a diagnostic tool (Gleichgerrcht et al., 2010). "
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    ABSTRACT: Neurodegenerative patients show often severe everyday decision making problems. Currently it is however not clear which brain atrophy regions are implicated in such decision making problems. We investigated the atrophy correlates of gambling decision making in a sample of 63 participants, including two neurodegenerative conditions (behavioural variant frontotemporal dementia - bvFTD; Alzheimer's disease - AD) as well as healthy age-matched controls. All participants were tested on the Iowa Gambling Task (IGT) and the behavioural IGT results were covaried against the T1 MRI scans of all participants to identify brain atrophy regions implicated in gambling decision making deficits. Our results showed a large variability in IGT performance for all groups with both patient groups performing especially poor on the task. Importantly, bvFTD and AD groups did not differ significantly on the behavioural performance of the IGT. However, by contrast, the atrophy gambling decision making correlates differed between bvFTD and AD, with bvFTD showing more frontal atrophy and AD showing more parietal and temporal atrophy being implicated in decision making deficits, indicating that both patient groups fail the task on different levels. Frontal (frontopolar, anterior cingulate) and parietal (retrosplenial) cortex atrophy covaried with poor performance on the IGT. Taken together, the atrophy correlates of gambling decision making show that such deficits can occur due to a failure of different neural structures, which will inform future diagnostics and treatment options to alleviate these severe everyday problems in neurodegenerative patients.
    Full-text · Article · Feb 2013 · Clinical neuroimaging
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