Other Neuropsychiatric Symptoms in FTD Mood Changes

Depression

Symptoms of depression and apparent sadness may be present, but the criteria of major depressive disorder are usually not met in bvFTD. Suicide attempts have been reported in a family with C9orf72 mutation [50]: a 72-year-old man tried to hang himself, but psychiatric examination showed a striking lack of concern, irrelevant answers, and inappropriate jocularity without any signs of depression. His wife reported subtle behavioral disinhibition (socially inappropriate behavior and impulsivity) and impairment of short-term memory and of face recognition for 2 years. MRI and FDG-PET revealed temporal atrophy including hippocampus and biparietal and temporomesial hypometabolism atypical for bvFTD. The patient’s sister committed suicide at age 50, and his mother suffered from late-onset progressive nonfluent aphasia after 80.

Other affective symptoms can occur in bvFTD: euphoria, apparent sadness, or anxiety [17].

Euphoria

Elated mood, inappropriate jocularity, and exaggerated self-esteem are observed in about a third of patients with bvFTD. When associated with restlessness and disin- hibition, they may mimic hypomania [9]. However, hypersomnia, rather than decreased need for sleep, and reduced speech, rather than pressure of speech, are usually observed in FTD [51].