Perfil sociodemográfico e clínico de uma amostra ambulatorial de pacientes com demência frontotemporal variante comportamental: ênfase no diagnóstico de transtorno mental grave pregresso

Abstract

The relationship between severe mental illness (SMI) and the behavioral variant of frontotemporal dementia (bvFTD) is currently not formally recognized in the literature. However, the patterns of symptoms and cognitive performance used to describe both conditions are similar and, at least for a small subgroup of patients, both seem to share common pathological genetic mutations. Objectives: to investigate the sociodemographic and clinical profile of a sample of outpatients diagnosed with bvFTD and compare those with a history of SMI with those without; and to document the occurrence of bvFTD succeeding SMI. Methods: Cross-sectional study in which consecutively selected patients, after receiving a diagnosis of probable bvFTD, had a family/guardian interviewed and submitted to the Structured Clinical Interview for DSM-IV Disorders (SCID-I). After the categorization into two groups - with or without prior SMI the subjects went through cognitive (Mini Mental Status Exam, verbal fluency, Frontal Assessment Battery - FAB, memory of figures test and recognition of facial emotions), functional (Functional Activities Questionnaire, Frontotemporal Dementia Rating Scale) phenotype (symptoms profile, Neuropsychiatric Inventory - NPI, use of antipsychotic drugs and primitive reflexes) and family history (Goldman Scale) assessments. Results: Patients with a history of prior SMI accounted for more than 1/3 of the sample (n = 17; 36.9%), while 63.1% (n = 29) showed no SMI history. The main nosology identified was bipolar affective disorder - BAD - (76.5%), distributed as follows: 64.7% BAD I, 5.9% and 5.9% BAD II and TAB NOS. Two other disorders were also recognized: schizoaffective disorder (17.6%) and schizophrenia (5.9%). The groups differed in NPI-12 (p = 0.01), antipsychotics (p = 0.01), family history of psychosis (p = 0.01), the presence of primitive reflexes (p = 0.04), FAB performance (p = 0.01), facial emotion recognition (p = 0.03), learning score in the memory of figures test (p = 0.02), in the presence of apathy (p = 0.03) and behavior stereotypic, compulsive or ritualistic (p = 0.01). Conclusions: A prior history of SMI was a common finding in this sample of bvFTD patients and seemed to modify their clinical presentation, but did not affect sociodemographic factors and was not associated with higher heritability of the disease.