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A 52-year-old female executive is referred for psychiatric evaluation by her primary care provider due to progressive cognitive decline over the past 14 months. Her husband reports personality changes including social disinhibition, apathy, and loss of empathy that preceded any memory complaints. She has made inappropriate comments to coworkers and recently shoplifted from a store, which is entirely out of character. On cognitive assessment, her memory recall is relatively intact, but she demonstrates significant deficits in executive function, including poor abstraction, impaired set-shifting on the Trail Making Test Part B, and reduced verbal fluency. Brain MRI reveals focal atrophy of the frontal and anterior temporal lobes bilaterally. Which assessment finding pattern is most consistent with this patient's likely diagnosis?
Explanation
Behavioral variant frontotemporal dementia presents with early and prominent personality and behavioral changes including disinhibition, apathy, loss of empathy, and executive dysfunction with relatively preserved episodic memory. This clinical pattern, combined with focal frontal and anterior temporal atrophy on neuroimaging, distinguishes bvFTD from Alzheimer's disease and other dementia subtypes. Early recognition is essential as bvFTD can be misdiagnosed as a primary psychiatric disorder.
Key Takeaway
Early-onset dementia presenting with prominent behavioral changes, social disinhibition, loss of empathy, and executive dysfunction with preserved memory and frontal-temporal atrophy on MRI is most consistent with behavioral variant frontotemporal dementia.