Behavioral variant frontotemporal neurocognitive disorder or psychiatric disorder: a diagnostic challenge
Bibliographic record
Abstract
Introduction The behavioral variant of frontotemporal neurocognitive disorder is the most common clinical syndrome within frontotemporal neurocognitive disorders and is primarily characterized by progressive changes in personality and behavior. Due to the heterogeneity of this condition and the lack of sensitive and specific complementary tests, patients are often misdiagnosed with a psychiatric disorder. Objectives To describe the clinical case of a patient with a long-standing history of psychiatric pathology who was admitted to the short-stay psychiatric unit due to newly emerged behavioral disturbances, and to conduct a brief review of the literature. Methods Case description and literature review. Results A 57-year-old male under psychiatric follow-up for Obsessive-Compulsive Disorder, impulse control disorder (kleptomania), and anxiety-depressive symptoms was voluntarily admitted to the short-stay psychiatric unit due to behavioral disturbances. During admission, the patient reported emotional dysregulation, experiencing irritability and difficulties with emotional containment and inhibition, noting feelings of impulsive discontrol and behavioral disinhibition. The family observed changes in the patient’s personality over the past months, describing him as aggressive and inappropriate. Basic complementary tests (blood analysis, urine analysis, and toxicology screening) showed no significant alterations. Brain MRI revealed subtle signs of cortico-subcortical atrophy, predominantly in the frontotemporal regions. Cognitive assessments, including the Mini Mental State Examination, Frontal Assessment Battery and Montreal Cognitive Assessment, indicated deficits suggestive of frontal impairment. The patient had been admitted one month prior due to possible hypomanic symptoms that resolved following pharmacological adjustment, leading to a proposed diagnosis of late-onset Bipolar Disorder Type II. However, after detailed history-taking with family members and additional testing, the diagnosis leaned more towards a frontal syndrome (possible behavioral variant of frontotemporal neurocognitive disorder). Conclusions The diagnosis of frontotemporal neurocognitive disorder remains a significant challenge, partly due to the limitations of complementary tests in the early stages of the disease, with diagnosis primarily based on clinical evaluation. Consequently, many patients with frontotemporal neurocognitive disorder initially receive a diagnosis of a psychiatric condition (more frequently if the patient has a personal history of psychiatric issues). Therefore, it is crucial to understand these differences, especially in the early phases of the disease, and to continue investigating new diagnostic modalities. Disclosure of Interest None Declared
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".