Descriptive Psychopathology: The Signs and Symptoms of ...

322 Section 3: Examination domainsTable 13.4. Behavioral warning signs of frontal–temporal dementiaIncreasing disinterest and reduced engagement in hobbiesDecreasing efficiency noted in work and household routines not explainedby disease or injuryAny personality change (e.g. becoming uncharacteristically unreliable,hedonistic, overly critical)Altered emotional expression (e.g. moodiness, irritability, apathetic)Deterioration in personal hygiene, eating habits, social graces and mannersForgetting to remember (e.g. missing appointments, not doing a chore)Assessing for frontal–temporal dementiaFrontal–temporal dementia is increasingly recognized. It is associated with manyconditions including chronic alcoholism, microvascular disease, HIV/AIDS, andLewy body disease. 26 Frontal–temporal dementia is characterized by behavioralchange in emotional expression and personality, abnormal motor function, andcognitive decline, particularly in executive function.Behavior change is commonly the earliest sign of frontal–temporal dementia.Personality alterations occur, the patient becoming disinhibited or apathetic,depending on which frontal area is affected first. Socially inappropriate behaviorsemerge (e.g. sexual touching of self or others, seductiveness, blunt commentary, useof profanity). Attention to grooming and hygiene is reduced. Tact and tablemanners deteriorate. Suspiciousness and irritability occur. Efficiency is reducedand a decline in planning ability leads to employment and interpersonal difficulties.Atypical mood symptoms occur and may be misconstrued as depressive illnessor hypomania. Behavioral warning signs of frontal–temporal dementia are listedin Table 13.4.Motor signs are almost always found in patients with frontal–temporaldementia. Prefrontal cortex disease is associated with motor regulatory problems.Basal ganglia disease is associated with mood and working memoryproblems and classic basal ganglia motor signs. Disease in both regions elicitscatatonic features. Thalamic lesions are associated with mood and perceptualchanges. Left basal ganglia and thalamic lesions are associated with speech andlanguage problems. White matter disease is associated with bradykinesia andbradyphrenia.Cognitive deficits associated with frontal circuitry dysfunction occur early in theillness progression of frontal–temporal dementia, and include decline in workingmemory, new learning, thinking and reasoning, and executive functioning.The auditory “A” test may show errors of commission suggestive of distractibility.Digit span performance may be mildly impaired. Performance on similarities will