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Frontotemporal dementia presenting as pathological gambling

Nature Reviews Neurology volume 6, pages 347–352 (2010)Cite this article

Subjects

Abstract

Background. A 69 year-old woman presented to an interdisciplinary medical group with pathological gambling, and went on to develop disinhibition, loss of empathy, and perseverative, stereotyped and ritualistic behavior. An initial neuropsychological evaluation showed selective impairment on the Iowa Gambling Task similar to that of patients with behavioral variant frontotemporal dementia, despite normal performance on standard neuropsychological tasks. MRI scans showed frontal lobe atrophy, which was consistent with findings on hexamethylpropyleneamine oxime single photon emission CT (HMPAO-SPECT).

Investigations. Physical examination, neuropsychiatric and neuropsychological assessments, MRI brain scan, HMPAO-SPECT.

Diagnosis. Behavioral variant frontotemporal dementia.

Management. Pharmacological treatment with the selective serotonin reuptake inhibitor paroxetine for impulsive behavior and carbamazepine to stabilize mood. The patient and her family also received counseling to advise on behavioral and legal issues.

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Figure 1: Iowa Gambling Test performance.
Figure 2: Brain MRI scans from a patient with behavioral variant frontotemporal dementia.

References

  1. Bechara, A., Damasio, A., Damasio, H. & Anderson, S. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 7–15 (1994).

    Article  CAS  Google Scholar 

  2. Crawford, J. R. & Garthwaite, P. H. Investigation of the single case in neuropsychology: confidence limits on the abnormality of test scores and test score differences. Neuropsychologia 40, 1196–1208 (2002).

    Article  CAS  Google Scholar 

  3. Neary, D. et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 51, 1546–1554 (1998).

    Article  CAS  Google Scholar 

  4. Kipps, C. M. et al. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement. Geriatr. Cogn. Disord. 23, 334–342 (2007).

    Article  Google Scholar 

  5. Mendez, M. F. Frontotemporal dementia: therapeutic interventions. Front. Neurol. Neurosci. 24, 168–178 (2009).

    Article  Google Scholar 

  6. Blanco, C. et al. A pilot study of impulsivity and compulsivity in pathological gambling. Psychiatry Res. 167, 161–168 (2009).

    Article  Google Scholar 

  7. Leung, K. S. & Cottler, L. B. Treatment of pathological gambling. Curr. Opin. Psychiatry 22, 69–74 (2009).

    Article  Google Scholar 

  8. Dubois, B., Slachevsky, A., Litvan, I. & Pillon, B. The FAB: a Frontal Assessment Battery at bedside. Neurology 55, 1621–1626 (2000).

    Article  CAS  Google Scholar 

  9. Partington, J. E. & Leiter, R. G. Partington Pathways Test. The Psychological Services Center Bulletin 1, 9–20 (1949).

    Google Scholar 

  10. Robinson, K. M. Rehabilitation applications in caring for patients with Pick's disease and frontotemporal dementias. Neurology 56 (11 Suppl. 4), S56–S58 (2001).

    Article  CAS  Google Scholar 

  11. Lo Coco, D. & Nacci, P. Frontotemporal dementia presenting with pathological gambling. J. Neuropsychiatry Clin. Neurosci. 16, 117–118 (2004).

    Article  Google Scholar 

  12. Nakaaki, S. et al. Impairment of decision-making cognition in a case of frontotemporal lobar degeneration (FTLD) presenting with pathologic gambling and hoarding as the initial symptoms. Cogn. Behav. Neurol. 20, 121–125 (2007).

    Article  Google Scholar 

  13. Torralva, T. et al. The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neuropsychologia 45, 342–349 (2007).

    Article  Google Scholar 

  14. Clark, L. & Manes, F. Social and emotional decision-making following frontal lobe injury. Neurocase 10, 398–403 (2004).

    Article  Google Scholar 

  15. Fuentes, D., Tavares, H., Artes, R. & Gorenstein, C. Self-reported and neuropsychological measures of impulsivity in pathological gambling. J. Int. Neuropsychol. Soc. 12, 907–912 (2006).

    Article  Google Scholar 

  16. Ratnavalli, E., Brayne, C., Dawson, K. & Hodges, J. R. The prevalence of frontotemporal dementia. Neurology 58, 1615–1621 (2002).

    Article  CAS  Google Scholar 

  17. Knopman, D. S., Petersen, R. C., Edland, S. D., Cha, R. H. & Rocca, W. A. The incidence of frontotemporal lobar degeneration in Rochester, Minnesota, 1990 through 1994. Neurology 62, 506–508 (2004).

    Article  CAS  Google Scholar 

  18. Giovannoni, G., O'Sullivan, J., Turner, K., Manson, A. J. & Lees, A. J. Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies. J. Neurol. Neurosurg. Psychiatry 68, 423–428 (2000).

    Article  CAS  Google Scholar 

  19. Tippmann-Peikert, M., Park, J. G., Boeve, B. F., Shepard, J. W. & Silber, M. H. Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists. Neurology 68, 301–303 (2007).

    Article  CAS  Google Scholar 

  20. Bozeat, S., Gregory, C. A., Ralph, M. A. & Hodges, J. R. Which neuropsychiatric and behavioural features distinguish frontal and temporal variants of frontotemporal dementia from Alzheimer's disease? J. Neurol. Neurosurg. Psychiatry 69, 178–186 (2000).

    Article  CAS  Google Scholar 

  21. Dubois, B. et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria. Lancet Neurol. 6, 734–746 (2007).

    Article  Google Scholar 

  22. Kipps, C. M., Mioshi, E. & Hodges, J. R. Emotion, social functioning and activities of daily living in frontotemporal dementia. Neurocase 15, 182–189 (2009).

    Article  Google Scholar 

  23. Burns, K. & Bechara, A. Decision making and free will: a neuroscience perspective. Behav. Sci. Law 25, 263–280 (2007).

    Article  Google Scholar 

  24. Mathuranath, P. S., Nestor, P. J., Berrios, G. E., Rakowicz, W. & Hodges, J. R. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology 55, 1613–1620 (2000).

    Article  CAS  Google Scholar 

  25. Rey, A. Psychological examination of traumatic encephalopathy. (The problems). [French]. Archives de Psychologie 28, 215–285 (1941).

    Google Scholar 

  26. Wechsler, D. Wechsler Memory Scale—Revised (The Psychological Corporation, San Antonio, Texas, 1987).

    Google Scholar 

  27. Kaplan, E. F., Goodglass, H. & Weintraub, S. The Boston Naming Test (Lea and Febiger, Philadelphia, 1983).

    Google Scholar 

  28. Nelson, H. E. A modified card sorting test sensitive to frontal lobe defects. Cortex 12, 313–324 (1976).

    Article  CAS  Google Scholar 

  29. Howard, D. & Patterson, K. Pyramids and Palm Trees (Thames Valley Test Company, Bury St Edmunds, 1992).

    Google Scholar 

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Acknowledgements

This study was funded by an Institute of Cognitive Neurology (INECO) grant and an Institute LyD grant. J. R. Hodges is supported by an Australian Research Council Federation Fellowship. The authors would like to thank the patient and her family for their help. Written consent for publication was obtained from the patient's brother-in-law.

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Authors and Affiliations

  1. Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Castex 3293 (1425), Argentina

    Facundo F. Manes, Teresa Torralva, María Roca & Ezequiel Gleichgerrcht

  2. The Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK

    Tristan A. Bekinschtein

  3. FRONTIER, Prince of Wales Medical Research Institute, University of New South Wales, Barker Street, Randwick, NSW 2031, Sydney, Australia

    John R. Hodges

Authors
  1. Facundo F. Manes
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  2. Teresa Torralva
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  3. María Roca
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  4. Ezequiel Gleichgerrcht
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  5. Tristan A. Bekinschtein
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  6. John R. Hodges
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Correspondence to Facundo F. Manes.

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The authors declare no competing financial interests.

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Manes, F., Torralva, T., Roca, M. et al. Frontotemporal dementia presenting as pathological gambling. Nat Rev Neurol 6, 347–352 (2010). https://doi.org/10.1038/nrneurol.2010.34

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