Efficacy of Electroconvulsive Therapy for Comorbid Frontotemporal Dementia with Bipolar Disorder

Challenges encountered in the diagnosis and treatment of frontotemporal dementia (FTD) are further confounded when presented with comorbid psychiatric disorder. Here we report a case of progressive FTD in a patient with a long history of bipolar affective disorder (BAD) 1, depressed type. We also report beneficial effects of electroconvulsive therapy and its potential application in similar comorbid disorders. 1. Introduction Despite the emergence of frontotemporal dementia (FTD) as the second most common neurodegenerative cause of early onset dementia following Alzheimer’s disease, its diagnosis and treatment are often problematic [1, 2]. The therapeutic and management options for FTD become even more challenging when presented with comorbid mood disorders such as bipolar affective disorder (BAD) 1, depressed type. In this report we describe a patient with a long history of BAD, further complicated by the diagnosis of FTD with emergence of novel behavioral and management issues. Presentation of catatonic-like symptoms further complicated the diagnosis and treatment options in this patient. 2. Case Report The patient is a 51-year-old divorced college-educated male with a long history of bipolar affective disorder type 1 and subsequent treatment. He was working as a software engineer prior to the recent diagnosis of dementia NOS. At the time of the present hospitalization, he was transferred from a nursing home with severe dysphasia and recurrent choking episodes. The patient also was preoccupied with the delusion that he was the Archangel Michael. At the age of 19, he was diagnosed with bipolar affective disorder type I, stabilized with lithium, and was able to lead a normal life until the age of 48 at which time his behavior started to show “bizarre” patterns. He began to display “childlike behaviors”—following his wife around the house and becoming increasingly argumentative. The patient was started on methylphenidate for unclear reasons and began experiencing difficulty completing complex computer codes; he also became increasingly argumentative and obstinate with his coworkers, which ultimately culminated in his dismissal. During this period of decline, the patient experienced manic episodes evidenced by racing thoughts, pressured speech, paranoid delusions, preoccupations with philosophy, religion, and some bizarre delusions. He began to purify his food and was convinced that someone was contaminating his contact lens solution. At some point during this period, lithium, which was a longstanding and very effective medication in this patient, was