Early-onset frontotemporal dementia misdiagnosed as psychosis: a case from rural Nepal.

BACKGROUND

Early-onset behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by prominent behavioral and personality changes and is frequently misdiagnosed as a primary psychiatric illness, particularly in low-resource settings, leading to diagnostic delays and inappropriate treatment.

MATERIALS AND

METHODS

We report the case of a 36-year-old man from rural Nepal with an 18-month history of progressive behavioral changes. Clinical history, longitudinal symptom progression, treatment response, family history, and neuroimaging findings were evaluated to establish the diagnosis.

RESULTS

The patient developed progressive disinhibition, hyperorality, impaired judgment, executive dysfunction, and cognitive decline. He was repeatedly treated for psychosis and substance-related disorders without sustained improvement. Further evaluation revealed a positive family history of early-onset behavioral illness and neuroimaging demonstrating bilateral frontal and temporal lobe atrophy, supporting a diagnosis of possible bvFTD.

CONCLUSION

This case highlights the importance of considering frontotemporal dementia in young patients presenting with atypical or treatment-resistant behavioral syndromes to reduce diagnostic delay and improve patient and caregiver outcomes.