[70-year-old woman with depressive symptoms and personality change]

A seventy-year-old woman, formerly healthy and active, gradually changed and withdrew from social contact. She was admitted to a psychogeriatric ward with depressive symptoms, delusions and change of personality. We treated the condition as a depressive psychosis, but with little success. She was mentally rigid, withdrawn, behaved inappropriately and did not cooperate in the treatment. After months of gradual worsening we suspected frontotemporal dementia. Cognitive testing showed abnormal scores in tasks of executive functions but no major memory or language problems. Computerised tomography was negative. Single photon emission tomography (SPECT) showed marked hypoperfusion especially in the frontal lobes and with the lowest function on the left side. The investigations thus supported the diagnosis. All medication was tapered and she moved to a dementia care unit in her community. The case illustrates some of the diagnostic challenges in psychogeriatric medicine. Early frontotemporal dementia may easily be mistaken for depression, especially when apathy and withdrawal is dominant (apathetic/pseudodepressive subtype) and not disinhibition and inappropriate behaviour (disinhibited subtype).