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"Fantastic thinking" in pathologically proven Pick disease
Sarah A Kremen1, Orestes E Solis, Jill S Shapira
1Neurobehavior Unit, Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. skremen@ucla.edu
Summary
Behavioral variant frontotemporal dementia (bvFTD) can manifest as vivid fantasies, distinct from delusions. This case highlights fantastic thinking as a potential bvFTD symptom, confirmed by Pick disease pathology.
Area of Science:
- Neurology
- Neuroscience
- Pathology
Background:
- Behavioral variant frontotemporal dementia (bvFTD) is associated with false beliefs, but their nature remains unclear.
- Distinguishing these experiences from other cognitive phenomena is crucial for diagnosis.
Observation:
- A 53-year-old woman presented with prominent, recurrent fantasies, including imagined romantic affairs.
- She met the Clinical Consensus Criteria for bvFTD.
Findings:
- Neuropathological examination revealed Pick disease, characterized by tau-immunoreactive Pick bodies in the frontal, temporal, and hippocampal cortices.
- The patient acknowledged the imaginary nature of her fantasies when confronted.
Implications:
- Vividly experienced imagination, termed fantastic thinking, may represent a distinct manifestation of bvFTD.
- This phenomenon could explain previously reported delusions and confabulations in bvFTD patients.
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