Frontotemporal Dementia Presenting as Gambling Disorder: When a Psychiatric Condition Is the Clue to a Neurodegenerative Disease

Behavioral variant frontotemporal dementia, the most common form of frontotemporal dementia, is characterized by executive dysfunction and changes in personality and behavior, sometimes with associated psychiatric disorders. We report a man who suddenly developed a gambling disorder when he was 55 years old. A year later he developed personality changes of agitation, euphoria, and disinhibition, along with binge eating and dysthymia. He did not improve on paroxetine 40 mg/day. Two years after the onset of his symptoms, he came to our clinic for evaluation. Neuropsychological testing showed deficits in cognitive control, planning, and attention. Brain magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography scans showed predominant frontal and temporal alterations, worse in the right hemisphere than the left. Cerebrospinal fluid analysis was not compatible with Alzheimer disease. On the basis of current criteria, we gave him a diagnosis of probable behavioral variant frontotemporal dementia presenting with a psychiatric symptom. Our findings in this unusual patient confirm the importance of close clinical monitoring in people who have a psychiatric disorder with atypical features, because the condition may mask an underlying neurodegenerative disease.

Les joueurs sans problème de jeu de 55 ans et plus : événements, conséquences et caractéristiques structurelles et environnementales influençant les habitudes de jeu

Gambling habits of people aged 55 years and over without gambling problems are rarely being investigated. In order to document life events and to identify the impacts of gambling on quality of life, 19 participants aged 55 to 74 years without gambling problems, male and female, were assembled in three focus groups. Qualitative content analysis of the groups reveals changes in gambling habits associated with transition to retirement and occurrence of health problems. The content analysis further reveals a variety of positive and negative consequences of gambling habits on finances, hobbies, social relationships, and psychological health. Although the focus groups did not target the structural or environmental characteristics of gambling that influence participants' gambling habits, those themes were brought up spontaneously. Results highlight the necessity to study life events from a larger perspective including, for example, protective and risk factors, in order to better understand the life contexts and the individual characteristics that may lead to an alteration or not of gambling habits.