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Frontotemporale dementie en de psychiatrische differentiaaldiagnose: twee gevalsbeschrijvingen en de rationale van de ‘Laat Ontstaan Frontaal syndroom (LOF)-studie’

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Tijdschrift voor Neuropsychiatrie en Gedragsneurologie

Samenvatting

De gedragsvariant van frontotemporale dementie (FTD) oftewel behavioural variant FTD (bvFTD) is een klinisch heterogeen syndroom, primair gekenmerkt door persoonlijkheids- en gedragsveranderingen. BvFTD kent symptomatische overeenkomsten, zowel met andere neurodegeneratieve ziekten als met diverse psychiatrische aandoeningen, want alle kunnen ze disfunctie van dezelfde frontosubcorticale circuits veroorzaken. Terwijl de differentiële diagnostiek met andere vormen van dementie door het gebruik van specifieke biomarkers steeds betrouwbaarder kan worden uitgevoerd, blijft het klinisch zeer relevante onderscheid tussen bvFTD en psychiatrische aandoeningen een uitdagend diagnostisch vraagstuk met prognostische consequenties. Er bestaat momenteel nog geen gestandaardiseerde diagnostische aanpak van frontale gedragsstoornissen die ontstaan op latere leeftijd. Wij presenteren in dit artikel twee gevalsbeschrijvingen die illustreren hoe lastig de differentiële diagnostiek kan zijn en hoe gemakkelijk de clinicus op het verkeerde been wordt gezet.

De problemen bij de differentiële diagnose tussen bvFTD en psychiatrische aandoeningen hebben ons ertoe gebracht de ‘Laat Ontstaan Frontaal Syndroom (LOF)-studie’ op te zetten. Het gaat hier om een naturalistische en prospectieve cohortstudie, waarvan de inclusiefase inmiddels is afgerond. Patiënten tussen de 45 en 75 jaar met frontale gedragsstoornissen (apathie, ontremming of compulsief dan wel stereotiep gedrag) werden verwezen vanuit zowel een psychiatrische als een neurologische instelling. De verdeling van etiologieën van het laat ontstane frontaal syndroom wordt de komende jaren bij deze patiënten onderzocht. De aanvullende waarde van MRI-, PET- en liquoronderzoek wordt bepaald door de klinische waarschijnlijkheidsdiagnose van de neuroloog en de psychiater te vergelijken voor en na het bekend worden van de uitslagen van aanvullend onderzoek. De diagnostische waarde van MRI-, PET- en liquoronderzoek wordt onderzocht aan de hand van de definitieve diagnose na twee jaar follow-up. Dit is de eerste grootschalige prospectieve studie naar patiënten met op latere leeftijd ontstane gedragsstoornissen. Door te includeren op basis van symptomen, benadert de LOF-studie de klinische praktijk zeer nauw. Uiteindelijk kunnen de resultaten van deze studie helpen een multidisciplinair diagnostisch paradigma te creëren voor op latere leeftijd ontstane gedragsstoornissen.

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Authors and Affiliations

  1. Alzheimer Centrum en afdeling neurologie, VU medisch centrum, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands

    Welmoed Krudop, Niels Prins, Wiesje van der Flier, Philip Scheltens & Yolande Pijnenburg

  2. Afdeling ouderenpsychiatrie, GGZInGeest, Amsterdam, The Netherlands

    Cora Kerssens, Annemiek Dols & Max Stek

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  1. Welmoed Krudop
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  2. Cora Kerssens
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  3. Annemiek Dols
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Correspondence to Welmoed Krudop.

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Alzheimer Centrum en afdeling neurologie, VU medisch centrum, Amsterdam

Afdeling ouderenpsychiatrie, GGZInGeest, Amsterdam

Correspondentie: Drs. W.A. Krudop, Alzheimer Centrum, VU medisch centrum, De Boelelaan 1117, 1081 HV Amsterdam, 1007 MB, Amsterdam, w.krudop@vumc.nl

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Krudop, W., Kerssens, C., Dols, A. et al. Frontotemporale dementie en de psychiatrische differentiaaldiagnose: twee gevalsbeschrijvingen en de rationale van de ‘Laat Ontstaan Frontaal syndroom (LOF)-studie’. Tijdsvoor Neuropsy en Gedragsneuro 1, 72–79 (2013). https://doi.org/10.1007/s40533-013-0020-8

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