A 62-year-old man is brought by his wife after two years of marked personality change. He makes inappropriate sexual jokes at family gatherings, shows no empathy when his brother died, and has begun overeating sweets compulsively. Memory testing and orientation are largely intact, and MMSE is 27/30. MRI shows selective frontal and anterior temporal atrophy. Which is the most likely diagnosis?

• A Behavioural variant frontotemporal dementia ✓
• B Early Alzheimer's disease
• C Lewy body dementia
• D Vascular dementia

Explanation

Behavioural variant FTD presents with early disinhibition, loss of empathy, compulsive behaviours, and dietary changes such as sweet craving, with relative preservation of memory and visuospatial function early in the course. Frontal and anterior temporal atrophy supports this. The best distractor is early Alzheimer's disease, but Alzheimer's begins with episodic amnesia while personality remains relatively preserved until later stages.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.