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Letters

A Case of Adult Asperger’s Syndrome Previously Diagnosed as Frontotemporal Dementia

A Case of Adult Asperger’s Syndrome Previously Diagnosed as Frontotemporal Dementia

To the Editor: There is no previous report of a patient with Asperger’s syndrome with a differential diagnosis of frontotemporal dementia. There are many older people who may have met the criteria for Asperger’s syndrome as children, but were never diagnosed. This is due to the fact that the disorder was established relatively recently. Currently, mental health in the context of an aging society is regarded as an important issue. However, little attention is paid to the difficulties that older people with Asperger’s syndrome face as they age.

Case report. Mr A, an 88-year-old Japanese man, had no previous psychiatric history. He owned a small family business and retired 20 years ago. He got into trouble with the police in 2010 because of inappropriate behavior: a young woman who was an inhabitant of the house that he owned complained that he telephoned her at her office many times a day. His family was called and brought him to a psychiatrist. Mr A presented with symptoms of dietary change (preference for sweet foods) and stereotyped behaviors (taking a walk on the same route at exactly the same time every day). He simply repeated that what he did was not wrong legally. He was subsequently diagnosed with frontotemporal dementia and was admitted to our hospital for further examination.

His laboratory data showed no abnormalities, and neither did magnetic resonance imaging, single-photon emission computed tomography, or electroencephalography. He completed the Mini-Mental State Examination1 (score = 30 of 30). He displayed an IQ within the normal range (full scale IQ = 100) according to the Wechsler Adult Intelligence Scale.2 However, his verbal IQ (110) was superior to his performance IQ (88). He showed no memory impairment on the Wechsler Memory Scale.2 His Autism Spectrum Quotient3 was 31 of a possible 50. He had marked impairment in eye-to-eye contact. He also manifested severe lateral interpretations of words. When asked about the meaning of “Even a monkey sometimes falls from a tree” (the same meaning as “Even Homer sometimes nods”), he always answered that “A monkey never falls from a tree” with the same phrasing and intonation.

He insisted that the young woman liked him because she preceded an appearance at his office, after he had invited her there for a business matter, by taking a shower. He indicated that he had to call her many times simply because she never answered. His children were interviewed about his personality traits. Their responses suggested that he was “too square” and had difficulties in making friends, but he never reported being lonely. He said he had no delay in language development. We were unable to acquire any more information about his childhood. He was subsequently diagnosed with Asperger’s syndrome. He promised not to bother the woman again and was discharged.

A search of the literature identified no previous report of a differential diagnosis between Asperger’s syndrome and frontotemporal dementia. As the latter is also a recently established disorder, we believe that our case contains an important insight on an issue that may be important in our rapidly aging society.

References

1. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. PubMed doi:10.1016/0022-3956(75)90026-6

2. Wechsler D. Wechsler Adult Intelligence Scale-Revised. San Antonio, TX: The Psychological Corporation; 1981.

3. Baron-Cohen S, Wheelwright S, Skinner R, et al. The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31(1):5-17. PubMed doi:10.1023/A:1005653411471

Tsuyoshi Okamura, MD

jacksonville1977@hotmail.com

Kazue Isoya, MA

Masuhiro Hosoda, MD

Author affiliations: Department of Psychiatry, University of Tokyo (Dr Okamura); and Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital (Dr Hosoda and Ms Isoya), Tokyo, Japan.

Potential conflicts of interest: None reported.

Funding/support: None reported.

Published online: September 29, 2011.

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