A case with a late-onset kleptomaniac and hoarding behavior

The case was a retired 66-year-old police officer. He had been manifesting kleptomaniac behaviors, which led to opening of a legal suit against him two months ago. For the last one year, he was stealing with a sudden impulse without any economic need. For the last 18 months, he could not get rid of the superşuous household goods. He was also resisting against family members’ attempts at getting rid of unnecessary objects. At the time of his hospitalization, HAM-D scale score was 23 points. On cranial MR, at the level of frontal lobes bilaterally, thinned cortex, prominent sulci, cortical and subcortical atrophy in the anteroparietal area and secondary to this atrophic process, chronic frontal subdural effusion measuring 9 mm at its thickest area were observed. Mini-mental performance test result of the patient without any complaint of amnesia was within normal limits (28/30 pts). EEG findings were normal. He had been assigned 90/100 points in Addenbrook cognitive test, which evaluates cognitive functions in more detail than mini-mental test. This test result demonstrated that his cognitive functions were normal when compared with age-matched healthy individuals. On neurological examination, he had an apathic appearance. His MMPI test results revealed that he had been vehemently seeking medical help. Neuropsychological tests related to the assessment of memory including Rey Complex Figure Test, Serial Digit Learning Test (SDLT) and Otkem Verbal Memory Processes Scale Tests were performed. The patient had memory factor scores nearing average values of the age-matched individuals. Benton Facial recognition and also judgment of Line Orientation Tests. Besides, his mental and intellectual faculties related to visual-spatial perception, imaging, orientation, spatial cognition and facial recognition were not impaired. Wisconsin Card Sorting Test (WCST), Stroop Test and Trail-Making tests were used to evaluate functions of the frontal lobe. In Stroop test his performance score was two standard deviations below than that of the age-matched healthy individuals. Based on WCST, Stroop and Trail-making test results, it has been detected that he was erroneously insistent on his reactions and had experienced difficulties in inhibiting improper reactions. When cognitive tests were evaluated as a whole, we thought that his executive functions were significantly impaired. The case with abnormal cranial MR findings together with impairment in executive functions as manifested in cognitive tests, by apathy, onset of hoarding behavior followed by habitual stealing acts seen since the last year, increase in appetite and change in eating habits, was diagnosed as behavioral variant FTD based on International Frontotemporal Dementia Consensus Criteria. Our case we presented here in was diagnosed as FTD, after detailed neurocognitive tests and review of new diagnostic criteria. While results of clinical tests related to memory and intellectual capacity are usually within normal limits in cases with late-onset behavioral problems, their evaluation together with frontal lobe function tests has been recommended in order not to overlook diagnosis of FTD.