Where There’s Smoke, There May Be Fire.

I’d like to present a case I treated that may help other families.

An early 50s male was referred to me by a neurologist because of recent thinking and behavioral changes. He had seizures due to a condition he was born with called Chiari malformation causing a mild learning disability in school and missed by the school system. Nonetheless, he managed through school, work, and his personal life.

But there were changes in his functioning over the past year and his wife, family, and friends were concerned.

His family doctor thought he should see a mental health professional (and what does that mean?) and a neurologist who referred the patient to our practice to help determine the nature of his condition, a diagnosis, and treatment plan.

He was administered a neuropsychological examination (NPE) which is our form of a CT/MRI of the brain showing all the thinking and behavioral components of the brain.

The NPE not only identified the source for the seizures, but also a pattern of findings consistent with a learning disability, again missed by the school system.

Finally, the most significant finding from the NPE was a pattern of results consistent with a type of dementia called Frontal Temporal Dementia (FTD). This type of dementia causes significant problems with thinking, daily efficiency, insight/judgement, proper behavior, organization, and skills that enables normal daily functioning.

Also, this type of dementia affects the frontal lobes of the brain which is the seat of our personality. I asked his wife if he had any unusual thoughts and beliefs and the entire family reacted YES, out of character for him, plus finally a doctor validating what they have been witnessing for a while. This is common with FTD. For e.g., he accused his wife of having an affair with his friends. These are called delusions and could easily be misunderstood as a psychiatric symptom, rather than a brain-based condition.

Once this was explained to the family in a follow up office visit after the NPE, they understood what to do and now we could start appropriate treatment.

The tragedy today with our aging population is this story is oftentimes not identified causing undue stress.

If you feel you have concerns regarding a family member’s behavior, don’t waste time. Get an answer. Give us a call and we shall direct you accordingly.


Robert B. Sica, PhD, ABN
Board certified, Neuropsychology
Founder and Director of NRS|LS