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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0412

Early-onset neurocognitive disorder and borderline personality disorder: challenges in differential diagnosis, a case report

EARLY-ONSET NEUROCOGNITIVE DISORDER AND BORDERLINE PERSONALITY DISORDER: CHALLENGES IN THE DIFFERENTIAL DIAGNOSIS. A CASE REPORT

In a presentation that appeared consistent with longstanding borderline personality disorder, longitudinal assessment, brain MRI, and FDG-PET established a diagnosis of behavioral variant frontotemporal dementia.

The aim of this study is to highlight the diagnostic challenges in young-onset neurodegenerative disorders presenting with prominent behavioral symptoms and to demonstrate how integrating longitudinal clinical assessment, neuropsychological assessment, brain magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) contributes to diagnostic accuracy. A comprehensive diagnostic evaluation was conducted in a 65-year-old man admitted to the intensive care unit following a severe intentional medication overdose. Psychiatric and neurological assessments and brain MRI were performed during hospitalization; following clinical stabilization, detailed longitudinal clinical assessment, neuropsychological testing, and FDG-PET were conducted during outpatient follow-up. The clinical history, information provided by family members, neuropsychological findings, and neuroimaging results were integrated to establish an etiological diagnosis. The clinical history, characterized by impulsivity, suicidal behavior, and low frustration tolerance, was considered consistent with longstanding borderline personality disorder. Family members, however, reported a five-year history of progressive changes in social behavior, describing loss of empathy, indifference to the impact of socially inappropriate remarks on others, apathy, and diminished interest in daily activities. The Montreal Cognitive Assessment (MoCA) score was 25/30, and the Frontal Behavioral Inventory (FBI) score was 39. Brain MRI showed diffuse cerebral atrophy without a characteristic frontotemporal pattern; neuropsychological assessment identified executive dysfunction; and FDG-PET revealed bilateral frontotemporal hypometabolism, more pronounced on the left, supporting a diagnosis of behavioral variant frontotemporal dementia. During hospitalization, risperidone and quetiapine were each discontinued because of extrapyramidal side effects. The patient was subsequently treated with sertraline and olanzapine, with a good clinical response. In conclusion, progressive changes in behavior and social cognition may indicate an underlying neurodegenerative disorder, even in patients whose clinical features suggest borderline personality disorder. A longitudinal, multimodal approach integrating neuropsychological assessment, brain MRI, and FDG-PET may improve the differential diagnosis of young-onset dementia. Recognizing increased sensitivity to antipsychotics in behavioral variant frontotemporal dementia is also important for clinical management.

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