LAUSR

Behavioral variant frontal temporal dementia (bvFTD) is characterized by progressive changes in behavior, personality, and cognition. Little is published on the presentation in non-English-speaking populations. Here is the case of a neuropsychological evaluation in a community health setting where language and cultural considerations were salient. A 73-year-old, right-handed, monolingual Vietnamese widowed female homemaker with five years of education and low literacy, was referred after gradual personality changes over five years caused family tension and a need for increased monitoring. History includes cardiovascular disease, hypertension, hypercholesterolemia, cholestatic hepatitis, and depression with remitting psychotic features and suicidal ideation. Neuroimaging shows right temporal encephalomalacia and mild diffuse atrophy commensurate with age. A bilingual phone interpreter was used. Test findings revealed low scores across all but two tasks (visuospatial processing speed, recognition memory). Several confrontation naming items were unknown to the patient or culturally irrelevant, per interpreter. Interview with an English-speaking daughter revealed declines in behavior and social comportment (e.g., unsympathetic, demanding, rigid, repetitive, disorganized, compulsive shopping and gaming, confabulatory) and modest declines in activities of daily living. Presentation was notably childlike, overly affectionate, “grabby”, insistent, restless, with poor conversational turn-taking (with interpreter), but generally intact expressive and receptive language. BvFTD was diagnosed. Addressing needs of a diverse, multi-cultural population in a community health setting can present significant challenges. This case study highlights the importance of non-psychometric sources of data, including history, observation, and collateral interviews, along with consideration of education, language, and culture on the evaluation process and case conceptualization.