Personality disintegration - it runs in the family

Jette Stokholm, Peter Johannsen, Jørgen Erik Nielsen, Anders Gade

Abstract

A 50-year-old man was referred for dementia evaluation a few months after losing his job as head of a department in a large company. According to colleagues his behavior and personality had gradually changed over a couple of years. Formerly responsible, correct, and always on time, he now neglected appointments and deadlines and spent most of a workday playing games on his computer. He had stopped caring about his personal appearance and hygiene; he let his hair and nails grow, stopped shaving, and wore the same jeans and T-shirt for days. During the summer he attended several music festivals, which he had never shown any interest in earlier, and was wearing caps and badges from these events. He had been given several warnings and moved to less demanding tasks, but the problems persisted, and he showed no sign of understanding when these were pointed out to him. When asked to resign from his job, he was offended but unconcerned about the causes and consequences. Although convinced that he was healthy and well functioning, he willingly accepted to participate in dementia evaluation. His family described marked changes in his social behavior and empathy over perhaps 2 to 3 years. He no longer showed any interest in their well-being and in general was inconsiderate towards other people. He would address strangers and ask inappropriate personal questions and he would comment on people in public, often being quite rude and very loud. Playing golf, he broke the rules and acted as if he was the only player on the course. At dinner, he would pile up loads of food on his plate and eat it in haste. After finishing his meal, he would just leave the table and sit down to watch TV. He spent most of the day in front of the TV following different shows at different channels and had no trouble keeping track of the time and place of these. If anybody asked him to take part in the daily chores or pointed out the inappropriateness of his behavior to him, he became irritated and might stick out his tongue at them, but otherwise just ignored them When left alone, he generally seemed to enjoy himself and would often burst into laughter without any obvious reason. The family also described that the patient withdrew from all social activity and that conversation with him was increasingly difficult. He almost never initiated a conversation and got lost in details and associations when trying to explain things. He would often search for words, but had no trouble understanding what was said, as long as it didn’t require verbal abstraction. He no longer understood irony or sarcasm and had lost his sense of humor. Even though he was forgetful in his everyday life, his memory for what had happened recently was perfect and detailed.

Original languageEnglish
Title of host publicationCase studies in Dementia : Common and uncommon presentations
EditorsS. Gautier, P. Rosa-Neto
Number of pages9
PublisherCambridge University Press
Publication date1 Jan 2011
Pages115-123
Chapter16
ISBN (Print)9780521188302
ISBN (Electronic)9780511997433
Publication statusPublished - 1 Jan 2011
SeriesCase Studies in Neurology

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