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“Fantastic Thinking” in Pathologically Proven Pick Disease

Kremen, Sarah A. MD* †; Solis, Orestes E. MD; Shapira, Jill S. RN, PhD; Vinters, Harry V. MD† ‡; Mendez, Mario F. MD, PhD* †

Cognitive and Behavioral Neurology: June 2010 - Volume 23 - Issue 2 - p 130-134
doi: 10.1097/WNN.0b013e3181df3007
Case Reports

Background Reports of false beliefs may be a unique feature of behavioral variant frontotemporal dementia (bvFTD) but the nature of these experiences is unclear.

Objective To report a case of pathologically verified Pick disease in a patient presenting with prominent and recurrent fantasies.

Methods We describe the clinical, neuroradiologic, and neuropathologic findings of a 53-year-old woman presenting with fantasies and meeting Clinical Consensus Criteria for bvFTD.

Results Early in her course, she reported interactions with different actors, having torrid affairs with them, and other related fantasies. When confronted with her false beliefs, she admitted that these relationships were imaginary. Autopsy revealed Pick disease with τ-immunoreactive Pick bodies in the frontal and temporal cortices, and in the hippocampi.

Conclusions Fantastic thinking, or vividly experienced imagination, may be a manifestation of bvFTD that is distinct from delusions and confabulations and could be the source of previously reported delusions and confabulations in bvFTD.

*Neurobehavior Unit, Department of Neurology, VA Greater Los Angeles Healthcare System

Department of Neurology

Division of Neuropathology, Department of Pathology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

Harry V. Vinters, MD is supported in part by the UCLA Alzheimer Disease Research Center grant P50AG16570 and the Daljit S. & Elaine Sarkaria Chair in Diagnostic Medicine.

Reprints: Sarah A. Kremen, MD, Neurobehavior Unit (Bldg. 500. 3S; 116AF), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073 (e-mail:

Received for publication July 30, 2009; accepted March 14, 2010

© 2010 Lippincott Williams & Wilkins, Inc.