Psychiatric Burden in a Large Cohort of Adults With Niemann Pick Type C Disease: From Psychotic Symptoms to Frontal Lobe Behavioral Disorders

Objectives: To describe Niemann-Pick type C (NPC) behavioral symptoms (focusing on psychotic symptoms) and its relation to frontal lobe functioning. Methods: We retrospectively reviewed medical charts of NPC-patients followed in the Lysosomal Diseases reference center in Paris Pitié-Salpêtrière. We collected demographic data, psychiatric clinical manifestations, psychometric scales, and extended neuropsychological data including executive and behavioral frontal lobe functions evaluations. Results: Nineteen patients were included in the study with ten of them having experienced at least one acute psychotic episode, being inaugural for six of them. Most of the patients suffered from behavioral (15/17) and cognitive disorders (18/19) (including executive dysfunction (11/12), apathy (13/17), impaired social cognition (11/13) and stereotyped behaviors (5/10)). For five patients, quality of life was significantly impaired by these abnormal behaviors. Concerning frontal neuropsychological evaluation, Facial emotion recognition was by far the most performed neuropsychological test (n=8) and the score was always abnormal. It is noteworthy that psychotic symptoms were often drug resistant (8/9) and that Miglustat was associated with a better control of psychotic symptoms. Conclusions: We report a high frequency of psychiatric symptoms in NP-C encompassing acute psychotic manifestations, presenting often early in the course of the disease with atypical features. We also report disabling behavioral manifestations related to frontal dysfunction.