Frontotemporal Dementia
This week we’ll deep dive into a common cause of dementia for people under age 65 called frontotemporal dementia or FTD. FTD most commonly occurs when a person is between age 40 and 60 with the average age of diagnosis at 58, and unlike Alzheimer’s disease the most common presenting symptoms are behavior changes rather than memory loss. This can make the diagnosis challenging, as many patients and physicians will focus on a psychiatric disorder rather than an underlying dementia as the cause of the symptoms.
To better understand FTD, a very basic description and explanation of the brain is necessary. The brain is comprised of 6 lobes: Frontal, Parietal, Occipital, Temporal, Limbic, and the Insular Cortex. The frontal lobe, unsurprisingly located in the front portion of our brain, is responsible for planning and executing tasks as well as memory, both short-term and long-term. The temporal lobe is located around the ears, and is responsible for processing sensory input, language recognition, and taking short-term memories and encoding them into long-term memories. Frontotemporal dementia is degeneration of these lobes leading to issues specific to the functions of these lobes.
Like dementia is an umbrella term that encompasses diseases such as Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia, FTD is an umbrella term that encompasses several clinical syndromes. There are two basic types of FTD, and the most commonly recognized one is the “behavioral variant,” and the other is known as Primary Progressive Aphasia. Knowing the function of the lobes of the brain can help in understanding these syndromes. Behavioral variant FTD (bvFTD) results from degeneration of the part of the frontal lobe that assist in planning, function, and inhibition of “bad” behavior. Commonly people are brought to the physician because loved ones notice a change in personality. Socially inappropriate behaviors such as kissing or touching in public, public urination, and offensive comments are some of the most noticed symptoms. Other symptoms include a lack of empathy and an increase in compulsive behaviors. All these symptoms together can be incredibly challenging to differentiate from other medical and psychiatric disorders, and bvFTD is likely underdiagnosed.
Primary Progressive Aphasia (PPA) is the other type of FTD result from specific degeneration of locations that are associated with language processing and speech. There are even more subtypes of PPA, and diagnosis within these subtypes is dependent on the symptoms a person is experiencing, but to make a diagnosis of PPA a difficulty with language must be impairing a person’s ability to complete their day to day activities. Neuropsychiatric testing can be very helpful in making the diagnosis of FTD as there is significant overlap between several medical and psychiatric conditions and FTD.
As with all types of dementia, FTD is progressive and ultimately fatal, and it is of utmost importance to communicate what Matters with loved ones throughout a dementia journey. A very challenging part of FTD, specifically bvFTD is the change in personality, and it is critical to remember the changes in personality and behaviors is not reflective of the person, but of the disease.
Key Points:
Frontotemporal dementia (FTD) is a common cause of early-onset (before 65) dementia
Behavioral variant FTD results in personality changes that are extremely challenging for patients and loved ones
Primary progressive aphasia results in language and communication difficulties that ultimately affect day to day life
Be sure to communicate what Matters to the loved ones in your life!
