Frontotemporal dementia: What’s to know?
Frontotemporal disorders involve damage to parts of the front and side, or temporal area, of the brain, resulting in dementia. Depending on the type, these can lead to changes in language use, behavior, and other aspects of well-being.
Types of frontotemporal dementia (FTD) include Pick’s disease, primary progressive aphasia, and semantic dementia. As well as affecting behavior and language use, they can impact a person’s posture and gait and increase the risk of falling.
FTD is the third most common cause of dementia among people aged 65 years and over, and it is the second most common in those aged under 65 years. It usually appears between the ages of 45 and 65 years. However, it is rare, accounting for fewer than 5% of all dementia cases.
In this article, learn more about the types, what to expect, and treatment options.
There are two main types of FTD: the behavioral variant and the language variant. However, a person may have symptoms of both.
FTD affects the frontal and temporal lobes of the brain. The frontal lobe is at the front of the brain, and the temporal lobe is at the side. These areas play a role in behavior, language, and the ability to plan and organize. Damage to neurons, or brain cells, in these parts of the brain can result in a range of symptoms.
The symptoms and lobes the condition affects will determine the precise diagnosis a person receives.
Around 60% of people with FTD have the behavioral variant, and around 40% have the language variant.
The behavioral variant can lead to:
- changes in personality
- a loss of empathy and emotional reactions
- changes in dietary behaviors
- a loss of inhibition, leading to inappropriate behaviors
- problems with abstract thinking
- difficulty planning and carrying out tasks
- an inability to resist touching and picking things up
- repeating words and activities for no apparent reason
Memory problems may occur at a later stage.
The person may also be unaware that their behavior is unusual. This can make it difficult to help them.
The language variant can be either progressive, non-fluent aphasia or semantic aphasia.
In progressive, non-fluent aphasia, the person has difficulty producing speech. They may produce jumbled words, have difficulty understanding complex sentences, and be unable to name objects. In the early stages, the person may still be able to calculate, remember things, and think abstractly.
In semantic dementia, the person may have difficulty understanding single words and recognizing familiar faces and objects. Speech may sound fluent but make no sense to a listener. In time, this type can also affect memory.
A person with FTD may also experience:
- insomnia, which affects 48% of people with the condition
- breathing problems while sleeping, which affect 68% of those with FTD
- restless legs syndrome, which occurs in 8% of cases
- a higher risk of falling
- a higher sex drive
- eating disorders, such as overeating, not eating, or developing specific food preferences
- changes in stride length, step cycle, balance, posture, and gait, which can lead to falls
- conflicts with loved ones if they do not understand the reason for the person’s behavior
Some movement disorders can occur alongside FTD. These include:
- motor neuron disease
- amyotrophic lateral sclerosis (ALS)
- progressive supranuclear palsy
There are three general stages of FTD: early, middle, and late. The following sections will look at each of these in more detail.
In the early stage of FTD, a person may not experience any memory difficulties. For this reason, some doctors may overlook the condition or misdiagnose it as a psychiatric one.
In the middle stage of FTD, the condition starts to appear more similar to other types of dementia, such as Alzheimer’s disease.
People in the middle stage of FTD may start to need more help with simple daily tasks, such as dressing and grooming. Family members and caregivers may also notice that behavioral disturbances happen more often and more consistently.
In late stage FTD, people often experience difficulties with both language and behavior, and their memory usually starts to deteriorate.
Some people with this stage of the condition need 24-hour care.
FTD seems to result from degeneration in the brain cells in the frontal and temporal lobes due to damage from proteins collecting in those areas.
In most cases, it is unclear why a person develops FTD. However, around 40% of people with the condition have a family member with FTD. Head injuries and thyroid disease may also increase the risk.
FTD and ALS may share some genetic features, but any link is currently unclear.
FTD symptoms vary between individuals and depend on the subtype. Broadly speaking, the condition can affect language, behavior, or both, according to the National Institute of Neurological Disorders and Stroke.
Depending on the type of FTD a person has, symptoms may include:
- inappropriate social behaviors
- boredom and listlessness
- a lack of empathy and difficulty understanding other’s emotions
- a reduced insight into their own behaviors
- an increased interest in sex
- changes in eating habits
- either agitation or blunted emotions
- a loss of interest in personal hygiene
- repeated or compulsive behaviors
- reduced energy and motivation
- speech and language difficulties
- changes in gait
- other physical symptoms, such as stiffness
- difficulty swallowing
- dystonia, or holding a part of the body in an unusual position
- weakness, rigidity, and cramping in the muscles
- an inability to carry out movements such as brushing the hair
- tremor and a tendency to drop things
In the later stages, FTD may also start to affect memory.
Diagnosing FTD can be challenging because various conditions have similar symptoms. These conditions include bipolar disorder, supranuclear palsy, Alzheimer’s disease, and other types of dementia.
A number of tests can help identify a diagnosis and rule out other potential conditions.
A doctor may:
- consider the symptoms
- assess the person’s ability to think and reason
- perform a physical examination
- review personal and family medical history
- order blood tests to rule out other conditions, such as thyroid problems
- conduct brain scans to detect any loss of brain cells in the frontal and temporal brain regions
- do laboratory tests of cerebrospinal fluid
Research is ongoing to find a more accurate way to diagnose conditions like this at an earlier stage.
There is currently no cure for FTD and no way to slow the progression of the condition. However, some treatment options can help manage the symptoms.
Behavior-related approaches and medications may help manage agitation and behaviors that may pose a threat to the well-being of the individual or another person. For example, a doctor may prescribe antidepressants or antipsychotic drugs.
Various drugs are available, but they may have adverse effects. The person or their caregiver can talk with the doctor to find a suitable option for them.
A speech therapist can help the individual maintain their language skills and find new ways to communicate. This could include using a notebook, photos, gestures, sign language, or drawings.
Caregivers can help by speaking slowly and clearly, using simple sentences, and waiting for a response. The individual and their caregiver may need to find alternative strategies as new challenges arise over time.
Caring for a loved one
Some tips for keeping the person safe and maximizing their quality of life include:
- helping them manage their finances and apply for disability payments, if appropriate
- preempting any physical, social, or psychological risks they may face
- making adaptations to reduce the risk of falls
- seeking counseling for depression and anxiety, if applicable
- maintaining a regular routine
- helping them avoid triggers of hypersexuality, overeating, and other behaviors that can lead to problems
The National Institute on Aging recommends accepting unusual statements rather than challenging them, as arguing is not usually helpful. It suggests that the caregiver takes “time out,” such as counting to 10, to help manage any frustration they have.
FTD is progressive. Progression can be rapid, ranging from 2 to over 10 years, but the outlook can vary significantly.
For most people, the condition will affect the functions they use in everyday life. They may eventually need around-the-clock care at home or in a residential care facility.
Caregivers may also need support from other family members, friends, and support groups.
FTD is a type of dementia that can affect speech, behavior, and other aspects of a person’s well-being. The symptoms are progressive and tend to worsen with time. The condition can affect life expectancy.
There is currently no cure, but treatment and support can help manage the symptoms and enhance a person’s quality of life while living with FTD.