| It
came as a complete shock to Joan Dunaway when her husband
was fired from his managerial position at the age of 52.
"They said it was
because he hadn't gone in to work on a Saturday,"
Dunaway says. "But he never worked Saturdays."
She never got more of an
explanation. And her husband never worked again.
It was when he began to
look for another job that she first saw he was having
problems. "My daughter and I would give him phone
numbers to call, and he would have trouble dialing in
sequence," Dunaway recalls. "And when it came to
filling out an employment application, he couldn't do
it."
As time passed, Joan
Dunaway's husband began to undergo a dramatic personality
change. He had always mostly kept to himself, but now he
became more social. The kicker came at a party, when one
of Dunaway's friends informed her that her husband was
drinking out of the punch bowl with the dipper.
By then Joan Dunaway was
aware that something was wrong, but it would take some
time before she knew exactly what it was that was
happening to her husband. After a series of misdiagnoses,
she learned he had frontotemporal dementia (FTD). She
would also learn that her husband's neurodegenerative
disease was very different from Alzheimer's disease, with
which it was frequently confused.
It's been 12 years since
Joan Dunaway's husband was diagnosed with frontotemporal
dementia, six years since he last spoke. He is
incontinent, has trouble feeding himself, and needs
constant supervision to ensure that he doesn't walk into
danger or place objects into his mouth that could cause
him to choke.
Whereas the initial symptom
expressed by Alzheimer's disease patients tends to be
forgetfulness, frontotemporal dementia patients - the |
disorder
was until recently classified as Pick's disease, but
experts now see Pick's as one subtype of FTD - rarely
begin the course of illness with memory loss. Instead,
because their disorder affects the part of the brain
related to social behavior, their first symptoms tend to
be personality changes, including apathy, loss of empathy
and/or disinhibition.
Experts are beginning to
understand that the disease has several subtypes, which
explains why its manifestations can vary. But certain
traits are common to many FTD patients. They may begin to
lose their fluency of speech early in the disease, and
many become completely mute by the middle or late stages.
Some become withdrawn and unemotional, displaying
characteristics reminiscent of autistic individuals.
Others, like Joan Dunaway's husband, become socially
uninhibited, and may engage in inappropriate behaviors.
FTD patients commonly develop an oral fixation that leads
them to put anything - food and objects alike - into their
mouths. They are likely to pace constantly in the
beginning and middle stages of the disease. And, with no
concept of danger, many need to be watched like toddlers
to ensure that they do not wander into harm's way.
"It's devastating," says Joan Dunaway, "and
very depressing."
FTD's Three Distinct
Subtypes
In 1892, Dr. Arnold Pick, a
psychiatrist, described the case of a 71-year-old man
whose mental state had deteriorated and whose
communication abilities were severely impaired. At the
time of the man's death, an autopsy showed shrinkage in
the frontal region of his brain. A few years later, Dr.
Alois Alzheimer noted that the brain of Dr. Pick's patient
had cellular abnormalities that appeared different from
the amytoid plaques and neurofibrillary tangles associated
with patients who had Alzheimer's disease. Instead, this
patient had abnormal protein deposits in the nerve cells
of the frontal cortex. These abnormalities were given the
name Pick bodies, and for many years what was thought to
be an extremely rare form of dementia, Pick's disease, has
been associated with personality changes; blunted,
impaired or lost speech; and disinhibition. |
