Frontotemporal dementia by
Dr Jonathan Rohrer, Dr. Rohani Omar & Dr. Jason Warren, Dementia Research Center
FTD is caused by degeneration (loss) of brain cells mainly affecting the parts of the brain (the frontal lobes mainly but also the temporal lobes) that control behaviour and personality.
Symptoms
The first symptom is usually a change in personality or behaviour (which is out of character for the person) – the symptoms may come on very slowly and not be noticed as abnormal at first. The symptoms include the following:
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Loss of inhibitions or increased extroversion. They may talk to strangers, make inappropriate remarks in public and be rude or impatient. They may also become aggressive.
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They may spend money excessively.
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Apathy or withdrawal from social activities
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Loss of empathy
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Changes in sexual behaviour: either a loss of interest, more or inappropriate interest.
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People may be very distractible.
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They often develop fixed routines or become obsessive about things. Some people begin to hoard things.
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People may also develop a sweet tooth and/or overeat leading to gain in weight. Preference for and/or excessive intake of unusual foods or alcohol may occur. In the later stages people with the illness may compulsively put objects in their mouths.
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Decreased amount of speech or repetitive speech.
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Often the person will be unaware of the true extent of the problems and lack insight.
In the early stages memory is often well maintained on psychological testing (unlike in Alzheimer’s disease) but difficulties in organisation and concentration often lead to an apparent memory problem and this is also a common complaint.
Medical tests
Behaviour and aspects of thinking (cognitive functions) will be assessed, initially by a doctor, and often followed by a more detailed assessment by a psychologist. Brain scans can show the loss of brain cells in FTD (shrinkage of the affected parts of the brain) but there is no single test that can specifically diagnose FTD with complete reliability during a person’s lifetime. Furthermore, in the early stages of the disease the scan may look normal. Diagnosis is therefore largely based on clinical judgment and FTD can be confused with other disorders in which there are problems with behaviour (e.g. some psychiatric disorders) and with other dementias. Your doctor will often arrange blood tests or other tests (usually including detailed brain scans, in particular MRI; an EEG or electroencephalogram; and sometimes a lumbar puncture or other specialised tests) to help confirm the clinical diagnosis and rule out diseases that can produce similar symptoms to FTD.
Treatment
Unfortunately, there are no medications presently available which can treat the disorder or slow its progression. Treatment therefore focuses on helping people to manage their symptoms, including the behavioural symptoms and treating problems such as mood changes that may contribute to the difficulties that people experience. Medication for behavioural symptoms and mood changes may be needed as the disease progresses.
Prognosis
Behavioural and personality problems deteriorate over time and other aspects of thinking such as memory may become affected. Although it is recognized that there is a slower form of FTD that progresses over a number of years (in some cases over ten), in the majority of patients behavioural problems continue to progress such that after two to five years people have problems carrying out their normal daily living activities and will need extra care and support.
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