Frontotemporal dementia (FTD)

Frontotemporal dementia (FTD) is a dementia that is characterized by drastic personality changes and language difficulties. FTD accounts for 20% of young onset dementia cases. Signs and symptoms typically manifest in late adulthood, more commonly between the ages of 55 and 65, approximately equally affecting men and women. Memory problems are not a main feature of this disease.

Signs and Symptoms

There are three main types of FTD. The first has major symptoms in the area of personality and behavior. This is called behavioral variant FTD or bv-FTD and is the most common. In bv-FTD, the person will have a change in personal hygiene, they will become rigid in their thinking, they rarely recognize that there is a problem, they will be socially withdrawn, and they will often have a drastic increase in appetite. The person may also be socially inappropriate. For example, the person may make inappropriate sexual comment. Apathy, or not caring about anything is a common symptom in many different dementias and is common in FTD.

Language

The other two types of FTD feature language problems as the main symptom. The main feature of the second type of FTD is the loss of the meaning of words. It may begin with difficulty naming things. The person eventually may also lose the meaning of objects as well.

The last type of FTD is called progressive non-fluent aphasia (PNFA). This is mainly a problem with producing speech. Patients have trouble finding the right words and have difficulty coordinating the muscles they need to speak. Eventually, someone with PNFA will only use one-syllable words or may become totally mute.

With the both types of non-bv-FTD the symptoms of behavior may be present, but milder and later than in bv-FTD. On imaging studies, there will be shrinking of the frontal and temporal lobes of the brain.

Binge eating

FTD patients tend to struggle with binge eating and compulsive behaviors including overeating, stuffing oneself with food, cravings for more sweets, carbohydrates, eating inedible objects and snatching food from others. Most FTD patients become unable to perform skills that require complex planning or sequencing. In addition, a number of primitive reflexes known as frontal release signs such as the palmomental reflex, which appears relatively early in the disease course can be elicited.

Treatment

Currently, there is no cure for FTD. However, treatments are available to manage the behavioral symptoms. Disinhibition and compulsive behaviors can be controlled by selective serotonin reuptake inhibitors (SSRIs). Although Alzheimer’s and FTD share certain symptoms, FTD cannot be treated with drugs that benefit Alzheimer’s patients (such as Aricept because the cholinergic systems that these drugs work on are not affected in FTD.

Prognosis

Because FTD often occurs in younger people (i.e. in their 40’s or 50’s), it can severely affect families. Patients often still have children living in the home. Financially, it can be devastating as the disease strikes at the time of life that often includes the top wage-earning years.

Personality changes in individuals with FTD are not voluntary, so they should not be blamed for them. Managing the disease is unique to each individual, as different patients with FTD will display different symptoms, sometimes of rebellious nature.

Symptoms of FTD progress at a rapid, steady rate. Patients suffering from the disease can survive between 2–10 years. Eventually patients will need 24-hour care for daily function.

As with most medical conditions, a timely evaluation by a physician specializing in diagnosis and treatment of memory disorders is the best approach to assuring the optimal outcome of a memory problem.

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