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Frontotemporal Dementia

Frontotemporal dementia (FTD) refers to a group of brain disorders caused by nerve cell damage.

The damage occurs in the brain's frontal lobes (behind the forehead) and temporal lobes (behind the ears).

It can cause changes in personality, behavior, and communication skills.

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What is Frontotemporal Dementia (FTD)?

FTD is the name for a group of brain disorders that cause problems with language and behavior. FTD is distinct from other types of dementia, including Alzheimer's disease.

Doctors used to call it Pick's disease.

FTD tends to strike younger people. Most cases occur in men and women between 45 and 64. Unlike Alzheimer's, memory loss is not the main symptom.

FTD isn't as common as other types of dementia. There are about 50,000 to 60,000 people with FTD in the U.S.

Types of frontotemporal dementia

There are three types of FTD:

  • Behavior variant FTD (bvFTD) is the most common type. People with bvFTD may have personality changes, conduct themselves poorly, or become withdrawn. But their ability to remember people and events often stays intact.
  • Primary progressive aphasia (PPA) affects a person's communication skills. They lose the ability to read and write and ultimately the ability to speak and understand others. Problems with memory, behavior, and reasoning may form.
  • Disturbances of motor function happen when nerve cell damage occurs to the parts of the brain that control movement. This damage may cause problems with walking, balance, and fine motor skills, along with memory and behavior issues. These FTD symptoms are like those of Parkinson's disease. ALS (Lou Gehrig's disease) is this type of FTD.

Frontotemporal dementia causes

Doctors believe that FTD occurs when certain proteins (tau and TDP-43) build up around the frontal and temporal lobes of the brain.

The frontal lobes of the brain help control:

  • Conduct
  • Judgment
  • Social responses
  • Foresight

The temporal lobes are the language center of the brain and help with:

  • Reading
  • Writing
  • Speaking
  • Emotions
  • Memory

These proteins occur naturally and help with cell function in a healthy person. Researchers don't yet know why the proteins build up in someone with FTD.

Frontotemporal dementia risk factors and complications

For most people with FTD, the cause of the disease is unknown.

People with a family history of the disease are more likely to get it. Between 10% to 30% of bvFTD cases are genetic.

There are no known risk factors other than a family history of FTD. Those with this risk of the disease may want to get genetic counseling and testing.

Complications of FTD include:

  • Balance problems.
  • Risk of falling.
  • Trouble swallowing.
  • Problems interacting with others (including trouble with social cues).
  • Infections.
  • Pneumonia.

How does FTD differ from Alzheimer's disease?

Although FTD and Alzheimer's share some of the same symptoms (personality and behavior changes), they're not the same.

Here are some main differences:

  • People with FTD are younger. Most people with FTD are in their 40s to 60s. People with the most common form of Alzheimer's (late-onset) are mostly over 65.
  • Memory loss is an early symptom of Alzheimer's. People with FTD often don't lose their memory until later.
  • Problems with speech and reading are more common in FTD. People with Alzheimer's can usually speak clearly in the earlier stages of the disease.
  • People with Alzheimer's are more prone to delusions. Hallucinations are rare in those with FTD.

Why choose UPMC for Alzheimer's care?

UPMC Senior Services:

  • Provides resources for older adults and their loved ones.
  • Educates people on the physical, mental, and social challenges faced by older adults.
  • Offers outreach programs to empower older adults and their families.

Frontotemporal Dementia Symptoms and Diagnosis

Unlike Alzheimer's disease, memory loss is not one of the first symptoms of FTD. Some people with FTD may suffer memory loss as the disease progresses.

Signs of FTD may include social, language, and physical problems.

Social problems

People with FTD may:

  • Form odd social behaviors (touching strangers, making rude or offensive comments, becoming belligerent).
  • Neglect their hygiene.
  • Lack empathy for others.
  • Change their eating habits (binge eating, eating non-food items).
  • Start hoarding items.
  • Have ritualistic or compulsive behavior.

Language problems

As FTD get worse, language issues become more common, such as:

  • Problems with grammar (leaving words out of sentences).
  • Not understanding common words they knew before.
  • Not being able to speak.
  • Not being able to come up with the names for familiar objects.

Posture and other physical problems

People with FTD often have:

  • Stiffness or weakness in arms and legs.
  • Balance problems.
  • Stiff, slow movement.
  • Lack of facial expression or a fixed stare.
  • Trouble with eye movements.
  • Problems swallowing.
  • Muscle spasms or shaking.

Diagnosing frontotemporal dementia

FTD is challenging to diagnose. Sometimes people have more than one type of dementia, called mixed dementia.

To help diagnose FTD and rule out other diseases, doctors may:

  • Run lab tests.
  • Do DNA testing since family history increases the risk of FTD.
  • Order brain scans such as MRI, FDG-PET, SPECT.
  • Do a complete physical exam.
  • Ask about your medical history.
  • Talk to loved ones about the person's behavior and symptoms.
  • Conduct tests that measure language, memory, and reasoning.

Frontotemporal Dementia Treatment

There's no cure for FDT. But you can manage some symptoms of the disease and improve your quality of life.

Doctors may suggest the following for treating FTD symptoms:

  • Medicine. Antidepressants and antipsychotic drugs can sometimes improve symptoms of FTD.
  • Speech and language therapy. In the early stages of FTD, a speech therapist may be able to help with communication skills.
  • Physical and occupational therapy. Exercise can help with movement and balance.
  • Managing behavior. Limit food choices, stick to a schedule, and keep a calm environment.

How long does someone with FTD live after diagnosis?

Someone with FTD will get worse as time goes on. The average life span for someone with FTD is 7 to 13 years after the start of symptoms.

But, many factors play into a person's life expectancy. Some people with FDT may live 20 years after the onset of the disease.

Infection and pneumonia are common in the late stages of the disease.