FRONTOTEMPORAL DEMENTIA: SIGNS AND SYMPTOMS

Frontotemporal dementia can be challenging for doctors to diagnose. The signs and symptoms can be very different from one person to another. In the past, people were often misdiagnosed with depression, schizophrenia, or Alzheimer’s disease. FTD affects the frontal and temporal lobes of the brain. It’s sometimes called frontal lobe dementia and used to be known as Pick’s disease.The affected areas of the brain control personality, emotions, behavior, executive functioning, and speech. At first, frontotemporal disorders leave other brain regions untouched, including those that control short-term memory. FTD is divided into 3 categories based on the most prominent symptoms in each:

• Behavioral variant frontotemporal dementia (bvFTD) – affects personality and behavior
• Primary progressive aphasia (PPA) – first affects speech, then behavior
• Progressive nonfluent aphasia – causes loss of ability to recall and speak words

Signs and symptoms of frontotemporal dementia

The most common signs and symptoms of frontotemporal dementia are extreme changes in behavior and personality. In the early stages of FTD, people typically have one type of symptom. As the disease progresses, more types of symptoms will appear as more parts of the brain are affected. It’s important to know that these behaviors are caused by physical damage inside the brain and aren’t things the person can control or contain. Often, they aren’t even aware that their behavior has changed or that it’s become a problem. Common behavioral and personality symptoms (especially in bvFTD)

• Changes in personality and mood – like becoming depressed, self-centered, or withdrawn
• Avoiding socializing or being unwilling to talk
• Repetitive or obsessive behavior
• Lack of inhibition or lack of social tact
• A decline in personal hygiene
• Lack of judgment
• Apathy – like no longer paying attention to hobbies and interests
• Lack of awareness of thinking or behavioral changes
• Loss of empathy and other interpersonal skills
• Increasingly inappropriate actions like unusual verbal, physical or sexual behavior
• Changes in eating habits, especially overeating
• Weight gain due to overeating
• Putting things in the mouth or trying to eat inedible objects

However, people with FTD can usually keep track of day-to-day events and understand what’s going on around them. And people with bvFTD usually keep their language skills and memory until late in the disease.

Common speech and language symptoms (especially in PPA)

• Difficulty finding the right word or in calling objects by the correct name
• Trouble with reading and writing
• Losing the ability to understand or put together words in a spoken sentence
• Speaking in a very hesitant or ungrammatical way

Some people with FTD could have severe problems recalling and understanding words, but still be able to speak fairly normally. But as the disease progresses, less and less language is used until the person becomes practically mute.

Common movement symptoms, In later stages, people develop movement problems. Some people may develop amyotrophic lateral sclerosis (ALS or Lou Gherig’s disease).

• Tremors
• Rigid muscles
• Muscle spasms or weakness
• Poor coordination
• Difficulty swallowing

Diagnosing frontotemporal dementia

There isn’t a single test that specifically diagnoses FTD. Doctors must try to identify certain characteristics while ruling out other possible causes, like liver or kidney disease. It can be especially difficult to diagnose in the early stages because the symptoms often overlap with those of other conditions. Standard testing may include blood tests, MRI, CT scan, PET scan, and neuropsychological testing. Tests used to diagnose frontotemporal dementia include:

• Blood tests to help identify other conditions that could cause similar symptoms
• Neuropsychological testing to check judgment and memory skills as well as to help determine the type of dementia, especially at an early stage
• Brain imaging to check for tumors, bleeding, or blood clots
• Magnetic resonance imaging (MRI) tests to give doctors a detailed image of the brain
• Computerized tomography (CT) scans to create images of brain in layers

The difference between Alzheimer’s and frontotemporal dementia

Age at diagnosis Most people with frontotemporal dementia are diagnosed between ages 45 and 65. The majority of Alzheimer’s cases happen in people over age 65.

Memory loss
With FTD, problems with memory may show up in advanced stages. In Alzheimer’s, memory problems show up early in the disease and tends to be a more prominent symptom.

Behavior changes
Changes in behavior are an early sign of FTD and often are the first noticeable symptoms. Behavior changes are also common as Alzheimer’s progresses, but they usually occur later in the disease. Problems with spatial orientation (like getting lost in familiar places) are more common with Alzheimer’s than with FTD. Hallucinations and delusions are also more common as Alzheimer’s progresses, but not very common in FTD.

Speech
People who have FTD often have more problems speaking, understanding speech, and reading than people with Alzheimer’s. People with Alzheimer’s might have trouble thinking of the right word or remembering names, but they usually have less trouble making sense when they speak, understanding when others speak, or reading.

Frontotemporal dementia risk factors

Today, the only known risk factor for developing FTD is if you have a family history of dementia. However, not everyone with a family history will develop FTD. It’s estimated that more than half of people diagnosed with FTD don’t have a family history of dementia.

Frontotemporal dementia treatment and life expectancy

Unfortunately, like other dementias, FTD is a progressive disease with no cure. That means the symptoms will worsen over time. The speed of decline will be different for each person.

Treatment options
Current treatments focus on easing symptoms, but can’t slow the progression. There are medications that can be used to improve quality of life by reducing behavioral symptoms.

Medications that may be used to reduce behavioral problems include:

• Antidepressants like trazodone
• Selective serotonin reuptake inhibitors (SSRIs) like Zoloft (sertraline) or Luvox (fluvoxamine)
• Antipsychotics like Zyprexa (olanzapine) or Seroquel (quetiapine)

Important: These medications must be used with caution because the side effects include an increased risk of death in people with dementia. Speech therapy could also help with language issues by teaching alternate communication strategies.

Life expectancy
Frontotemporal dementia shortens a person’s life span. Each person is different, but most people with FTD live 6 to 8 years after the first symptoms appear. FTD will eventually cause a person to have difficulty with essential bodily functions like chewing, swallowing, moving around, and controlling the bladder and bowels. These changes can cause serious infections in the lungs, urinary tract, and skin – leading to death.