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Frontotemporal DementiaFrontotemporal Dementia: Causes, Symptoms, Types, Stages and Treatments

Commonly asked questions about Alzheimer’s disease, learn about causes, symptoms, types, stages, and Treatments. Call: (866) 280-4722

What is FTD?

Frontotemporal dementia, one of the most common dementias, is a group of disorders that result in progressive damages occurring when nerve cells in the frontal temporal lobes of the brain are lost. This causes the lobes to shrink and while doing so, affect behavior, personality, language, and movement. FTD is also a commonly referred to as frontotemporal generation, fronto-temporal lobar degeneration, or Pick’s disease.

What Causes Frontotemporal Dementia?

The current cause of FTD is unknown. Researches have linked certain subtypes of FTD to mutations on several genes. A few people with FTD have tiny structures, named Pick bodies, in their brain cells that contain an abnormal amount or type of protein.

What are the Symptoms of Frontotemporal Dementia?

Although this one of the most common forms of dementia, patients were often misdiagnosed with depression, schizophrenia, or Alzheimer’s disease.
Early symptoms that identify Frontotemporal Dementia typically involve personality or mood changes such as depression or withdrawal, sometimes obsessive behavior and language difficulties. Many patients display antisocial behavior. Doctors however, have noted that a few individuals developed extraordinary visual or musical creativity while simultaneously impairment in language and social impairment.

In later symptoms patients develop movement disorders such as imbalance, rigidity, slowness, twitches, muscle weakness, or difficulty swallowing and cannot fend for themselves.

Behavioral Symptoms

  • Unwillingness to talk
  • Change in personality and mood
  • Lack of inhibition and social tact
  • Obsessive or repetitive behavior
  • Unusual verbal, physical, or sexual behavior
  • Wait gain due to dramatic overeating
  • Neglect hygiene
  • Aren’t aware of these changes and neglect behavior

Language Symptoms

Occur during the first stages of FTD

  • Difficulty speaking
  • Unable to name objects
  • Problems when reading or writing

Language is minimized as the disease progresses until the patient is virtually mute.

Understanding meaning of words is increasingly difficult

  • Problems recalling words and phrases

What are the Risk Factors for Frontotemporal Dementia?

A vast amount of factors have been associated with the increased risk of dementia, however cardiovascular risks are more prominent. These include:

  • A history of diabetes
  • Hypertension
  • Smoking
  • Obesity
  • Dyslipidemia

Very few reports are found in FTD with comparison to Alzheimer’s disease, Vascular dementia, and Lewy Body Disease.

What are the Types of Frontotemporal Dementia?

Behavioral Variant Frontotemporal Dementia (bvFTD)

BvFTD takes up approximately 60% of people with any form of FTD. By definition, this form of FTD affects social skills, emotions, personal behavior, and self-awareness. Frontal and regional lobes are the most affected regions of the brain when these symptoms occur.

With damage in this area, people show mood and behavior changes such as stubbornness, emotional coldness or distance, apathy and selfishness. Patients don’t show similar signs as Alzheimer victims in terms of forgetfulness and orientation.

Semantic Dementia (SD)

Semantic Dementia or also known as “temporal variant FTD” accounts for 20% of FTD cases. Language difficulty is cause of damage to the left temporal lobe, a critical area that accounts for assigning meaning to words. Generalizations start to occur when naming different objects pertaining to one category. For instance, different dog breeds won’t be recognized, however are all identified as “dog”. Names of people are forgotten easily as well as sentence structure and language. Muscle control for daily activity lessens substantially and patients develop behaviors from bvFTD including disinhibition, apathy, and diminished insight. Six years of life are expected after this type of FTD has been diagnosed.

Progressive non-fluent aphasia (PNFA)

PNFA only accounts to 20% of affected people with FTD, and contrasting to Semantic dementia, meaning of words are kept but patients have difficulty pronouncing them. People with PNFA start developing Parkinsonian symptoms such as the inability to move eyes from side to side, muscle rigidity in the arms and legs, falls, and weakness in the muscles around the throat.

FTD with motor neuron disease

Approximately 15% of patients with FTD develop motor neuron disease along with it, most commonly occurring in patients with bvFTD. MND affects motor nerve cells in the spinal cord, the brain stem and the cerebral cortex. The most common type of MND is amyotrophobic lateral sclerosis, also called Lou Gehrig’s disease and can occur as purely a motor disorder. These symptoms include slurring of speech, difficulty swallowing, choking, limb weakness or muscle wasting. In patients with FTD motor neuron disease there is often a family history of disease, and scientists are closer to identifying gene mutations causing the illness.

What is the Treatment for FTD?

  • Occupational therapy: This helps identify problems related to daily activity such as getting dressed and bathing.
  • Speech therapy: Helps improve any communication problems that may occur.
  • Physiotherapy: Helps with movement problems that patients face on a daily basis.
  • Psychological treatments: This includes cognitive stimulation in order to help improve memory, problem solving skills, and language ability
  • Relaxation therapies: Music or dance therapy, massage, and aromatherapy helps increase blood flow and elevate mood.
  • Scheduled food: A scheduled meal plan with correct portions prevents binge eating and possible weight gain.

What is the Diagnosis for Frontotemporal Dementia?

The diagnosis of FTD relies heavily on the context of the patient’s history and neurological test results. Based on this, brain scan imaging such as MRIs and glucose positron emission (PET) scans are very helpful when assessing a diagnosis for Frontotemporal Dementia.

  • MRI: An imaging technique that uses radio waves and a magnetic field to create cross-sectional images of your head and body. It highlights the brain’s white and gray matter, therefore is useful when detecting brain disorders.
  • PET: An imaging test that helps locate and examine how your tissues and organs are functioning. This method uses a radioactive drug named tracer to show the continuous activity happening within the brain.

What are the Stages of FTD?

 

Stages Behavioral Variant Frontotemporal Dementia (bvFTD) Semantic Dementia (SD) Progressive non-fluent Aphasia (PNFA)
DescriptionPace can vary from person to person, however in general the mild stage becomes more pronounced over a course of 8-10yrs
Mild
  • behavioral changes such as disinhibition, apathy, loss of sympathy or empathy for others, or overeating
  • problems with organization and memory
  • impaired judgement
  • social withdrawal, apathy, less interest in family
  • behave inappropriately with strangers, lose their social manners, and act impulsively

However, individual is still capable of taking care of themselves in a regular manner, and behaviors can be managed with lifestyle or environmental changes

  • difficult time coming up with a word or phrase
  • decline in awareness of human emotion
  • Trouble speaking and producing language
  • slowed speech and trouble expressing thoughts
Moderate2-4yrs after diagnosis

  • Behaviors in mild stage are more pronounced
  • compulsive and repeated behaviors
  • binge eating
  • Cognitive problems worsen such as mental rigidity, forgetfulness,  planning and attention
  • MRI shows shrinking of the brain tissue and expansion to larger areas of the frontal lobes as well as brain structures involving motor coordination, cognition, emotions, and learning
2-3yrs after diagnosis

  • Disease involves both sides of the brain
  • some behavioral problems of bvFTD
  • Trouble understanding people
  • difficulty recognizing names and faces of people- even friends and family
  • Declining in reading and writing
  • Skills regarding numbers, colors, and shapes remain intact
3-4yrs after diagnosis

  • more trouble producing speech
  • short sentences
  • face, emotion recognition, and skills with numbers, colors, and shapes remain intact
Severe5+yrs after diagnosis

  • Profound behavioral symptoms
  • language difficulty
  • memory loss

Generally 4-5yrs until end stage

5+yrs after diagnosis

  • language skills have eroded
  • communication very difficult
  • behavioral problems significantly increase including: disinhibition, apathy, compulsions, impaired face recognition, weight gain

Generally 6yrs until end stage

 

5+yrs after diagnosis

  • virtually mute
  • Behavioral problems like bvFTD
  • rigid and stiff (Parkinson’s motor problems)

Generally 6yrs until end stage

End Stage

Patients have trouble coordinating their muscles, 24 hour care is required, and physical decline becomes more obvious. Great difficulty swallowing, chewing, moving, and controlling bladder and/or bowels.

Death is usually caused by these physical changes as well as infections in the lungs, skin, or urinary tract.=

How do I Prevent Frontotemporal Dementia?

Data from Age UK suggests that 76% of changes in the brain occur based on lifestyle decisions and therefore taking appropriate precautions lowers the risk of developing dementia by more than a third.

  • Regular Exercise (aerobic, resistance, or balance activity)
  • Mediterranean diet
  • No Smoking
  • Moderated alcohol (heavy drinking is related to dementia)
  • Preventing and treating diabetes

What Drugs are Used to Treat Frontotemporal Dementia?

The following drugs and medications are in some way related to, or used in the treatment of Alzheimer’s, according to Memory.UCSF.edu

Antidepressants

  • fluoxetine (Prozac®)
  • sertraline (Zoloft®)
  • paroxetine (Paxil®)
  • fluvoxamine (Luvox®)
  • citalopram (Celexa®)
  • escitalopram (Lexapro®)

Antipsychotics

 

  • olanzepine (Zyprexa®)
  • quetiapine (Seroquel® or Ketipinor®)
  • risperidone (Risperdal®)
  • ziprasidone (Geodon®)
  • aripiprazole (Abilify®)
  • paliperidone (INVEGA®)

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