Frontotemporal dementia
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Frontotemporal dementia (FTD) is one of three clinical syndromes associated with frontotemporal lobar degeneration. FTD selectively affects the frontal lobe of the brain and may extend backward to the temporal lobe. There are two main types: Pick's disease, which has been recognised for many years, and Dementia of the Frontal Lobe Type (DFLT), more recently described. The pathology of these two conditions is different although the clinical manifestations are similar.
The frontal lobe is involved in many aspects of mental function. These include motivation and drive, classifying and categorizing, emotion and personality. Social behaviour is also influenced as is appetite. People affected by frontaltemporal dementia (FTD) often display marked changes in personality over a very short period of time. This is often the first clue for family members that there is a health concern. As the disease progresses, sufferers develop many different symptoms that are different from one person to another. Sexual inappropriate remarks can occur but may be related to what they have recently watched. Sudden obsessions with food often leads to weight gain, and some care givers report an increased focus upon schedules and time. The some people with FTD lose their ability for insight. They often do not realize they are seriously ill due to a lack of pain as in other diseases such as cancer. Their ability to accurately judge their skills is hampered due to lack of attention.
Because the disease usually displays in people who are younger in life, the affects on families are severe. Oftentimes, victims still have children living in the home. Financially, it can be devastating. The disease strikes at the time of life that are often the top wage earning years.
Sometimes in the slow progression form of the disease, the patient may exhibit increased ability in other areas that the person never have fully developed. For instance, an accountant will take up art and a chemist will take up dancing.
Usually in the mid stages of the disease, the victim begins to lose his or her ability to speak. As time progresses and the disease spreads to other parts of the brain, the victim loses the ability to control muscle functions, very end stage. A recent study found that death usually occurs due to an car accident such as walking across the street. Distraction for an FTD patient becomes deadly.
Frontal dysfunction may therefore lead to apathy or conversely disinhibition, disordered high level thinking- perseveration, and personality change. The manifestation will depend on which part of the lobe is more affected — dorsolateral or orbitomedial. Many routine dementia assessments do not test the frontal lobe.
Frontotemporal dementia sometimes occurs with Motor neurone disease.
Further reading
- [Columbia University Update]
- [A collection of articles about Frontotemporal dementia in the journal Neurology]
- Radin, Lisa. "What If It's Not Alzheimer's: A Caregiver's Guide to Dementia." Prometheus Books. 2003.
References
- Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF. "Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria." 'Neurology' (1998) 51(6):1546-54. Available: [link]
- Neary D, Snowden JS, Mann DM. "Classification and description of frontotemporal dementias." Ann N Y Acad Sci (2000) 920:46-51. Available: [link]
- Kramer JH, Jurik J, Sha SJ, Rankin KP, Rosen HJ, Johnson JK, Miller BL. "Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease." Cogn Behav Neurol. (2003) 16(4):211-8. Available: [link]
- Rosen HJ, Gorno-Tempini ML, Goldman WP, Perry RJ, Schuff N, Weiner M, Feiwell R, Kramer JH, Miller BL. "Patterns of brain atrophy in frontotemporal dementia and semantic dementia." Neurology (2002) 58(2):198-208. Available: [link]
- Miller BL, Seeley WW, Mychack P, Rosen HJ, Mena I, Boone K. "Neuroanatomy of the self: Evidence from patients with frontotemporal dementia." Neurology (2001) 57:817-821. Available: [link]
See also
- Frontotemporal lobar degeneration
- Pick's disease
- Semantic dementia
- Progressive nonfluent aphasia
- Alzheimer's disease
- Corticobasal degeneration
External links
- [Fronto-temporal dementia online support group]
- [The Association for Frontotemporal Dementias]
- UCSF Memory and Aging Center - [FTD Resources] and [FTD Info]
- Mayo Clinic - [FTD Info]
- [Pick's Disease Support Group Online]
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