What is Frontotemporal Dementia?

One of the uncommon types of dementia, frontotemporal dementia (FTD), is characterized by damage to neurons in the frontal and temporal lobes of the brain. It is typically diagnosed between ages 45 and 64. FTD is not a single illness. In fact, it is “three distinct illnesses with overlapping clinical presentations,” says Steven Posar, MD, CEO of GuideStar Eldercare.

FTD symptoms and diagnosis

FTD is a progressive illness that may present initially with just one symptom, explains the National Institutes of Health (NIH). As other parts of the brain are affected, symptomatology may grow. “It's important to note that with some frontotemporal disorders, the primary symptoms are problems with speech or movement, rather than dementia symptoms,” the NIH points out.

Neurological and psychiatric assessment are crucial to ensuring an accurate diagnosis and successful plan of care. Symptoms can be missed or misinterpreted, so expertise and experience are valuable assets to a long-term care facility.

Three types of frontotemporal disorders

NIH describes the three illnesses as: behavioral variant frontotemporal dementia, primary progressive aphasia, and movement disorders.

• Behavioral variant frontotemporal dementia “involves changes in personality, behavior, and judgment,” according to the NIH. A patient may have difficulty planning and sequencing things or difficulty in prioritizing tasks. A patient may repeat a word over and over or repeat an activity. Behavior may become impulsive or inappropriate, and a person may lose interest in activities or other people.
• Primary progressive aphasia (PPA) presents as difficulty using and understanding speech. Difficulty speaking or slurred speech can occur; some patients become mute. Some variations in how symptoms evolve include semantic PPA, in which a person cannot understand single words; agrammatic PPA, in which a person has trouble speaking; and logopenic PPA, in which a person retains the ability to understand language but cannot find the right words when speaking.
• Movement disorders associated with FTDs may appear as shaky hands and problems with walking and balance. These disorders “occur when the parts of the brain that control movement are affected,” according to the NIH, and may ultimately affect thinking and language as well. Atrophy of nerve cells in parts of the brain that control movement can lead to corticobasal syndrome. “The most prominent symptom may be apraxia, the inability to use the hands or arms to perform a movement despite normal strength, such as difficulty closing buttons or operating small appliances,” explains the NIH.  Another movement disorder, progressive supranuclear palsy, “causes problems with balance and walking,” says the NIH.

Challenging neurodegenerative disorders

The various FTDs are neurodegenerative disorders, which can result from abnormal tau protein accumulation, accumulation of abnormal TDP-43 proteins, or Alzheimer’s disease. Each of these mechanisms has an impact on symptoms and clinical course, according to Northwestern Medicine.

Integral to patient care when language impairments are present is “maintaining language skills and using new tools and other ways to communicate,” explains the NIH. Because clinical presentations and pathologies of FTDs vary, so do approaches to treatment.

Targeted management approaches, including medications when warranted, can be managed by a neuropsychiatric specialist. For help developing accurate diagnoses and effective care plans, reach out to the neuropsychiatric professionals at GuideStar Eldercare. We’re here to help.