This video examines what to expect with Frontotemporal Dementia as well as looks at signs and symptoms of the disease. FTD is a common cause of …
So why am I talking about this disease
frontal temporal dementia? I recently had
a patient
who just passed away with this diagnosis.
She had not reached
60 yet and had been working, in fact as a
healthcare professional,
a few years before the diagnosis.
Her husband was at her bedside until the
very end;
tending and taking care of her as he
watched her Soul and Being, unfortunately
with away
with this progressive debilitating
disease i'm Dr.John
Board Certified in both Internal Medicine
and Geriatric Medicine
with over 20 years of experience in
If you're interested in tips and advice
to promote
healthy aging this is the right place
for you. So what is
frontal temporal dementia? Frontotemporal
is a form of dementia which affects the
front of your brain
and the side of your brain as well. The
frontal lobe,
as the name implies, is located in the
front of the brain
and the temporal lobe is located to the
of your brain near your temples. The
frontal lobe
has many functions and I'll talk about
some of these functions
in the next couple of minutes. The
frontal lobe
helps put thoughts into words.
So damage to a specific area in the
frontal lobe
called the Broca's region affects speech
and the ability to understand language.
It also has some role in forming
long-term memory. It plays a role in
forming your personality;
therefore, damage to this area
affects someone's personality. Some of
your loved ones
might have been previously reserved
maybe introverted
individuals might be acting up or there
might be loss of inhibition
with hypersexual behavior.
Motor skills can also be affected if the
frontal lobe is damaged.
The skills that control voluntary
movements such as walking
or running, moving your hands are
controlled by the frontal lobe.
The frontal lobe is also important for
You might discover that your loved one
is not reacting in a usual manner
or they are in fact indifferent. The
frontal lobe
tells me that I'm sitting here! It helps
me plan
and organize complex tasks. If the
frontal lobe is damaged
these are all affected. The temporal lobe
plays a role in encoding memory as well
processing auditory information.
The temporal lobes also have a role
in language processing as well as
of our emotions. So, at what age can we
frontal temporal dementia? Frontal
temporal dementia is a common cause of
onset dementia and usually occurs around
the age of 60.
It has also been reported as early in
the 20s and as
late as in the 90s. So are there
different types
of frontal temporal dementias? Yes, in fact
there are three different types. I just
think that you should be aware of them.
Treatment and approach does not really
change. The three types
are a behavioral variant of frontal
temporal dementia
and two forms of primary
progressive aphasia, a non-fluent variant
of primary progressive aphasia
and a semantic variant of primary
progressive aphasia. So what causes
frontal temporal dementia? Frontal
temporal dementia is caused by
clumps of abnormal protein called tau,
forming inside brain cells.They damage
the brain cells
and stop them from working as they
should be. The brain cells are then not
able to communicate with each other.
Other risk factors are family history
and genetics.
So what is the difference between
frontal temporal dementia and the most
type of dementia which is Alzheimer's
So, there are many different types of
dementias and
distinguishing them is important not
only to establish a diagnosis
but the prognosis is different depending
on the type of dementia
and it also helps in terms of the choice
of medications
to help with symptom management
of the different dementias.So when I
talk about dementia per se,
this is very general and this is a very
global term and the analogy I draw
is with pain. Pain is also a very general
term but the different types of pain
you have muscle pain, stomach pain,
headaches and all of these types of pain
are different
and they're also treated differently.
there are different types of dementia.
Patients I talk to and even caregivers
ask me so what will happen
to me what will happen to my loved one
as the disease progresses. So the way I
see dementia
is the reverse of aging and I categorize
into mild, moderate
and advanced. So what do you see with
teenagers, for example?
With teenagers you see that they're
fairly independent but you need somebody
in the background
to make sure that you guide them and
steer them in the right
direction and they can have mood swings
and these mood swings at times can be
quite acute.
As dementia progresses from mild
to moderate the analogy is the
regression from a teenager
towards a toddler. So what do you do with
With toddlers you help them put their
clothes on, you help them with feeding,
you help them with toileting, you help
them with
going to the bathroom also they can have
their mood swings and these mood swings
can be more acute
with sharp upturns and down
downturns as well.
And as dementia progresses from moderate
to severe or from moderate to advanced
you see this regression from a toddler
towards an infant. What do we do with
We help them with
everything, with feeding,
with nourishment, with with toileting
with going to the bathroom and
when they are in distress we tend to
and we take care of the needs. The same
thing applies
with advancing dementia because they
our total help, our total devotion
and our total care! So if you're finding
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are the symptoms of frontal temporal
I'll mainly speak about the behavioral
variant frontal
temporal dementia. It can be socially
inappropriate behavior such as touching
strangers or urinating in public
or being rude or making offensive
Taking away objects or items.
Similarly to young toddlers they might
have an oral fixation and place objects
in their mouths. Sometimes, they fill up
their mouths
with food and they do not even chew the
Food cravings might change and they have
a liking for very sweet foods.
Some behaviors can be very repetitive
and even stereotypical such as
constantly cleaning or holding, hiding
constantly checking. Some of your loved
ones might even have
very rigid routines which they do not
want to change
which can be extremely tiresome and
frustrating for you,
the caregiver. Some patients lose empathy
with lack
of motivation and regressing and
becoming extremely
passive. This type of apathy
can be often mistaken for depression.
About 20% also
develop a modern neuron disease
affecting overall
function and movement. One sentence on
the other variant which is the
primary progressive aphasia. This variant
is characterized by early loss of
with episodic preservation of
overall cognition.And if you're
interested in five proven ways to
dementia click on this link above. How do
we diagnose
frontal temporal dementia? The diagnosis
is made clinically and other testing is
done just to help exclude other disease
entities. The diagnosis is based on
physical examination and in particular
a neurological examination. Your doctor
order blood tests to exclude other
organic causes such as b12 deficiency.
He or she might order neuropsychological
early in the course of the disease to
executive function. Neuro-imaging testing
such as brain scans such as an MRI
and glucose positron emission scans
are tests to help exclude structural
abnormalities and pathologies. So what
about prognosis and treatment?
Usually from the time of diagnosis and
when the times
symptoms begin till when someone passes
away takes about eight to ten years.
And the behavior variant has a shorter
especially if they have the motor
variant of the disease and the prognosis
is usually less than two years.
there are no curative drugs.
Non-pharmacological approach
is emphasized and will require probably
multiple and different care members or
team members to help with the
coordination of care including physical
therapy and occupational therapy,
social workers, behavioral therapists
home health coordinators,
nurses, dietitians and
home health aides. You can reach out to
specialized organizations and
associations to help
with this coordination of care and there
must be some organizations
in your area. Medications can be used,
however, they're not curative they help
with symptom
management. They should be only used if
non-pharmacological approaches have not
and have been totally exhausted. And if
you're interested in a drug
used in Alzheimer's disease click on
this link above.
So, Question of the Day? Are you taking
care of with someone
with frontal temporal dementia? Don't
forget to
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