Frontotemporal dementia (FTD) is a group of disorders caused by progressive cell degeneration in the brain's frontal lobes (the areas behind your forehead) or its temporal lobes (the regions behind your ears).
The cell damage caused by FTD leads to tissue shrinkage and reduced function in the brain's frontal and temporal lobes, which control planning and judgment; emotions, speaking and understanding speech; and certain types of movement.
FTD used to be called Pick's disease after Arnold Pick, a physician who in 1892 first described a patient with distinct symptoms affecting language. Some doctors still use the term "Pick's disease." Other terms you may see used to describe FTD include frontotemporal disorders, frontotemporal degeneration and frontal lobe disorders.
FTD was once considered rare, but it's now thought to account for up to 10 to 15 percent of all dementia cases. It's still believed to be less common than Alzheimer's disease, Vascular Dementia and Dementia with Lewy Bodies.
Experts group frontotemporal dementia into three main categories. Initially, these groups tend to cause different core symptoms based on the first parts of the brain's frontal or temporal lobes they affect. But there's increasing overlap in symptoms as these disorders progress.
Symptoms related to the three types of FTD include:
- Behavioral variant frontotemporal dementia (bvFTD) takes its greatest toll on personality and behavior. It may begin with subtle changes that may be mistaken for depression. As bvFTD progresses people often develop disinhibition, a striking loss of restraint in personal relations and social life.
- Primary progressive aphasia (PPA) affects language skills in early stages, but often also affects behavior as it advances. The two chief forms of PPA have somewhat different symptoms:
- In semantic dementia, people speak easily, but their words convey less and less meaning. They tend to use broad general terms, such as "animal" when they mean "cat." Language comprehension also declines.
- In progressive nonfluent aphasia, people lose their ability to generate words easily, and their speech becomes halting, "tongue-tied" and ungrammatical. Ability to read and write also may be impaired.
- FTD movement disorders affect certain involuntary, automatic muscle functions. These disorders also may impair language and behavior. The two primary FTD movement disorders are:
- Corticobasal degeneration (CBD), which causes shakiness, lack of coordination, and muscle rigidity and spasms.
- Progressive supranuclear palsy (PSP), which causes walking and balance problems, frequent falls and muscle stiffness, especially in the neck and upper body. It also affects eye movements.
There is no single test (or any combination of tests) that can conclusively diagnose frontotemporal dementia. FTD is a "clinical" diagnosis representing a doctor's best professional judgment about the reason for a person's symptoms. Magnetic resonance imaging (MRI) often plays a key role in diagnosis because it can detect shrinkage in the brain's frontal and temporal lobes, which is a hallmark of FTD.
In some cases, it may be hard to distinguish FTD from Alzheimer's disease. In the future, tests to detect specific protein abnormalities linked to Alzheimer's and FTD may help clarify the diagnosis in difficult cases.
Key Differences Between FTD and Alzheimer's
- Age at diagnosis may be an important clue. Most people with FTD are diagnosed in their 50s and early 60s. Only about 10 percent are diagnosed after age 70. Alzheimer's, on the other hand, grows more common with increasing age.
- Memory loss tends to be a more prominent symptom in early Alzheimer's than in early FTD, although advanced FTD often causes memory loss in addition to its more characteristic effects on behavior and language.
- Behavior changes are often the first noticeable symptoms in bvFTD, the most common form of FTD. Behavior changes are also common as Alzheimer's progresses, but they tend to occur later in the disease.
- Problems with spatial orientation — for example, getting lost in familiar places — are more common in Alzheimer's than in FTD.
- Problems with speech. Although people with Alzheimer's may have trouble thinking of the right word or remembering names, they tend to have less difficulty making sense when they speak, understanding the speech of others, or reading than those with FTD.
- Hallucinations and delusions are relatively common as Alzheimer's progresses, but relatively uncommon in FTD.
Help is available
The Association for Frontotemporal Degeneration (AFTD) is a nonprofit organization that provides information, education and support to those affected by FTD and their caregivers. Call AFTD at 866.507.7222.
The Alzheimer's Association can help you learn more about Alzheimer's and other dementias, and help you find local support services. Call our 24/7 Helpline at 800.272.3900.
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