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About Alzheimer's & Dementia

Types of dementia Frontotemporal Dementia (FTD)

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What is Frontotemporal Dementia?

Frontotemporal lobe dementia (FTD) is an umbrella term for a spectrum of relatively uncommon disorders that primarily affect the frontal and temporal lobes of the brain, which are the areas associated with personality, behavior and language. It is caused by the death of brain cells in the frontal and temporal lobes of brain, causing portions of those areas to atrophy or shrink, and is a significant cause of dementia in younger people.
 
It is often assumed that Frontotemporal Dementia is synonymous with Pick’s disease. This is not true. Pick’s disease just one type of FTD.
 
The frontal lobes of the brain are located behind the forehead and are associated with personality and behaviour (on the right side) and language (on the left side). The temporal lobes of the brain are responsible for comprehension or the understanding of words (on the left side) and a person’s memory (more on the right side).
 
It tends to occur at a younger age than Alzheimer's disease - typically between 50 and 70 years of age. FTD is more common when a person reaches their 60’s but has been known to occur as early as the late 40’s. 
 
It is generally considered to be more rapidly progressive than Alzheimer’s disease. The average life span is 6-8 years. It can be as short as 2 years when it is associated with ALS (Amyotrophic lateral sclerosis, also referred to as motor neurone disease or Lou Gehrig's disease) or it might exceed 10 years.

Is it genetic? Can it be passed on to family members?

A combination of genetic, environmental, and lifestyle factors have been suggested by researchers. A variety of changes on multiple genes have been linked to specific subtypes of frontotemporal dementia, but more than half of people who develop frontotemporal dementia have no family history of dementia.
 
A person’s risk of developing frontotemporal dementia is higher if he/she has a family history of dementia. Roughly 10-15% of persons living with the disease have a strong family history of the disease.
Currently, there are no other known risk factors.

What changes can I expect?

Unlike Alzheimer’s disease (which is commonly associated with memory loss), frontotemporal dementia is often associated with behaviour changes or language difficulties. The signs and symptoms of FTD may vary greatly from one individual to the next. Researchers have identified several clusters of symptoms that tend to occur together, and 3 broader subtypes have been identified: Behavioural variant FTD, Primary progressive aphasia and FTD with movement disorder.
 
Behavioural variant FTD = Behavioural changes
The most common signs and symptoms of frontotemporal dementia involve extreme changes in behavior and personality. These include loss of inhibition; loss of empathy; inappropriate speech, behavior and other interpersonal skills; lack of judgment; repetitive compulsive behavior; changes in eating habits (craving sweets or compulsive overeating); and an inability to detect and understand emotions in others.
 
Primary progressive aphasia = Speech and language problems
Some subtypes of frontotemporal dementia are evidenced by loss of speech and language difficulties. For example, this might include an increasing difficulty in using and understanding written and spoken language. People with another subtype, semantic dementia, utter grammatically correct speech that has no meaning, or may have difficulty recalling the words for common objects.
 
FTD with movement disorders
About 10-20% of people with FTD can develop motor symptoms before or after they are diagnosed with dementia, characterized by problems with movement, similar to those associated with Parkinson's disease or amyotrophic lateral sclerosis (ALS), which is also often called Lou Gehrig's disease.
The movement disorders usually associated with FTD include Motor neuron disease, progressive supra nuclear palsy, and corticobasal degeneration
Movement-related signs and symptoms may include tremor, rigidity, poor coordination, difficulty swallowing, and muscle weakness.
 

How is it diagnosed?

FTD is often misdiagnosed as a psychiatric problem or as Alzheimer's disease. No single test alone can identify it with certainty. Doctors attempt to identify certain characteristic features while excluding other possible causes.
 
The process for making a diagnosis includes blood tests, neurological testing, cognitive assessment and brain scans (such as MRI, CT and PET scans). CT & MRI scans help to assess any patterns of damage in the brain. They can also rule out other conditions such as strokes or tumours. Specialized brain scans  such as PET (positron emission tomography) and SPECT (single photon emission computerized tomography) can be conducted to measure brain activity. These scans may detect reduced activity in the frontal and/or temporal lobes at an earlier stage, even before CT or MRI scan might pick up any structural changes.
 
When there is a strong family history of FTD, genetic testing may help in confirming the diagnosis and enabling family members to find out their risk of developing the disease.

What kind of treatment is available?

There is currently no known cure for frontotemporal dementia and no effective way to slow its progression. Treatment relies on managing the symptoms. Antidepressants form the main approach to treatment and antipsychotic pharmaceuticals are occasionally used.
 
Caring for a person with frontotemporal dementia can be challenging and stressful because of the personality and behaviour changes experienced. Caregivers need assistance from family members and friends; support groups and educators; or respite care provided by adult day programs or home health care agencies. For those with language difficulties, a speech and language therapist can help maximize existing skills and help the individual learn alternate ways of communicating. This can also assist the caregiver in developing new ways of connecting.

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