Frontotemporal dementia (FTD) is a neurodegenerative disease that affects the frontal and the temporal lobes of the cerebral cortex. In people under age 60, FTD is the most common cause of dementia and affects as many people as Alzheimer’s disease in the 45–64 age group.
Behavioral variant frontotemporal dementia (bvFTD)
In the past, bvFTD was called Pick's disease, named after Arnold Pick, the German scientist who first described it in 1892. This behavioral variant is the most common form of frontotemporal dementia (FTD) and is characterized by alterations in their social behavior as well as increased likelihood of disinhibition, apathy, overeating, emotional blunting, obsessiveness, repetitive motor behaviors, and impairment in judgment and insight. Along with these behavioral changes, the individual may start exhibiting deficits in executive control (such as problems with planning, organizing, and generating ideas).
Primary progressive aphasia (PPA) is another form of FTD. This form has three subtypes:
Progressive nonfluent aphasia, which affects a person’s ability to speak. The individual can present with a progressive decline in expressive speech and written speech. Their speech is non-fluent but effort. It gradually presents with increased phonological and grammatical errors. Over time, they may begin to use short sentences, omitting smaller words, like articles and adjectives.
Semantic dementia, which affects a person’s ability to use and understand language. For example, they might say “animal” instead of “cat.” As their word comprehension gets worse, they may eventually have a hard time understanding conversations. Over time, the individual may lose the knowledge of what words mean and what objects are. For example, a individual with semantic dementia might not know what a peanut butter and jelly sandwich is, even though they can still make one.
Logopenic progressive aphasia, impacts the persons ability to find words when they are speaking. As a result, they may speak slowly and hesitate frequently as they search for the right word. Unlike in semantic dementia, these individuals do not lose the ability to understand words. They may develop problems with working memory, and as a result, they might have increasing difficulty repeating sentences and phrases, or following lengthy instructions. Individuals with logopenic progressive aphasia later in the course of the disease may have such difficulty finding words that they might stop speaking completely.
Corticobasal syndrome (CBS), also called corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP) are two related diseases that are not classified as FTD but often share symptoms with FTD.
What should I do if I suspect FTD in myself or a loved one?
Family members are often the first to notice subtle changes in a person’s behavior or language skills. Therefore it will be important for a person to see a doctor as early as possible to so they can discuss:
Symptoms they are concerned about. Such as which symptoms, when they began, and how often they occur
Medical history and any previous medical problems
Medical histories of family members
Prescription medications, over-the-counter medicines, and any dietary supplements taken
Currently there is no single test that can diagnose frontotemporal dementia. Typically, doctors will order routine bloodwork and perform physical exams to rule out other conditions that could cause similar symptoms. If they suspect frontotemporal dementia, the doctor may:
Refer you to a neurologist so they can evaluate the person’s neurological health—reflexes, muscle strength, muscle tone, sense of touch and sight, coordination, and balance
Refer you to a neuropsychologist who can assess the person’s neuropsychological status—memory, problem-solving ability, attention, language, and reasoning skills
Order magnetic resonance imaging, computed tomography or PET scans of the brain