Frontotemporal dementia

Symptoms

Symptoms of frontotemporal dementia vary from person to person and usually get worse over time, often over years.

People with frontotemporal dementia often have groups of symptoms that occur together. They also may have more than one group of symptoms.

Early symptoms of frontotemporal dementia

These often involve changes in behavior, personality or language rather than memory. These symptoms may be mistaken for a mental health condition at first.

Early symptoms may include:

• Changes in personality or behavior, such as acting in ways that seem out of character.
• Reduced ability to understand or respond to other people's feelings.
• Trouble planning, organizing or making decisions.
• Repeating words or actions.
• Changes in speech or language, such as trouble finding the right word.
• Lack of interest, also called apathy.

Behavioral changes in frontotemporal dementia

The most common symptoms of frontotemporal dementia involve extreme changes in behavior and personality. These include:

• Behavior that seems socially inappropriate or out of character.
• Reduced ability to understand or respond to other people's feelings, a lack of empathy.
• Lack of judgment.
• Loss of inhibition.
• Lack of interest, also known as apathy. Apathy can be mistaken for depression.
• Compulsive behaviors such as tapping, clapping, or smacking lips over and over.
• Changes in eating habits. People with FTD may overeat or prefer sweets and carbohydrates.
• Eating things that are not food.
• Repeatedly placing objects in the mouth.

Speech and language symptoms

Some subtypes of frontotemporal dementia lead to changes in language ability or loss of speech. Subtypes include primary progressive aphasia (PPA), including the semantic variant and the nonfluent or agrammatic variant.

These conditions can cause:

• Increasing trouble using and understanding written and spoken language. People with FTD may not be able to find the right word to use in speech.
• Trouble naming things. People with FTD may replace a specific word with a more general word, such as using "it" for pen.
• Not understanding the meaning of words.
• Hesitant speech that may use short, simple sentences.
• Making mistakes in sentence building.

Primary progressive apraxia of speech is a brain condition that mainly affects how speech is produced, which is distinct from an aphasia. People with the condition know exactly what they want to say, but the brain has increasing difficulty planning and coordinating the movements of the lips, tongue and jaw needed to speak. As a result, speech may sound slow, effortful, choppy or distorted, even though understanding, reading and thinking may not be affected early on.

Movement symptoms

Rare subtypes of frontotemporal dementia cause movements similar to those seen in Parkinson's disease or amyotrophic lateral sclerosis (ALS).

Movement symptoms may include:

• Tremor.
• Rigidity.
• Muscle spasms or twitches.
• Poor coordination.
• Trouble swallowing.
• Muscle weakness.
• Laughing or crying at times that don't match the situation.
• Falls or trouble walking.

Frontotemporal dementia versus Alzheimer's disease dementia

Frontotemporal dementia and Alzheimer's disease are both types of dementia, but they affect the brain in different ways.

Frontotemporal dementia often begins at a younger age, usually between ages 40 and 65. Alzheimer's disease is more common in older adults.

Memory loss may not be an early symptom. In Alzheimer's disease, memory loss is often one of the first symptoms.

Frontotemporal dementia is sometimes mistaken for a mental health condition or Alzheimer's disease, especially in early stages.

Sometimes the clinical features of frontotemporal dementia and Alzheimer's disease overlap and can lead to a hard time diagnosing the condition.

Risk factors

Your risk of developing frontotemporal dementia is higher if you have a family history of dementia. Some inherited gene changes are linked to frontotemporal dementia. In many people, the exact cause isn't known.

Treatment

There's no cure for frontotemporal dementia. Treatment focuses on managing symptoms. Medicines used to treat or slow Alzheimer's disease don't seem to help people with frontotemporal dementia. Some Alzheimer's medicines can even make FTD symptoms worse. But other medicines and speech therapy can help manage symptoms.

Medications

These medicines may help manage behavioral symptoms of frontotemporal dementia.

• Antidepressants. Some types of antidepressants, such as trazodone, may reduce behavioral symptoms. Selective serotonin reuptake inhibitors (SSRIs) also are effective for some people. They include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Brisdelle) or sertraline (Zoloft).
• Antipsychotics. Antipsychotic medicines, such as olanzapine (Zyprexa) or quetiapine (Seroquel), are sometimes used to treat behavioral symptoms of FTD. But these medicines must be used with caution in people with dementia. They can have serious side effects, including an increased risk of death.

Therapy

People with frontotemporal dementia who have trouble with language may benefit from speech therapy. Speech therapy can help people use communication tools and find other ways to communicate.

Coping and support

If you've been diagnosed with frontotemporal dementia, receiving support, care and compassion from people you trust can be invaluable.

Through your healthcare professional or the internet, find a support group for people with frontotemporal dementia. A support group can provide information tailored for your needs. It also allows you to share your experiences and feelings.

For caregivers and care partners of people with frontotemporal dementia

Caring for someone with frontotemporal dementia can be challenging because FTD can cause extreme personality changes and behavioral symptoms. It may be helpful to educate others about behavioral symptoms and what they can expect when spending time with the person with FTD.

Caregivers and the spouses, partners or other relatives who care for people with dementia, known as care partners, need assistance. They might find help from family members, friends and support groups. Or they may use respite care provided by adult care centers or home healthcare agencies.

It's important for caregivers and care partners to take care of their health, exercise, eat a healthy diet and manage their stress. Participating in hobbies outside the home may help ease some stress.

When a person with frontotemporal dementia requires 24-hour care, most families turn to nursing homes. Plans made ahead of time will make this transition easier and may allow the person to be involved in the decision-making process.