People often think of Alzheimer's
Disease when the issue of dementia arises.
However, there are other causes of
dementia. Frontotemporal Dementia is one
of them. Estimates of it's occurrence vary
from 2-15% of all diagnosed dementias. Elder
Voice focuses on it this month, because
it is less well known. It is important to
be aware of frontotemporal dementia as a
possible reason for changes in an older
person's behaviour and personality because
the initial presenting symptoms can be so
different from those of Alzheimer's disease in
which memory loss is often the first and
prevailing symptom.
As the name implies, Frontotemporal dementia
affects the temporal and/or frontal
lobes of the brain. The frontal lobe is
the the part of the brain responsible for what
is called executive function and decision
making. The temporal lobe governs language
and behaviour. As dementia occurs,
these portions of the brain atrophy,
and the cells die. In some cases, the brain
cells get larger, containing what
are known as Pick's bodies (thus, Pick's
Disease is a form of frontotemporal dementia).
Frontotemporal dementia often starts
at an earlier age than Alzheimer's
Disease. Family
members or close friends may notice
that someone is acting strangely, their
mood or personality may be different, or
they may be more emotional or have frequent
mood changes. They may be disinhibited,
telling off colour jokes or stories. They may
exhibit "negative" symptoms such as withdrawal,
apathy, or a decrease in attention
to personal hygiene.
The changes in
executive function that may be noticed
are changes in the individuals ability
to plan and carry out tasks. Their
reasoning ability may change or decrease
and their judgment and insight may
become impaired. Thus they may act
in a certain way but have no understanding
that their behaviour is inappropriate or
offensive. They may not be able to interpret
signals or social cues in their environment. One
result of impaired executive function
is that people are at an increased
risk to be taken advantage of by
fraud or to make inappropriate decisions
regarding finances, care, or driving.
Frontotemporal
dementia can often cause problems
in use of language. Word
finding can be very difficult and
comprehension can be impaired. For example,
they may continually
talk about "that thing" because they cannot
find the word for what they mean.
Changes
in behaviour, personality and language such
as those that occur because
of frontotemporal dementia can also
be caused by stroke, when the damage happens from
the stroke occurs in the frontal
or temporal lobes. Vascular dementia is
not considered the same as frontotemporal
dementia, but in these cases the effects and
presenting symptoms can be the same.
Without understanding that changes
in someone's behaviour
and personality may be indicative
of frontotemporal dementia It is easy to
misinterpret the
meaning of those changes, especially
in the early stages. The person may be
thought to have a psychological problem
or be labelled "eccentric." Family
members and friends may inadvertently judge
the person or be angry, embarrassed
or frustrated with
them. Spouses especially may see
changes and feel emotionally abandoned. A
correct diagnosis helps to put the
changes in perspective so that people understand
that there is a disease process occurring,
which is not under the control of
the person who seems so different.
If you
notice changes in a family
member, make an appointment with
a family doctor. A primary investigation
can rule out other factors which may be
causing the behaviour. If necessary, the
physician can refer the person to a
neurologist or dementia clinic for further
investigation. These investigations should
include brain scans of the frontal
and temporal lobes.
For more information:
Mayo
Clinic
Family
Caregiver Alliance
Association
for Frontotemporal Dementias
