Frontotemporal Dementia

You have probably read about Bruce Willis’ struggles with dementia and specifically Frontotemporal Dementia or FTD.  But what is Frontotemporal Dementia and what makes it different from other forms of dementia?

VHH - Frontotemporal Dementia 1

Frontotemporal dementia (FTD) is one of the less common types of dementia. It is sometimes called Pick’s disease or frontal lobe dementia. The first noticeable FTD symptoms are changes to personality and behaviour and/or difficulties with language.

The word ‘frontotemporal’ refers to the two sets of lobes (frontal and temporal) in the brain that are damaged in this type of dementia. FTD occurs when disease damages nerve cells in these lobes.

This damage then causes the connections between these and other parts of the brain to break down.  Also, the level of chemical messengers in the brain reduces over time.  These messengers allow nerve cells to send signals to each other and other parts of the body.

As more and more nerve cells are damaged and die, the brain tissue in the frontal and temporal lobes starts to get smaller.

The two broad types of Frontotemporal Dementia

BEHAVIOURAL VARIANT FTD:  this is where damage to the frontal lobe of the brain causes changes to behaviour and personality.  These lobes are found behind the forehead and process information that affects how we behave and the control of our emotions. They also help us to plan, solve problems and focus for long enough to finish a task.

PRIMARY PROGRESSIVE APHASIA (PPA):  this occurs when damage to the temporal lobes which are located on the side of the head next to the ears causes language problems.  The key function of the left temporal lobe is to store the meaning of words and the names of objects.  While the right temporal lobe helps us to recognise faces and objects.

The first recognisable signs that someone may be suffering from FTD are a change in behaviour/personality or beginning to struggle with language.  

What are the symptoms of Frontotemporal Dementia?

FTD affects everyone differently and as with all types of dementia is progressive so over time the symptoms will get much worse.  

Symptoms of behavioural variant FTD
  • Loss of motivation – this will affect things that used to be enjoyed such as hobbies
  • Struggling to concentrate – becoming easily distracted
  • Loss of inhibitions – behaving in socially unacceptable ways, making rude or unkind comments about other people or even being verbally or physically aggressive.
  • Lose the ability to understand others’ thoughts or feelings – becoming increasingly unaware of the needs of others.  Becoming cold and unfeeling.
  • Demonstrating repetitive or obsessive behaviour – for example, repeating phrases or gestures, hoarding or being obsessed with timekeeping.
  • Crave unhealthy foods and forget their table manners – They may also no longer know when to stop eating, drinking alcohol or smoking.
Symptoms of Primary Progressive Aphasia (PPA)

There are two main forms of PPA; they are Semantic Variant PPA and Non-fluent Variant PPA.  They exhibit different symptoms.  

Semantic Variant PPA
  • Loss of vocabulary over time – at first mostly words they are less familiar with, such as technical words (for example ‘accelerator’) or less common words (for example ‘crinoline’). They may try to use more general words instead – for example, calling a ‘spanner’ a ‘tool’ or a ‘thingy’. As the condition develops, they will start to forget even basic words, such as ‘wet’ or ‘sugar’.
  • Forget the use of familiar objects – a person may forget the use of something as everyday as a cup and why it is kept in the kitchen. 
Non-fluent Variant PPA
  • Start speaking differently – this may include speaking slower, using incorrect grammar or putting words in the wrong order. 
  • Use shorter and simpler sentences that miss out short words – this is called telegraphic speech and can result in sentences such as; tired, going bed.
  • Saying the opposite of what they mean – for example, saying yes when they actually mean no.

How quickly FTD progresses, and the life expectancy of someone with the condition varies from person to person. Many factors can affect the speed and pattern of progression. This includes a person’s age when they were diagnosed and whether they have other health conditions.

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