Frontotemporal dementia (FTD), often called frontotemporal degeneration (FTLD), is not a single disease but a group of disorders caused by the progressive loss of nerve cells in the brain's frontal and temporal lobes. The specific symptoms that emerge first depend on which brain region is most affected. This article details the primary ways FTD impacts an individual's life, from changes in personality and behavior to language difficulties and motor skill issues.
Behavioral Variant Frontotemporal Dementia (bvFTD)
As the most common form of FTD, behavioral variant FTD (bvFTD) is characterized by notable changes in personality and behavior. Damage to the frontal lobes, which are responsible for judgment, foresight, and empathy, leads to a decline in socially appropriate behavior and self-control. These changes are often the first to be noticed by a person's family and friends, as the individual may not be aware of their altered actions.
Impact on social skills and emotions
- Loss of empathy: A person with bvFTD may become cold, emotionally distant, and indifferent to the feelings of others. They may not recognize or care that a loved one is upset.
- Socially inappropriate behavior: The individual may lose inhibitions, leading to tactless, rude, or offensive comments. Impulsive actions, such as shoplifting or making inappropriate sexual remarks, can also occur.
- Apathy: A significant loss of motivation and initiative is common. The person may seem withdrawn and lose interest in previously enjoyed hobbies and social activities. This can be mistaken for depression, though the individual does not experience feelings of sadness.
Impact on routines and eating habits
- Compulsive or repetitive behaviors: A person may develop repetitive actions, such as hand-rubbing, humming, or hoarding. They might become rigidly attached to certain routines, resistant to any changes.
- Changes in eating habits: It is common for people with bvFTD to develop new eating habits, such as an insatiable craving for sweet foods or carbohydrates. They may also binge eat or lose table manners.
Primary Progressive Aphasia (PPA)
Primary progressive aphasia (PPA) is a variant of FTD that primarily affects language skills due to damage in the temporal lobes. It is often diagnosed when speech and language problems are the most prominent symptoms at the onset of the disease.
Three subtypes of PPA
- Semantic Variant PPA: Individuals with this subtype lose the meaning of words over time. They might use general words like "thingy" instead of a specific term and may lose the ability to recognize familiar objects or people.
- Nonfluent-Agrammatic Variant PPA: Speech becomes slow, hesitant, and effortful. Grammar is significantly impaired, with individuals often omitting small linking words. They may eventually stop speaking altogether.
- Logopenic Variant PPA: This subtype is characterized by difficulty finding the right words during conversation. Pauses and repetition are common, though grammar and understanding of single words remain relatively intact.
Movement Disorders Associated with FTD
In some cases, FTD can involve damage to motor-control areas of the brain, leading to movement disorders. These can appear with or without the behavioral or language symptoms typical of FTD and can include conditions similar to Parkinson's disease.
Common motor symptoms
- Muscle stiffness and weakness: Individuals may experience slowed, stiff movements, muscle spasms, or weakness.
- Balance and coordination issues: Poor coordination and balance can lead to frequent falls.
- Difficulty swallowing (Dysphagia): Problems with swallowing can become severe in later stages, increasing the risk of aspiration pneumonia.
- Eye movement problems: Progressive supranuclear palsy (PSP), a movement-related FTD, can cause difficulty with eye movements, particularly looking up and down.
The Progression of Frontotemporal Dementia
FTD is a progressive disease, meaning its symptoms worsen over time, and its course can vary significantly among individuals. The overlap of symptoms across the different variants tends to increase as the disease advances. A person initially diagnosed with a language variant may later develop significant behavioral changes. As the condition progresses to later stages, the individual's ability to care for themselves will diminish, eventually requiring 24-hour care. The average life expectancy is 7 to 13 years after the onset of symptoms, though this is highly variable.
| Aspect of Life | Impact of Early-Stage FTD | Impact of Late-Stage FTD |
|---|---|---|
| Behavior | Increased apathy, disinhibition, lack of empathy, and poor judgment become noticeable. | Extreme apathy and withdrawal. Inappropriate behaviors become more pronounced. May experience delusions or repetitive actions. |
| Language | Speech becomes slow, hesitant, or ungrammatical. Word-finding difficulties. Loss of vocabulary and meaning for common words. | Communication becomes severely limited or nonexistent. Difficulty swallowing and controlling mouth muscles further impairs speech. |
| Motor Skills | Often unaffected in early stages, but some variants may show early signs like slowed movements or stiffness. | Significant mobility problems, muscle stiffness, and loss of coordination are common. Eventually leads to full dependence on caregivers. |
| Memory | Typically spared early on, differentiating FTD from Alzheimer's. | Memory loss and disorientation can develop as the disease affects more areas of the brain. |
| Daily Functioning | Impaired executive function affects planning, organization, and problem-solving, impacting work and managing finances. | Inability to perform daily activities such as bathing, dressing, and eating without assistance. Requires constant supervision. |
Conclusion
Frontotemporal dementia profoundly affects a person by causing the progressive deterioration of the frontal and temporal lobes of the brain, resulting in devastating changes to their personality, language, and behavior. For family members, understanding that these are symptoms of a neurodegenerative disease, not intentional actions, is key to coping. While there is currently no cure, symptomatic treatments, therapy, and caregiver support are available to help manage the condition and improve the quality of life for those affected. As the illness progresses, the need for care and assistance increases significantly, making early diagnosis and planning vital for families dealing with this challenging disease. For more information and support resources, consider consulting the Association for Frontotemporal Degeneration.
