By Sophie Farr
Published 10:08 EST, Mon November 30th, 2021
Dementia encompasses a range of diseases which, over time, cause changes to the brain and mostly impact the elderly populations. Unlike other types of dementia, most notably Alzheimer’s disease, frontotemporal dementia predominantly affects speech and behavioural management and has an earlier onset than other varieties. The disease is labelled as frontotemporal as it is characterised by damage to both the frontal lobe and temporal lobe regions of the brain which are at the front and sides. Social interaction and personality traits are key functions of the frontal lobe and these are drastically impacted in patients with frontotemporal dementia.
The main cause of frontotemporal dementia is atrophy- shrinking- of these regions of the brain, resulting in changes to behaviour, language and social interactions, which they are responsible for. Although it is a rare form of dementia, frontotemporal lobe is often highly noticeable to friends and family of the patient and this results in early diagnoses, typically between the ages of 45 and 65 when the majority of dementia cases usually occur in over 65 year olds. Despite some genetic mutations having been linked to frontotemporal lobe dementia, roughly 50% of patients have no existing records of the disease in their families. Upcoming research has supposedly found connections between frontotemporal types of dementia specifically and a type of sclerosis, amyotrophic lateral sclerosis (ALS).
Frontotemporal dementia is most commonly noticed by loved ones first as the patient’s social manners and behaviour gradually seem more erratic or inappropriate for their setting. This can be difficult for healthcare professionals to detect without knowing the patient well, meaning observation from close family and friends is vital to an accurate diagnosis. Symptoms often worsen over a few years, and apathy towards previous interests, lack of empathy and changes to their behaviour can be obvious symptoms. Despite these being more uncommon, frontotemporal dementia can also cause symptoms more common to other types of the disease such as cognitive problems and lack of mobility. Frontotemporal dementia can occasionally be misinterpreted as aggression, discourtesy and even obsessive behaviours and patients may develop new routines or even lose interest in self care and begin to have disregard for the feelings of others.
Language can also be severely impacted by this form of dementia, where patients lose their vocabularies, mistake objects, struggle to form sentences and even copy what someone else says in conversation. Sufferers also often lack the ability to organise themselves or see other perspectives, becoming distracted and agitated very quickly and unable to stick to plans. Combined with these mental changes, those with frontotemporal dementia may also become incontinent and struggle to be mobile without difficulties. Although memory and physical impairments can occur, this usually happens when the disease is more progressed and behavioural differences will be observed first.
It can be challenging to get a diagnosis of frontotemporal dementia as the patient may be unwilling to cooperate or even be aggressive and rude when prompted to seek medical advice. If the sufferer suspects they may have changes to their behaviour or physical health, they should consult a GP and a loved one could perhaps urge them to make an appointment and join them for support while they are there. Doctors are able to assess the symptoms and further investigations at a hospital may be required to check whether any noticeable abnormalities are present in the frontal or temporal lobes. Other comorbidities can also be ruled out and this can offer both the patient and their family peace of mind.
Receiving a diagnosis of frontotemporal dementia can be challenging for both the patient and their family. It is common for some to reject the diagnosis and even be offended by it, however it is important that the right support is provided so that their quality of life is preserved and their families are able to manage their symptoms. The multidisciplinary team is likely to advise that a care plan is established, including whether nursing support is required at home, to support carers of those suffering with frontotemporal dementia. Antidepressants are occasionally used to manage symptoms and occupational therapy, speech and language therapy and dementia friendly groups and activities can help patients to remain as comfortable and independent as possible as the disease progresses. Despite it being a rare occurrence, antipsychotics can be prescribed to lessen violence or aggression that may risk the carers’ safety and creating coping mechanisms for challenging behaviour is advisory. Financial support may also be offered to help create changes to the family home to make it as suitable and accessible as possible for the sufferer.
Sophie Farr, Youth Medical Journal 2021
Mayo Clinic, “Frontotemporal Dementia”, Accessed July 2021 from: https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737
NHS England, “Frontotemporal Dementia”, Accessed July 2021 from: https://www.nhs.uk/conditions/frontotemporal-dementia/