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How Frontotemporal Dementia Affects Brain Function and Daily Life

Updated: Dec 23, 2023

What is Frontotemporal Dementia (FTD)?

Frontotemporal dementia (FTD) is a type of dementia that causes progressive damage to the frontal and/or temporal lobes of the brain. The frontal lobes are responsible for executive functions, such as planning, problem-solving, decision-making, and behaviour regulation. Therefore, FTD typically presents with significant changes in mood, behaviour and self-control, activity levels, thinking and cognition, social and interpersonal skills. speech and communication, personality and will over time lead to increasing dependence.


Dementia
Facing dementia can be like being lost in a maze.

What are the Early Symptoms of FTD?

Early symptoms of FTD can be subtle and may include changes in personality and behaviour, emotional indifference, loss of empathy, decreased interpersonal skills, and decreased judgment and decision-making skills. These symptoms can cause significant challenges for individuals with FTD and their caregivers and may require specialised care and management.


Below we will explore the range of areas commonly affected by FTD.


Changes in Emotions and Mood

Apathy and Emotional Indifference

FTD can cause emotional indifference, which is a lack of emotional response or apathy towards situations or people that would typically elicit an emotional response. Examples of emotional indifference in FTD may include:

  • A lack of interest in hobbies or activities that were previously enjoyed,

  • Ignoring social cues in conversations that suggest a particular emotion should be expressed.

Emotional indifference can manifest as a lack of emotional connection or engagement with loved ones, even in situations that would typically warrant a strong emotional response.


Loss of Empathy

People with FTD may lose their ability to empathise with others. They may have difficulty understanding others' emotions or responding appropriately to others' needs. They may also seem indifferent or cold towards others, which can lead to strained relationships.


Lability or Frequent Mood Changes

Mood lability refers to rapid changes in mood in response to the environment. Patients with FTD may experience rapid mood swings, including inappropriate laughing or crying. They may also become easily frustrated, angry, or agitated. These mood changes can be sudden and intense, and may not always be triggered by an obvious event or situation.


Emotional Withdrawal

Emotional withdrawal is a common symptom of FTD. Patients may become emotionally detached, uninterested in social interactions, and show less affection towards their loved ones. They may also withdraw from activities they once enjoyed and become less motivated to participate in social events.


Changes in Behaviour

Limited Self-Control and Behavioural Dysregulation: Disinhibition and Impulsivity

Impulsivity is a common symptom of FTD. Impulsivity in FTD can manifest in various ways, such as impulsive or inappropriate comments or actions, disregard for social norms, decreased inhibition and increase impulsiveness.


Some examples of impulsive behaviours that can result from FTD include:

  • Poor financial decisions or impulsive spending including being easily scammed,

  • Increased risk-taking behaviour, such as reckless driving or engaging in unsafe sexual activity,

  • Engaging in inappropriate sexual behaviour, such as making inappropriate advances or engaging in public nudity, and

  • Compulsive or inappropriate eating, such as overeating or eating non-food items.

Stimulus-Driven Behaviour

Stimulus-driven behaviour refers to behaviours that are triggered by external stimuli, such as sounds, sights or smells, rather than by internal processes, such as thoughts or emotions. In other words, stimulus-driven behaviour occurs when a person responds automatically to a particular stimulus without conscious awareness or control. This type of behaviour is often associated with FTD.


For example, a person with FTD may exhibit stimulus-driven behaviour by repeatedly picking up and playing with an object in their environment, such as a pen or paperclip, without any apparent reason or purpose. They may also become fixated on certain activities or behaviours, such as pacing or tapping their foot, in response to external stimuli. This type of behaviour can be disruptive and may interfere with a person's daily activities or relationships with others.


Problems with Initiation

Problems with initiation refers to difficulties in starting or initiating tasks, activities, or behaviours. This can be a common symptom in a number of neurological and psychiatric conditions, including FTD.


In individuals with FTD, problems with initiation may manifest as a lack of interest or motivation in previously enjoyed activities, difficulty beginning new projects, or an inability to follow through on plans or goals. For example, a person with FTD may have trouble starting a conversation, preparing a meal, or engaging in social activities they previously enjoyed.


Perseveration (Repetitive Behaviours or Thoughts)

Perseveration refers to the repetition of thoughts, words, or actions beyond what is necessary or appropriate for a given situation. It is a common symptom of a number of neurological and psychiatric conditions, including frontotemporal dementia.


In individuals with FTD, perseveration may manifest as repeating words or phrases, engaging in repetitive behaviours, or fixating on a particular topic or idea. For example, a person with FTD may repeatedly ask the same question, tell the same story, or perform the same action, even if it is no longer relevant or necessary.


Changes in Activity Levels

Agitation

Agitation is a common symptom of FTD. Patients may become restless, irritable, or agitated for no apparent reason. They may pace, fidget, or become easily frustrated.


Loss of Energy and Motivation

FTD can cause patients to lose their energy and motivation. They may become lethargic, disinterested, and unengaged in activities they once enjoyed.


Changes in Thinking or Cognition

Here is a breakdown of how FTD affects a person's thinking and cognitive processes.


Attention and Distractibility

FTD can affect a patient's ability to focus and concentrate. They may become easily distracted or have difficulty following conversations.


Inflexibility or Cognitive Rigidity

Rigidity in thinking, also known as cognitive rigidity or thought rigidity, refers to cognitive inflexibility or an inability to adapt to changing circumstances or perspectives. It is a common symptom of several neurological and psychiatric conditions, including FTD.


In individuals with FTD, rigidity in thinking may manifest as a narrow or fixed set of interests or behaviours, a tendency to stick to familiar routines and habits, or difficulty switching between tasks or activities.


A person with FTD may have difficulty adapting to changes in their environment or in social situations, leading to social awkwardness or inappropriate behaviour.


Problem-Solving

People with FTD often have difficulties with problem-solving, planning, and decision-making, as they may be unable to consider alternative solutions or approaches. As the disease progresses, individuals with FTD may have increasing difficulty with these cognitive processes.


For example, a person with FTD may struggle to adapt to changing circumstances, have difficulty generating or implementing alternative solutions to a problem, or have difficulty prioritising and organising tasks. They may also have difficulty making decisions or may make impulsive or inappropriate choices.


Planning and Organising

FTD can impact a patient's ability to plan and organise. They may struggle to complete everyday tasks, such as managing their finances or maintaining their hygiene.


Decision-Making

FTD can make it difficult for patients to make decisions. They may struggle to weigh the pros and cons of different options or have difficulty making choices about their care.


Impaired Judgement

Impaired judgment refers to a condition in which an individual has difficulty making sound decisions, particularly in situations that require complex reasoning or long-term planning. It is a common symptom of a number of neurological and psychiatric conditions, including FTD.


In individuals with FTD, impaired judgment may manifest as poor decision-making, risk-taking behaviour, and lack of insight into their own behaviour. For example, a person with FTD may make impulsive purchases, engage in inappropriate sexual behaviour, or fail to recognise the consequences of their actions.


Lack of Insight and Decreased Self-Awareness

Lack of insight refers to a condition in which an individual has difficulty recognising or acknowledging their own limitations or deficits. It is a common symptom of a number of neurological and psychiatric conditions, including FTD.


In individuals with FTD, lack of insight may manifest as a failure to recognise changes in their own behaviour or abilities, denial of their diagnosis or need for treatment, or resistance to assistance from caregivers or healthcare providers.


A person with FTD may not recognise their own memory loss or difficulties with decision-making, or they may resist help with daily tasks even though they are unable to perform them independently.


Memory loss

Memory impairment is not typically an early symptom of FTD. However, as the disease progresses, some patients may experience memory loss. Unlike Alzheimer's disease, memory loss is not typically the primary symptom of FTD.


Changes in Social or Interpersonal Skills

People with FTD may have difficulty with social skills such as turn-taking, maintaining eye contact, and initiating and maintaining conversations. They may also become less interested in social activities and prefer to spend time alone.


Changes in Speech or Communication

People with FTD may have difficulty with language, including word-finding difficulties, reduced vocabulary, and difficulty with grammar and syntax. They may also have difficulty with nonverbal communication, such as facial expressions and body language.


FDT can result in hesitation when speaking, or less frequent speech. It can also impact the ability to use or understand language. This may include difficulty naming objects, expressing words, or understanding the meanings of words.


Changes in Personality

Overall FTD is a progressive brain disorder that affects the frontal and temporal lobes of the brain, leading to a range of symptoms that can result in personality changes. These symptoms include:


  • Behavioural changes include inappropriate social behaviour, loss of empathy and interpersonal skills, and lack of judgment.

  • Cognitive changes, such as problems with attention, problem-solving, planning, decision-making, and inflexibility.

  • Emotional changes, such as emotional withdrawal, mood changes, and apathy.

  • Physical changes, such as changes in movement, include Parkinsonism.

These symptoms can lead to significant changes in an individual's personality, including changes in social behaviour, emotional expression, decision-making, and overall demeanour. For example, individuals with FTD may exhibit impulsive or socially inappropriate behaviour, which can be very different from their pre-dementia personality. Additionally, the loss of empathy and interpersonal skills can make it difficult for individuals with FTD to maintain relationships with family and friends. The cognitive changes associated with FTD can lead to difficulty with problem-solving and decision-making and inflexibility in thinking and behaviour. These changes can further contribute to personality changes, such as becoming more rigid and less adaptable.


Overall, FTD can significantly impact an individual's personality and behaviour, which can be challenging for family members and caregivers to manage. However, a coordinated care team, including healthcare professionals and caregivers, can help to provide support and assistance to manage these changes and improve the quality of life for the individual with FTD.


Increasing Dependence

As the disease progresses, the symptoms become more severe and interfere with the person's ability to function in daily life. The person may struggle with language, including speaking, understanding, reading, and writing. They may also experience changes in movement, such as stiffness, tremors, or difficulty with coordination.


In summary, FTD is a type of dementia that affects the frontal and/or temporal lobes of the brain, resulting in significant changes in behaviour and personality. Early symptoms can include changes in personality and behaviour, loss of empathy and other interpersonal skills, and lack of judgment, which can progress to include impulsivity, disinhibition, stimulus-driven behaviour, memory loss, lability, perseveration, and problems with initiation. As the disease progresses, the symptoms become more severe and can affect language and movement.


The Course of Dementia can Differ Between Individuals

It's important to note that these behaviours can vary widely between individuals and depend on the type of FTD. It's also possible for individuals with FTD to exhibit behaviours that are opposite to their previous behaviour, such as becoming excessively cautious or risk-averse. Therefore, it's essential to consult a healthcare provider if any concerning behaviour changes are observed.


Are There any Effective Treatments for FTD

At present, there are no effective treatments that can cure or halt the progression of FTD. However, some treatment approaches can help manage some symptoms and improve the quality of life for individuals with FTD.


One approach is to focus on managing the behavioural and psychological symptoms of FTD, which may include medications to manage agitation, depression, or anxiety. Other strategies may include environmental modifications to reduce sensory overload or triggers for problematic behaviours or engaging in activities that promote relaxation and social connection.


Another approach is to provide supportive care that addresses the physical and emotional needs of individuals with FTD and their caregivers. This may include assistance with activities of daily living, such as bathing, dressing, and eating, as well as respite care to relieve caregivers.


Research is ongoing to identify potential disease-modifying therapies for FTD, but these are still in the early stages of development and have not yet been proven effective in clinical trials.


Overall, the goal of treatment for FTD is to improve the quality of life for individuals with the disease and their caregivers and to provide supportive care and symptom management that can help individuals with FTD to maintain their independence and dignity for as long as possible.


Caring for Carers and Family

Living with someone who has FTD can be a challenging and emotionally demanding experience for caregivers and family members. FTD is a progressive disease that causes significant changes in behaviour, personality, and language abilities. As the disease progresses, individuals with FTD may become increasingly dependent on their caregivers for assistance with daily activities, such as dressing, bathing, and eating.


Feelings of grief, loss, and frustration can accompany the experience of caregiving for someone with FTD. Watching a loved one's personality and abilities change can be a painful experience, and caregivers may experience a sense of loss for the person they once knew. Additionally, the unpredictable and often socially inappropriate behaviours that can accompany FTD can be challenging for caregivers to manage and may cause strain on relationships and social support networks.


It is important for caregivers to seek support and resources to help manage the emotional demands of caring for someone with FTD. This may include joining a caregiver support group, seeking counselling or therapy, or connecting with community resources such as respite care or home health services. In addition, caregivers may benefit from education about FTD and strategies for managing challenging behaviours, as well as assistance with navigating the healthcare system and accessing appropriate resources and support. With the right support and resources, caregivers can help maintain their own well-being while providing high-quality care to their loved ones with FTD.


Teamwork

Teamwork is essential for supporting someone with FTD because this condition affects multiple aspects of an individual's functioning and requires a coordinated effort from various professionals and caregivers to provide comprehensive care.


Additionally, FTD can be challenging for family members and caregivers to manage on their own, and it can be emotionally and physically exhausting to provide care without a support system in place.


The team involved in supporting someone with FTD may include a variety of professionals, such as a primary care physician, neurologist, psychiatrist, psychologist, speech therapist, occupational therapist, and social worker. In addition to these professionals, family members and caregivers are also an essential part of the team.


Each team member's role may vary depending on the individual's specific needs and symptoms. For example, a neurologist may help to diagnose and manage the underlying brain changes associated with FTD, while a speech therapist may help with communication difficulties. Social workers can help connect families with community resources and support, and occupational therapists may provide guidance on environmental modifications that can promote independence and safety.


Family members and caregivers are also essential members of the care team, providing day-to-day support and assistance with activities of daily living, such as bathing, dressing, and meal preparation. They can also help manage challenging behaviours and provide emotional support to the individual with FTD.


By working together, the care team can provide comprehensive and coordinated care that addresses the individual's physical, emotional, and social needs. This can help improve the quality of life for the person with FTD and reduce the burden on caregivers and family members.


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(c) 2023 Dean Harrison



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