These days almost everyone knows that when elderly adults struggle with forgetfulness, have difficulties solving problems and get confused about dates or places, it could be the warning signs of Alzheimer’s disease.
But Alzheimer’s is not the only cause of dementia. There are kinds of dementia that can be just as devastating, and that often get misdiagnosed. When that happens, people can waste months or years on the wrong kind of treatment…
One particular kind of dementia is often confused for early-onset Alzheimer’s disease, because the person’s behavior suddenly becomes strange and aberrant. But the common symptoms have nothing to do with memory or confusion.
Read on to discover this lesser-known type of cognitive disorder and its symptoms. That way if it strikes you or someone you love, you’ll know what’s really happening.
The kind of dementia I’m referring to is called Frontotemporal dementia (FTD), sometimes referred to as Pick’s disease (although nowadays this describes only a specific type of FTD).
FTD is a rare form of dementia that can be mistaken for early-onset Alzheimer’s disease because it affects adults between the ages of 40 and 60, with the average age being about 57.
Symptoms of FTD
Rather than affecting memory, early symptoms of FTD are usually things like:
- Odd or antisocial behavior changes, including possible law-breaking activities like stealing
- Socially inappropriate behavior, lack of social tact, including odd sexual remarks, or lack of inhibition in social situations
- Neglecting appearance or hygiene
- Depression and withdrawal from society
- Language difficulties, loss of speech and/or an unwillingness to talk
- Seeming to not care about how one’s behavior is affecting oneself or loved ones (indifference, lack of empathy)1
When a person’s symptoms primarily affect their personality and emotions (rather than language), doctors attribute it to a kind of FTD called behavioral variant frontotemporal dementia (bvFTD).
Additional symptoms of bvFTD include:
- Obsessive-compulsive and “hyperoral” behaviors including overeating, only eating specific foods, attempting to eat inedible objects and consuming excess liquids or alcohol
- Hyperactive behavior, excessive pacing or wandering
- Abrupt mood swings and outbursts of frustration and anger
- Impulsive acts like shopping sprees or grabbing food off another person’s plate
This is just a sample of the range of the symptoms a person can show. As you can see, some of the symptoms resemble those of Alzheimer’s. The wide range of possible behaviors makes it difficult to diagnose the condition and can be frustrating to family members, who have no idea what could be causing their loved one to act so strangely.
Causes of FTD
The symptoms of FTD are different than Alzheimer’s disease because the two kinds of dementia affect different regions of the brain.
Alzheimer’s disease primarily affects the hippocampus, the seat of memory, while FTD affects the frontal and/or temporal lobes of the brain (hence the name “frontotemporal dementia”).
The frontal lobe, located at the front of the brain behind the forehead, is responsible for a person’s. . .
- Executive functioning, including mental abilities like planning, sequencing and prioritizing tasks as well as multitasking and recognizing and correcting errors.
- Emotional responses and social cues, such as knowing to speak quietly during a church service or in a library.
- Language understanding and the ability to put words together logically.2
The temporal lobes, located on the sides of the brain behind each temple, are also responsible for different aspects of language and emotion, such as. . .
- Understanding the meaning of words in order to speak, read and write effectively
- Relating specific emotions to events, such as quiet respect and/or grief at a funeral.
Which lobe is first affected by FTD influences the kinds of early symptoms.
Subtypes of frontotemporal dementia
There are three subtypes of FTD, each with a different root cause:
- Tau proteins clump onto the neurons in the front and/or temporal lobes of the brain, as in Alzheimer’s disease.
- Mutations in the TARDBP gene can be caused by transactive responsive DNA binding protein (TDP-43). TDP-43 can cause changes in the amino acids of the gene, leaving the rest of the proteins intact.3
- The binding protein known as fused in sarcoma (FUS), which regulates different aspects of gene expression, can go haywire and start depositing too many proteins into the neurons.4
While the first two subtypes are the most common, each root cause listed above leads to the same end: the neurons in the frontotemporal lobes begin to die and the tissue atrophies. This irreversible process triggers the ever-worsening symptoms of FTD.
An MRI can help determine whether the condition is Alzheimer’s disease or FTD, and what subtype it might be. But at the beginning stages the scan may still look normal.
Prognosis and treatment
The prognosis for people diagnosed with frontotemporal dementia is generally poor using conventional treatments. Usually, about eight to ten years lapse between diagnosis and death from complications of the disease, with the average timespan being five years.
Some kinds of medication, speech therapy, occupational therapy and strategies that help people and their caretakers cope with challenging behavior can all improve the symptoms of FTD for a while.
While alternative treatments involving diet, supplements, treating sleep disorders, reducing chronic inflammation and balancing blood sugar are successfully controlling and reversing Alzheimer’s disease, I don’t know of any similar effort being tried to treat FTD.
Some medications that help a little in managing the symptoms of Alzheimer’s disease, like acetylcholinesterase inhibitors, do not work on FTD.5
If you notice a loved one is showing strange behaviors and they seem “too young” to be struggling with Alzheimer’s disease, it could be early symptoms of frontotemporal dementia.
Talk to their doctor and get the correct diagnosis as soon as possible.
- Frontotemporal dementia, signs and symptoms.
- Changes in the brain.
- TARDBP gene.
- Commentary on: Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?
- Frontotemporal dementia – treatment.