Frontotemporal dementia (FTD) is a group of disorders that damage the frontal and temporal lobes of the brain. These areas are important for personality, social judgement, language, planning and behaviour.
FTD often begins earlier than more common forms of dementia. It may first appear as changes in behaviour, personality or language rather than memory loss.
Types
The main clinical groups are behavioural variant frontotemporal dementia, primary progressive aphasia and FTD associated with movement disorders.
Behavioural variant FTD can cause social disinhibition, apathy, loss of empathy, repetitive behaviour, poor judgement, changes in eating habits and difficulty planning.
Primary progressive aphasia mainly affects language. A person may lose word meaning, have difficulty naming objects, speak more slowly, make grammatical errors, or struggle to understand speech.
Movement-related forms can overlap with motor neuron disease, corticobasal syndrome or progressive supranuclear palsy. These may involve weakness, stiffness, falls, swallowing difficulty or abnormal eye movements.
Causes
FTD is associated with abnormal protein build-up inside nerve cells, commonly involving tau or TDP-43. The protein changes damage neurons and lead to loss of brain tissue in the frontal and temporal lobes.
There is often a genetic link. Some cases are caused by inherited changes in genes such as C9orf72, MAPT or GRN, but many cases occur without a known family history.
Symptoms
Symptoms vary by subtype. Behavioural symptoms may include loss of inhibition, reduced empathy, compulsive routines, apathy, poor judgement and changes in food preference. Language symptoms may include word-finding problems, loss of word meaning, effortful speech or grammar problems.
Memory may be relatively preserved early on, which can make FTD look different from Alzheimer's disease. As the condition progresses, symptoms broaden and daily support needs usually increase.
Diagnosis
Diagnosis is based on the pattern of symptoms, neurological examination, cognitive and language testing, brain imaging and sometimes genetic testing. MRI or PET imaging may show changes in the frontal or temporal lobes.
FTD can be mistaken for depression, bipolar disorder, other mental health conditions or Alzheimer's disease, especially early in the illness.
Treatment and Care
There is currently no cure for FTD. Care focuses on symptoms, communication, safety, daily structure and support for family or carers.
Speech and language therapy can help with communication strategies. Occupational therapy may help with routines and safety. Some medicines may be used for distressing symptoms, but treatment is individual and should be reviewed carefully.
Planning is important because FTD is progressive. Financial, legal and care arrangements often need to be discussed earlier than families expect.
Notable People
Publicly reported cases have included author Terry Pratchett, who was diagnosed with posterior cortical atrophy, and actor Bruce Willis, whose family announced a diagnosis of frontotemporal dementia in 2023. Public reports about individual diagnoses should be handled cautiously and sourced clearly.
See Also
References
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