Frontotemporal Dementia – Impulsive, Inflexible, yet Not Forgetful

frontotemporal dementia

While at work, you receive a phone call from a police officer to inform you that your mature-aged father was caught urinating into the neighbor’s garden. You are utterly bewildered by the news because your father is a considerate man, and this type of behavior is completely uncharacteristic of him. This scenario outlines an example of a patient developing frontotemporal dementia, a form of mental illness typically seen in an unusually young patient population (ages 45-64). There are various types of frontotemporal dementia, but the behavioral variant delineated above accounts for at least half of the cases seen in this disorder. Habitually, patients with this class of dementia are incorrectly labeled as having a primary psychiatric illness, given that their disturbances tend to fall outside the commonly recognized symptoms observed in other types of dementia (e.g. short term memory loss in Alzheimer’s). Moreover, in addition to the fact that these patients are relatively young, they also score well on psychological tests involving executive function and memory, making the diagnostic process even more challenging. Although there is no cure for frontotemporal dementia, expediting the treatment protocol does improve a person’s general well-being.

Frontotemporal dementia is a degenerative brain disorder and, as its name implies, affects the frontal and temporal lobes in the brain. The frontal segment of the brain is responsible for decision making, problem solving, planning, personality, and the ability to speak; whereas the temporal lobe is in charge of hearing and speech comprehension. Scientists do not know what causes frontotemporal dementia, but genetics are known to play a role. Patients with the behavioral variant subtype will generally manifest the following: disinhibition, such as kissing a stranger or making offensive remarks; apathy; lack of empathy; particular food cravings, say, increasing their intake of sugary foods; compulsive and ritualistic behaviors, like excessive repetitive cleaning; and inflexibility. The other major subtype of frontotemporal dementia is called primary progressive aphasia, and in this variant patients experience language impairment. They may have word-generating difficulties or lack word comprehension. The diagnosis of frontotemporal dementia is clinical, but imaging tests such as MRI’s might be useful. The treatment involves a combination of medications (e.g. antipsychotics, stimulants), speech therapy, and behavior modification. Of note, in this population, prescription drugs need to be started at a low dose, due to the fact that in a fair number of cases, patients may develop a paradoxical unintended drug reaction.

Frontotemporal dementia is a particularly problematic disorder because patients can suddenly become impulsive and suffer a significant impairment in their judgment. As a result of this, patients need supervision in tasks such as driving or in making major financial decisions. Aside from the pharmacologic treatment, partaking in routine exercise activity is highly recommended, as studies have shown that this leads to an improved mood and cognition. For those who have difficulty with communication, speech therapy will be necessitated. Unfortunately, frontotemporal dementia progresses rapidly, even more so than Alzheimer’s disease. Consequently, family members of patients with frontotemporal dementia should consider palliative care. In that manner, the focus of care will be centered on improving the patient’s quality of life and relieving the inevitable burden placed upon the caregivers.

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