So why am I talking about this disease frontal temporal dementia? I recently had
a patient who just passed away with this diagnosis.
She had not reached 60 yet and had been working, in fact as a
healthcare professional, a few years before the diagnosis.
Her husband was at her bedside until the very end;
tending and taking care of her as he watched her Soul and Being, unfortunately
with away with this progressive debilitating
disease i'm Dr.John Board Certified in both Internal Medicine
and Geriatric Medicine with over 20 years of experience in
healthcare. If you're interested in tips and advice
to promote healthy aging this is the right place
for you. So what is frontal temporal dementia? Frontotemporal
dementia is a form of dementia which affects the
front of your brain and the side of your brain as well. The
frontal lobe, as the name implies, is located in the
front of the brain and the temporal lobe is located to the
side of your brain near your temples. The
frontal lobe has many functions and I'll talk about
some of these functions in the next couple of minutes. The
frontal lobe helps put thoughts into words.
So damage to a specific area in the frontal lobe
called the Broca's region affects speech and the ability to understand language.
It also has some role in forming long-term memory. It plays a role in
forming your personality; therefore, damage to this area
affects someone's personality. Some of your loved ones
might have been previously reserved maybe introverted
individuals might be acting up or there might be loss of inhibition
with hypersexual behavior. Motor skills can also be affected if the
frontal lobe is damaged. The skills that control voluntary
movements such as walking or running, moving your hands are
controlled by the frontal lobe. The frontal lobe is also important for
empathy. You might discover that your loved one
is not reacting in a usual manner or they are in fact indifferent. The
frontal lobe tells me that I'm sitting here! It helps
me plan and organize complex tasks. If the
frontal lobe is damaged these are all affected. The temporal lobe
plays a role in encoding memory as well as
processing auditory information. The temporal lobes also have a role
in language processing as well as processing
of our emotions. So, at what age can we see
frontal temporal dementia? Frontal temporal dementia is a common cause of
early onset dementia and usually occurs around
the age of 60. It has also been reported as early in
the 20s and as late as in the 90s. So are there
different types of frontal temporal dementias? Yes, in fact
there are three different types. I just think that you should be aware of them.
Treatment and approach does not really change. The three types
are a behavioral variant of frontal temporal dementia
and two forms of primary progressive aphasia, a non-fluent variant
of primary progressive aphasia and a semantic variant of primary
progressive aphasia. So what causes frontal temporal dementia? Frontal
temporal dementia is caused by clumps of abnormal protein called tau,
forming inside brain cells.They damage the brain cells
and stop them from working as they should be. The brain cells are then not
able to communicate with each other. Other risk factors are family history
and genetics. So what is the difference between
dementia, frontal temporal dementia and the most
common type of dementia which is Alzheimer's
dementia? So, there are many different types of
dementias and distinguishing them is important not
only to establish a diagnosis but the prognosis is different depending
on the type of dementia and it also helps in terms of the choice
of medications to help with symptom management
of the different dementias.So when I talk about dementia per se,
this is very general and this is a very global term and the analogy I draw
is with pain. Pain is also a very general term but the different types of pain
you have muscle pain, stomach pain, headaches and all of these types of pain
are different and they're also treated differently.
Similarly, there are different types of dementia.
Patients I talk to and even caregivers ask me so what will happen
to me what will happen to my loved one as the disease progresses. So the way I
see dementia is the reverse of aging and I categorize
dementia into mild, moderate
and advanced. So what do you see with teenagers, for example?
With teenagers you see that they're fairly independent but you need somebody
in the background to make sure that you guide them and
steer them in the right direction and they can have mood swings
and these mood swings at times can be quite acute.
As dementia progresses from mild to moderate the analogy is the
regression from a teenager towards a toddler. So what do you do with
toddlers? With toddlers you help them put their
clothes on, you help them with feeding, you help them with toileting, you help
them with going to the bathroom also they can have
their mood swings and these mood swings can be more acute
with sharp upturns and down downturns as well.
And as dementia progresses from moderate to severe or from moderate to advanced
you see this regression from a toddler towards an infant. What do we do with
infants? We help them with
everything, with feeding, with nourishment, with with toileting
with going to the bathroom and when they are in distress we tend to
them and we take care of the needs. The same
thing applies with advancing dementia because they
need our total help, our total devotion
and our total care! So if you're finding value in this video
LIKE, COMMENT and SHARE, might as well hit that notification button and please
smash the SUBSCRIBE button as well. What are the symptoms of frontal temporal
dementia? I'll mainly speak about the behavioral
variant frontal temporal dementia. It can be socially
inappropriate behavior such as touching strangers or urinating in public
or being rude or making offensive remarks.
Taking away objects or items. Similarly to young toddlers they might
have an oral fixation and place objects in their mouths. Sometimes, they fill up
their mouths with food and they do not even chew the
food. Food cravings might change and they have
a liking for very sweet foods. Some behaviors can be very repetitive
and even stereotypical such as constantly cleaning or holding, hiding
items, constantly checking. Some of your loved
ones might even have very rigid routines which they do not
want to change which can be extremely tiresome and
frustrating for you, the caregiver. Some patients lose empathy
with lack of motivation and regressing and
becoming extremely passive. This type of apathy
can be often mistaken for depression. About 20% also
develop a modern neuron disease affecting overall
function and movement. One sentence on the other variant which is the
primary progressive aphasia. This variant is characterized by early loss of
language with episodic preservation of
overall cognition.And if you're interested in five proven ways to
prevent dementia click on this link above. How do
we diagnose frontal temporal dementia? The diagnosis
is made clinically and other testing is done just to help exclude other disease
entities. The diagnosis is based on physical examination and in particular
a neurological examination. Your doctor might
order blood tests to exclude other organic causes such as b12 deficiency.
He or she might order neuropsychological testing
early in the course of the disease to evaluate
executive function. Neuro-imaging testing such as brain scans such as an MRI
and glucose positron emission scans are tests to help exclude structural
abnormalities and pathologies. So what about prognosis and treatment?
Usually from the time of diagnosis and when the times
symptoms begin till when someone passes away takes about eight to ten years.
And the behavior variant has a shorter prognosis
especially if they have the motor variant of the disease and the prognosis
is usually less than two years. Unfortunately,
there are no curative drugs. Non-pharmacological approach
is emphasized and will require probably multiple and different care members or
team members to help with the coordination of care including physical
therapy and occupational therapy, social workers, behavioral therapists
home health coordinators, nurses, dietitians and
home health aides. You can reach out to specialized organizations and
associations to help with this coordination of care and there
must be some organizations in your area. Medications can be used,
however, they're not curative they help with symptom
management. They should be only used if non-pharmacological approaches have not
helped and have been totally exhausted. And if
you're interested in a drug used in Alzheimer's disease click on
this link above. So, Question of the Day? Are you taking
care of with someone with frontal temporal dementia? Don't
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