Welcome to the 6th in our 17-part series on dementia. About 50 million people suffer from dementia worldwide. It is a debilitating disease, but it may be preventable. So I’ve set out to learn as much as I can and bring you along with me. In part 3 I went through the many types of dementia, and we’re going to have separate episodes on the most common of these. This is the third of that series-within-a-series.
Frontotemporal Dementia – that’s a mouthful (we’ll just call it FTD), but it just refers to a group of disorders caused by nerve damage in 2 particular lobes of the brain: the frontal lobe, which appropriately is located in the front of the brain, and the temporal lobe, which controls time travel. Okay, not really time travel. It’s actually more concerned with visual memory, language comprehension, and emotional association. The name, like the frontal lobe’s, comes from its location near the temples.
There’s a really nice animation of a rotating skull that shows the location of the frontal lobe so check that out.
There are six types of FTD:
1. Behavioral Variant.
2. Semantic Variant Primary Progressive Aphasia
3. Nonfluent Agrammatic Variant Primary Progressive Aphasia. An example of aphasia is not being able to find the right word.
4. Corticobasal Syndrome.
5. Progressive Supranuclear Palsy.
6. FTD associated with Motor Neuron Disease.
FTD was first described by Arnold Pick in 1892, and in older literature you may see it described generally as Pick’s Disease, but now Pick Disease refers to one specific type of FTD..beyond scope of this episode, but more detail in the references RunningAFEVER.com/229. FTD is more common in middle-aged people than in seniors, presents in the 40’s and 50’s. One article puts it on par with vascular dementia as the 2nd most common type of dementia. And in people under age 65 it is as common as Alzheimer’s.
The frontal lobe is the largest part of the brain. All mammals have one. The frontal lobe contains most of the dopamine neurons in the cerebral cortex. Remember the episode on dopamine? If not, go back and check out, it’s number 151, you can find it at RunningAFEVER.com/151 of course. In that episode I called it the “natural fun drug”, it’s part of the reward system, and is triggered by achievement of goals. The frontal lobe also handles things like attention, short-term memory tasks, planning, and motivation. If you’re paying attention right now, you are using your frontal lobe.
These parts of the brain are not to be cast aside willy-nilly, they are important — of course, the entire brain is important. Anyway with all this functionality, symptoms of FTD vary quite a bit. They can include dramatic personality changes, inappropriate social behavior, uncharacteristic impulsiveness, emotional indifference, poor financial judgment, a decline in personal hygiene, and overeating. Others experience problems with speech and language.
So, the big difference here is personality changes. You can really start to see how dementia is so misunderstood .. it’s hard to understand and the symptoms often lead us in a completely different direction. And this even makes it difficult for doctors to diagnose.
But a person with FTD will still retain perception, spatial skills, memory, and praxis (which is motor planning to perform tasks or movements). MRI and other scans can reveal atrophy in the frontal or temporal lobes. I looked up atrophy too, it’s a wasting away due to inadequate nutrition. There are also a few tests which can be performed by a neuropsychologist. These are the guys who do the legit intelligence tests among other things. They are neuroscientists.
I found the names of these tests interesting:
1. Iowa gambling task
2. Faux Pas test
3. Hotel task
4. Mind in the Eyes
5. Multiple errands task.
These are really only applicable to the behavioral variant. And since these tests can reveal weaknesses before any atrophy shows up on an image scan such as an MRI, they can be more useful in early detection of bvFTD… too many acronyms but that is shorthand for the behavioral variant.
As the disease progresses, the types overlap as the patient develops symptoms from multiple subtypes of FTD. There seems to be a relatively strong genetic component, so be aware if you have family members with FTD.
As usual, there is no stated cure. The disinhibition (that’s a loss of inhibition) and compulsive behaviors can be controlled with SSRI’s which are usually used to treat depression, otherwise we’re talking palliative care again. Antipsychotics can be helpful as well, but used with care due to side effects.
Prognosis is a rapid progression with a life expectancy of 2-20 years, some of which may see the patient in full-time care.
Now this is kind of a sad ending, because there appears to be no preventive action that can be taken. Apparently 60 minutes called FTD the cruelest disease you’ve never heard of. So I took some extra time to look at some research going on. There are several university health systems with centers specifically for FTD or closely related disorders, including Johns Hopkins and the University of Pennsylvania.
One article did give me hope! At dana.org. I didn’t go into it earlier, but there is a connection with the tau protein, which I have mentioned before, in episode 227 on Alzheimer’s. The article says “Researchers have already demonstrated the viability of an approach to the treatment of abnormal tau in an animal model of FTD and are actively pursuing how this might be applied in humans.” If this is important in FTD, and apparently it is, it’s a good thing, because it also is important in Alzheimer’s, and there is a lot of attention on AD as it is the most common dementia. Much more info in that article.
Many many references are in the show notes at runningafever.com/229. And on that positive note, I’ll call it a day until next time. I hope you enjoy learning about dementia and the other topics I present here. And if you do I would love to hear from you.
References:
Outsmart Dementia. (2020). The latest tools for controlling cognitive health — preventing dementia and Alzheimer’s disease. Morton Grove, IL: Publications International, Ltd.
https://en.wikipedia.org/wiki/Temporal_lobe
https://en.wikipedia.org/wiki/Frontal_lobe
https://en.wikipedia.org/wiki/Frontotemporal_dementia
https://en.wikipedia.org/wiki/Pick%27s_disease
https://www.dictionary.com/browse/atrophy?s=t
https://www.dictionary.com/browse/disinhibition?s=t
https://en.wikipedia.org/wiki/Aphasia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170532/
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Frontotemporal-Disorders
https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737
https://www.dana.org/article/dawning-hope-for-the-other-dementia/