Frontotemporal dementia 101: Symptoms, causes, types, care & treatment

When we see our older family members forget things or do repetitive behaviours, we might be inclined to brush it off as one of the quirks of old age. However, this is not a part of normal aging and it can be a sign of dementia which can cause further deterioration if left unchecked.

According to a 2015 study by the Institute of Mental Health, one in ten Singaporeans aged 60 and above have dementia. There are several major types of dementia including Alzheimer’s disease, Lewy body dementia and frontotemporal dementia.

We will talk about what frontotemporal dementia is, how we can treat it, and how we can support our loved ones with this condition.

What is frontotemporal dementia?

Dementia is a condition that affects brain cells, causing them to die out at a faster rate. This leads our intellectual abilities to decline, which causes difficulties in speaking and simple tasks, memory loss, and changes in personality.

Frontotemporal dementia, also known as FTD, affects the cells in the brain’s frontal lobes located behind the forehead and the temporal lobes behind the ears. FTD frequently affects one’s ability to understand and produce speech.

This condition affects behaviour as well as the ability to produce and understand speech. One quarter of frontotemporal dementia cases occur in later life from around 60 years of age. However, FTD symptoms can start as early as one’s 20s or as late as one’s 80s.

Frontotemporal dementia symptoms

There are two typical variants of FTD: The behavioural variant which affects, and the language variant which affects language capabilities.

Symptoms of the behavioural variant of FTD include impatience, insensitivity, carelessness, compulsive behaviours, and rigid routines. People with behavioural FTD may have trouble with problem solving or focusing on a task for a long period of time.

The language variant of frontotemporal dementia can lead to losing one’s ability to understand certain words spoken in a sentence or to produce ungrammatical, laboured, or hesitant speech.

The behavioural variant is more common than the language variant, though both types can eventually progress to a dementia that affects other mental and physical functions. Other symptoms include:

• Emotional withdrawal
• Loss of interest in normal daily activities
• Lower self-awareness
• Sharp personality changes like swearing more often, an increased interest in sex, or decreased personal hygiene.

ALSO READ: What not to say to someone with dementia

Causes of frontotemporal dementia

Frontotemporal dementia is caused by brain disorders which affect certain proteins in the brain. Scientists aren’t sure why those disorders tend to affect the frontal and temporal lobes.

The disorders damage certain types of nerve cells, including those that control empathy, judgment, foresight, and behavioural conduct. These nerve cells break down, which affects the brain’s ability to send messages to each other and to different parts of the body.

The frontal and temporal lobes of the brain will shrink as more nerve cells get damaged and die.

Frontotemporal dementia risk factors

Generally, you are at higher risk of having frontotemporal dementia if you have a family history of dementia. Scientists estimate that one in ten cases of FTD are inherited. There are some genes which give an increased risk of inherited forms of FTD.

Other risk factors for FTD are less well- understood. Researchers have found correlations between obesity and frequent smoking to an increased chance of having FTD. Having diabetes, a prior head injury or an autoimmune disorder like rheumatoid arthritis are also understood to be risk factors for FTD.

Differences between FTD from other types of dementia

Alzheimer’s disease is another type of dementia which can affect people in later life. While Alzheimer’s tends to become more common in older age groups, FTD tends to have its onset in people between the ages of 40 and 60.

Alzheimer’s affects different mental abilities than FTD, so that symptoms like losing one’s sense of direction will be present in people with Alzheimer’s but not FTD.

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Memory loss is also a key feature of Alzheimer’s although people with FTD may experience it as their condition progresses. People with Alzheimer’s also tend to have less difficulty speaking or thinking of words than people with FTD.

Lewy’s body dementia is another type of dementia that causes changes in behaviour and mood like FTD. Caused by abnormal deposits of a type of protein in the brain, it leads to problems with thinking and movement.

People with Lewy’s body dementia tend to have symptoms affecting the muscular system like muscle stiffness, repeated falls, loss of coordination and difficulty swallowing. Unlike people with FTD they may have problems with hallucinations, fluctuations in alertness and sleep behaviour disorder.

Frontotemporal dementia treatment

The prognosis for FTD is like that of Alzheimer’s disease, with lower life expectancy but a higher survival rate. FTD will progress steadily to the point where the individual cannot carry out activities of daily living on their own. The progression to the point where the individual is totally dependent on others can take between 2 to 10 years.

Medication is sometimes used to alleviate FTD symptoms like aggressive and agitated behaviours. However, there is no medication that can completely cure FTD. Medications can also lead to side effects if taken inappropriately or with other medicines.

Please consult your doctor on whether medication is needed to treat FTD symptoms in yourself or your loved one. They can decide if a particular medicine would be useful in your individual case.

Occupational therapy to help improve one’s ability to carry out daily activities may be used to help the person with FTD find practical solutions to everyday problems.

Other forms of support like relaxation techniques, physiotherapy and speech and language therapy to help with problems like swallowing may be used to address other areas where difficulties might be faced because of FTD.

Every individual is different, and your loved one has care needs that are unique. Engaging a caregiver for your loved one not only encourages interaction; it also helps build a strong emotional support for your loved one.

To give your loved one the best care he/she deserves, we provide a free care consultation for you and your loved one, to ensure that they get a Care Professional that best suits their needs.

Frontotemporal dementia complications

People with advanced FTD may need 24-hour dementia care to carry out activities of daily living like feeding and going to the bathroom. You may have to decide if it is feasible for you or your loved one to remain at home to be looked after by a caregiver, or if more specialised care at a nursing home is required.

If you or your loved one has been diagnosed with frontotemporal dementia, it would also be helpful to address legal issues to prepare for end-of-life. Giving a trusted relative lasting power of attorney to make decisions on your behalf can be essential if your condition progresses to the point where it is difficult to make decisions on your own.

The person whom you refer as your attorney must be aged 18 or older. In Singapore, the certificate for a lasting power of attorney can be issued by a medical practitioner, a registered psychiatrist, or a practicing lawyer. More information on how to get a certificate for lasting power of attorney can be found on the Ministry of Social and Family Development (MSF) website.

ALSO READ: Will you develop Alzheimer's disease? Early signs could be detected in your eyes before symptoms arise

Caring for a loved one with frontotemporal dementia

It can be distressing or even frustrating to see yourself or your loved one gradually become unable to do even simple activities. When you talk to someone with dementia, ask simple and direct questions and keep the interaction positive to avoid overwhelming them.

Try not to get upset at them if they do inappropriate behaviours but maintain a sense of behaviour and try to break activities down into steps.

Having to constantly care for your relatives can be physically exhausting and emotionally draining. Caregiver burnout may occur if you expend too much of your energy on caring for your loved ones.

To have the energy to keep looking after those you love, it is important that you take time out to attend to your own emotional needs. There are also support groups available to help you find others who can give you advice.

This article was first published in Homage.