Frontotemporal Dementia
This is a very broad neurodegenerative syndrome. Within it, two main variants can be found: a behavioural variant, which causes behavioural disorders and a clear impairment of executive functions and a variant that mainly affects language in the initial stages, called primary progressive aphasia.
Behavioural variant of frontotemporal dementia
The most common form of frontotemporal dementia (FTD). Also called Pick’s disease or frontotemporal degeneration (less common and less commonly used names). It tends to affect younger people (under 65 years of age) compared to other types of dementia. People with this variant are often misdiagnosed with psychiatric disorders or other neurological diseases because of the changes in behaviour and personality that occur in the early stages.
Impairment of executive functions (planning, organisation, logical reasoning, behavioural inhibition, decision-making and judgement) is the main feature in the early stages. Unlike other types of dementia, such as Alzheimer’s dementia, memory and visuospatial abilities are usually not severely compromised until later stages of the disease.
The following are some of the most characteristic and common symptoms of this behavioural variant:
This is a decrease or loss of the ability to adapt behaviour to different social norms or precepts, which sometimes leads to socially inappropriate behaviour and a certain degree of impulsivity. Some examples of this type of behaviour may be:
- Making unusual, rude or offensive comments towards other people.
- Shoplifting.
- Impulsive and reckless shopping.
- Episodes of irritability and/or aggressiveness.
- Inappropriate sexual behaviour.
Lack of interest or indifference towards activities that are important or meaningful to the person. There may be, for example, a loss of interest in work, hobbies or personal relationships. The initiative to perform these and other actions is lost and may even affect self-care (e.g. personal hygiene).
These are behaviours or behavioural routines that are performed repeatedly and are not very susceptible to change. These may include repeating phrases or words, rereading the same book over and over again, etc.
There is often a loss of the ability to put oneself in the place of others, sometimes leading to an inability to recognise the feelings of loved ones. They also tend to show less sensitivity, lack of concern or indifference to important events or events (e.g. the death of a family member).
Changes in eating may occur, both in the amount of food and drink consumed and in dietary preferences. Binge eating, excessive consumption of water or alcohol, cravings for foods with a high glycaemic index, attempts to consume inedible objects, etc. may occur.
Executive functions are those that allow us to be flexible in our day-to-day lives and cover different skills such as the ability to plan and organise, decision making, etc. In people with frontotemporal dementia, they are often affected, which means that they often have difficulties in their daily lives. Some frequent examples are:
- Difficulty in planning different activities of daily living.
- Questionable economic or financial decisions.
- Errors in the workplace.
Mood swings may be more frequent and intense compared to those experienced by the person before the disease.
People with frontotemporal dementia are often unaware of these changes.
As a result, they may have a rejection response to compensatory behaviour from different people in their environment, e.g. they may blame their boss for the loss of their job, or they may show anger or anger at the offer of help to cope with the limitations resulting from the disease from family or friends.
Primary progressive aphasia
Primary Progressive Aphasia (PPA) is mainly characterised by a gradual loss of the ability to speak, read, write and understand what others say. These language problems usually occur in isolation, without being accompanied by difficulties or deficits in other cognitive functions (memory, attention, praxis, etc.). Primary Progressive Aphasia is further subdivided into three clinical subtypes depending on which aspect of language is primarily affected:
Non-fluent variant: People with this variant have increasing difficulties in speaking, however, they still remember the meaning of words and phrases.
Semantic variant: The main characteristic of this subtype is the progressive loss of the meaning of words. They have problems understanding language, however, they retain fluent speech, but it is vague and difficult to understand as many words are omitted or substituted.
Logopenic variant: Difficulties in finding words when they are speaking. As a result, they tend to speak slowly and with continuous hesitations while trying to find the word or words with which they want to express themselves.
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