By Stephen Des Georges
Desert Haven Home Care and Apollo Residential Assisted Living provides residents with high-quality supervision and treatment reflective of its proprietary three cornerstones of managed care for seniors: meaningful, patient-centered care, best-class service and passionate advocacy. Healthcare professionals at each residence are knowledgeable and respected servants, familiar with the latest evidence-based research and outcomes. It is our privilege to regularly share with you timely and topical insights into issues that impact elderly loved ones. In this installment, frontotemporal dementia, a debilitating brain disorder, is reviewed – particularly its causes and treatments.
American author, painter and illustrator Norman Rockwell produced artwork with broad popular appeal in the United States for their reflection of American culture. Rockwell is most famous for the cover illustrations of everyday life he created for The Saturday Evening Post magazine over nearly five decades. Rockwell struggled with severe depression throughout his life, and in his last decades developed dementia; eventually he was unable to continue his artistic pursuits. Interestingly, Rockwell’s paintings are now used sometimes in dementia therapy because of the memories and nostalgia they elicit.[1]
Understanding and coping with a dementia diagnosis can be overwhelming, but you’re not alone; nearly 50 million people worldwide have been diagnosed with a form of dementia, according to the World Health Organization.
What is dementia?
First, dementia is not Alzhemier’s; Alzheimer’s is a form of dementia. Says AARP correspondent Kathleen Fifield:
“The terms ‘dementia’ and ‘Alzheimer’s’ have been around for more than a century,
which means people have likely been mixing them up for that long, too … the
difference is important. In the simplest terms, one is broader than the other. If the
two were nesting dolls, Alzheimer’s would fit inside dementia, but not the other
way around. While Alzheimer’s disease is the most common form of dementia,
there are several other types. The second most common form, vascular dementia,
has a very different cause — namely, high blood pressure. Other types of dementia
include alcohol-related dementia, Parkinson’s dementia and frontotemporal
dementia; each has different causes as well. In addition, certain medical conditions
can cause serious memory problems that resemble dementia.”[2]
Dementia is a general term for a decline in cognitive function. Memory, thinking, problem-solving and language issues are among the functions impacted for people with dementia. Dementia isn’t a normal part of aging — it’s a group of disorders caused by abnormal brain changes. These changes lead to cognitive decline, which can be severe enough to impede independent life, affect behaviors, and alter feelings or relationships.
Frontotemporal degeneration, also known as frontotemporal dementia (FTD), is a general term for several brain disorders affecting mainly temporal and frontal lobes of the brain.[2, 3] These brain regions are responsible for language, behavior and personality.
Dementia primarily affects individuals over the age of 65, while frontotemporal dementia frequently onsets at a younger age. Although most FTD cases are diagnosed between the ages of 45 and 65, it can also affect younger or older individuals.[4]
Frontotemporal dementia causes shrinkage, or atrophy, of sections of these lobes. As with other types of dementia, for example, vascular dementia, FTD often develops slowly and worsens with time.
Additionally, signs and symptoms of frontotemporal dementia differ according to the region of the brain affected. Some patients with FTD undergo major personality changes, become impulsive, socially inappropriate or emotionally indifferent, while others lose their ability to communicate properly.[5]
Unfortunately, there is no cure for FTD, but several treatment options, including medications and supporting programs for senior living, assisted living and home care services are available to help patients improve their quality of life.
Causes of dementia
Scientists define FTD by examining the patterns of brain changes observed during an autopsy after death. These alterations include the death of neurons and abnormal levels or types of TDP-43 and tau proteins2. These proteins are found naturally in the body and assist in the normal functioning of cells. When proteins do not function correctly – for any reason – neurons in the brain areas are destroyed.
In most cases, the cause of dementia is unknown. Scientists believe that individuals who have a family history of FTD have an increased risk of developing the illness. From 10 to 30 percent of bvFTD (behavioral variant) cases are linked to unique genetic causes.
Additionally, frontotemporal dementia inherent in families is frequently caused by mutations in certain genes.6 It is important to note that genes are the fundamental units of heredity that instruct cells on how to generate the proteins required for proper body function. Even tiny changes in a gene can result in the production of an abnormal protein, which can lead to brain abnormalities and disease.[7]
Symptoms of frontotemporal dementia
Early signs and symptoms of frontotemporal dementia include: [12, 13]
Changes in attitude and behavior
An individual with FTD will show impulsive or inappropriate behavior, appear unsympathetic and selfish, neglect personal hygiene, tend to overeat, repeat questions or stories, and become insensitive. Sometimes, a person in the early stages of this diagnosis can appear to have a lack of inhibition or social skills. There is also a tendency to become obsessive and repetitive with certain actions such as cleaning or shaving.
Language difficulties
One suffering from FTD speaks slowly, can have difficulty in making the proper sounds while pronouncing a word, uses words incorrectly, gets words in the wrong sequence; this can lead to an unwillingness to talk. He/she might become easily distracted and struggle with planning and organizing.
Difficulties with memory
Memory loss may appear later in life, compared to other types of dementia such as Alzheimer's, a degenerative brain disease, or vascular dementia, which develops due to reduced blood flow to the brain and tends to get worse over time. People diagnosed with dementia can have trouble with time – forgetting the time of day, what month it is, when an event occurred. Common memory lapses include making frequent mistakes or a subtle decline in performing the activities of normal daily living – paying bills, remembering medications, traveling outside of the house, recognizing acquaintances and even loved ones.
Physical difficulties
Physical difficulties may also occur in patients with dementia – slowed or stiff movements, loss of bowel or bladder control, muscular weakness or chewing and swallowing trouble are among such changes. Dementia sufferers tend to have trouble with coordination and fine motor movements. These challenges can exacerbate during the performance of everyday tasks, to the point that the individuals will not be able to take care of themselves and intervention is needed.
Treatment of frontotemporal dementia
At the moment, there is no cure available for FTD. However, healthcare experts can prescribe medication to alleviate symptoms. Antidepressants are beneficial in the treatment of anxiety and in the management of obsessive-compulsive behaviors and other symptoms. Sleeping aids can assist in the treatment of insomnia and other sleep disorders.
In addition to medical treatments, there are other supporting programs available, such as assisted living and senior living services and home care services that help a person in maintaining brain health, controlling behavioral symptoms, and enhancing their overall quality of life.
At Desert Haven Home Care and Apollo Residential Assisted Living in Greater Phoenix, Arizona, professional healthcare team members are on hand to make certain the proper treatments for dementia are always in place and constantly practiced. Team members know the symptoms of the syndrome and are prepared to ensure all appropriate measures are taken to ensure the good health and comfort of their residents.
Among the foundations of our care, as endorsed by the Alzheimer’s Association Campaign for Quality Residential Care, are:
Quality relationships shared with residents by professional team members; a supportive environment
Assessment of each resident’s abilities for proper acre and planning; recognition of special needs
Person-focused strategies; working with residents to ensure the best-possible quality-of-life results
Meaningful, daily social interactions
Formal and informal activities that provide personal meaning and sense of community and choices.
For more information about Desert Haven Home Care and Apollo Residential Assisted Living, visit www.deserthavenaz.com.
References
[1] Fifield, Kathleen. Dementia vs. Alzheimer’s: Which Is It?. AARP. (2020) https://www.aarp.org/health/dementia/info-2018/difference-between-dementia-alzheimers.html?CMP=KNC-DSO-COR-DementiaAlzheimers-19386-GOOG-HEALTH-Dementia-Dementia-Dementiavs.Alzheimers-Exact-NonBrand&gclid=EAIaIQobChMI-v3v8Jvp9AIVzBmtBh1YbgaREAAYAiAAEgJDbfD_BwE&gclsrc=aw.ds.
[2] Rabinovici GD, Miller BL. Frontotemporal lobar degeneration: epidemiology, pathophysiology, diagnosis, and management. CNS drugs. 2010; 24 (5): 375-98.
[3] Mackenzie IR, et. al. A harmonized classification system for FTLD-TDP pathology. Acta neuropathologica. 2011; 122 (1): 111-3.
[4] Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. Journal of Neurology, Neurosurgery and Psychiatry. 1994; 57 (4):416-8.
[5] Warren JD, Rohrer JD, Rossor MN. Clinical review. Frontotemporal dementia. BMJ. 2013;347:f4827-f.
[6] Rohrer JD, Warren JD. Phenotypic signatures of genetic frontotemporal dementia. Current opinion in neurology. 2011;24(6):542-9.
[7] Bretag-Norris R, Gallur L, Flynn P. Heterogeneity in the psychiatric presentation of behavioral variant frontotemporal dementia (bvFTD). Australasian psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists. 2019; 27 (5): 491-5.
[8] Stanford, Prudence M., Claire E. Shepherd, Glenda M. Halliday, William S. Brooks, Peter W. Schofield, Henry Brodaty, Ralph N. Martins, John B. J. Kwok, and Peter R. Schofield. "Mutations in the Tau Gene That Cause an Increase in Three Repeat Tau and Frontotemporal Dementia." Brain 126, no. 4 (2003): 814-26.
[9] van Swieten, John C., and Peter Heutink. "Mutations in Progranulin (Grn) within the Spectrum of Clinical and Pathological Phenotypes of Frontotemporal Dementia." The Lancet Neurology 7, no. 10 (2008/10/01/ 2008): 965-74.
[10] Prudencio M, et.al. Truncated stathmin-2 is a marker of TDP-43 pathology in frontotemporal dementia. J Clin Invest. 2020 Nov 2; 130.
[11] Balendra R, Isaacs AMJNRN. C9 or f72-mediated ALS and FTD: multiple pathways to disease. Nat Rev Neurol. 2018; 14 (9): 544-58.
[12] Chan DK, et. al. Frontotemporal dementia - features, diagnosis, and management. Australian Family Physician. 2011; 40 (12): 968-72.
[13] Karlawish J. Is It Dementia? Everyday Signs That Merit a Doctor Visit; A Leading Brain Health Expert Shares What You Should Look Out For. 25 June 2018. Retrieved from https://www.aarp.org/health/dementia/info-2018/everyday-tasks-dementia-signs.html?CMP=KNC-DSO-COR-DementiaAlzheimers-21685-Bing-HEALTH-Dementia-Dementia-Signs-Phrase-NonBrand&&msclkid=f8e22c7a197a15e96d114dcb3f45b955&utm_source=bing&utm_medium=cpc&utm_campaign=Health-DementiaAlzheimers-NonBrand-Phrase&utm_term=early%20signs%20of%20frontal%20lobe%20dementia&utm_content=Dementia-Signs&gclid=f8e22c7a197a15e96d114dcb3f45b955&gclsrc=3p.ds.
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