Has someone close to you suddenly changed? Could it be Frontotemporal Dementia (FTD)?

Imagine, your father, husband, or someone very close to you... Suddenly his behavior changes completely. The person who was previously very kind and sociable now says hurtful things to others, and behaves inappropriately in society. You might think that this is some kind of mental problem, maybe something like depression. But, this could be something different, a brain-related condition. Today we are talking about a condition that causes such changes, different from Alzheimer's disease, but that many people do not know about. That is Frontotemporal Dementia, or FTD.

What is Frontotemporal Dementia (FTD)?

Simply put, FTD is a condition that occurs when damage occurs to the frontal and temporal lobes of our brain. These are the parts that control our personality, behavior, and language. So when these parts are damaged, symptoms go beyond memory loss. A person's behavior, the way they speak, the way they understand words, and even their body movements can change.

Although FTD is not as well-known as Alzheimer's, between 10% and 20% of people with dementia have some form of FTD. It can have a significant impact on lives because it can begin earlier than other types of dementia, usually between the ages of 45 and 60 .

Because of the early symptoms, such as being stubborn, unkind, or acting out, it is often misdiagnosed as a mental illness. This is a major reason why FTD is often initially delayed. Your doctor may also refer to it as Pick's disease.

What are the main types of FTD?

FTD can be divided into several main categories based on the symptoms that first appear. To understand this clearly, let's look at this table.

What are the possible symptoms of FTD?

The symptoms of FTD vary from person to person. They tend to get worse over time. Let's look at these symptoms under several categories.

Behavioral changes

• Socially indecent: Says what's on your mind without any shame. Tells hurtful things to others, tends to get too close to others.
• Loss of empathy: Inability to understand other people's feelings. May act as if someone is very cold-hearted.
• Apathy: Loss of interest or concern for things you used to enjoy.
• Repeating the same things over and over: Doing things like clapping hands, biting lips, etc. Repeating the same words and sounds.
• Neglecting personal hygiene: not brushing teeth or bathing.
• Changes in eating habits: Eating a lot of sweets at once, sometimes trying to eat things that are not good for you.

Differences in speech and language

• It's hard to find the right words when speaking.
• Words are losing their meaning.
• Speaks in very simple, short sentences.
• Sometimes things said may not make any sense.

Changes in body movement

• Difficulty moving the eyes.
• Body tremors, muscle twitching.
• Stiffness of the body.
• Loss of body control.
• Difficulty swallowing food.
• The story is confusing.
• I'm going to fall, it's going to be hard to walk.

What are the causes and risk factors for FTD?

As brain cells (neurons) die in people with FTD, parts of the brain shrink. Scientists believe that this is caused by abnormal activity of certain proteins that our bodies produce. In particular, this damage is caused by the accumulation of abnormal forms of two proteins called tau and TDP-43 in the brain.

About 40% of FTD patients have a family history of the disease . This means it may be genetic. In addition, other factors can increase the risk:

• A serious head injury: This can increase the risk of developing FTD by about three times.
• Thyroid disease: This more than doubles the risk.

How is FTD diagnosed?

It can be difficult to accurately diagnose FTD because its symptoms can be similar to other illnesses, such as Parkinson's, Alzheimer's, depression, and schizophrenia .

The doctor will ask about your family history and may order blood tests to rule out other conditions. They will often refer you to a neurologist. He or she will test things like your balance, reflexes, memory, and thinking skills. Tests such as these may be ordered to confirm FTD:

• CT scan: A detailed X-ray image of the brain.
• MRI scan: Uses magnets and radio waves to produce very clear images of the brain.
• FDG-PET scan: A radioactive substance is injected intravenously to see how active different parts of the brain are.
• EEG (electroencephalogram): Measurement of the electrical activity of the brain.
• Spinal tap: Examination of the fluid surrounding the brain and spinal cord.
• Neuropsychological testing: Tests that measure mental abilities such as memory, language ability, and reasoning ability are measured through questionnaires, drawing pictures, and solving puzzles.

What are the treatments for FTD?

Unfortunately, there is no cure or treatment for FTD. Medications used to treat Alzheimer's disease do not work for FTD. In some cases, these medications can even make symptoms worse.

However, there are some medications and treatments that can help manage symptoms:

• Antidepressants: Control mood and behavioral problems.
• Antipsychotics: Although they can help control severe behavioral problems, they can have serious side effects. These are used only under the close supervision of a doctor.
• Speech therapy: Help with communication problems.

Living with and caring for FTD

This disease is a huge challenge for both the patient and the family. Therefore, it is very important to seek the help of a doctor who is well-versed in the disease as soon as it is diagnosed.

If you are a caregiver for someone with FTD...

This journey can be very tiring for the caregiver. Here are some things that can help you:

• Keep a diary: Note changes in the patient's behavior and the triggers that cause them. This can help you avoid problematic situations.
• Establish a consistent routine: Things like feeding and bathing at the same time can provide some relief to the patient.
• Explain the situation to others: Inform visitors and relatives about the patient's condition in advance.
• Think about yourself too: This is very important. You can only take good care of the patient if you are physically and mentally well. Eat well, sleep well, and exercise. Get help from someone else to give you a break (respite care).
• Plan for the future: Over time, the patient will need 24-hour care. This may require care in a nursing home. It is important to plan ahead for this.

The average life expectancy after a diagnosis of FTD is about 7.5 years. Death is more likely to occur from complications of the disease than from the disease itself. For example, pneumonia due to difficulty swallowing is a leading cause of death.