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Frontotemporal dementia or FTD is a degenerative brain disorder initially described over 100 years ago by the German neurologist, Arnold Pick, who was a colleague of Alois Alzheimer. Although Alzheimer's disease (AD) and Pick's disease (as FTD used to be known) have some similarities, they have a number of important differences. FTD is much rarer than AD overall, but among individuals age 65 years or less, FTD and AD are about equally common.

AD vs. FTD

AD is defined by the accumulation of amyloid plaques and neurofibrillary tangles that are composed of an abnormal form of a protein called tau. FTD, by contrast, is defined by either the abnormal accumulation of tau protein that form structures called Pick bodies, in some cases, or the excess accumulation of a protein called ubiquitin, in other cases.

Three Types of FTD

Clinically, AD almost always involves short-term memory difficulties as the most prominent sign, whereas FTD comes in three main "flavors" or types, depending on which parts of the frontal and/or temporal lobes are most affected.

When the left frontal and temporal lobes of the brain are primarily affected, this gives rise to a syndrome of expressive language difficulties referred to as "primary progressive aphasia." When the right frontal or temporal lobes are most affected, this typically results in altered behavior and personality traits, such as developing obsessive-compulsive behaviors (e.g. craving sweets), becoming apathetic or disinhibited, and having diminished social skills and personal hygiene. Judgment and insight may also be severely compromised out of proportion to other cognitive deficits that are more easily detected on standard clinical testing.

A third main form of FTD occurs when both temporal lobes are affected, resulting in the gradual loss of being able to attach meaning to words (semantic dementia). In reality, these different forms of FTD often overlap, making it more difficult to distinguish FTD from AD.

Implications of FTD

One of the unfortunate aspects of FTD is that it tends to occur much earlier than AD, with the average onset in the 50's or 60's. This has several important implications. Many patients still have children living at home and spouses who work. Children of affected individuals often don't understand why their parents are behaving in certain ways or no longer show affection towards them.

FTD also tends to be more strongly inherited than AD, with 20% of all cases arising in families with many affected individuals, compared to 5-10% of all AD cases. Financial implications can also be devastating when an affected individual loses a job due to symptoms or is no longer able to live on their own.

In the early stages, FTD also is difficult to recognize and diagnose, and may be misunderstood as a primary psychiatric problem.

Help is Available

To provide help with the unique and sundry challenges faced by individuals with FTD and their families, Alzheimers North Carolina, Inc. has support groups for caregivers of individuals with FTD.

Other Resources on FTD

  • Neurology, Vol. 56, No. 11, Supplement 4, 2001: A Multi-disciplinary Approach to Pick's Disease and Frontotemporal Dementia, Murray Grossman, M.D., Ed.D., Supplement Editor.
  • Alzheimer's Care Quarterly, July/September 2005 issue on "Atypical Dementias." Published by Lippincott Wilkins Williams, Carol Bowlby Sifton, Editor. This issue focuses on frontotemporal dementia, with a variety of articles about FTD written for the lay public, including one by an FTD patient. Visit www.ovid.com.
  • Alzheimer's Disease and Associated Disorders, Vol. 19, Supplement 1, October/December 2005, Murray Grossman, Editor. Contains articles from the July 2004 FTD Symposia. Please visit www.alzheimerjournal.com. Click on "Archive" and scroll to supplement.

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