Frontotemporal dementia (FTD) is a group of disorders that primarily affect the frontal and temporal lobes of the brain, which control behavior, language, and decision-making. It is one of the most common types of dementia in people under 60, often starting with subtle changes in personality or language rather than memory loss. While there is no cure, early diagnosis can help manage symptoms and improve quality of life.

FTD is categorized based on the specific brain regions and symptoms involved:

• Behavioral Variant FTD (bvFTD): Causes significant changes in personality, social behavior, and judgment.
• Primary Progressive Aphasia (PPA): Affects language skills, leading to difficulty speaking, understanding, or naming objects.
  • Semantic Variant: Trouble understanding word meanings.
  • Nonfluent/Agrammatic Variant: Difficulty forming or speaking grammatically correct sentences.
• FTD with Movement Disorders: Includes conditions like corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP), which affect motor skills.

Each type has distinct symptoms but shares the common feature of progressive brain degeneration.

Symptoms of FTD can vary depending on the type but often include:

• Behavioral Variant FTD (bvFTD):

  • Personality changes, such as apathy or inappropriate social behavior.
  • Loss of empathy or increased impulsiveness.
  • Difficulty with planning or decision-making.

• Primary Progressive Aphasia (PPA):

  • Struggling to find words or name objects.
  • Difficulty understanding spoken or written language.
  • Trouble constructing grammatically correct sentences.

• FTD with Movement Disorders:

  • Muscle rigidity, tremors, or balance problems.
  • Slowness of movement or difficulty controlling eye movements.

Unlike Alzheimer’s, memory problems are typically not the earliest symptom.

Diagnosing FTD involves:

1. Medical and Family History: Reviewing symptom onset, changes in behavior or language, and family history of neurological conditions.
2. Neurological and Cognitive Testing: Assessing memory, language, problem-solving, and behavioral changes.
3. Imaging Studies: MRI or CT scans to detect brain shrinkage, especially in the frontal and temporal lobes.
4. Genetic Testing: Identifying mutations linked to inherited forms of FTD.
5. Blood Tests and Spinal Fluid Analysis: Ruling out other conditions that may mimic FTD symptoms.

Early and accurate diagnosis is crucial for planning care and managing symptoms.

There is no cure for FTD, but treatment focuses on managing symptoms and maintaining quality of life:

• Behavioral Management: Structured routines and behavioral strategies to address personality changes.
• Speech Therapy: Helping individuals with PPA improve communication or use alternative methods.
• Medications:
  • Antidepressants for mood changes or apathy.
  • Medications to manage movement symptoms in cases with motor involvement.
• Lifestyle Adjustments: Regular exercise, a healthy diet, and social engagement to support overall well-being.
• Supportive Care: Counseling, support groups, and caregiver education to navigate the challenges of FTD.

A multidisciplinary approach tailored to individual needs can help individuals and families cope with the progression of FTD.