Steven Lippmann, M.D.

Frontotemporal dementia (FTD) is a progressive dementing illness starting during middle to older life. This neurodegenerative brain disease of the frontal and temporal lobes results in personality, behavioral, and language alterations. These clinical features are much more prominent than the forgetfulness and diminished cognition of most other dementing illnesses.

FTD is an uncommon type of dementia. The deterioration initially is observed in social spheres, thus recognition is often difficult or delayed. The pathological finding of neuronal inclusions, called Pick bodies, yields the original descriptive name, Pick’s Disease; abnormal protein accumulation and gliosis are also documented histologically.

Clinical observation focuses on abnormalities of behavior that include impulsivity, dysinhibiton, distractibility, and poor judgment. These result in considerable social distress, thus FTD can easily be mistaken for a psychiatric condition. Dysfunction at self-care, speech, and socialization appear. In more advanced cases, cognitive declines and problem solving difficulties become clinically overt.

The diagnosis of frontotemporal dementia requires a comprehensive assessment. There is history of change in social behavior, speech, and continence. On physical examination, frontal lobe neurological dysfunction may be documented with the signs of snout, rooting, grasp, and palmer-mental reflexes. Neuroimaging sometimes reveals selective frontal and temporal atrophy, but scan results are not well correlated to clinical presentations. Electroencephalogram results are non-specific, and may or may not document frontotemporal slowing.

There is no specific treatment for FTD. Behavioral education might be helpful very early in the course. Symptomatic or behavioral control medicinals are applied, as indicated. Impulsivity, aggression, and hypersexuality may call for mood stabilizer drugs or other calmative pharmacotherapy; hormonal treatments may sometimes be indicated in selected cases. Routine dementia-related, cognitive-enhancement medicines are not traditionally utilized. Nursing or personal care may be required, either in the home or in institutional settings. Supportive care and community social services can be valuable for patients, family, and society at large.