What is frontotemporal dementia?
Frontotemporal dementia (FTD) is a group of brain conditions that affect the front and side parts of the brain. These areas control personality, behavior, language, and sometimes movement. FTD often begins at a younger age than other types of dementia, frequently in a person’s 50s or 60s. There are several main types, described below.
Common symptoms
Behavioral variant FTD
This is the most common type. It mainly affects personality and behavior. Common changes include:
- Acting differently than usual, such as being impulsive or losing social “filters”
- Loss of motivation or interest (appearing withdrawn or apathetic)
- Reduced empathy or concern for others’ feelings
- Changes in eating habits or new cravings
- Trouble with planning, organizing, and decision-making
Because the early signs are about behavior, FTD is often first mistaken for depression, stress, a midlife crisis, or another mental health condition.
Primary progressive aphasia (PPA)
This type mainly affects language: speaking, understanding words, or both. Memory is often relatively spared early on. There are three variants:
- Semantic variant: Speech stays smooth, but the person gradually loses the meaning of words and the names of everyday objects.
- Nonfluent/agrammatic variant: Speaking becomes slow, effortful, and halting, with trouble forming grammatical sentences. Understanding is usually preserved.
- Logopenic variant: The main problem is difficulty finding the right words and repeating phrases, with frequent pauses while searching for words.
FTD with parkinsonism
Some people with FTD also develop movement problems similar to Parkinson’s disease. These can include:
- Stiffness or rigidity in the muscles
- Slowed movement
- Balance problems
- Tremor in some cases
Each person’s experience with FTD is different, and symptoms can overlap between types. A specialist can help determine which type is present and guide care, support, and planning.
How we make the diagnosis
The diagnosis starts with a careful history. Family members are often the first to notice changes, so we ask them to come to the visit and share what they have seen.
At your visit, we will:
- Talk with you and your family about changes in behavior, personality, and language, and when they started
- Ask about family history of dementia, ALS, or psychiatric illness
- Do a neurological exam
- Do in-office cognitive and language testing
We use blood tests to rule out reversible causes. A brain MRI can show shrinking in the frontal or temporal lobes and rule out other causes. Sometimes we order other brain scans.
Alzheimer’s disease can sometimes look like FTD. To check for it, we may order an amyloid blood biomarker test, an amyloid PET scan, or a spinal fluid (CSF) test. When FTD runs in the family, genetic testing may help.
Treatment options
There is not yet a medicine that stops FTD. But treatment can help with symptoms, safety, and quality of life, and we build the plan around the person and the family.
Behavior and mood. Some medicines may help with behavior changes, anxiety, or depression. Memory medicines used for Alzheimer’s disease usually do not help FTD, and some can make behavior worse, so we choose medicines carefully.
Speech and language. Speech therapy can teach new ways to communicate, such as using pictures, writing, or a tablet.
Movement and safety. Physical therapy helps with walking and balance. We also talk about safety at home, driving, and money.
Daily routines. A steady daily routine, a calm setting, and simple choices can make each day easier.
Your medication list
Make sure you bring a typed list of medications used to treat frontotemporal dementia that failed or caused side effects. Use BPMedTracker to track your medications and print a list.
Support for families
FTD can be very hard on families. The person may not realize that anything is wrong, and changes in behavior can strain relationships. Many families also face challenges with work, money, and children still at home.
Caregivers are welcome at every visit. We can help you understand the changes, plan for safety, and find help. Planning ahead for legal, money, and health decisions early is important. Taking care of your own health matters too.
When to see a specialist
Consider an evaluation if you or a loved one has:
- New changes in behavior or personality, especially in midlife
- Loss of interest, poor judgment, or acting out of character
- Trouble finding words or understanding language
- Changes in behavior along with slowness, stiffness, or muscle weakness
- A family history of FTD or early dementia
An accurate diagnosis can explain confusing changes and help families plan. Call 940-828-MOVE (6683) to schedule a visit.
Support and resources
Frontotemporal dementia affects the whole family. The Association for Frontotemporal Degeneration (AFTD) offers a free HelpLine, education, and support groups for people living with FTD and their caregivers.
