Frontotemporal Dementia: A Review for Primary Care Physicians
ROBERTO CARDARELLI, DO, MPH, University of North Texas Health Science Center, Fort Worth, Texas ANDREW KERTESZ, MD, University of Western Ontario, London, Ontario, Canada JANICE A. KNEBL, DO, University of North Texas Health Science Center, Fort Worth, Texas
Am Fam Physician. 2010 Dec 1;82(11):1372-1377.
http://www.aafp.org/afp/2010/1201/p1372.pdf
Frontotemporal dementia (formally known as pick disease) is a disease which causes progressive decline in behavior and communication. It is due to atrophy of the frontal and temporal lobes of the brain. There are three categories:
behavioral variant FTD,
semantic dementia, and
progressive nonfluent aphasia.
They can be differentiated by histology. Tau-positive inclusions are more common in progressive nonfluent aphasia. Ubiquitin-positive inclusions are seen in semantic dementia. Behavioral variant FTD will contain both tau and ubiquitin inclusions. Pick bodies in inclusions are still called Pick disease.
The variations can also be determined through a good history, family history, and physical exam. In all variants, the onset is gradual and insidious, and memory is not affected (unlike in alzheimer's disease patients). Behavioral variant FTD is identified as having changes primarily in personality, leading to inappropriate social behaviors, emotional dulling, apathy, loss of insight, inappropriate sexual comments and inappropriate physical contact. Semantic dementia is characterised as having speech that is meaningless and generic. It will lack specific meaning and have semantic general terms instead of the correct words. They will also not be able to recognize familiar or famous faces (like of family or celebrities). Progressive nonfluent aphasia is characterised as having a hard time with speech. They will have hesitant, stuttering, nonfluent and agrammatic speech. They will also have anomia (problem naming objects) and agrammatism (omitting of grammatical terms). Alzheimers will present with memory and visuospatial deficits. Lewy body dementia will have memory and cognition problems, as well as visual hallucinations. Vascular dementia will present with problems with focal neurological deficit, gait problems, and changes in mood and personality.
Treatment consists mostly of SSRIs and antipsychotics, if there is aggressive behavior. Nonpharmacologic treatment includes addressing the caregivers needs, functional issues with ADLs, social stressors, counseling for the caregivers and family members, and providing education about the disease.
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