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    Fronto Temporal Dementia (FTD) is an early-onset dementia that primarily affects the frontal and temporal lobes. It presents with changes in behavior and personality before memory loss. There are several variants of FTD including behavioral-variant FTD (bvFTD) characterized by a decline in regulation of personal conduct, primary progressive aphasia (PNFA) with non-fluent aphasia but intact comprehension, and semantic dementia (SD) with a loss of semantic knowledge. Treatment focuses on managing behavioral symptoms with SSRIs or antipsychotics but does not target improving cognition like AchEIs.

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    Fronto Temporal Dementia (FTD) is an early-onset dementia that primarily affects the frontal and temporal lobes. It presents with changes in behavior and personality before memory loss. There are several variants of FTD including behavioral-variant FTD (bvFTD) characterized by a decline in regulation of personal conduct, primary progressive aphasia (PNFA) with non-fluent aphasia but intact comprehension, and semantic dementia (SD) with a loss of semantic knowledge. Treatment focuses on managing behavioral symptoms with SSRIs or antipsychotics but does not target improving cognition like AchEIs.

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    9 views20 pages

    FTD Class Thursday

    Uploaded by

    seby
    Fronto Temporal Dementia (FTD) is an early-onset dementia that primarily affects the frontal and temporal lobes. It presents with changes in behavior and personality before memory loss. There are several variants of FTD including behavioral-variant FTD (bvFTD) characterized by a decline in regulation of personal conduct, primary progressive aphasia (PNFA) with non-fluent aphasia but intact comprehension, and semantic dementia (SD) with a loss of semantic knowledge. Treatment focuses on managing behavioral symptoms with SSRIs or antipsychotics but does not target improving cognition like AchEIs.

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    of 20

    1

    Fronto Temporal Dementia Spectrum

    Col K Seby
    Dementia
    2

    ◻ Major Neurocognitive disorder


    ◻ De Mentia (Latin) = “Devoid of mind”
    ◻ 20% are treatable/reversible (Heji et al 2002)
    Importance of FTD for Psychiatrists
    3
    Importance of FTD for Psychiatrists
    4

    ◻ Early onset compared to Alzheimer’s Dementia (AD)


    ◻ Early behavioural & personality changes mimicking
    primary psy disorder
    ¤ Memory impairment later
    Spectrum of FTD
    5

    ◻ Non-homogenous group
    ◻ Varied etiology
    ◻ Frontal or temporal or both affected out of proportion
    to other parts of brain
    History of FTD
    6

    ◻ 1892 Arnold Pick (German neurologist) – Pick’s


    disease
    ¤ Insidious personality/behavioural change
    ¤ Disinhibition
    ¤ Subsequent gradual loss of speech
    ◻ 1990 paper by Gustafson & Brun
    Epidemiology of FTD
    7

    ◻ 0.15% prevalence
    ◻ 10-15% of neurodegenerative dementias

    ◻ Onset 45-65 yrs (50-60 yrs)

    ¤ except SD – onset 70 yrs

    ◻ 50% familial

    ¤ Autosomal Dominant commonly


    Variants
    8

    ◻ Bv FTD or fv FTD
    ◻ PFNA

    ◻ SD

    ◻ FTD-MND
    bvFTD - Features
    9

    ◻ Early decline of IP conduct


    ◻ Early decline in regulation of personal conduct

    ◻ Early emotional blunting

    ◻ Early loss of insight


    bvFTD – Features contd
    10

    ◻ Decline in personal hygiene


    ◻ Mental inflexibility/impersistence/ distractibility

    ◻ Hyperorality

    ◻ Dietary changes

    ◻ Perseverative or stereotyped behaviour

    ◻ Utilization behaviour

    ◻ Purposeless behaviour, lacking in goals

    ◻ OC symptoms – hoarding, pica, eating same kind of


    food like sweets
    ◻ Emotional lability, apathy
    bvFTD contd
    11

    ◻ Orbitofrontal type
    ¤ Overactive, disinhibited

    ◻ Other frontal areas


    ¤ Apathetic
    bvFTD contd
    12

    ◻ Males = Females
    ◻ Duration 2-15 yrs

    ◻ Psychometry
    ¤ Executive dysfunction
    ¤ Reduced verbal recall
    ¤ Phonemic fluency affected more than categorical
    fluency
    ¤ Preserved visual memory
    ¤ Preserved recognition memory
    bvFTD contd
    13
    PNFA
    14

    ◻ Non-fluent aphasia with intact comprehension


    ◻ Anomia

    ◻ Phonemic paraphasia

    ◻ Social skills preserved & behavioural symptoms mild

    ◻ Eventually mutism
    PNFA
    15
    SD
    16

    ◻ Temporal variant FTD


    ◻ Semantic knowledge loss

    ◻ Supra-ordinate paraphasia

    ◻ Surface dyslexia

    ◻ More behavioural symptoms than PPA

    ◻ Progresses to mutism
    SD
    17
    FTD-MND
    18

    ◻ 10% of ALS patients develop FTD


    ◻ ALS symptoms – fasciculations, weakness,

    hyperreflexia, spasticity, upgoing plantars


    ◻ Swallowing difficulties, choking
    Rule out
    19

    ◻ Structural frontal pathology


    ¤ Meningioma

    ¤ Chronic SDH

    ◻ Vit B12 deficiency

    ◻ Neurosyphilis

    ◻ Hexa Nucleotide repeat in strongly familial cases


    Treatment
    20

    ◻ SSRI
    ¤ Apathy, depressive symptoms

    ◻ Low dose SDA like Quetiapine

    ¤ Agitation

    ◻ No role for AchEI like Donepezil

    ¤ Memantine may be tried

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