What is dementia?
Frontotemporal dementia (FTD), or Pick's disease, is a syndrome featuring shrinking of the frontal and temporal anterior lobes of the brain.
- The symptoms of frontotemporal dementia fall into two clinical patterns that involve either: (1) changes in behavior, or (2) problems with language.
- Frontotemporal dementia is often inherited and runs in families.
- There is no treatment for frontotemporal dementia and treatment is directed toward minimizing symptoms.
- Frontotemporal dementia progresses steadily and often rapidly and is fatal. The duration of disease ranges from less than 2 years in some individuals to more than 10 years in others
What is frontotemporal dementia (Pick's disease)?
Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Originally known as Pick's disease, the name and classification of frontotemporal dementia has been a topic of discussion for over a century. The current designation of the syndrome groups together Pick's disease, primary progressive aphasia, and semantic dementia as frontotemporal dementia. Some doctors propose adding corticobasal degeneration and progressive supranuclear palsy to frontotemporal dementia and calling the group Pick Complex. These designations will continue to be debated.
What are the symptoms for dementia?
Dementia symptoms vary depending on the cause, but common signs and symptoms include:
- Memory loss, which is usually noticed by a spouse or someone else
- Difficulty communicating or finding words
- Difficulty reasoning or problem-solving
- Difficulty handling complex tasks
- Difficulty with planning and organizing
- Difficulty with coordination and motor functions
- Confusion and disorientation
- Personality changes
- Inappropriate behavior
When to see a doctor
See a doctor if you or a loved one has memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important to determine the underlying cause.
What are the causes for dementia?
Dementia involves damage of nerve cells in the brain, which can occur in several areas of the brain. Dementia affects people differently, depending on the area of the brain affected.
Dementias are often grouped by what they have in common, such as the part of the brain that's affected or whether they worsen over time (progressive dementias). Some dementias, such as those caused by a reaction to medications or vitamin deficiencies, might improve with treatment.
Types of dementias that progress and aren't reversible include:
Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most common cause of dementia.
Although the cause of Alzheimer's disease isn't known, plaques and tangles are often found in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.
Certain genetic factors might make it more likely that people will develop Alzheimer's.
- Vascular dementia. This second most common type of dementia occurs as a result of damage to the vessels that supply blood to your brain. Blood vessel problems can be caused by stroke or other blood vessel conditions.
- Lewy body dementia. Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease. This is one of the more common types of progressive dementia.
Frontotemporal dementia. This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.
As with other dementias, the cause isn't known.
- Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer's disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.
Other disorders linked to dementia
- Huntington's disease. Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills usually appear around age 30 or 40.
Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.
Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms, such as depression, explosiveness, memory loss, uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms might not appear until years after the trauma.
Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to an abnormal form of a protein. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue.
Signs and symptoms of this fatal condition usually appear around age 60.
- Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).
Dementia-like conditions that can be reversed
Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:
- Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body's attempt to fight off an infection. Conditions such as multiple sclerosis that result from the body's immune system attacking nerve cells also can cause dementia.
- Metabolic problems and endocrine abnormalities. People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or an impaired ability to absorb vitamin B-12 can develop dementia-like symptoms or other personality changes.
- Nutritional deficiencies. Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms.
- Reactions to medications. A reaction to a medication or an interaction of several medications can cause dementia-like symptoms.
- Subdural hematomas. Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to dementia.
- Poisoning. Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as alcohol abuse or recreational drug use can lead to symptoms of dementia. Symptoms might resolve with treatment.
- Brain tumors. Rarely, dementia can result from damage caused by a brain tumor.
- Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia can occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.
- Normal-pressure hydrocephalus. This condition, which is caused by enlarged ventricles in the brain, can cause walking problems, urinary difficulty and memory loss.
What are the treatments for dementia?
No treatment has been shown to slow the progression of frontotemporal dementia. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Antidepressants have been shown to improve some symptoms.
What are the risk factors for dementia?
Many factors can eventually lead to dementia. Some factors, such as age, can't be changed. Others can be addressed to reduce your risk.
Risk factors that can't be changed
- Age. The risk rises as you age, especially after age 65. However, dementia isn't a normal part of aging, and dementia can occur in younger people.
- Family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do. Tests to determine whether you have certain genetic mutations are available.
- Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease.
- Mild cognitive impairment. This involves difficulties with memory but without loss of daily function. It puts people at higher risk of dementia.
Risk factors you can change
You might be able to control the following risk factors of dementia.
- Heavy alcohol use. If you drink large amounts of alcohol, you might have a higher risk of dementia. Some studies, however, have shown that moderate amounts of alcohol might have a protective effect.
- Cardiovascular risk factors. These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis) and obesity.
- Depression. Although not yet well-understood, late-life depression might indicate the development of dementia.
- Diabetes. If you have diabetes, you might have an increased risk of dementia, especially if it's poorly controlled.
- Smoking. Smoking might increase your risk of developing dementia and blood vessel (vascular) diseases.
- Sleep apnea. People who snore and have episodes where they frequently stop breathing while asleep may have reversible memory loss.
Is there a cure/medications for dementia?
Several prescription medications are approved by the Food and Drug Administration (FDA) to treat symptoms of dementia caused by AD. These drugs can provide short-term relief from cognitive dementia symptoms. Some can also help slow the progression of AD-related dementia.
While these drugs are approved to treat symptoms of AD, they’re not approved to treat symptoms of other types of dementia. However, researchers are exploring off-label uses of these medications for people with non-AD dementias.
According to the Alzheimer’s Association, some AD medications may benefit people with Parkinson’s disease dementia and vascular dementia.
Some of the most commonly prescribed medications used to treat symptoms of AD are cholinesterase inhibitors and memantine.
Cholinesterase inhibitors work by increasing acetylcholine, a chemical in your brain that aids in memory and judgment. Increasing the amount of acetylcholine in your brain may delay dementia-related symptoms. It may also prevent them from worsening.
The more common side effects of cholinesterase inhibitors include:
Some commonly prescribed cholinesterase inhibitors are:Donepezil (Aricept)
Donepezil (Aricept) is approved to delay or slow the symptoms of mild, moderate, and severe AD. It may be used off-label to help reduce behavioral symptoms in some people with thought problems following a stroke, LBD, and vascular dementia.
It’s available as a tablet.Galantamine (Razadyne)
Galantamine (Razadyne) is approved to prevent or slow the symptoms of mild to moderate AD. It may be used off-label to help provide the same benefit for people with LBD or vascular dementia.
It’s available as a tablet, an extended-release capsule, and an oral solution.Rivastigmine (Exelon)
Rivastigmine (Exelon) is approved to prevent or slow the symptoms of mild to moderate AD or mild to moderate Parkinson’s dementia.
It’s available as a capsule and as an extended-release skin patch.
Memantine (Namenda) is mainly used to delay increasing cognitive and behavioral symptoms caused by moderate to severe AD. This effect may allow people with AD to function more normally for a longer time.
Memantine may be used off-label to provide the same benefit for people with vascular dementia.
Memantine isn’t a cholinesterase inhibitor, but it also acts on chemicals in the brain.
In fact, memantine is often prescribed in combination with a cholinesterase inhibitor. An example of this combination is Namzaric. The medication combines extended-release memantine with donepezil.
Memantine is available as a tablet, an extended-release capsule, and an oral solution.
Its more common side effects include:
- high blood pressure
- increased sensitivity to contract the flu