Representing nearly 20% of degenerative dementias, frontotemporal dementia is one of the neurodegenerative pathologies related to Alzheimer’s disease. Essentially characterized by a progressive impairment of cognitive faculties, this form of dementia results from localized brain damage. How does it manifest? What treatments can it be subject to?
1. What are the signs of frontotemporal dementia?
The onset of symptoms of this neurodegenerative dementia occurs gradually. Initially, brain lesions located in the frontal and temporal areas will cause behavioral and language disorders likely to occur concomitantly or successively:
- Behavioral disorders: they initially take the form of slight intellectual apathy and withdrawal, associated with emotional reactions considered confusing by those around them. However, it happens that the clinical signs are more explicit and that the affected person adopts attitudes considered inappropriate by society (disinhibition, inappropriate gestures, inappropriate comments, etc.). At the same time, eating disorders (bulimia, anorexia, unwanted snacking, etc.) can occur, while an alteration in personal hygiene may be observed.
- Language disorders: they generally appear after behavioral disorders. At the beginning, the patient will have a tendency to search for words or will present some articulatory difficulties. The vocabulary also becomes poorer and reading becomes laborious. The more the lesions develop, the more speech function will be impacted until it is completely impaired. Ultimately, the person will lose their speech (aphasia) even if their comprehension abilities are preserved.
Although these two types of disorders are the majority in frontotemporal dementia, they can be accompanied by other clinical signs. Motor functions, in particular, are often affected. Movements and gestures become rigid. Walking becomes difficult. At the most advanced stages of the pathology, the patient completely loses his autonomy. He becomes incontinent, mute and apathetic. Swallowing disorders make eating complicated. In the majority of cases, the patient must be placed in a specialized establishment in order to receive medical assistance and care adapted to their disorders.
2. How is frontotemporal dementia diagnosed?
The diagnosis of this form of neurodegeneration still remains quite difficult to formally establish today. Behavioral disorders that trigger the patient’s clinical picture tend to primarily direct practitioners towards a psychiatric track and delay treatment of the pathology. The diagnosis of frontotemporal dementia is primarily based on a clinical examination and careful questioning of the patient to assess the nature and severity of their symptoms. Cognitive tests can then be carried out to determine possible alterations in speech, movements, mood, etc. In the event of strong suspicion, the neurologist will recommend carrying out a brain MRI or emission tomography. positrons to confirm the presence of lesions in the frontal lobe and/or temporal lobe.
3. What is the treatment for frontotemporal dementia?
Currently, there is no cure for frontotemporal dementia. The management of neurodegenerative pathology will therefore aim to reduce the effects of the various symptoms presented by the patient. Molecules aimed at increasing serotonergic tone, such as paroxetine or fluvoxamine, may be recommended to combat the patient’s apathy or lack of interest. Sedatives may be preferred in agitated patients, while certain antipsychotic medications will be administered to aggressive or particularly anxious people.
According to Reference center for rare or early-onset dementias, the use of cholinesterase inhibitors — usually recommended in the context of Alzheimer’s disease — is contraindicated for this form of dementia. These medications would, in fact, be likely to aggravate behavioral disorders. Alongside the pharmacological treatment implemented, non-drug treatment is essential. This generally involves a multidisciplinary team of practitioners with a view to improving the patient’s comfort of life: speech therapist, physiotherapist, occupational therapist, psychologist, gerontologist, etc. Support for the patient’s relatives is also offered, because the pathology has a serious impact on the patient’s life. surroundings.
Sources
- Fronto-temporal dementias, Orphanet General Public Encyclopedia, Reference Center for rare or early-onset dementias, September 2007
- Frontotemporal degeneration (FTD), Federation for Brain Research (FRC)
- Frontotemporal Dementia, Juebin Huang, The MSD Manual — Consumer Version, February 2023
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