Mri Acquisition And Volumetric Analysis
In addition to AD-RAI, in this study, a novel MRI-based biomarker named FTDI was derived based on the volumetric results of brain regions with significant volume difference between AD and FTD using the NACC data.
To increase the comparability of the numerical metrics, the relative volumes of the involved brain regions and lobe atrophy Ri were normalized to Ri, i.e.,
where Ri is the relative volume of the ith volumetric brain measure of the jth subject among all the subjects from NACC included in this study. For the ease of formulation, assume values in the array Ri are arranged so that the first m values are the subjects with FTD and the total number of subjects with FTD and AD is n. The FTD dominant structures are the structures with statistically larger Ri values in the FTD group, and the AD dominant structures are those with statistically larger Ri values in the AD group. It should be noted that the FTD/AD dominant structures did not refer to the abnormal brain regions of FTD/AD patients. They were derived from the group-level comparisons and were the volumetric metrics with the statistically larger values. min and max represent the minimal and maximal values in the ith volumetric brain measure of all subjects from NACC included in this study, respectively.
where i = are the FTD dominant structures and i = are the AD dominant structures.
Who Gets Frontotemporal Dementia
Frontotemporal dementia can affect anyone.
Symptoms of frontotemporal dementia typically occur between the ages of 40 and 65, though it can affect people younger or older than this. Almost a third of people with frontotemporal dementia have a family history of dementia. However, only about 10 to 15 per cent of people with the condition have familial frontotemporal dementia caused by a gene mutation.
The genetic basis of the condition is not fully understood and is being researched.
Frontal Lobe Dementia Onset
One main difference between frontal lobe dementia and Alzheimers disease is that, on average, frontal lobe dementia first presents itself significantly earlier in life. Frontal lobe dementia symptoms usually appear between 45 and 65 years of age, while the majority of Alzheimers cases occur in those over 65.
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Dementia Caused By Huntingtons Disease
Huntingtons disease is an inherited degenerative brain disease that affects the mind and body. It usually appears between the ages of 30 and 50, and is characterised by intellectual decline and irregular involuntary movement of the limbs or facial muscles. Other symptoms include personality change, memory disturbance, slurred speech, impaired judgement and psychiatric problems.There is no treatment available to stop the progression of this disease, but medication can control movement disorders and psychiatric symptoms. Dementia occurs in the majority of people with Huntingtons disease.
What Are The Symptoms Of Frontotemporal Dementia
Frontotemporal dementia affects everyone differently. Its symptoms vary a lot and depend on which areas of the frontal and temporal lobes are damaged and so the type of FTD the person has.
As with most forms of dementia, FTD is progressive. This means its symptoms may be mild at first, but they will get worse over time.
Find out more about FTD symptoms below.
Behavioural variant FTD
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There Are Two Broad Types Of Frontotemporal Dementia:
- Behavioural variant FTD where damage to the frontal lobes of the brain mainly causes problems with behaviour and personality. These lobes are found behind the forehead and process information that affects how we behave and the control of our emotions. They also help us to plan, solve problems and focus for long enough to finish a task.
- Primary progressive aphasia occurs when damage to the temporal lobes on either side of the head nearest the ears causes language problems. This part of the brain has many roles. A key function of the left temporal lobe is to store the meanings of words and the names of objects. The right temporal lobe helps most people recognise familiar faces and objects.
The first noticeable symptoms for a person with FTD will be changes to their personality and behaviour and/or difficulties with language.
These are very different from the early symptoms of more common types of dementia. For example, in Alzheimers disease, early changes are often problems with day-to-day memory. In the early stages of FTD, many people can still remember recent events.
Diagnosing Frontal Lobe Dementia
No one test is able to diagnose frontal lobe dementia. Instead physicians are able to use the balance of evidence to diagnose frontal lobe dementia based on their best judgment. Because there is no foolproof test and diagnosis depends on the physicians knowledge, judgment, and observation of the patient, frontal lobe dementia is notoriously difficult to diagnose in its early stages. Although as the disease progresses, it becomes easier to definitely distinguish it between other disorders.
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Pathophysiological Comparison Between Alzheimers Disease And Frontotemporal Dementia
Frontotemporal dementia affects the temporal behind the forehead and is responsible for judgment in a social situation. In contrast, Alzheimers disease affects the hippocampus and the brain circuits responsible for memory. FTD is a group of degenerative brain disorders that mostly tend to occur at a young age and result in the progressive loss of brain nerves in the frontal and temporal regions . This leads only to loss of function in the mentioned brain areas, such as language problems and deterioration of behavior and personality.
Moreover, Alzheimers disease affects hypertrophies in the hippocampus as the initial part is involved in the brains memory areas and spatial orientation. In addition, the neurons responsible for the brains behavior and perception regions are lost as the disease progresses. People with Alzheimers have no problems making sense of speech, unlike FTD, whose language is completely impaired. Those with Alzheimers are prone to hallucinations and delusions compared to FTD .
Staging Of The Ad In The Case Study
In the case study, the patient is in the moderate or middle stage of AD. This stages main feature is the decline in the ability to do daily living activities and irritability or withdrawn mood . At this stage, the individual losses abstract thinking and reason, and the spatial abilities get impaired. These features are evident in the case study as the patient needs help with daily living activities such as dressing. He is also unable to solve problems and incapable of balancing a checkbook. He is also aggressive and irritable. The wife is concerned about the patient wandering away from home. At this stage, the bladder and bowel sphincter are usually functional. The patient in the case study has a feature of moderate stage of AD.
Behavioral Variant Frontotemporal Dementia
Behavioral variant frontotemporal dementia was previously known as Pick’s disease, and is the most common of the FTD types. BvFTD is diagnosed four times as often as the PPA variants. Behavior can change in BvFTD in either of two waysit can change to being impulsive and disinhibited, acting in socially unacceptable ways or it can change to being listless and apathetic. About 1213% of people with bvFTD develop motor neuron disease.
The Pick bodies in behavioral variant FTD are spherical inclusion bodies found in the cytoplasm of affected cells. They consist of tau fibrils as a major component together with a number of other protein products including ubiquitin and tubulin.
Metacognition And Behavior In Ftd
Metacognition refers to high-level processing that consists of planning, self-evaluation, and self-monitoring of cognitive activities. Deficits in self-regulatory behavior, deriving from a lack of metacognitive control on executive abilities, have been related to prefrontal lesions.
Recently, this aspect was investigated in patients with FTD, and mostly patients with the frontal variant showed poor self-awareness and self-knowledge, not only in cognitive but also in emotional and social domains.87
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How Is Frontotemporal Dementia Diagnosed
Family members are often the first to notice subtle changes in behavior or language skills. Its important to see a healthcare provider as early as possible to discuss:
- Symptoms, when they began, and how often they occur
- Medical history and previous medical problems
- Medical histories of family members
- Prescription medicines, over-the-counter medicines, and dietary supplements taken
No single test can diagnose FTD. Typically, healthcare providers will order routine blood tests and perform physical exams to rule out other conditions that cause similar symptoms. If they suspect dementia, they may:
- Evaluate neurological status health including reflexes, muscle strength, muscle tone, sense of touch and sight, coordination, and balance
- Assess neuropsychological status such as memory, problem-solving ability, attention span and counting skills, and language abilities
- Order magnetic resonance imaging or computed tomography scans of the brain
Whats The Outlook For This Condition
FTD gradually affects more and more areas of your brain, disrupting the abilities those areas control. The average life expectancy for a person after diagnosis with FTD is 7.5 years.
While FTD isnt fatal on its own, it often causes other issues that are serious or even life-threatening. One common problem that often happens as FTD gets worse is dysphagia . Having dysphagia causes problems with eating, drinking and speaking, and increases the risk of developing pneumonia or respiratory failure.
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Difference : Affected Brain Regions
The destruction and death of nerve cells in the brain are responsible for the many cognitive problems experienced by Alzheimers patients. Plaques and tangles develop in areas of the brain important to memory, then spread to other regions. Communication between nerve cells is blocked, and cells die.
In Alzheimers patients, the damage occurs in the hippocampus and entorhinal cortex, areas of the brain responsible for memory function. As Alzheimers progresses, more neurons die. Affected parts of the brain continue to shrink. During the final stages of the disease, brain tissue has shrunk significantly.
When brain cells die, the elderly individuals memory begins to fail. Alzheimers disease also causes personality changes in patients. The senior has difficulty executing everyday activities independently. Eventually, as the disease advances, the senior will depend on caregivers to function in daily life.
Frontotemporal dementia develops when nerve cells in the frontal and temporal lobes of the brain become damaged, and the lobes shrink. As a result of the loss, the patient loses function in these areas. Frontotemporal dementia causes changes in behavior, personality, movement, and language.
Clinical Finding Of Ad As In The Case Study
In the case study, the wife complains that the patient loses memory and sometimes forgets his way back home. Memory loss is one of the key features and the initial sign and symptoms of Alzheimers disease. It is also accompanied by a lack of spatial abilities as the individual is explained to have lost the way several times and had to be brought back by the relatives. Another sign common in Alzheimers patients is irritability which is evident in the case study as the client gets angry and irritable when asked where he is going. Studies have shown that persons with dementia have difficulty thinking and reasoning in an abstract manner . This is evident in the history that the patient is unable to solve problems and balance checkbooks. The progression affects the daily activities of daily living, and it is evident in the past since, at times, the sick person is unable to dress. The critical confirmation of the diagnosis is the hippocampuss hypertrophy, as stated in the Magnetic resonance report. Also, the family history is positive for Alzheimers disease.
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What Can I Expect If I Have This Condition
FTD is a degenerative brain disease. That means that the effects on your brain get worse over time. Memory loss isnt usually a problem until later in the disease, but other symptoms and effects are likely. Depending on the type of FTD you have, youll likely lose one of the following:
- Control over your behavior.
- Ability to speak.
- Ability to understand others when they speak.
People with FTD commonly also develop a problem known as anosognosia. This means lack of insight, and it causes a problem with how your brain processes symptoms or evidence that you have a medical condition. That means you lose the ability to tell that you have a medical condition and to understand what this means for you in the long run.
Because this condition gradually affects your ability to control your actions or communicate, most people who have it eventually can’t live independently. Commonly, people with this condition need 24/7 skilled medical care, such as in a skilled nursing facility or long-term care setting.
Outlook For Frontotemporal Dementia
How quickly frontotemporal dementia gets worse varies from person to person and is very difficult to predict.
People with the condition can become socially isolated as the illness progresses. They may not want to spend time in the company of others, or may behave in rude or insulting ways.
The average survival time after symptoms start is around 8 to 10 years. But this is highly variable and some people live much longer than this.
If you or a loved one has been diagnosed with dementia, remember you’re not alone. The NHS and social services, as well as voluntary organisations and specialist support groups, can provide advice and support for you and your family.
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Living With Frontotemporal Dementia
Coping with FTD can be frightening, frustrating, and embarrassing for the patient and family members. Since some symptoms cant be controlled, family members shouldn’t take their loved ones behaviors personally. Families need to maintain their own well-being, while ensuring that their loved one is treated with dignity and respect.
Caregivers should learn all they can about FTD and gather a team of experts to help the family meet the medical, financial, and emotional challenges they are facing.
Its important to find a healthcare provider knowledgeable about FTD. Other healthcare specialists who may play a role on the team are home care nurses, neuropsychologists, genetic counselors, speech and language therapists, as well as physical and occupational therapists. Social workers can help the patient and caregivers find community resources, such as medical supplies and equipment, nursing care, support groups, respite care, and financial assistance.
Attorneys and financial advisors can help families prepare for the later stages of the disease.
Advanced planning will help smooth future transitions for the patient and family members, and may allow all to participate in the decision-making process.
The Difference Between Alzheimers And Another Type Of Dementia
People not familiar with Alzheimers and frontotemporal dementia might use the terms interchangeably, but theyre actually two different diseases that not only have varying effects on behavior, but also look entirely different within a patients brain. Frontotemporal dementia affects the frontal and temporal lobes, which are behind the forehead and between the ears and responsible for judgment calls in social situations. Alzheimers, on the other hand, affects the hippocampus and the back of the brain, deep inside memory circuits. We spoke to Dr. Brad Dickerson, an associate professor of neurology at Harvard Medical School and a director in the neurology department at Massachussetts General Hospital, about why getting a diagnosis that distinguishes between Alzheimers and dementia is important for both patients and caregivers.
- Alzheimers and dementia patients are affected in different parts of the brain, meaning they experience memory loss or personality changes in different ways.
- Its important to differentiate between Alzheimers and frontotemporal dementia, or FTD, so that patients and families can know what to expect, receive targeted therapies and join the right support community.
- People who receive a diagnosis of either disease in their 50s or earlier can feel marginalized if theyre not able to participate in their treatment plan.
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Being Patient:With FTD, is there memory loss that is apparent in the initial stage?
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Frontotemporal Dementia Vs Alzheimer’s
Frontotemporal dementia is caused by progressive loss of nerve cells in the front and side areas of the brain. This is the area behind your forehead and behind your ears. These areas are responsible for decision making, behavior, emotion, and language. Damage to nerve cells will cause deterioration in these areas.
The main symptoms of frontotemporal dementia are changes in personality and behavior, and trouble with language ability. This might be accompanied with a hard time writing and comprehension problems.
Frontotemporal dementia was formerly referred to as Picks Disease. Dr. Arnold Pick first made notes about a patient with language skills problems back in 1892. Today, it might also be referred to as frontotemporal degeneration.
Onset of frontotemporal dementia is usually around 60 years of age. It is less common than Alzheimers in seniors over 65 years of age. However, in the 45-65 age range, it is just as common as Younger-Onset Alzheimers.
How Does Ftd Differ From Alzheimers Disease
FTD brings a gradual, progressive decline in behavior, language or movement, with memory usually relatively preserved.
It typically strikes younger.
Although age of onset ranges from 21 to 80, the majority of FTD cases occur between 45 and 64. Therefore, FTD has a substantially greater impact on work, family, and finances than Alzheimers.
It is less common and still far less known.
FTDs estimated U.S. prevalence is around 60,000 cases , and many in the medical community remain unfamiliar with it. FTD is frequently misdiagnosed as Alzheimers, depression, Parkinsons disease, or a psychiatric condition. On average, it currently takes 3.6 years to get an accurate diagnosis.
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