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Last Stages Of Frontal Lobe Dementia

Types Of Frontotemporal Dementia

What is frontotemporal dementia?

There are two primary types and a third rarer form of frontotemporal dementia:

  • Frontal or behavioral variant frontotemporal dementia typically impacts an individual’s behavior and personality. This type involves nerve cell loss in the areas responsible for empathy, conduct, control, judgment, foresight, and other abilities.
  • Primary progressive aphasia can impact an individual’s speech centers, affecting ability to write, speak, and comprehend. This type of frontotemporal dementia can be segmented into two subtypes:
  • Semantic PPA dementia affects an individual’s ability to understand and use language. They could lose the ability to formulate words in a sentence or understand those words.
  • The progressive non-fluent variant of PPA impacts an individual’s ability to speak. Their speech could be labored, very hesitant, or ungrammatical.
  • If your loved one has disturbances in motor skills, the frontotemporal disorder can be with behavior or language complications.
  • Amyotrophic lateral sclerosis, ALS, or Lou Gehrig’s disease causes the wasting away of or weakness of muscles.
  • Progressive supranuclear palsy causes changes in posture, difficulty walking, eye movement complications, and muscle stiffness.
  • Corticobasal syndrome causes legs and arms to be stiff or uncoordinated.
  • What Causes Frontotemporal Dementia

    FTD happens when neurons, a key type of brain cell, deteriorate. This usually happens when there’s a malfunction in how your body creates certain proteins. A key part of how proteins work is their shape. Much like how a key won’t turn or open a lock if it’s not the right shape, your cells can’t use proteins when they’re not the right shape. Your cells often can’t break those faulty proteins down and get rid of them.

    With nowhere to go, those misshapen proteins can tangle and clump together. Over time, these faulty proteins accumulate in and around your neurons, damaging those cells until they dont work at all. Experts have linked misfolded proteins with FTD and its related conditions, such as Picks disease. Misfolded proteins also play a role in conditions like Alzheimers disease.

    These protein malfunctions happen with certain DNA mutations. DNA is like an instruction manual for your cells, telling them how to do a specific job. Mutations are like typos in the manual. Your cells strictly follow DNA instructions, so even small mutations can cause problems.

    Some DNA mutations run in families, which is why about 40% of FTD cases involve a family history of the disease. Mutations can also happen spontaneously, meaning you developed the mutation and didn’t get it from your parents.

    What Should Be Your Role As A Caregiver In The End

    During the final stage of dementia, the affected individual becomes completely dependent on the people around them to carry out basic activities.

    If a person is a caregiver, they need to take care of the patient regarding certain important aspects, including:

    Nutrition

    The appetite of the affected individual may decrease in the final stages of dementia due to the inability to stay physically active. They may forget to eat food or drink fluids.

    To help ensure that the person in the final stage of dementia receives adequate nutrition, try the following tips:

    Bowel and bladder function

    The patient may eventually lose control of bladder and bowel function in the final stage of dementia.

    To maintain bowel and bladder function, try the following tips:

    Skin and bone health

    A patient with end-stage Alzheimers disease can eventually become bedridden or chair-bound. This can result in skin breakdown, pressure sores, and freezing of joints .

    To keep the skin healthy and bones functioning, try the following tips:

    Oral hygiene

    Good oral hygiene reduces the risk of bacteria in the mouth that can lead to infections, including pneumonia. Brush the patients teeth every time after the patient eats. If the patient wears dentures, remove them and clean them every night.

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    Early Stage Frontotemporal Dementia

    Unlike Alzheimers and other forms of dementia, memory may be completely unaffected in frontotemporal dementia. While there are several sub-types of FTD, many in the early stage exhibit a behavioral variant that can cause them to appear to be unusually callous, selfish, and uncaring. They may also behave more abruptly than usual, lose their inhibitions, or develop a sudden affinity for sweet foods and overeating. In other variants called semantic dementia and non-fluent aphasia, language is affected first, creating difficulty with recalling names or words, difficulty understanding words, or difficulty speaking coherently.

    How Can I Ensure My Wishes Are Followed When I Cant Choose Myself

    What is frontotemporal dementia (FTD)?

    If you have an early diagnosis of frontotemporal dementia of any kind, you may want to talk to your healthcare provider, your family or loved ones, and to anyone you trust to make important decisions for you. These discussions are important because they can help you ensure caregivers can honor your wishes if you cant choose for yourself in the future.

    While these conversations often feel unpleasant or difficult, having them sooner rather than later can help avoid confusion about what you want for yourself in the years to come. They also mean your loved ones don’t face the painful, difficult situation of having to guess what you wanted.

    In addition to those conversations, you should also put your wishes and decisions in writing. That includes preparing documents connected to legal issues and what happens if you can’t care for yourself or make decisions for your care or well-being. Many people choose to consult an attorney when preparing these documents. However, many of these are ones you can prepare on your own .

    Also Check: How Early Can Dementia Start

    Diagnosis Of Frontotemporal Dementia

    • Generally similar to diagnosis of other dementias

    • Additional clinical evaluation to differentiate from some other dementias

    • Cognitive or behavioral symptoms interfere with the ability to function at work or do usual daily activities.

    • These symptoms represent a decline from previous levels of functioning.

    • These symptoms are not explained by delirium or a major psychiatric disorder.

    Diagnosis of frontotemporal dementia is suggested by typical clinical findings .

    As for other dementias, cognitive deficits are evaluated. Evaluation involves taking a history from the patient and from someone who knows the patient plus doing a bedside mental status examination How to Assess Mental Status The patient√Ęs attention span is assessed first an inattentive patient cannot cooperate fully and hinders testing. Any hint of cognitive decline requires examination of mental status ( see Examination… read more or, if bedside testing is inconclusive, formal neuropsychologic testing Assessment of cognitive function Dementia is chronic, global, usually irreversible deterioration of cognition. Diagnosis is clinical laboratory and imaging tests are usually used to identify treatable causes. Treatment is… read more .

    What Can I Do If A Loved One Shows Signs Of Frontotemporal Dementia Or A Similar Condition

    People with FTD often lack insight, which means they can’t recognize their symptoms or condition. Because they cant see the problem, they often don’t believe they need medical care or treatment. That lack of understanding can lead to frustration or fear for the person with the symptoms and their loved ones.

    If you notice a loved one showing signs of FTD or a related condition, you can try to help them by doing the following:

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    How Dementia Causes Death

    A person in the late stage of dementia is at risk for many medical complications. Because they might not be able to move, they’re at especially high risk for certain conditions.

    They could get a urinary tract infection or pneumonia . They can also experience skin breakdown, pressure ulcers , or blood clots.

    Trouble swallowing, eating, and drinking leads to weight loss, dehydration, and malnutrition. This further increases their risk of infection.

    In the end, most people with late-stage dementia die from underlying dementia or a related complication.

    For example:

    • A person may die from an infection like aspiration pneumonia. If someone has trouble swallowing, food or liquids may go down the wrong tube. Instead of going into the esophagus or stomach, it’s breathed into the airways or lungs. This leads to a type of pneumonia called aspiration pneumonia.
    • Dementia increases the risk of death from a blood clot in the lung because they are bedbound and not mobile.

    It’s important to know that late-stage dementia is a terminal illness and can lead to death. In these cases, the death certificate may list dementia as the cause of death.

    Causes Of Frontotemporal Dementia

    Frontotemporal Dementia

    Frontotemporal dementia is caused by clumps of abnormal protein forming inside brain cells. These are thought to damage the cells and stop them working properly.

    The proteins mainly build up in the frontal and temporal lobes of the brain at the front and sides. These are important for controlling language, behaviour, and the ability to plan and organise.

    It’s not fully understood why this happens, but there’s often a genetic link. Around 1 in 8 people who get frontotemporal dementia will have relatives who were also affected by the condition.

    If you have a family history of frontotemporal dementia, you may want to consider talking to your doctor about being referred to a geneticist and possibly having a genetic test to see if you’re at risk.

    There’s a lot of research being done to try to improve understanding of the causes of frontotemporal dementia so treatments can be discovered.

    If you’re interested in helping with research, you can speak to a doctor or register your interest on Join Dementia Research.

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    What Is The Outlook For Frontotemporal Dementia

    In the early stages, the symptoms and signs of frontotemporal dementia can be cared for and treated with good results. Late-stage frontotemporal dementia can take years to develop. As the disease progresses, 24-hour care may become necessary.

    Frontotemporal dementia shortens a persons life span. The condition will eventually cause a person to have difficulty with bodily functions such as:

    • swallowing

    Stage : Very Mild Changes No Dementiaquality Of Life: Little To No Impact

    You still might not notice any changes in your loved one. Youll see daily memory problems that look like a normal part of aging. You may see:

    • Some difficulty finding the right words.
    • The ability to make up for memory problems, such as substituting one word for another.
    • Normal functioning in the home, community, and workplace.

    How You Can Help:

    As with Stage 1, start to plan now. Use our tools to help your loved one document his or her values and priorities about the type of care wanted during the various stages of dementia.

    You can also watch for new signs that you may not have seen before.

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    Towards End Of Life Care

    When a person with dementia is approaching the advanced stages of their condition. it can be a very difficult time for them and their loved ones. Although its hard, talking with friends and loved ones and planning ahead can help ensure that a persons needs, and the needs of those around them, are met at the end of their life. Ideally, this should be done as early as possible in the illness when someone is best able to decide for themselves what they would want. For more information about this topic, including advanced care planning, palliative care and support for carers, you may find the Alzheimers Society website useful.

    The duration of the behavioural form of FTD differs from person to person. Although bvFTD itself is a life-shortening condition, people with FTD are often affected by another illness, such as pneumonia. This is because FTD affects how the body copes with infection and with other physical problems. Pneumonia is the cause of death in up to two thirds of people with a dementia.

    We are currently working to expand and develop our guidance on the late stages of FTD to make it more informative. If you would be interested in contributing your experience and expertise to this work please get in touch. The experiences of support group members and families are very valuable to researchers in helping to advise people in the future.

    How Is It Diagnosed

    Dying From Dementia With Late

    A healthcare provider, usually a neurologist, can diagnose FTD based on your medical history and a physical and neurological examination . Some lab tests are also possible, and imaging tests are important because they can show areas of your brain where deterioration is happening.

    In addition to neurological examinations, healthcare providers will often have you do a neurocognitive assessment. In this test, you’ll do tasks or answer questions. Based on how you do on the test, providers can identify whether or not you have problems in certain areas of your brain, which can help narrow down whether or not you have FTD.

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    What Happens In Bvftd

    Due to their impaired judgment, people with bvFTD can fall prey to scams, online or in person. As the disease progresses, this lack of judgment may lead to criminal behavior . At the extreme, the impulsivity can be self-destructive, as when patients try to get out of a moving car. In some people, inappropriate sexual behavior occurs.

    There may also be repetitive or compulsive behaviors that may include hoarding, doing the same thing over and over , pacing, or repeating particular catch phrases over and over.

    The person with bvFTD may experience false thoughts that are jealous, religious or bizarre in nature. Or they can develop a euphoria excessive or inappropriate elation or exaggerated self-esteem.

    Even though they might complain of memory disturbance, people with bvFTD can usually keep track of day-to-day events and understand what is going on around them. Their language skills and memory usually remain intact until late in the disease.

    Problems with language and other thinking skills can also happen in bvFTD. People may start speaking in shorter phrases and may eventually lose their ability to speak. Sometimes, people with bvFTD may have weakness in their muscles, difficulty swallowing, or difficulty walking.

    These behaviors have a physical cause and are not something that the person can usually control or contain. Indeed, often the person has little or no awareness of the problem behaviors.

    What Are The Early Signs Of Frontal Lobe Dementia

    When frontotemporal dementia affects the frontal lobe first, this causes the behavioral variant of this condition. The earliest signs and symptoms of this condition include:

    The symptoms of bvFTD fall under six categories:

    • Loss of inhibitions. This means a person has trouble controlling themselves. That can lead to them making inappropriate comments or behaving in socially unacceptable ways.
    • Apathy. This usually causes a lack of interest or motivation. This is often similar to depression.
    • Loss of empathy. This means a person has trouble reading other peoples emotions or acts as if they dont care about the feelings of others.
    • Compulsive behaviors. This usually means repetitive movements or behaviors that they cant control.
    • Changes in diet or mouth-centered behaviors. This usually causes people with FTD to overeat or eat things that aren’t food. They may also put things in their mouth, similar to how babies do as they explore objects around them.
    • Loss of executive function. This causes a person to have trouble planning, carrying out tasks or motivating themselves to do certain things.

    A note from Cleveland Clinic

    Unfortunately, this condition isn’t curable, and there’s no standard treatment. It’s sometimes possible to treat the symptoms, but this varies from person to person. Eventually, most people with this condition need 24/7 care from skilled healthcare professionals.

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    What Is The Life Expectancy Of Ftd

    The average life expectancy after a diagnosis of FTD is 7.5 years. But the condition can progress faster or slower. Your healthcare provider is the best person to tell you more about the progress of the disease and the likely timeline. They can also update you throughout the course of the disease if it progresses faster or slower than expected.

    What Are The Complications Of Frontotemporal Dementia

    Frontotemporal dementia: Signs and Symptoms

    FTD is not life-threatening people may live with it for years. But it can lead to an increased risk for other illnesses that can be more serious. Pneumonia is the most common cause of death, with FTD. People are also at increased risk for infections and fall-related injuries.

    As FTD progressively worsens, people may engage in dangerous behaviors or be unable to care for themselves. They may need 24-hour nursing care or to stay in an assisted living facility or nursing home.

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    What Is Frontal Lobe Dementia

    The frontal lobes of the brain are located as the name suggests at the front of the brain. Loosely speaking, it contains what we call the higher functions of the brain. These are the areas of the brain responsible for emotions, understanding, speech some types of movement, planning and judgement in other words the things which make you a person, and personality. Like all dementias the people who develop symptoms face a slow loss of self and those who care for them, losing the person they care for by slow degrees.

    Frontal lobe dementia is also known as frontotemporal dementia , or frontotemporal degeneration, it is an overarching term for several categories of a loss of brain function. The changes to the brain are caused by an abnormal build-up of tau proteins, which stop the brain cells from functioning properly, so they die. In frontal lobe dementia parts of the frontal and temporal lobes of the brain are damaged. It was previously known as Picks disease after the doctor Arnold Pick who identified and first documented the symptoms in a patient over a hundred years ago in 1892.

    Unlike the most widely diagnosed form of dementia, Alzheimers disease, frontal lobe dementia occurs at a much younger age and is partly genetic. That means while there is no certainty that if you have had a close blood relative with FLD you will get it too, your chances of developing it are much higher than for other members of the population.

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