To the extent possible, treat concurrent illnesses and pain as these may manifest as increased behavioral symptoms. In a minority of FTD patients there is profound loss of pain awareness, making the patient vulnerable to burns and other sorts of trauma. Be aware that these patients may experience drug reactions and interactions that may appear weeks after a change in medications. Encourage the caregiver to consult you for even minor concurrent conditions.

Driving is a difficult subject for patients as their lack of insight and judgment as well as slower reaction times may make them a serious hazard. Clinicians should counsel people with a progressive dementia and their families that giving up driving will be an inevitable consequence of their disease. Strategies to ease this transition should occur early in the clinical course of the disease. Refer caregivers to our practical tips section for different strategies on limiting driving or coping with a patient who is upset about not being able to drive.

There are currently no approved treatments for the prevention or cure of FTD but there are a number of pharmacological and non-pharmacological interventions available for improving the quality of life for both patient and caregivers, the ultimate goal at this time.

Some simple steps to improve communication:

• Avoid highly technical language or jargon
• Show appropriate concern for problems expressed by your patient or their family
• Pause to listen to your patient and their family
• Verify that your patient and their family understand the information you have provided – give them something in writing, even if it is mailed to them later
• Use a personal approach – be yourself
• Be available to the patient and family – let them have a means to contact you
• Talk to both your patient and their caregivers – don't talk "around" a patient as if they are not there, even if they can't add to the conversation
• Avoid just springing a diagnosis on the family – present the evidence and build the story of why you believe someone has FTD
• Remember the "Rule of 3s": don't give people too much to remember at any one time – three things tends to work for most people, watch your patient and their caregivers to gauge how much information they want and how much stress they are feeling

It really helps caregivers to have a brochure or handout that they can take home from an office visit. That handout can provide tips and suggestions, but resources are the most useful. Some helpful information for families includes:

• Contact information for local support groups
• Educational websites
• Information about respite care and professional help
• Local adult day care facilities
• Legal and financial resources

At time of diagnosis:

• What dementia is and how it influences cognitive and behavioral changes
• Treatments available
• If applicable:
  • Driving concerns
  • Occupational concerns
  • Financial and legal concerns (advance directives, power of attorney)
  • Strategies for behavioral symptoms
  • Research participation

At an early follow-up (Weeks or months after initial diagnostic visit):

• Course of the illness and what to expect
• Complimentary therapies
• Supportive services/resources (support groups, ADHC, respite, etc.)
• Financial and legal issues (advance directives, power of attorney)
• End of life planning (screening, treatment, placement)

At a later follow-up (several months or annual visit):

• Effects of caregiving, develop a plan/reinforce need for caregiver support
• Having an emergency plan in place
• Safety concerns