Diagnosis

The first step in the treatment of FTD is an accurate diagnosis. Although not uncommon, FTD is the second most common dementia in those under 65, these patients often go undiagnosed and instead get treated as psychiatric patients. bvFTD, the behavioral variant of FTD, presents with changes in personality, behavioral problems, executive impairment or any combination of these signs and symptoms. The behavioral and social inappropriateness of FTD are a source of grief and frustration for caregivers and in some instances patients and can endanger the patient and those with whom the patient interacts. Improving these symptoms can improve quality of life for both patients and their caregivers. Treatment begins with discussing the diagnosis and educating the family about the disease. The caregivers need to be informed about safety concerns for both the patient’s safety (e.g., leaving pots on the stove, wandering outside while inappropriately clothed or becoming lost) but also the risk to the caregiver needs to be assessed because the patient’s lack of insight and disinhibition may lead to potentially dangerous behaviors whereby aggressive outbursts by the patient could lead to harm. There may be a need to remove dangerous items from the home and eliminate driving if the patient is unsafe.

SD, often presents with marked language impairment, usually in the form of a loss of memory for words or a loss of word meaning. SD patients are usually aware of their expressive difficulties which is a source of frustration but they often lack insight into their comprehension deficits. There are also behavioral signs and symptoms. Many of the treatments for bvFTD can also be used for SD. PNFA, on the other hand, involves changes in fluency or word finding difficulty without associated cognitive and behavioral abnormalities so that depression and social withdrawal are more common problems in this subtype of FTD.