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Key points
- Onset of frontotemporal dementia tends to occur between the ages of 45 and 65, although one-quarter of patients develop it after age 65.
- Those with frontotemporal dementia often demonstrate abnormal eating behaviors. Other symptoms include neglect of self-care and repeating words.
- Symptoms of frontotemporal dementia can overlap with those associated with stroke and brain tumor.
I was attending a support group for caregivers when I heard the following story:
“My husband was diagnosed at age 55. It began with him becoming a jerk. For example, not only did he no longer hold open the door for me, he would go through first and let it slam in my face. If he didn’t like what I was watching on TV, he would just change the channel without asking me. He purchased a fancy new car that we couldn’t afford.
Then he began to eat things—like a tub of ice cream or a whole box of cookies—in bed while I was trying to sleep. But the thing that really upset me is that around that time I was diagnosed with cancer—it’s OK now, I’m doing fine. But the point is that he really didn’t care. He just complained that my chemotherapy schedule was interfering with him getting to his golf game. I don’t mind telling you that I cried that night.
On the one hand, all this took me by surprise, because my husband always used to be so sweet. On the other hand, it came on so slowly that I just thought, ‘Here’s that midlife crisis men go through that my mother warned me about.’ And this is all happening in his fifties—it never occurred to me that it was some kind of dementia. I finally figured out something was wrong with him when he stopped playing golf—and then he stopped going to work. All he wanted to do was sit on the couch, stare at the TV, and eat—anything: a box of cake mix, a tin of frosting, or a jar of mayonnaise. And he didn’t even care if the TV was on or not—he would stare at it either way.
That’s when I took him to his doctor. I feel so guilty for thinking he was just being a jerk and not bringing him to the doctor sooner! The biggest problem I’m dealing with now is that when he wants to urinate he will just do it wherever he is. He won’t bother going into the bathroom or pulling down his pants. And when I tell him we need to go change him into clean clothes, he argues with me!”
Frontotemporal dementia usually looks different than Alzheimer’s disease and other causes of dementia in a few ways. Most people with frontotemporal dementia start to show symptoms between the ages of 45 and 65, although in about one-quarter of individuals, the disease is first detected after age 65.
Additionally, the most prominent symptoms are changes in personality, behavior, and trouble performing complicated activities. Friends and family members of individuals with frontotemporal dementia frequently describe them as behaving like “different people.” They often show socially inappropriate behaviors, have poor manners, make impulsive decisions, and engage in careless actions. They frequently show little sympathy or empathy for others. Loss of interest, drive, and motivation to do anything is very common.
Some individuals compulsively perform repetitive movements, such as turning the light switch off and on whenever they walk by it. Others show a marked change in food preferences (often preferring sweets), engage in binge eating, or excessive smoking or drinking alcohol.
Individuals with frontotemporal dementia are unable to realize or understand that anything is wrong with their behavior; it is family or friends who bring the abnormal behavior to medical attention. Changes in memory are related to difficulty paying attention which impairs the formation of new memories and the ability to retrieve them. Performing complicated activities becomes difficult, such as using a new software program, preparing a gourmet meal, balancing the checkbook, and setting up an electronic gadget.
Common features of frontotemporal dementia
General Features
- Three-quarters of individuals present between the ages of 45 to 65
- Prominent change in personality—individual often seems like a different person
Changes in behavior
- Socially inappropriate behavior including inappropriate social remarks
- Loss of manners
- Impulsive, rash, or careless actions
Apathy or inertia
- Loss of interest, drive, or motivation
- Decreased initiation of activity
- Neglect of self-care
Loss of sympathy or empathy
- Diminished response to other people’s needs or feelings
- Diminished social interest, interrelatedness, personal warmth, and social engagement
Perseverative, stereotyped, or compulsive/ritualistic behavior
- Simple repetitive movements
- Compulsive or ritualistic behaviors
- Repeating the same words
Abnormal eating behavior
- Altered food preferences
- Binge eating or increased use of alcohol or cigarettes
- Putting inedible objects in mouth
Thinking and memory problems
- Poor attention
- Difficulty with complicated activities
- Difficulty forming and retrieving memories
Key Question
Q: You’ve noticed that your wife, age 57, is acting odd. Previously a considerate person, she now says what she thinks without concern of whether it would hurt someone’s feelings. Although she used to be health-conscious, she now wants to eat dessert for breakfast, lunch, and dinner. Lately, she has been stealing food off of other people’s plates at restaurants. What’s going on?
A: If your loved one behaves in the way just described, make sure he or she sees their doctor. Frontotemporal dementia, strokes, or a brain tumor are just some of the possible causes.
© Andrew E. Budson, MD, 2019.
References
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.
