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Frontotemporal dementia (FTD) (Clinical presentation (Behaviour/personal…
Frontotemporal
dementia (FTD)
Definition
Dementia subtype affecting
the frontotemporal region of
the brain, causing changes
in personality and behaviour
Management
Medical
Antipsychotics
Indication: aggression, psychosis
E.g. haloperidol, quetiapine, olanzapine
SSRIs
Indication: depression, anxiety
E.g. citalopram, fluoxetine
Androgen antagonist
Indication: sexual disinhibition
(e.g. cimetidine, spironolactone
Hypnotics
Indication: insomnia
E.g. zopiclone
Conservative
Information, advice, support
MDT approach (psychiatrist, specailist nurse, GP, care co-ordinator, social services, OT/physio, dietician)
Legal (LPAs, ADs)
Carer support (support groups, charities, respite care)
Psychological
CBT
Indication: behaviour problems
Epidemiology
2nd commonest early onset dementia
Onset 45-65y
M=F
5th commonest dementia overall (only 2%)
Pathophysiology
Mechanism
Atrophy of frontal and temporal cortex, hence affecting behaviour, emotions and language
Neuronal loss,gliosis, spongiosis
Subtypes of Tau, Ub, and TDP43
Many types e.g. Picks
Genetics
Often early onset with strong FH
Involves progranulin and MAPT genes
Clinical
presentation
Behaviour/personality change
Disinhibition
Extroversion
Stereotyped behaviour
Hyperorality
Hyperphagia, overindulgence
Puts things in mouth
Language problems
Reduced speech
Word finding difficulties
Primative reflexes
Plamar grasp
Rooting
Memory
Preserved until relatively late
Diagnosis
History
DH
Meds, allergies
FH
Dementia (especially early onset)
PMH
CVD, endocrine disease,
other medical problems
SH
Living arrangements, social support,
smoking, alcohol, drugs
PC/HPC
Collatoral hx: first symptoms, progression,
ADLs affected most
Examination
MSE
A+B, mood, speech, thoughts,
perceptions,cognition, insight
AMTS
Cognition (name, DOB, placem 2 people, WW1 date, monarch, count back from 20, remember an address)
Physical exam
Cardio, abdo, neuro, thyroid
Investigations
Bloods
FBC, CRP, U+E, LFT, clotting,
TFTs, bone profile, Ca, B12/folate, glucose, lipids
Infection screen (syphilis, HIV)
Immune screen (ANA, ANCA)
Bedside
Obs
ECG (arrhythmias)
Imaging
MRI (frontal and paralimbic atrophy)
EEG (slowing)
Special tests
Cognitive tests (MMSE, MOCA, Addenbrooks);
MMSE determines severity
Diagnostic
criteria
Early decline in social conduct
Early emotional blunting
Insidious onset, gradual progression
Early loss of insight