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Frontotemporal Dementia. Dr Rita Kronstorfer Old Age Psychiatry BCULHB. Why do we talk about FTD?. 3 rd most common dementia under 65 Recent study in Cambridgeshire: Age range 45–64 years 11.5 cases per 100,000 person-years, 3.5 FTD Poorly understood in general public

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Frontotemporal Dementia

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Frontotemporal dementia l.jpg

Frontotemporal Dementia

Dr Rita Kronstorfer

Old Age Psychiatry

BCULHB


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Why do we talk about FTD?

  • 3rd most common dementia under 65

  • Recent study in Cambridgeshire: Age range 45–64 years 11.5 cases per 100,000 person-years, 3.5 FTD

  • Poorly understood in general public

  • Challenge to patients, carers and professionals


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Lobes of the Brain


Dementia onset under 65 years harvey et al jnnp 2003 74 1206 1209 l.jpg

Dementia - Onset under 65 yearsHarvey et al. JNNP 2003; 74; 1206-1209


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Accepted Referrals: Diagnoses (SYD, 2008, 37 cases)


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Variants of FTD / Pick Complex

  • Behavioural / frontal variant (classic Pick’s Disease)

  • Temporal Variants:Semantic Dementia - fluentPrimary Progressive Aphasia – non fluent

  • Progressive Supranuclear Palsy

  • Corticobasal Degeneration

  • FTD with Motoneuron Disease


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Symptoms – Frontal variant

  • Disinhibition / inhibition

  • Elated mood / depression / flat mood

  • Agitation / apathy

  • Repetitive behaviour

  • Loss of social skills

  • Preference of sweet food

  • Utilisation behaviour


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Treatment

  • Antidepressants

  • Neuroleptics

  • Acetylcholinesterase Inhibitors ?

  • Memantine ?

  • Trageting Tau- Pathology: Research


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Problems

  • Delay in diagnosis

  • Early Onset

  • Problems with communication

  • Lack of services skilled to meet needs

  • Sometimes progression can be rapid

  • Very variable course of illness

  • Sometimes mobility problems as well


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Carer Stress

  • Early personality change – not the person they know / love any more

  • Disinhibition and lack of social understanding cause distress / trouble with police

  • Lack of public knowledge around diagnosis

  • Difficulties recognizing symptoms as organic

  • Communication problems


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Genetics

  • Seems higher than in Alzheimer’s disease

  • Some known mutations – explain around 5-10%

  • Higher frequency in certain areas

  • Sometimes Motoneuron disease and FTD in same family

  • Many cases are sporadic


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Summary

  • Frequent, but poorly understood illness

  • Diagnosis is very important to help patient/ family cope and get support

  • High carer stress

  • Symptomatic treatment available

  • Very variable disease course – Not one, but many illnesses!


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…for your attention!


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