Definitevely Diagnosing FTD

An FTD diagnosis can be confirmed in two ways:

Gathering as much information from family members and looking over the medical history will start the probable FTD diagnosis process. The medical team would also want to order blood tests to uncover any possible genetic mutations and similar conditions. Neuropsychological evaluation will assess behavior, language, memory and other cognitive losses. Brain imaging testing will identify changes in the brain and shrinkage in the frontal and temporal lobes. An MRI may look normal on a person with FTD, so it would be best to use positron emission tomography (PET) or single photon emission computed tomography (SPECT) scans. These scans measure the activity in the brain by monitoring blood flow, glucose and oxygen usage. They can also rule out Alzheimer’s or exclude other causes of dementia such as strokes and brain tumors, or could identify that this person has two or more co-existing dementias.

Brain Scan

Why Is Getting a Diagnosis So Important?

FTD is frequently misdiagnosed as Alzheimer’s or a psychiatric disorder, its symptoms often overlap and look like these. FTD dementia poses a diagnostic challenge and its victims are quickly losing cognitive ground. They are not getting the correct treatment and understanding of their behaviors. They also lose valuable pre-planning time so they may make personal decisions based on what kinds of treatment and wishes they would like rather than having another family member or a guardian take over this aspect of their future medical and financial care needs.

Some patients with FTD develop Lou Gehrig's disease, also known as amyotrophic lateral sclerosis (ALS). Doctors don't yet fully understand the connection between the two diseases but are studying the trend.

Some of the important steps to getting a proper diagnosis include the following:

1. Routine blood work: Tests for specific chemicals, proteins, hormones and antibodies to detect conditions that can have similar clinical features to FTD, such as thyroid disease, B12 deficiency, infections such as syphilis or HIV, dehydration, or cancer. These conditions are treated differently, and some are manageable or curable.

2. Neurological exam: A detailed examination of the entire nervous system including physical and cognitive functioning. An initial evaluation usually takes about an hour and includes:

Even among neurologists there are different specialties; therefore, it is not uncommon for an individual to see more than one neurologist. It is extremely important for an individual to be evaluated by a neurologist experienced with FTD and related neurodegenerative conditions. Neuropsychological testing can include:

Note: There is a subtype (variant) of Alzheimer’s disease (AD) that is called hippocampal-sparing AD. Because these younger (mostly male) patients have near normal memories, clinicians often mis-diagnose them with FTD. New evidence from the Mayo Clinic brain bank program suggests that this variant made up 11% of the AD confirmed brain autopsies. This research will help doctors to better understand that loss of memory is not present in every AD patient.

Pick's Disease - Arnold Pick

Where Pick's Disease Gets Its Name

First described in 1892 by Arnold Pick, a term now reserved for one specific type of frontotemporal dementia is Pick’s disease. Unlike patients who suffer from Alzheimer’s disease, patients with Pick’s disease do not lose short-term memory. Pick was a professor of psychiatry in Prague, and was described as an intelligent, modest, and principled man who made substantial contributions to the fields of psychiatry and neurology through numerous publications. Pick’s studies often included brain autopsy’s to study size and/or shrinkage of specific brain regions.

FTD Symptoms

The person with a FTD disorder cannot control their behavior and lacks the understanding that they even have a problem. Impaired awareness of illness (anosognosia) is a major problem and it is important for the caregiver to not show anger and think this person is doing this on purpose.

Executive Functioning Problems – Cannot organize thought to figure out planning what steps come first, second, or third for an activity and then to shift to another task.

Perseveration – Repeating the same steps, word or gesture long after it makes no sense.

Social Disinhibition – Acting inappropriately at a social gathering, show an outburst of laughter at a tragedy, and not consider how others would perceive this strange behavior.

Compulsive Eating – Taking food from anywhere – off a grocery shelf, off another person’s plate – or eating items that are not meant for human consumption like glitter, wallpaper, and plants. (There is another disorder called Pica in which a person may crave and ingest non-food items such as paint, plaster, string, hair, laundry starch, plastic, pencil erasers, freezer frost, fingernails, paper, coal, chalk, wood, plaster, light bulbs, needles, wire, cigarette butts, sand, or cloth.)

Utilization Behavior – Unable to resist grasping or using an object placed in front of them, regardless of the context or environment. For example, this person may see and use another persons’ toothbrush. This demonstrates the appropriate action (brushing) but with the inappropriate usage. This dysfunction of the frontal area causes the inappropriate motor responses to specific objects in their visual field in the environment.