What Brain or Drug Disoreder Can Make a Person Stumble or Fall

Frontotemporal disorders (FTD), sometimes chosen frontotemporal dementia, are the result of damage to neurons in the frontal and temporal lobes of the brain. Many possible symptoms can result, including unusual behaviors, emotional problems, trouble communicating, difficulty with work, or difficulty with walking. FTD is rare and tends to occur at a younger age than other forms of dementia. Roughly 60% of people with FTD are 45 to 64 years onetime.

FTD is progressive, meaning symptoms get worse over time. In the early stages, people may have just one symptom. Every bit the disease progresses, other symptoms appear as more parts of the encephalon are affected. It is difficult to predict how long someone with FTD will live. Some people live more than 10 years subsequently diagnosis, while others live less than two years afterwards they are diagnosed.

There is currently no cure for FTD, and no treatments slow or cease the progression of the disease, just there are ways to assistance manage the symptoms.

What do the terms hateful?

Share this infographic and assistance spread the word near agreement unlike types of dementia.

One of the challenges shared by people living with these disorders, families, clinicians, and researchers is what terminology to apply. Here, we have used the term frontotemporal disorders to characterize this group of diseases and the abridgement FTD, which is commonly used to refer to them. Other terms used include frontotemporal lobar degeneration and frontotemporal dementia, but it's of import to note that with some frontotemporal disorders, the primary symptoms are problems with voice communication or motility, rather than dementia symptoms. Physicians and psychologists diagnose the different forms of FTD based on a person'due south symptoms as well equally the results of brain scans and genetic tests.

What are the types and symptoms of FTD?

In the early on stages, it can be difficult to know which type of FTD a person has because symptoms and the club in which they announced can vary from one person to another. Also, the same symptoms can announced across unlike disorders and vary from one phase of the disease to the side by side equally dissimilar parts of the brain are affected.

Symptoms of FTD are ofttimes misunderstood. Family members and friends may call up that a person is misbehaving, leading to anger and conflict. It is important to understand that people with these disorders cannot command their behaviors and other symptoms and lack whatever awareness of their illness.

There are three types of frontotemporal disorders (FTD): behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and motility disorders.

Behavioral variant frontotemporal dementia

The virtually common FTD, bvFTD, involves changes in personality, behavior, and judgment. People with this disorder may have problems with cognition, simply their memory may stay relatively intact. Symptoms tin include:

• Problems planning and sequencing (thinking through which steps come outset, 2d, and and then on)
• Difficulty prioritizing tasks or activities
• Repeating the same activity or saying the same word over and over
• Interim impulsively or saying or doing inappropriate things without considering how others perceive the behavior
• Condign disinterested in family or activities they used to care about

Over time, linguistic communication and/or movement problems may occur, and the person living with bvFTD will demand more intendance and supervision.

Primary progressive aphasia

PPA involves changes in the ability to communicate — to employ language to speak, read, write, and understand what others are proverb. This includes difficulty using or understanding words (aphasia) and difficulty speaking properly (e.g., slurred speech). People with PPA may have i or both of these symptoms. They may become mute or unable to speak.

Many people with PPA develop symptoms of dementia. Problems with memory, reasoning, and judgment are not apparent at showtime but can develop over time. In addition, some people with PPA may experience meaning behavioral changes, similar to those seen in bvFTD, as the affliction progresses.

There are three types of PPA, categorized by the kind of linguistic communication problems that appear start.

• Semantic PPA: A person slowly loses the ability to sympathize single words and sometimes to recognize the faces of familiar people and common objects.
• Agrammatic PPA: A person has more and more trouble speaking and may omit words that link nouns and verbs (such every bit to, from, the). Eventually, the person may no longer be able to speak at all. The person may somewhen develop movement symptoms similar to those seen in corticobasal syndrome.
• Logopenic PPA: A person has problem finding the right words during a conversation merely can understand words and sentences. The person does not have issues with grammar.

Researchers practise not fully sympathize the biological ground of the unlike types of PPA. But they promise i solar day to link specific linguistic communication problems with the changes in the brain that crusade them.

Movement disorders

Ii rare neurological move disorders associated with FTD, corticobasal syndrome and progressive supranuclear palsy, occur when the parts of the brain that control motility are affected. The disorders may affect thinking and language abilities, too.

• Corticobasal syndrome can be caused past corticobasal degeneration — a gradual cloudburst (shrinkage) and loss of nerve cells in specific parts of the encephalon. This degeneration causes progressive loss of the power to command motion, typically outset around age sixty. The well-nigh prominent symptom may be apraxia, the inability to use the hands or arms to perform a motility despite normal strength, such every bit difficulty endmost buttons or operating pocket-sized appliances. Other symptoms can include muscle rigidity and difficulty swallowing. Symptoms may appear showtime on one side of the body, simply eventually both sides are affected. Occasionally, a person with corticobasal syndrome showtime has language problems or trouble orienting objects in infinite and after develops movement symptoms. Not everyone who has corticobasal syndrome has problems with memory, knowledge, linguistic communication, or beliefs.
• Progressive supranuclear palsy causes problems with balance and walking. People with the disorder typically move slowly, experience unexplained falls, lose facial expression, and have body stiffness, peculiarly in the neck and upper body — symptoms similar to those of Parkinson'due south disease. A hallmark sign of this disorder is problem with eye movements, particularly looking down. These symptoms may give the face a fixed stare. Bug with behavior, retentiveness, problem solving, and judgment tin likewise develop.

Other movement-related types of FTD include frontotemporal dementia with parkinsonism and frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS).

• Frontotemporal dementia with parkinsonism tin be an inherited affliction acquired by a genetic tau mutation. Symptoms include movement issues similar to those of Parkinson'southward disease, such as slowed movement, stiffness, and balance problems, and changes in behavior or linguistic communication.
• FTD-ALS, also called FTD with motor neuron affliction, is a combination of bvFTD and ALS, the latter commonly known every bit Lou Gehrig'southward illness. In addition to the behavioral and/or language changes seen in bvFTD, people with FTD-ALS experience the progressive musculus weakness seen in ALS, fine jerks, and wiggling in muscles. Symptoms of either affliction may appear showtime, with other symptoms developing over time. Mutations in sure genes have been constitute in some people with FTD-ALS, though most cases are not hereditary.

What causes FTD?

Scientists are commencement to understand the biological and genetic footing for the changes observed in brain cells that lead to FTD.

Scientists describe FTD using the patterns of modify in the encephalon seen in an dissection after death. These changes include loss of neurons and abnormal amounts, or forms of proteins called tau and TDP-43. These proteins occur naturally in the body and help cells function properly. When the proteins don't work properly, for reasons non nonetheless fully understood, neurons in specific brain regions are damaged.

In most cases, the cause of a FTD is unknown. Individuals with a family history of FTD are more probable to develop such a disorder. About 10 to thirty% of bvFTD is due to specific genetic causes.

FTD that runs in a family is frequently related to mutations (permanent changes) in certain genes. Genes are basic units of heredity that tell cells how to brand the proteins the body needs to role. Even pocket-sized changes in a gene may produce an abnormal poly peptide, which can lead to changes in the encephalon and, somewhen, disease.

Scientists have discovered several different genes that, when mutated, can pb to FTD:

• Tau gene (also called the MAPT gene) — A mutation in this gene causes abnormalities in a protein called tau, which then forms tangles inside neurons and ultimately leads to the destruction of brain cells. Inheriting a mutation in this gene ways a person will almost surely develop a frontotemporal disorder, usually bvFTD, simply the verbal age of onset and symptoms cannot be predicted.
• GRN cistron — A mutation in this gene can lead to lower production of the protein progranulin, which in turn causes another protein, TDP-43, to go awry in encephalon cells. Many frontotemporal disorders can result, though bvFTD is the most mutual. The GRN gene can cause different symptoms in different family unit members and cause the disease to begin at unlike ages.
• C9ORF72 gene — An unusual mutation in this gene appears to be the most mutual genetic abnormality in familial frontotemporal disorders and familial ALS. This mutation can cause a frontotemporal disorder, ALS, or both weather condition.

In recent years researchers have discovered several other genetic mutations in genes that lead to rare familial types of frontotemporal disorders. These other mutations account for less than 5% of all cases of FTD.

Families afflicted by inherited and familial forms of FTD can help scientists advance research by participating in clinical studies and trials. For more information, talk with a health intendance professional or visit the Alzheimers.gov Clinical Trials Finder.

How is FTD diagnosed?

FTD tin exist difficult to diagnose considering the symptoms are like to those of other conditions. For example, bvFTD is sometimes misdiagnosed as a mood disorder, such as depression. To make matters more confusing, a person can have both FTD and another blazon of dementia, such as Alzheimer's disease. Also, because these disorders are rare, physicians may exist unfamiliar with the signs and symptoms.

To help diagnose frontotemporal dementia, a doctor may:

• Perform an test and ask nigh symptoms
• Look at personal and family medical history
• Use laboratory tests to assistance dominion out other conditions
• Society genetic testing
• Conduct tests to assess retentivity, thinking, linguistic communication skills, and physical functioning
• Lodge imaging of the brain

A psychiatric evaluation tin help determine if depression or another mental health condition is causing or contributing to the condition. But genetic tests in familial cases or a brain autopsy after a person dies tin confirm a diagnosis of FTD.

Researchers are studying ways to diagnose FTD earlier and more accurately and to distinguish them from other types of dementia. Ane area of research involves biomarkers, such equally proteins or other substances in the blood or cerebrospinal fluid which can be used to measure disease progression or the effects of handling. Researchers are also exploring ways to amend brain imaging and neuropsychological testing.

Treatment and management of FTD

So far, at that place is no cure for FTD and no way to slow down or prevent these diseases. Even so, at that place are ways to manage symptoms. A team of specialists — doctors, nurses, and speech, physical, and occupational therapists — familiar with these disorders can aid guide treatment.

Managing behavior changes in FTD

Beliefs changes associated with bvFTD can upset and frustrate family members and other caregivers. Understanding changes in personality and beliefs and knowing how to answer can reduce frustration and aid provide the best care for a person with FTD.

Managing behavioral symptoms can involve several approaches. Hither are some strategies to consider:

• Try to accept rather than claiming someone with behavioral symptoms. Arguing or reasoning volition not help, because they cannot control their behaviors or see that they are unusual or upsetting to others. Instead, be as sensitive every bit possible and empathize that it's the illness "talking."
• Take a "timeout" when frustrated — take deep breaths, count to ten, or leave the room for a few minutes.
• To deal with aloofness, limit choices and offer specific choices. Open-ended questions, such equally "What exercise you want to do today?" are more difficult to answer than specific ones, such as "Do you want to become to the park or for a walk?".
• Maintain a regular schedule, reduce distractions, and change the environs to reduce confusion and ameliorate the person'due south sleep.
• If compulsive eating is an issue, consider supervising eating, limiting food choices, locking cabinets and the refrigerator, and distracting the person with other activities.

To ensure the rubber of a person and his or her family, caregivers may take to take on new responsibilities or arrange care that was not needed before.

Medications are available to treat certain behavioral symptoms. Antidepressants called selective serotonin reuptake inhibitors are usually prescribed to treat social disinhibition and impulsive behavior. People with aggression or delusions sometimes take low doses of antipsychotic medications. If a particular medication is not working, a doctor may try another. Always consult a doctor before irresolute, adding, or stopping a drug or supplement.

Treating language problems in FTD

Handling of PPA has two goals — maintaining language skills and using new tools and other means to communicate. Handling tailored to a person's specific language problem and phase of PPA generally works best. Since language power declines over time, different strategies may be needed as the illness progresses. The following strategies may assistance:

• Use a communication notebook (an album of photos labeled with names of people and objects), gestures, and drawings to communicate without talking.
• Shop lists of words or phrases in a figurer or phone to point to.
• Speak slowly and clearly, use simple sentences, await for responses, and inquire for description if needed.
• Work with a spoken language-language pathologist familiar with PPA to determine the best tools and strategies to use. Notation that many speech-linguistic communication pathologists are trained to treat aphasia caused by stroke, which requires unlike strategies from those used with PPA.

Managing movement problems in FTD

Medications and physical and occupational therapy may provide small-scale relief for the move symptoms of FTD. A doctor who specializes in these disorders tin guide treatment.

For people with corticobasal syndrome, Parkinson'south disease medicines may offer some temporary improvement. Concrete and occupational therapy may help the person move more easily. Speech therapy can help them manage language symptoms.

For people with progressive supranuclear palsy, sometimes Parkinson's illness drugs provide temporary relief for slowness, stiffness, and residue problems. Exercises tin go on the joints limber, and weighted walking aids — such as a walker with sandbags over the lower front end rung — can assist maintain remainder. Oral communication, vision, and swallowing difficulties usually exercise not answer to any drug handling. Antidepressants take shown modest success. For people with abnormal eye movements, bifocals or special glasses called prisms are sometimes prescribed.

People with FTD-ALS typically pass up quickly over two to three years. During this time, concrete therapy can aid treat muscle symptoms, and a walker or wheelchair may be useful. Spoken language therapy may aid a person speak more clearly at offset. Subsequently on, other ways of communicating, such every bit a oral communication synthesizer, can be used. The ALS symptoms of the disorder ultimately arrive impossible to stand, walk, consume, and exhale on one's own.

Physicians, nurses, social workers, and physical, occupational, and speech therapists who are familiar with these weather condition can ensure that people with movement disorders get advisable medical treatment and that their caregivers tin help them live as well as possible.

The future of FTD treatment

Researchers are continuing to explore the biological changes in the body, including genetic mutations and proteins, that pb to FTD and identify and examination possible new drugs and other treatments. They are also developing ameliorate ways to track disease progression, so that treatments, when they go bachelor, tin exist directed to the correct people. Clinical trials and studies are underway to accelerate these efforts. People with FTD and healthy people may be able to participate. To find out more than, talk to your health intendance provider or visit the Alzheimers.gov Clinical Trials Finder.

Where to find FTD diagnosis and treatment

Columbia-Presbyterian Medical Center
Department of Neurology
New York, NY
646-426-3876

Houston Methodist Hospital
Frontotemporal Degeneration Unit of measurement
Houston, TX
713-441-7650

Indiana University School of Medicine
Indiana Alzheimer'due south Disease Eye
Indianapolis, IN
317-963-5500

Johns Hopkins University School of Medicine
Frontotemporal Dementia and Young-Onset Dementias Dispensary
Baltimore, MD
410-955-5147

Massachusetts General Hospital
Frontotemporal Disorders Unit of measurement
Boston, MA
617-726-1728

Mayo Dispensary
Department of Neurology
Rochester, MN
507-538-3270
Jacksonville, FL
904-953-0853
Phoenix or Scottsdale, AZ
800-446-2279

Northwestern University Feinberg School of Medicine
Mesulam Center for Cerebral Neurology and Alzheimer'south Illness
Chicago, IL
312-908-9339

University of Alabama, Birmingham
Neurology Department, Sectionalization of Memory Disorders
Birmingham, AL
205-996-3679

Academy of California, Los Angeles
Neurobehavior Clinic
Los Angeles, CA
310-794-1195

University of California, San Diego
Shiley-Marcos Alzheimer's Disease Research Eye
La Jolla, CA
858-822-4800

University of California, San Francisco
Retentivity and Aging Center
San Francisco, CA
415-353-2057

University of Pennsylvania Health System
Penn Frontotemporal Degeneration Eye
Philadelphia, PA
215-349-5863

Washington University
Department of Neurology
St. Louis, MO
314-362-1408

For more than information about FTD

NIA Alzheimer's and related Dementias Didactics and Referral (ADEAR) Heart
800-438-4380
adear@nia.nih.gov
world wide web.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and complimentary print publications near Alzheimer'south and related dementias for families, caregivers, and health professionals. ADEAR Centre staff respond phone, electronic mail, and written requests and make referrals to local and national resources.

Alzheimers.gov
www.alzheimers.gov
Explore the Alzheimers.gov portal for information and resources on Alzheimer'south and related dementias from across the federal regime.

This content is provided past the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and upwards to date.

Content reviewed: July xxx, 2021

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Source: https://www.nia.nih.gov/health/what-are-frontotemporal-disorders

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