FTD

Neurocognitive Disorders: It’s not all Alzheimer’s Disease

Dr. Bill E. Beckwith

Dementia, according to current terminology neurocognitive disorder, presents in various forms, levels of severity, and many stages. Many, even professionals, treat Alzheimer’s disease as being synonymous with dementia. The terms are not interchangeable. Dementia/neurocognitive disorder is a permanent and irreversible brain disorder that progressively robs a person of independence and ultimately requires some level of external care and supervision. There are no current treatments that can reverse a dementia. There are no “pseudodementias.” If one is confused because of thyroid disorder or deficiency of vitamin B 12 and replacement makes the confusion go away, the person was not demented as by definition dementias, no matter what the cause, are not reversible.

There are a multitude of possible causes of neurocognitive disorders. They may be the result from a stroke, viral infection, or a head injury that happen suddenly. Alternatively, these disorders may result from progressive neurodegenerative diseases such as Alzheimer’s disease, Lewy body disease, and Parkinson’s disease. A less common and often more challenging form of neurocognitive disease is called frontotemporal degeneration as it results from disease of the frontal lobes of the brain. Frontotemporal degeneration has at least two major subtypes: behavioral/personality and language depending on which part of the frontal lobe is affected. These disorders typically strike at a younger age, progress faster, and do not attack memory first as does Alzheimer’s disease.

The behavioral subtype is often characterized by changes in personality. The afflicted person manifests decline in decision making, judgment, and reasoning. He or she may lose inhibitions and moral judgment. They may shop lift or have eating binges or other stereotyped or compulsive behaviors like hording. The afflicted person is apathetic and often socially inappropriate. There are often years of misdiagnosis ranging from midlife crisis to psychiatric disorder (e.g., depression, bipolar disorder, anxiety disorder, PTSD, psychopathic personality).

The language subtype of frontotemporal dementia is often called primary progressive aphasia. It is often characterized by struggling to get words out. As the disorder progresses speech becomes more halting and finally either mutism or a form of babbling appears. The afflicted person, in the early stage, often knows what they want to say but cannot find the word.  As it progresses speech becomes less and less fluent but memory is not as much of an issue as not being able to say what one wants to say.   

The first cases of frontotemporal degeneration were described by Arnold Pick and hence were called “Pick’s disease.” Now these disorders are called frontotemporal degeneration or FTD for short. Frontotemporal degeneration often looks very similar to what we call Alzheimer’s disease in its middle to late stages – as do many progressive neurocognitive disorders. Frontotemporal degeneration often appears in the 50s. 

There are no currently approved medical treatments for frontotemporal degeneration. Interestingly, these disorders are occasionally associated with bursts of poorly understood creativity. The most effective interventions are aimed at the caregivers who must manage through the years of misdiagnosis and progressive deterioration at a comparatively young age.

Dr. Beckwith is a neuropsychologist, speaker, and author of Managing Your Memory: Practical Solutions for Forgetting. He can be reached at memoryseminars@aol.com or (239)851-1968. Visit Dr. Beckwith on Facebook at the Life and Memory Center or at www.lifeandmemorycenter.com.