FTD is a form of dementia, or altered mental status, which is distinct from the cognitive and memory problems evident in Alzheimer’s disease.
FTD involves a change in personality that can produce obsessive behavior, loss of the ability to plan or make decisions, and other more subtle signs that something is amiss in the cerebral cortex.
Frontotemporal refers to the forward part of the brain that sits above the eyes and behind the temples. It is the last region of the cerebral cortex to mature, which explains why teens often cannot make good “adult” decisions. Lowering of the function of this region can lead to impulsive and emotional behavior.
Showing posts with label symptoms. Show all posts
Showing posts with label symptoms. Show all posts
Thursday, January 15, 2009
Sunday, December 28, 2008
Changes in Speech and Handwriting
Found 2 birthday cards Michael sent mom one month before his death. One was signed "Have a Nice Day" and the other signed "Merry Birthday". Now I know, both were real clues as to what was going on with him.
He was saying very little at this time and mostly would repeat "Have a Nice Day".
Then for him to say Merry Birthday instead of Happy Birthday.....was out of context for him.
His handwriting was changing as well. Patsy's handwriting changed drastically as well. I noticed her handwriting changed about 7 years before her death. Michael's didn't change until about a year before his death.
Saturday, December 20, 2008
Artistic and Musical Abilities
Howard S Kirshner, MD, Professor of Neurology, the doctor that helped me find the wonderful doctors in Houston, wrote Nov 2, 2006 in emedicine, a great article - "Frontal and Temporal Lobe Dementia"
This was one aspect I find very interesting, since both my brother and sister had artistic abilities surface with this disease. Another clue for families. Dr. Kirshner states:
"Some North American authors have included under the FTD category cases in which artistic and musical abilities have actually emerged after the onset of the illness, usually in association with progressive language impairment. "
This was one aspect I find very interesting, since both my brother and sister had artistic abilities surface with this disease. Another clue for families. Dr. Kirshner states:
"Some North American authors have included under the FTD category cases in which artistic and musical abilities have actually emerged after the onset of the illness, usually in association with progressive language impairment. "
Tuesday, December 16, 2008
Crazy Behaviors
In 2001 when we brought my sister to South Texas so we (her son and his wife, mom, my husband, and me) could help care for her and try to figure out what was going on with her. Initially she was living with her son and his wife.
As the holidays approached, one doctor put Patsy on Aricept. Soon after, she took a bottle of pills one day when the kids were at work. She called me and told me what she had done. I asked her why she took the pills and she said she didn't know why. She was hysterical, screaming and crying.
The hospital transferred her to a private psychiatric facility for evaluation. This facility was a joke. They didn't want to deal with her because she had no money for treatment. At this stage, Patsy could still talk and was very good at covering many of the symptoms for short periods of time. However, if you spent any length of time with her, you would see the odd behaviors. They called us all in for a meeting, and after telling us all we were sorry examples for human beings because we couldn't care for her...they released her to a Salvation Army store. We of course went over to gather her up and bring her home.
The scary thing here is, if she had no family, she would have become a street person. Makes you wonder about those poor people out there on the streets that may be ill and their families have all been pushed away.
At this point, she would wander aimlessly and leave the house if you weren’t watching every move. She would walk in on us in our bedroom, walk out the front door, yell and throw a fit if we didn’t drive her to the right store or park in the right parking spot….you get the idea.
We actually were a bit afraid. I remember having thoughts that she might grab a knife and come after us. Seems so odd now when I look back on it. She had turned into someone I didn’t know and the doctors were no help.
As the holidays approached, one doctor put Patsy on Aricept. Soon after, she took a bottle of pills one day when the kids were at work. She called me and told me what she had done. I asked her why she took the pills and she said she didn't know why. She was hysterical, screaming and crying.
The hospital transferred her to a private psychiatric facility for evaluation. This facility was a joke. They didn't want to deal with her because she had no money for treatment. At this stage, Patsy could still talk and was very good at covering many of the symptoms for short periods of time. However, if you spent any length of time with her, you would see the odd behaviors. They called us all in for a meeting, and after telling us all we were sorry examples for human beings because we couldn't care for her...they released her to a Salvation Army store. We of course went over to gather her up and bring her home.
The scary thing here is, if she had no family, she would have become a street person. Makes you wonder about those poor people out there on the streets that may be ill and their families have all been pushed away.
At this point, she would wander aimlessly and leave the house if you weren’t watching every move. She would walk in on us in our bedroom, walk out the front door, yell and throw a fit if we didn’t drive her to the right store or park in the right parking spot….you get the idea.
We actually were a bit afraid. I remember having thoughts that she might grab a knife and come after us. Seems so odd now when I look back on it. She had turned into someone I didn’t know and the doctors were no help.
Tuesday, December 2, 2008
What is Frontotemporal Dementia
Taken from NINDS Frontotemporal Dementia Information Page
(National Institute of Neurological Disorders and Stroke)
What is Frontotemporal Dementia ?
Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Originally known as Pick’s disease, the name and classification of FTD has been a topic of discussion for over a century. The current designation of the syndrome groups together Pick’s disease, primary progressive aphasia, and semantic dementia as FTD. Some doctors propose adding corticobasal degeneration and progressive supranuclear palsy to FTD and calling the group Pick Complex. These designations will continue to be debated. As it is defined today, the symptoms of FTD fall into two clinical patterns that involve either (1) changes in behavior, or (2) problems with language. The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation. The second type primarily features symptoms of language disturbance, including difficulty making or understanding speech, often in conjunction with the behavioral type’s symptoms. Spatial skills and memory remain intact. There is a strong genetic component to the disease; FTD often runs in families.
Michael and Patsy had symptoms from both, changes in behavior and problems with language. As the disease progressed, so did the symptoms.
Is there any treatment?
No treatment has been shown to slow the progression of FTD. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Anti-depressants have been shown to improve some symptoms.
Anti-depressants did help Patsy with the aggressive and angry behaviors. Sleeping pills helped her to rest at night.
Since we didn’t have clue what was going on with Michael, no drugs were administered, so no benefit here. Two weeks before his death, a doctor prescribed Aricept. A doctor later told us, this was the wrong medication, it actually gave him the ability to plan his death. He said it made the disease speed up in his case, allowing him to think more clearing in short periods of time.
What is the prognosis?
The outcome for people with FTD is poor. The disease progresses steadily and often rapidly, ranging from less than 2 years in some individuals to more than 10 years in others. Eventually some individuals with FTD will need 24-hour care and monitoring at home or in an institutionalized care setting.
After putting together a graph of behaviors over the years, I was able to trace Patsy’s odd behaviors to her late 20’s and Michael’s to his 30’s. Both progressed slowly until they weren’t working on a regular basis and at that time, it seems the disease progressed more rapidly.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS), and other institutes of the National Institutes of Health (NIH), conduct research related to FTD in laboratories at the NIH, and also support additional research through grants to major medical institutions across the country.
I tried to get Patsy into a clinical trial in NIH, that was the only facility at the time with any trials. We couldn't work it out, since it was so far away and there were no government funds or assistance to help with living expenses/lost wages etc with a location so far away from home (DC Area only at that time). Dr. Paul Schulz, a Neurologist in Houston did want our family to participate in on going testing to keep an eye out. As of this date, we have not done that. There is still very little being done in research compared to other diseases. One doctor told me "Today is like the 1980's were to Alzheimer's, we are just starting to work on FTD Education and Treatment."
(National Institute of Neurological Disorders and Stroke)
What is Frontotemporal Dementia ?
Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Originally known as Pick’s disease, the name and classification of FTD has been a topic of discussion for over a century. The current designation of the syndrome groups together Pick’s disease, primary progressive aphasia, and semantic dementia as FTD. Some doctors propose adding corticobasal degeneration and progressive supranuclear palsy to FTD and calling the group Pick Complex. These designations will continue to be debated. As it is defined today, the symptoms of FTD fall into two clinical patterns that involve either (1) changes in behavior, or (2) problems with language. The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation. The second type primarily features symptoms of language disturbance, including difficulty making or understanding speech, often in conjunction with the behavioral type’s symptoms. Spatial skills and memory remain intact. There is a strong genetic component to the disease; FTD often runs in families.
Michael and Patsy had symptoms from both, changes in behavior and problems with language. As the disease progressed, so did the symptoms.
Is there any treatment?
No treatment has been shown to slow the progression of FTD. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Anti-depressants have been shown to improve some symptoms.
Anti-depressants did help Patsy with the aggressive and angry behaviors. Sleeping pills helped her to rest at night.
Since we didn’t have clue what was going on with Michael, no drugs were administered, so no benefit here. Two weeks before his death, a doctor prescribed Aricept. A doctor later told us, this was the wrong medication, it actually gave him the ability to plan his death. He said it made the disease speed up in his case, allowing him to think more clearing in short periods of time.
What is the prognosis?
The outcome for people with FTD is poor. The disease progresses steadily and often rapidly, ranging from less than 2 years in some individuals to more than 10 years in others. Eventually some individuals with FTD will need 24-hour care and monitoring at home or in an institutionalized care setting.
After putting together a graph of behaviors over the years, I was able to trace Patsy’s odd behaviors to her late 20’s and Michael’s to his 30’s. Both progressed slowly until they weren’t working on a regular basis and at that time, it seems the disease progressed more rapidly.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS), and other institutes of the National Institutes of Health (NIH), conduct research related to FTD in laboratories at the NIH, and also support additional research through grants to major medical institutions across the country.
I tried to get Patsy into a clinical trial in NIH, that was the only facility at the time with any trials. We couldn't work it out, since it was so far away and there were no government funds or assistance to help with living expenses/lost wages etc with a location so far away from home (DC Area only at that time). Dr. Paul Schulz, a Neurologist in Houston did want our family to participate in on going testing to keep an eye out. As of this date, we have not done that. There is still very little being done in research compared to other diseases. One doctor told me "Today is like the 1980's were to Alzheimer's, we are just starting to work on FTD Education and Treatment."
Monday, November 10, 2008
This article from NW University Website http://www.brain.northwestern.edu/mdad/frontal.html
Notes in Red are personal additions based on our family experience
The psychological, social, family and financial issues that affect individuals with frontotemporal dementia are drastically different from those that affect individuals with Alzheimer's type dementia. When dementia occurs earlier in life, issues such as working, teenage children and financial stress are different from the issues dealt with by individuals who are older and most likely retired. Planning for the family's financial security and for the education of children becomes a difficult prospect when an individual is faced with a dementing illness in the prime of his/her working career. The nature of the symptoms themselves are often embarrassing to family members and there may be loss of friends and other sources of social support. [If we had only known, but this family didn’t. Michael and Patsy masked the symptoms very well for years. The docs told us, because they were intelligent and had a strong work ethic, they were able to function more effectively and longer. The docs asked us if they drank alcohol alot...oh yea they did. Docs said it was common for FTD patients to drink, they do it to cover up the slow creeping symptoms they don't know how to handle. When Michael retired, his decline was more rapid, again the docs defer to “not keeping the brain active”. Once he retired, he wasn’t feeding his brain; socially, educationally, or literally (good foods). Patsy took time off from work to write and publish an instructional manual for Windows 95 & 98 (she was a Microsoft Certified Systems Engineer). Because she moved away from the normal work environment into an home office environment, she wasn’t feeding her brain socially, educationally etc. When she tried to reenter the workforce, her skill sets had declined and was not able to secure the same level of employment. She worked as an admin assistant, but was let go when they claim she made several errors like ordering too many lunches etc. She gave me information (proof, which might dispute some of the reasoning they used to let her go, but I never did anything with it as we were so busy just getting through the days. I figure Humana (the company she worked for) just didn’t know what was going on with her and some of her odd behaviors. Once we moved her to be closer to us, she was not able to get a job, although did volunteer work. This did help her maintain daily functions until the wrong medications were given to her.]
Finally, most adult day programs and residential care facilities are not equipped to address the special needs of the younger patient, especially if the behavioral symptoms are difficult to manage. As more is known about the disease, more policy changes may come into effect. Some residential care and adult day programs are recognizing the needs of the younger dementia patient and are beginning to offer services to meet their needs. Before making any decisions, it is best to investigate your options. [When this happen to our family, there were really no options or assistance for a young person with this illness. Her son and daughter-in-law first took her into their home, until her suicide attempt. Then we took her in for a bit, but almost impossible due to her increasing agitated state and nonstop wandering. When a doctor diagnosed her with “brain shrinkage” we were able to move her to a nursing facility. The facility was not set up for a young adult with this condition. Patsy would memorize the security codes and let her self out of the facility daily].
Obtain a psychiatric evaluation from an individual with experience treating people with dementia. Certain medications can help with behavior problems such as agitation and hostility.
[The doctor that finally did this for us, called my sister directly and told her to come into his office. He told her (without any family in attendance) her brain was shrinking. Imagine a Doctor sitting you down and telling you this with no family support, hard to believe. INSIST on a SPECT or PET scan of the brain, it was not until I INSISTED it be done, the real diagnosis came in. The doctors in Houston told us most doctors are not skilled at diagnosing FTD from MRI’s (which are what Michael and Patsy both previously had). They said you can tell activity, but you really have to know what to look for, whereas a SPECT or PET scan show more definitively what is going on in each area of the brain].
Attend a caregiver support group. Listening to others who are going through similar experiences can be very comforting. They may also aid you in developing new caregiver techniques and learn about different resources within your community. [There was no such critter for us back then, the doctors even suggested we try to get one going…but we were way too tired most days to do anything so ambitious. Now I see there are more options out there…in fact the AFTD site has a support group attached which I have been going on and can see it is a great support for people navigating their way around this challenge - http://www.ftdsupportforum.com/].
Obtain a driving evaluation: Contact your local Alzheimer's Association for the driving evaluation program near you. [I can see this would be hard to deal with. We finally took the car away from my sister, she didn’t seem to mind. I can see this would be a case by case basis].
Friday, November 7, 2008
Symptoms of Frontotemporal Dementia
More information from NW University Website, with notes as they pertained to our family http://www.brain.northwestern.edu/mdad/frontal.html
Symptoms of Frontotemporal Dementia
* Impairments in social skills- inappropriate or bizarre social behavior (e.g., eating with one's fingers in public, being overly familiar with strangers)- "loosening" of normal social restraints (e.g., using obscene language or making inappropriate sexual remarks) [My brother became more restrained in public, not wanting to talk or interact, whereas my sister became more flirtatious and extroverted]
*Change in activity level- apathy, withdrawal, loss of interest, lack of motivation, and initiative which may appear to be depression but the patient does not experience sad feelings.- in some instances there is an increase in purposeless activity (e.g., pacing, constant cleaning) or agitation. [This varied as the stages varied. Michael had no desire to do anything, just wanted to watch a couple shows on TV and Patsy would buy a scratch lotto ticket, coke and candy bar every day "because it was a good deal".]
* Decreased Judgment- impairments in financial decision- making (e.g., impulsive spending)- difficulty recognizing consequences of behavior- lack of appreciation for threats to safety (e.g., inviting strangers into home) [Michael was frugal, where Patsy would take out credit cards and spend to the limit. Michael had my mother pay for repairs to his home during a visit. Before his illness, he would never have allowed that. Patsy had to be bailed out financially several times by mom. She couldn't pay her rent because she had spent her money on scratch tickets or computer equipment.]
* Changes in personal habits- lack of concern over personal appearance- irresponsibility- compulsiveness (need to carry out repeated actions that are inappropriate or not relevant to the situation at hand. [Michael and Patsy both gained weight late into the disease. They couldn't cook or operate the kitchen equipment any longer. Michael stopped showering regularly. Both were paranoid about security, would check and double check making sure the blinds were closed and doors locked.]
* Alterations in personality and mood- increased irritability, decreased ability to tolerate frustration [Michael would get frustrated with mom when she was visiting. He would go behind her and make sure she was locking the doors, she‘d open the blinds, he‘d close them. One time he got very angry with her when she pinched his side when he was playing pool (she was playing), he whirled around with the cue in his hand like he was going to hit her (he didn‘t, but here was a man that was very gentle historically…scared mom to death. Patsy got so frustrated when she got a ticket one time and I was trying to help her handle the situation in the courtroom. She got angry with me when I was trying to tell her what to say, or suggested I handle it...she just yell and I backed off. When the time came, she just blubbered not saying anything of consequence and the judge I am sure wondered what in the heck she was even doing there.]
* Changes is one's customary emotional responsiveness- a lack of sympathy or compassion in someone who was typically responsive to others' distress- heightened emotionality in someone who was typically less emotionally responsive. [Both showed less interest in their grandchildren, were afraid to hold them or play with them. You could tell them something sad about another person and they might smile and walk away.]
* I am adding this one. Artistic abilities may excel. For years Patsy would paint, draw, work with clay etc. She created many beautiful pieces, but towards the end, her drawings became dark. Then she got where she couldn't draw at all. Michael was an excellent golfer, but towards the end couldn't make a 6' put. He also started to draw. He drew mostly flowers and mountains. The doctors tell us since our mother was artistic, that ability existed all along, they just never developed it. Once the brain started to atrophy, this section was working overtime to compensate....so they started to paint and draw.
Persons with this form of dementia may look like they have problems in almost all areas of mental function. This is because all mental activity requires attention, concentration and the ability to organize information, all of which are impaired in frontal lobe dementia. Careful testing, however, usually shows that most of the problems stem from a lack of persistence and increased inertia.
Symptoms of Frontotemporal Dementia
* Impairments in social skills- inappropriate or bizarre social behavior (e.g., eating with one's fingers in public, being overly familiar with strangers)- "loosening" of normal social restraints (e.g., using obscene language or making inappropriate sexual remarks) [My brother became more restrained in public, not wanting to talk or interact, whereas my sister became more flirtatious and extroverted]
*Change in activity level- apathy, withdrawal, loss of interest, lack of motivation, and initiative which may appear to be depression but the patient does not experience sad feelings.- in some instances there is an increase in purposeless activity (e.g., pacing, constant cleaning) or agitation. [This varied as the stages varied. Michael had no desire to do anything, just wanted to watch a couple shows on TV and Patsy would buy a scratch lotto ticket, coke and candy bar every day "because it was a good deal".]
* Decreased Judgment- impairments in financial decision- making (e.g., impulsive spending)- difficulty recognizing consequences of behavior- lack of appreciation for threats to safety (e.g., inviting strangers into home) [Michael was frugal, where Patsy would take out credit cards and spend to the limit. Michael had my mother pay for repairs to his home during a visit. Before his illness, he would never have allowed that. Patsy had to be bailed out financially several times by mom. She couldn't pay her rent because she had spent her money on scratch tickets or computer equipment.]
* Changes in personal habits- lack of concern over personal appearance- irresponsibility- compulsiveness (need to carry out repeated actions that are inappropriate or not relevant to the situation at hand. [Michael and Patsy both gained weight late into the disease. They couldn't cook or operate the kitchen equipment any longer. Michael stopped showering regularly. Both were paranoid about security, would check and double check making sure the blinds were closed and doors locked.]
* Alterations in personality and mood- increased irritability, decreased ability to tolerate frustration [Michael would get frustrated with mom when she was visiting. He would go behind her and make sure she was locking the doors, she‘d open the blinds, he‘d close them. One time he got very angry with her when she pinched his side when he was playing pool (she was playing), he whirled around with the cue in his hand like he was going to hit her (he didn‘t, but here was a man that was very gentle historically…scared mom to death. Patsy got so frustrated when she got a ticket one time and I was trying to help her handle the situation in the courtroom. She got angry with me when I was trying to tell her what to say, or suggested I handle it...she just yell and I backed off. When the time came, she just blubbered not saying anything of consequence and the judge I am sure wondered what in the heck she was even doing there.]
* Changes is one's customary emotional responsiveness- a lack of sympathy or compassion in someone who was typically responsive to others' distress- heightened emotionality in someone who was typically less emotionally responsive. [Both showed less interest in their grandchildren, were afraid to hold them or play with them. You could tell them something sad about another person and they might smile and walk away.]
* I am adding this one. Artistic abilities may excel. For years Patsy would paint, draw, work with clay etc. She created many beautiful pieces, but towards the end, her drawings became dark. Then she got where she couldn't draw at all. Michael was an excellent golfer, but towards the end couldn't make a 6' put. He also started to draw. He drew mostly flowers and mountains. The doctors tell us since our mother was artistic, that ability existed all along, they just never developed it. Once the brain started to atrophy, this section was working overtime to compensate....so they started to paint and draw.
Persons with this form of dementia may look like they have problems in almost all areas of mental function. This is because all mental activity requires attention, concentration and the ability to organize information, all of which are impaired in frontal lobe dementia. Careful testing, however, usually shows that most of the problems stem from a lack of persistence and increased inertia.
Thursday, November 6, 2008
Comportment, Insight, and Reasoning
More information from NW University Website, with notes as they pretained to our family
http://www.brain.northwestern.edu/mdad/frontal.html
Comportment, Insight, and Reasoning
Frontotemporal dementia affects the part of the brain that regulates comportment, insight and reasoning. "Comportment" is a term that refers to social behavior, insight, and "appropriateness" in different social contexts. Normal comportment involves having insight and the ability to recognize what behavior is appropriate in a particular social situation and to adapt one's behavior to the situation. For example, a funeral is a solemn event requiring certain types of behavior and decorum. Similarly, while it may be perfectly natural and acceptable to take one's shoes and socks off at home, it is probably not the thing to do while in a restaurant. [My mother wouldn't take Michael to a restaurant anylonger, because of his unusual behaviors; making sucking noises with his teeth, passing gas, and stuffing the food in his mouth as though he was starving. Same with my sister, she would shovel the food in her mouth as though there was no tomorrow and would grab things from other peoples plates.] Comportment also refers to the style and content of a person's language. Certain types of language are acceptable in some situations or with friends and family, and not acceptable in others.
Insight, an important aspect of comportment, has to do with the ability to "see" oneself as others do. Insight is necessary in order to determine whether one is behaving in a socially acceptable or in a reasonable manner. Insight is also necessary for the patient to recognize his/ her deficits and illness. Changes in comportment may be manifested as "personality" alterations. A generally active, involved person could become apathetic and disinterested. The opposite may also occur. A usually quiet individual may become more outgoing, boisterous and disinhibited. Personality changes can also involve increased irritability, anger and even verbal or physical outbursts toward others (usually the caregiver). Comportment is assessed by observing the patient's behavior throughout the examination and interviewing other people (family and friends) who have information about the patient's "characteristic" behavior.
Individuals with frontotemporal dementia frequently have executive function and reasoning deficits. "Reasoning" refers to mental activities that promote decision-making. Being able to categorize information and to move from one perspective of a problem to another are examples of reasoning. "Executive functions" is a term that refers to yet another group of mental activities that organize and plan the flow of behavior. A good example of executive functions is what might happen if one were driving a car, talking with the passenger and suddenly having to respond to a child running into traffic. The ability to handle all the stimulation and to quickly plan a course of action is accomplished via executive functions. Individuals with frontal lobe dementia often lack flexibility in thinking and are unable to carry a project through to completion. [Our doctors told us when the other doctors put Michael on Aricept for memory problems, it helped his executive functions abilities. He was able to plan his suicide. Without the Aricept, he would never of been able to plan his death.] Failure of executive functions may increase safety risk since they may not be able to plan appropriate actions or inhibit inappropriate actions.
http://www.brain.northwestern.edu/mdad/frontal.html
Comportment, Insight, and Reasoning
Frontotemporal dementia affects the part of the brain that regulates comportment, insight and reasoning. "Comportment" is a term that refers to social behavior, insight, and "appropriateness" in different social contexts. Normal comportment involves having insight and the ability to recognize what behavior is appropriate in a particular social situation and to adapt one's behavior to the situation. For example, a funeral is a solemn event requiring certain types of behavior and decorum. Similarly, while it may be perfectly natural and acceptable to take one's shoes and socks off at home, it is probably not the thing to do while in a restaurant. [My mother wouldn't take Michael to a restaurant anylonger, because of his unusual behaviors; making sucking noises with his teeth, passing gas, and stuffing the food in his mouth as though he was starving. Same with my sister, she would shovel the food in her mouth as though there was no tomorrow and would grab things from other peoples plates.] Comportment also refers to the style and content of a person's language. Certain types of language are acceptable in some situations or with friends and family, and not acceptable in others.
Insight, an important aspect of comportment, has to do with the ability to "see" oneself as others do. Insight is necessary in order to determine whether one is behaving in a socially acceptable or in a reasonable manner. Insight is also necessary for the patient to recognize his/ her deficits and illness. Changes in comportment may be manifested as "personality" alterations. A generally active, involved person could become apathetic and disinterested. The opposite may also occur. A usually quiet individual may become more outgoing, boisterous and disinhibited. Personality changes can also involve increased irritability, anger and even verbal or physical outbursts toward others (usually the caregiver). Comportment is assessed by observing the patient's behavior throughout the examination and interviewing other people (family and friends) who have information about the patient's "characteristic" behavior.
Individuals with frontotemporal dementia frequently have executive function and reasoning deficits. "Reasoning" refers to mental activities that promote decision-making. Being able to categorize information and to move from one perspective of a problem to another are examples of reasoning. "Executive functions" is a term that refers to yet another group of mental activities that organize and plan the flow of behavior. A good example of executive functions is what might happen if one were driving a car, talking with the passenger and suddenly having to respond to a child running into traffic. The ability to handle all the stimulation and to quickly plan a course of action is accomplished via executive functions. Individuals with frontal lobe dementia often lack flexibility in thinking and are unable to carry a project through to completion. [Our doctors told us when the other doctors put Michael on Aricept for memory problems, it helped his executive functions abilities. He was able to plan his suicide. Without the Aricept, he would never of been able to plan his death.] Failure of executive functions may increase safety risk since they may not be able to plan appropriate actions or inhibit inappropriate actions.
Wednesday, November 5, 2008
Frontotemporal dementia explained
A doctor from Northwestern University was interested in seeing my brother and sister's artwork. I keep an eye on their website, some good information there.
This information is found on the NW University Website http://www.brain.northwestern.edu/mdad/frontal.html
I made sidenotes in red about our family experience with this disease:
What is frontotemporal dementia?
There is a type of dementia called "frontotemporal" which typically affects patients at a very early age. [Have now traced my sister’s from her 20’s and my brother in his 30’s] In this type of dementia, there is no true memory loss in the early stages of the type that is seen in Alzheimer's dementia. Instead, there are changes in personality, ability to concentrate, social skills, motivation and reasoning. Because of their nature, these symptoms are often confused with psychiatric disorders. [My sister had bouts of depression, once treated with electric shock treatments. My brother exhibited signs of depression in his 30’s and 40’s.] There are gradual changes in one's customary ways of behaving and responding emotionally to others. Memory, language and visual perception are usually not impaired for the first two years, yet as the disease progresses and spreads to other areas of the brain, they too may become affected. Typically, the disorder affects females more than males.
The symptoms reflect the fact that the brain degeneration is not initially widespread and settles in the parts of the brain that are important for social skills, reasoning, judgment and the ability to take initiative.
When the brains of individuals with frontal lobe dementia are studied after death, the types of microscopic abnormalities that are seen are typically of two kinds. The first type is called Non-specific focal degeneration and the second is labeled Pick's disease. [My sister was confirmed as Non-specific, we assume my brother was the same] Non-specific focal degeneration accounts for 80% of cases of frontal lobe dementia. It is called "non specific" because there are no abnormal particles that are identifiable-only evidence that brain cells have been eliminated. Pick's disease, which accounts for 20% of cases of frontal lobe dementia, is identified under the microscope by abnormal particles called "Pick bodies", named after the neurologist who first observed them.
This information is found on the NW University Website http://www.brain.northwestern.edu/mdad/frontal.html
I made sidenotes in red about our family experience with this disease:
What is frontotemporal dementia?
There is a type of dementia called "frontotemporal" which typically affects patients at a very early age. [Have now traced my sister’s from her 20’s and my brother in his 30’s] In this type of dementia, there is no true memory loss in the early stages of the type that is seen in Alzheimer's dementia. Instead, there are changes in personality, ability to concentrate, social skills, motivation and reasoning. Because of their nature, these symptoms are often confused with psychiatric disorders. [My sister had bouts of depression, once treated with electric shock treatments. My brother exhibited signs of depression in his 30’s and 40’s.] There are gradual changes in one's customary ways of behaving and responding emotionally to others. Memory, language and visual perception are usually not impaired for the first two years, yet as the disease progresses and spreads to other areas of the brain, they too may become affected. Typically, the disorder affects females more than males.
The symptoms reflect the fact that the brain degeneration is not initially widespread and settles in the parts of the brain that are important for social skills, reasoning, judgment and the ability to take initiative.
When the brains of individuals with frontal lobe dementia are studied after death, the types of microscopic abnormalities that are seen are typically of two kinds. The first type is called Non-specific focal degeneration and the second is labeled Pick's disease. [My sister was confirmed as Non-specific, we assume my brother was the same] Non-specific focal degeneration accounts for 80% of cases of frontal lobe dementia. It is called "non specific" because there are no abnormal particles that are identifiable-only evidence that brain cells have been eliminated. Pick's disease, which accounts for 20% of cases of frontal lobe dementia, is identified under the microscope by abnormal particles called "Pick bodies", named after the neurologist who first observed them.
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