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What is Behavioral Variant Frontotemporal Dementia (bvFTD): Symptoms, Diagnosis, Treatment

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  • Post last modified:June 19, 2024

Behavioral Variant Frontotemporal Dementia (bvFTD) is a significant yet often misdiagnosed form of dementia, accounting for about half of all frontotemporal dementia cases. Characterized by dramatic changes in personality and behavior, bvFTD profoundly affects patients and their families. 

This article explores the key symptoms, diagnostic challenges, and current management strategies for bvFTD, highlighting the importance of early detection and the ongoing research aimed at improving understanding and treatment of this complex condition.

Table of Contents

    What is bvFTD?

    behavioral variant frontotemporal dementia

    Behavioral Variant Frontotemporal Dementia (bvFTD), also known as frontal lobar Degeneration or Pick’s disease. This form of FTD is characterized by frontal lobe issues which then causes significant changes in personality, apathy, and a progressive decline in socially appropriate behavior, judgment, self-control, and empathy.

    Clinical Symptoms of bvFTD

    behavioral variant frontotemporal dementia

    Behavioral Variant Frontotemporal Dementia (bvFTD) is characterized by significant changes in personality, apathy, and a progressive decline in socially appropriate behavior, judgment, self-control, and empathy. The clinical symptoms of bvFTD can be broadly categorized into several key areas:

    Impairments in Social Skills

    • Inappropriate or bizarre social behavior: Examples include eating with one’s fingers in public, doing sit-ups in a public restroom, or being overly familiar with strangers.
    • “Loosening” of normal social restraints: This includes using obscene language or making inappropriate sexual remarks.

    Changes in Activity Level

    • Apathy, withdrawal, loss of interest, lack of motivation and initiative: These symptoms may appear similar to 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.

    Decreased Judgment

    • Impairments in financial decision-making: This includes impulsive spending and difficulty recognizing consequences of behavior.
    • Difficulty recognizing threats to safety: For example, inviting strangers into one’s home.

    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)

    Alterations in Personality and Mood

    • Increased irritability, decreased ability to tolerate frustration
    • Changes in emotional responsiveness: This includes a lack of sympathy or compassion in someone who was typically responsive to others’ distress, as well as heightened emotionality in someone who was typically less emotionally responsive.

    Diagnosis and Misdiagnosis

    Diagnosis of bvFTD can be challenging, especially in the early stages. It is often misdiagnosed as depression, other psychiatric disorders, Alzheimer’s disease, vascular dementia, Parkinson’s disease, or even an alcohol or drug dependence. The Association for Frontotemporal Degeneration (AFTD) has developed a diagnostic checklist to help identify red flags for bvFTD and ensure accurate diagnosis.

    Treatment and Management

    There are no treatments that can slow the progression of bvFTD. Behavioral and environmental interventions are currently considered the most effective way to manage symptoms. These interventions include:

    1. Challenging Disruptive Behaviors: Addressing and redirecting problematic behaviors.
    2. Reassuring and Distracting Tactics: Using calming and engaging strategies to reduce agitation.

    Pharmacotherapy options are limited, but some individuals may benefit from selective serotonin reuptake inhibitors (SSRIs) to address symptoms such as apathy, irritability, and disinhibited behavior. However, these medications are not specifically approved for FTD.

    Imaging studies, such as MRI and CT scans, can demonstrate the typical changes associated with bvFTD. These include atrophy of the frontal lobes and, to a lesser extent, the temporal lobes. The degree of atrophy can be asymmetric and is often associated with a decrease in volume of the caudate heads.

    Research and Future Directions

    Several multicenter natural history research programs are focused on sporadic and familial bvFTD and associated disorders. These programs aim to conduct comprehensive longitudinal clinical and biomarker measures to inform clinical trial methodology and foster research advances in bvFTD and related disorders.

    Conclusion

    Behavioral Variant Frontotemporal Dementia (bvFTD) is a complex and challenging condition that requires accurate diagnosis and effective management. While there are no treatments to slow its progression, behavioral and environmental interventions can help alleviate symptoms. Ongoing research aims to improve diagnostic accuracy and develop new therapeutic approaches for this condition.

    Frequently Asked Questions (FAQ)

    What is the life expectancy of a person with behavioral variant frontotemporal dementia?

    The life expectancy of a person with behavioral variant frontotemporal dementia (bvFTD) varies significantly. The disease typically progresses over a period of 8-10 years, with the pace of symptoms and length of disease varying dramatically from person to person.

    What is the prognosis for behavioral variant frontotemporal dementia?

    The prognosis for behavioral variant frontotemporal dementia (bvFTD) is generally poor. The disease is progressive, and the symptoms become more pronounced and disabling over time. There is no cure, and treatment options are limited to managing the symptoms. The disease can lead to significant impairment in daily life and social relationships.

    What are 5 extreme behavior changes found with FTD?

    Some extreme behavior changes associated with behavioral variant frontotemporal dementia (bvFTD) include:

    • Pathological Gambling: New onset of pathological gambling is a symptom that can occur in some cases of FTD.
    • Hyper-Religiosity: Rarely, individuals with FTD may exhibit hyper-religiosity, which can be a significant change in their behavior.
    • Stereotypic or Aberrant Motor Behavior: Patients with bvFTD may exhibit repetitive or stereotypic motor behaviors, such as echolalia or perseveration.
    • Impaired Satiety and Changes in Eating Preferences: Changes in eating behavior, such as impaired satiety and preferences for sweet foods, are common in bvFTD.
    • Loss of Empathy: A common early symptom of bvFTD is the loss of empathy, leading to difficulties in understanding and relating to others