In the November/December edition of Scientific American-Mind, one of the feature articles discusses an often misdiagnosed illness called Frontal-Temporal Dementia (FTD). Formerly called Pick's Disease, a disease that has been known about for a number of years but not often diagnosed, it is a form of dementia that obliterates the personality of individuals. Although the study of dementia is still underfunded and in its incipient stages, FTD is a neurodegenerative disease that is less funded with a lower quantity of research done than other more prominently known neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Although Alzheimer's disease is still far more common, many middle aged and older adults may actually be misdiagnosed and be manifesting the effects of FTD than Alzheimer's disease.
Understanding the implications of FTD may be important for those that service older adults, especially in long-term care environments. There are a few reasons for this. First, individuals that acquire FTD often are younger, with many patients suffering from this disease first manifesting their symptoms in middle age. Therefore, many individuals that end up in long-term care facilities will potentially need a different level of accommodation of needs than would be provided to an older adult with Alzheimer's disease. Second, this disease targets the personality of the individual, slowing destroying many of the acquired social skills that are so important for human functioning. Therefore, these individuals frequently demonstrate behavioral problems that alter their personality, often to a diametric point of opposition from what their personality on a premorbid level was prior to their illness. Many of these individuals will become combative and demonstrate markedly inappropriate social behavior, features that are not typically a part of the profile of those that suffer from Alzheimer's disease.
FTD strikes different parts of the brain as compared to its more commonly known relative, Alzheimer's disease. With FTD, the destruction of critical brain areas in the frontal region and temporal regions is marked, which differentiates it from Alzheimer's. By insinuating its influence especially in the frontal areas of the brain, especially within the prefrontal cortex, an area that is responsible for appropriate social behavior and personality, the progressive unraveling of the basic core of humanity is slowly eroded. This subsequently creates a different profile than that which is found with Alzheimer's disease, a disease that more prominently targets memory yet does not demonstrate the level of personality degeneration as is found in FTD.
Since FTD creates an incredible debilitating influence on the social behaviors of the person, this in itself can be very important for correct diagnoses and treatment. Although the disease cannot be cured, and it is progressive and ultimately fatal, incorrectly diagnosing the disease can lead to treatment interventions that are better suited for those with Alzheimer's. Since inappropriate social behaviors from even a single individual that suffers from FTD can ultimately be destructive to the milieu of the long-term care environment and other residents that interact with this individual, accurately diagnosing and tailoring a particular treatment intervention that addresses the potentially unwieldy and inappropriate behavior of those that suffer from this terrible disorder is necessary.
Because FTD is often a social disorder, the aberrant social behaviors that gradually surface as the person's personality degenerates, needs to be controlled to maintain a productive and therapeutic milieu within the long-term care facility. Although no form of therapy will reverse the progression of the disorder, sensitive clinical intervention is often needed to appropriately target the symptoms and reduce the severity of their manifestation.
As many who work in long-term care are well aware, it only takes one resident that fails to have proper control over their behavior that can cause a reign of terror and lead to total disruption of the environment. Subsequently, this can also lead to excessive paperwork, reports being made and submitted due to resident altercations, as well as heightened labor costs due to the need for one to one care being rendered for the disruptive resident. One has to wonder how often individuals with FTD, due to being misdiagnosed and given inappropriate treatment, are found in long-term care settings. Furthermore, one has to wonder how much calmer many of these facilities could be if individuals with this disorder were appropriately addressed.
Ultimately it is up to the staff to become more educated on the types of dementias that exist, their distinctive forms and manifestations, and subsequently the appropriate forms of treatment that need to be targeted toward addressing the symptoms of various forms of dementia. Although this may seem a daunting task, it nevertheless is increasingly necessary to provide appropriate therapeutic intervention that will lead to a less stressful environment for residents and workers alike.
Chen, I. When character crumbles. Scientific American-Mind Nov/Dec 2010;30-37.