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Alzheimer’s disease and frontotemporal dementia (FTD) are two common forms of dementia that often present with different early symptoms and affect everyday life in different ways.
In Alzheimer’s disease, the condition is usually first noticed through memory problems and difficulties learning new things. Frontotemporal dementia, on the other hand, often begins with clear changes in personality, behavior, or language, while memory may be relatively preserved in the early stages. FTD often affects people at a younger age, sometimes as early as their 50s or 60s, whereas Alzheimer’s is more common after the age of 65.
Treatment also differs: medications used for Alzheimer’s often have limited or no effect in FTD, where the focus instead is on daily structure, adaptations, and symptom relief. Understanding these differences is important so that early signs are taken seriously and the right assessment and support can be put in place.
What Is Frontotemporal Dementia (FTD) and What Is Alzheimer’s Disease?
Dementia is an umbrella term for various diseases that affect brain function to such an extent that everyday basic activities become difficult to manage. Two common forms of dementia are Alzheimer’s disease and frontotemporal dementia (FTD).
Alzheimer’s disease often initially affects memory and spatial orientation, while frontotemporal dementia primarily causes early changes in behavior, judgment, impulse control, and language. FTD is a broad term that includes several different variants, often categorized based on whether the main changes involve behavior (bvFTD) or language (primary progressive aphasia).
The Role of the Brain and Why the Diseases Present Differently
Alzheimer’s Disease
Alzheimer’s disease affects the hippocampus, a region that is crucial for memory and learning. This means that the affected person may have difficulty remembering conversations, appointments, and events, especially those that occurred recently.
Frontotemporal Dementia (FTD)
FTD affects the frontal lobes of the brain, which control planning, impulse control, judgment, and social interaction. In some cases, the disease also affects the temporal lobes, which are involved in language and interpretation of social cues. As a result, early signs are more often related to behavioral or language changes rather than memory impairment.
Who Can Be Affected by Dementia?
Age as the Main Common Factor
There are no clear answers as to why someone develops dementia, but the strongest common factor is age. Alzheimer’s disease is most common among people over the age of 65, while FTD often begins earlier in life—sometimes as early as the 50s or 60s, though it can also occur later.
Early Signs of Dementia
The first sign of frontotemporal dementia is often that the person is “not quite themselves,” rather than noticeable memory problems. In Alzheimer’s disease, forgetfulness and difficulty handling new situations are often what raise early concern.
Symptoms That Distinguish Frontotemporal Dementia from Alzheimer’s Disease
Behavioral and Personality Changes
In FTD, behavioral and personality changes are often evident early after onset. Common changes include:
- Disinhibition: reduced impulse control, leading the person to say or do things that previously would have felt inappropriate.
- Reduced initiative: the person becomes apathetic and loses motivation and interests.
- Decreased empathy: the person may act emotionally cold or appear uninterested in others.
- Compulsive behaviors: repetitive routines, hoarding, or restless behavior.
- Changes in eating habits: increased appetite, stronger cravings for sweets, or eating the same foods repeatedly.
Behavioral changes can also be part of Alzheimer’s disease but usually occur later in the course of the illness. Anxiety, low mood, and stress may appear early, often as a reaction to declining memory.
Impact on Memory
In Alzheimer’s disease, clear memory impairment is a common early sign, particularly difficulties with learning new information. People with Alzheimer’s often misplace items, forget appointments, and repeat questions.
Memory difficulties can also occur in FTD, but they are often less prominent in the early stages than in Alzheimer’s disease. The problems are more commonly related to planning, judgment, and organization rather than memory loss itself.
Language Impairments
Language difficulties are common in FTD. The person may struggle to find words, understand words they previously knew, or express themselves grammatically. Speech may become slower, simplified, or lacking in meaningful content.
In Alzheimer’s disease, the person may sometimes have trouble finding the right words, but these difficulties are often linked to memory loss and develop gradually.
Orientation and Spatial Awareness
People with Alzheimer’s disease may have difficulty navigating familiar environments, may get lost, and may struggle with understanding time and space.
In FTD, orientation is often preserved in the early stages, especially in those affected by the behavioral variant.
Disease Insight and Judgment
People with FTD often have poor insight into their condition and may not perceive that anything is wrong. They may make risky decisions regarding finances, driving, and social boundaries.
In Alzheimer’s disease, insight may be somewhat better in the early stages and decline later, though this varies between individuals.
Prognosis and Disease Progression
The course of the disease varies between individuals. Generally, Alzheimer’s disease progresses gradually over several years, with increasing need for support as the disease advances. In many people, FTD causes early difficulties in work and relationships. As a result, the disease may feel as though it progresses more rapidly, although there is also considerable variation depending on the specific variant and the individual. The rate at which different functions are affected depends on overall health, access to support services, stress levels, and coexisting conditions.
Examinations and Diagnosis
Dementia assessments are often carried out in primary care and, if needed, at a memory clinic. The goal is to determine which type of dementia is present and to rule out other possible causes. Common components of the evaluation include interviews with the patient and relatives, cognitive testing, physical examination, and imaging such as MRI of the brain or computed tomography. In cases of FTD, information from relatives is often particularly important, as the person affected frequently has limited insight into their condition.
Treatment of Dementia
At present, there is no curative treatment for either Alzheimer’s disease or FTD, but there are tools and strategies that can ease daily life and reduce symptoms.
Treatment for Alzheimer’s Disease
Treatment plans for Alzheimer’s disease often include medications that may slow progression or alleviate symptoms, practical support such as memory aids and home adaptations, and support for anxiety, low mood, and sleep problems.
Treatment for Frontotemporal Dementia (FTD)
In FTD, supportive care for the patient is most important, such as help with clear routines, stress management, and simplifying choices. The patient benefits from a gentle approach with calm, concrete communication. Medications may sometimes be used to treat anxiety and compulsive behaviors, but their effectiveness varies.
It is important to remember that what helps in Alzheimer’s disease does not always help in FTD, and vice versa. Therefore, an accurate diagnosis is essential.
When Should You Seek Medical Care?
Seek medical care if you or a loved one experiences clear changes in memory, language, behavior, or judgment that affect daily life. Particular attention should be paid if the changes are noticeable to others and have been present for a long time.
When Emergency Care May Be Needed
Dementia itself is not an acute medical condition, but there are situations where prompt help is necessary. For example, if the person poses a risk to themselves or others through dangerous driving or becomes very aggressive. Some signs of dementia can also be mistaken for signs of infection, stroke, or other acute illnesses. Seek emergency care if you experience sudden confusion or rapid deterioration, weakness or numbness on one side of the body, slurred speech, loss of vision, or severe headache.