Frontotemporal dementia (FTD) is a group of neurodegenerative conditions that primarily affect the parts of the brain responsible for behaviour, personality, decision-making and communication. Unlike many other dementias, FTD often develops earlier in life, commonly affecting adults in mid-life rather than older age.

Because the areas of the brain involved control how we interact with others and express ourselves, the early signs of FTD are often behavioural or language-related rather than memory-based. These changes can be subtle at first but tend to become more noticeable as the condition progresses.

FTD presents in different ways depending on which brain networks are most affected:

• Behavioural variant FTD (bvFTD)
  Characterised by changes in personality, social awareness and impulse control, often leading to behaviour that is out of character or socially inappropriate.
• Primary Progressive Aphasia (PPA)
  A form of FTD where communication difficulties are the earliest feature, including problems understanding language or finding the right words.
• Progressive Non-Fluent Aphasia (PNFA)
  A subtype of PPA that mainly affects speech production, making conversation increasingly effortful and fragmented over time.

Frontotemporal dementia develops as a result of ongoing damage to the frontal and/or temporal regions of the brain. These areas are essential for regulating behaviour, emotions, language and executive function.

• Changes in the frontal regions can affect motivation, emotional control, social awareness and problem-solving abilities.

• Damage within the temporal regions may disrupt language processing, speech, and the ability to recognise people or objects.

In some cases, FTD has a genetic component, meaning it may run in families. Specialist assessment can help determine whether inherited factors are likely to be involved.

The temporal lobes of the brain process hearing and sight. Damage to these lobes may lead to difficulty recognising objects, understanding or expressing language.

With most cases of dementia, symptoms typically begin to present themselves and become noticeable in people over the age of 65. However, symptoms of frontotemporal dementia can begin at a much earlier age. This is because the abnormal proteins that build up inside the brain cells are not solely a factor of age.

The main symptoms of frontotemporal dementia are a progressive change in personality and behaviour or progressive deterioration in language abilities.

Behavioural Symptoms

Individuals with frontotemporal dementia might display changes to their behaviour and personality. Examples include:

• Inappropriate social behaviour
• Lack of empathy and interpersonal skills
• Poor judgement
• Loss of inhibitions and increased recklessness
• Apathy
• Compulsive behaviours
• Changes to their eating habits, including eating inedible objects
• A decrease in personal hygiene

Physical Symptoms

Frontotemporal dementia can cause issues with speech and language. These symptoms might include: 

• Difficulty understanding language, both written and spoken
• Struggling to name things
• No longer understanding what some words mean
• Communicating in short, simple sentences 
• Having trouble correctly structuring sentences

Speech and Language Symptoms

Physical symptoms may also begin to present as the disease frontotemporal dementia progresses. These could include any of the following:

• Difficulty swallowing
• Loss of bladder and bowel control
• General movement difficulty and muscle weakness.