In Part Two of this series we looked at several types of dementia: Alzheimer’s Disease, Vascular Dementia and Lewy Body Dementia, and discussed their etiology (cause), characteristics and symptoms. In this Post I would like to look at two other types: Parkinson’s Disease and Frontotemporal Dementia (FTD).
Parkinson’s disease is a fairly common neurological disorder in older adults, estimated to affect nearly 2 percent of those older than age 65. The National Parkinson Foundation estimates that 1 million Americans have Parkinson’s disease. While the part of the brain affected means there are classic movement symptoms, people with Parkinson’s can also go on to develop dementia symptoms as the degenerative changes in the brain gradually spread. It’s been estimated that 50 to 80 percent of those with Parkinson’s disease eventually experience Parkinson’s disease dementia. On average, the symptoms of dementia develop about 10 years after a person first gets Parkinson’s disease.
The brain changes caused by Parkinson’s disease begin in a region that plays a key role in movement. As Parkinson’s brain changes gradually spread, they often begin to affect mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task. It also also includes tremor, rigid muscles, and a face without emotion.
Parkinson’s disease dementia is very similar to Lewy Body Dementia. They have the same symptoms, and people with both conditions have signs of Lewy bodies in their brains. The key brain changes linked to Parkinson’s disease and Parkinson’s disease dementia are abnormal microscopic deposits composed chiefly of alpha-synuclein, a protein that’s found widely in the brain but whose normal function isn’t yet known. Evidence suggests that dementia with Lewy bodies, Parkinson’s disease and Parkinson’s disease dementia may be linked to the same underlying abnormalities in brain processing of alpha-synuclein. Another complicating factor is that many people with both Lewy Body Dementia and Parkinson’s disease dementia also have plaques and tangles — hallmark brain changes linked to Alzheimer’s disease.
Frontotemporal dementia (FTD) is a dementia which consists of cell damage in areas of the brain that control planning and judgment, emotions, speech, and some types of movement. It is characterized by drastic personality changes and language difficulties. In all FTD the person will have a relatively early social withdrawal and early lack of insight into the disease. Memory problems are not a main feature of this disease.
There are three main types of FTD. The first has major symptoms in the area of personality and behavior. This is called behavioral variant FTD (bv-FTD) and is the most common. In bv-FTD, the person will have a change in personal hygiene, they will become rigid in their thinking, they rarely recognize that there is a problem, they will be socially withdrawn, and they will often have a drastic increase in appetite. The person may also be socially inappropriate. For example, the person may make inappropriate sexual comments, or may begin using pornography openly when they had not before. One of the most common signs is apathy, or not caring about anything. Apathy, however, is a common symptom in many different dementias.
The other two types of FTD feature language problems as the main symptom. The second type is called semantic dementia or temporal variant dementia (TV-FTD). The main feature of this is the loss of the meaning of words. It may begin with difficulty naming things. The person eventually may also lose the meaning of objects as well. For example, a drawing of a bird, dog, and an airplane in someone with FTD may all appear just about the same. In a classic test for this, a patient is shown a picture of a pyramid and below there is a picture of both a palm tree and a pine tree. The person is asked to say which one goes best with the pyramid. In TV-FTD the person would not be able to answer that question.
The last type of FTD is called progressive non-fluent aphasia (PNFA). This is mainly a problem with producing speech. They have trouble finding the right words, but mostly they have a difficulty coordinating the muscles they need to speak. Eventually, someone with PNFA will only use one-syllable words or may become totally mute.
With both TV-FTD and PNFA the symptoms of behavior may be present, but milder and later than in bv-FTD. On imaging studies, there will be shrinking of the frontal and temporal lobes of the brain.
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