Behavioral variant frontotemporal dementia

Clinic

• BvFTD was previously known as Pick's disease
• It is the most common of the FTD types.
• It can change to being impulsive and disinhibited, acting in socially unacceptable ways; or it can change to being listless and apathetic.
• About 12–13% of people with bvFTD develop motor neuron disease.

• The Pick bodies are spherical inclusion bodies found in the cytoplasm of affected cells. They consist of tau fibrils as a major component together with a number of other protein products including ubiquitin and tubulin.

Sign / Symptoms

Six distinct clinical features have been identified as symptoms of bvFTD.

1. Disinhibition
2. Apathy/ Inertia
3. Loss of Sympathy/ Empathy
4. Perseverative/ Compulsive behaviors
5. Hyperorality
6. Dysexecutive neuropsychological profile

Marked behavioral changes such as

• Trouble in controlling behavior / Impulsive behavior: It is associated with a lack of inhibition, resulting in inappropriate behavior, such as temper tantrums, touching strangers, public urination or diminished social tact. At the extreme, the impulsivity can be self-destructive, as when patients try to get out of a moving car. In some people, inappropriate sexual behavior occurs.
• Apathy, lack of motivation: It is often the first symptom reported by caregivers and may be mistaken for depression.
• Loss of Sympathy / Empathy: Social withdrawal, they behave inappropriately with strangers, lose their social manners, act impulsively and even break laws. They become self-centered, emotionally distant and withdrawn. They become increasingly unkempt.
• Overeating: Overeating is common and “food fads” can occur where the person with bvFTD will only eat certain foods. Care partners often notice an overactive sweet tooth.
• Problems with planning, organization and sometimes memory are evident, but the individual is still capable of managing household tasks and self-care with minimal help.
• Restlessness, irritability, aggressiveness, violent outbursts or excessive sentimentality are not unusual either. But at this stage, the behaviors can often be managed with lifestyle and environmental changes (read our practical tips for ideas)
• Impaired judgment which lead to criminal behavior (such as shoplifting, indecent exposure, running stop lights, poor financial judgment or impulsive buying).
• Repetitive / Compulsive behaviors that may include hoarding, doing the same thing over and over, pacing, or repeating particular “catch phrases” over and over or repetitive urination, hoarding or collecting objects, compulsive cleaning or silly repetitive movements (like stomping on ants). Binge eating may create weight problems and other health issues.
• Delusions that are jealous, religious or bizarre in nature.
• Euphoria – excessive or inappropriate elation or exaggerated self-esteem.
• The cognitive problems leads to mental rigidity, forgetfulness, severe deficits in planning and attention and difficulty understanding conversations.
• Their language skills and memory usually remain intact until late in the disease but Problems with language and other thinking skills can also happen and they may start speaking in shorter phrases and may eventually lose their ability to speak.
• Sometimes, they may have weakness in their muscles, difficulty swallowing, or difficulty walking.

BvFTD Black- Box

	Entities	Miasms	Remedies
	Behavioral chgange
	Depression or Anger
	Cognition impaired
	Delusion
	Dementia