BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA (BVFTD)

OVERVIEW

The behavioral variant of Frontotemporal dementia (bvFTD) is the most common presentation of Frontotemporal degeneration.  This variant is characterized by progressive atrophy (cell loss) in frontal and anterior temporal regions of the brain leading to alterations in complex thinking, personality and behavior.

SYMPTOMS

Below are the typical symptoms of behavioral variant Frontotemporal degeneration:

•  Behavioral disinhibition: Disinhibition is the hallmark feature of bvFTD and can manifest as socially inappropriate behavior (e.g., inappropriately approaching or touching strangers), loss of manners or decorum (e.g., violation of personal space, rude or offensive remarks), or impulsive, rash or careless actions (e.g., reckless buying or sellling).
•  Apathy/Inertia: Patients with bvFTD also present with a general loss of interest, drive or motivation. In extreme cases, patients may need prompts to initiate or continue basic activities (e.g., bathing, dressing). 
•  Loss of empathy: bvFTD patients may seem emotionally cold or detached and can exhibit an overt disregard for others pain or distress.
•  Perseverative/Compulsive behaviors: These can range from simple repetitive behaviors such as tapping, scratching or picking, to complex compulsive behaviors such ordering, cleaning or collecting.
•  Changes in eating habits: Dietary changes can range from altered food preferences or “food fads” (e.g., only eating a particular type of food) to indiscriminate binge eating and weight gain.
•  Executive dysfunction:  Due to cell loss in their frontal lobes, bvFTD patients exhibit deficits in complex thinking or “executive functions” such as planning, organizing, mental flexibility and generation of ideas.

DIAGNOSIS CHALLENGES

Given the gradual behavioral and personality changes typical of bvFTD, diagnosis of the syndrome can be challenging.  Many patients endure multiple physician and mental-health referrals before their disease is recognized as a neurodegenerative disorder.  Even when patients are identified as suffering from a neurological problem, they are often misdiagnosed with Alzheimer’s disease or other forms of dementia.  Early and accurate diagnosis of bvFTD is crucial, as it allows for appropriate care and counseling of patients and their families. Most importantly, accurate diagnosis of behavioral variant Frontotemporal degeneration will identify patients likely to benefit from new medications, once these become available.