Pick's Disease: Behavioral Variant Frontotemporal Dementia

This Type of Frontotemporal Degeneration Is Also Known as Pick's Disease

Behavioral Variant Frontotemporal Dementia
Frontotemporal Dementia. MedicalRF.com/ Getty Images

Behavioral variant frontotemporal dementia (bvFTD) is one of several types of dementias that fall into the "frontotemporal degeneration" category. This category affects approximately 50,000 to 60,000 Americans. As the name indicates, this kind of dementia primarily affects the frontal and temporal lobes of the brain. The most common frontotemporal dementias are of the behavioral-variant type. Behavioral-variant frontotemporal dementia is sometimes referred to as Pick's disease.

Symptoms

The most common symptoms of bvFTD are behavioral or emotional challenges, including compulsively overeating, having an emotionally-detached demeanor, making socially inappropriate responses, acting hypersexual in conversation and thought, along with irritability, agitation, apathy and selfishness.

Some individuals with bvFTD also experience movement difficulties similar to Parkinson’s disease, including decreased facial expressions, muscle stiffness, weakness and rigidity.

Unlike Alzheimer's, memory loss does not usually develop until the disease is its later stages. As a caregiver, you may then notice some memory difficulties, as well as challenges with planning or attention (related to executive functioning).

In severe bvFTD, language also is affected, making communication very difficult.

How Is Pick's Disease Different from Alzheimer's?

Behavioral variant frontotemporal dementia (Pick's disease) has some overlap with Alzheimer's disease since both diseases typically affect cognition, emotion and behaviors.The earlier symptoms of Pick's disease, however, consist primarily of changes in emotion, judgment, executive functioning and behavior, while in Alzheimer's disease, memory, orientation and communication deficits are more common initially.

 

Diagnosis

Diagnosis of BvFTD is often delayed because initially it may be thought that an affected person is just being rude, selfish, depressed or acting out of character. As symptoms progress, however, families usually seek a clinician's assistance for diagnosis and treatment. Diagnosis depends on the presence of multiple symptoms that are outlined above, as well as the ability to rule out other dementias such as Alzheimer's or vascular dementia.

Reviewing the official criteria for behavioral variant FTD may be helpful for family members if BvFTD is diagnosed or being considered by the physician.

An MRI can also assist in diagnosing bvFTD because it will often show some atrophy (shrinkage) of the frontal lobe of the brain. As the disease progresses, the atrophy will increase and spread to the temporal areas, as well as the basal ganglia.

Prognosis (Long-Term Outlook)

Average life expectancy from onset of symptoms is approximately eight to nine years, though some people may live 20 years or so with the disease. As with any dementia, it can be a challenging disease for caregivers. Treatment may consist of attempting to use non-drug behavior strategies to curb specific behaviors. Some physicians prescribe antidepressants called selective serotonin reuptake inhibitors (SSRIs), which may help with some of the obsessive-compulsive behaviors such as hoarding or overeating.

A Word from Verywell

It's normal to feel overwhelmed at times as you cope with the challenges of behavioral variant frontotemporal dementia. Ignore the temptation to try to do it all yourself; instead, reach out for support to those around you, whether that's through a community support program, an online discussion about BvFTD or a friend who's willing to take you out for coffee or sit at home with your loved one while you take a nap.

Additionally, The Association for Frontotemporal Dementia lists local support groups as well as online resources and a phone line for help.

Sources:

Annals of Neurology. Eating and hypothalamus changes in behavioral-variant frontotemporal dementia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084499

The Association for Frontotemporal Degeneration. International consensus criteria for behavioural variant FTD. http://www.theaftd.org/wp-content/uploads/2009/02/Table-3-International-consensus-criteria-for-behavioural-variant-FTD.pdf

Banks, S., Weintraub, S. Journal of Geriatric Psychiatry and Neurology. Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia.. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892801/

Neurology. Sensitivity of current criteria for the diagnosis of behavioral variant frontotemporal dementia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821829/

University of California, San Francisco. Disease Progression: Behavioral variant FTD.  http://memory.ucsf.edu/ftd/overview/ftd/progression/multiple

Continue Reading