Frontotemporal Dementia

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Frontal or frontotemporal dementia is a less common subtype. Earlier, all such cases were thought to have Pick's bodies, a specific type of microscopic abnormality, but many cases of frontotemporal dementia do not show this lesion. The clinical features overlap with those of Alzheimer's disease, but ''frontal lobe disinhibition" signs are more prominent: overeating, sleeping excessively, hypersexuality, motor agitation, and impulsive and unpredictable behavior. Following damage to the temporal and frontal lobes, impulsive behaviors are unleashed from lower parts of the brain, as in the case of Phineas Gage, the railroad foreman whose frontal lobes were crushed by a tamping iron over a hundred years ago. For example, I remember a patient of mine with frontal lobe dementia who gained eighty pounds in one year and lost a hundred pounds in the next. These changes happened without any conscious effort on her part to either diet or put on weight. It was as if the appetite center in the hypothalamus (in a deep part of the brain) was receiving different inputs from the damaged frontal lobes in different calendar years. Some patients with frontal lobe dementia develop complete apathy and lethargy, a near vegetative existence. This can happen even when memory loss is only mild to moderate in severity.

currently, there is no specific, approved treatment for either Lewy body disease or frontotemporal dementia.

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