From: deputydog23x@gmail.com   
      
       
   Strange Behavior Caused by Frontotemporal Dementia (FTD)   
   Posted by James Cooper MD   
      
   inShare   
    frontal atrophy   
      
   In FTD, the front part of the brain (arrow) is atrophied. Copyright image by   
   James Cooper, all rights reserved.   
      
   "I like your wig, it's really nice," he said, with sincerity, to the woman in   
   the hallway he had never seen before. She abruptly turned and walked away.   
      
   "I bet you're great in bed, honey," he said to the attractive young female   
   physician, nodding his head in self-agreement. She ignored his comment, and   
   continued taking a medical history.   
      
   We were evaluating this 61 year-old retired dentist in our clinic. "He says   
   things he never would have before. I guess his personality just changed. And   
   you should see how he goes for sweets now!" his wife said.   
      
   With that, she essentially made the diagnosis for us, pointing directly   
   towards frontotemporal lobe degeneration (FTD).   
      
      
       
   What is FTD? (Frontotemporal Lobe Dementia)   
      
   FTD is a common but under-diagnosed type of dementia. It's a dementia because   
   it is a progressive brain disorder that results in death of brain cells, and,   
   ultimately, memory loss. Family support groups often prefer that the "D" stand   
   for degeneration.   
      
   This emphasizes FTD as a unique disorder, separate from the most common   
   dementia, Alzheimer's. Also, "dementia" may bring to mind a completely   
   different and incorrect picture of how the person with FTD functions early in   
   the disease.   
      
   FTD is a fairly big umbrella under which a number of interesting clinical   
   syndromes exist. Each clinical syndrome has a separate diagnosis name. Most   
   have in common that they are "tauopathies," meaning that at the level of the   
   brain cell, the neuron,     
   abnormal tau can be found.   
      
   Tau (rhymes with cow) is a microtubule associated protein. Microtubules are   
   like old-time coal shafts that allowed coal lumps to go from the street to the   
   furnace in the basement. Microtubules are access channels that allow large   
   molecule proteins to    
   enter the neuron. Tau holds the shaft open. When tau is abnormal, the shaft   
   collapses and the neuron starves.   
      
   Abnormal tau and neuron fragments (tangles) can be identified microscopically   
   in tauopathies. No one knows what causes the abnormal tau, but it is often   
   associated with gene mutation.   
      
   The specific disease or clinical picture that erupts from tauopathy depends on   
   two factors: variation in the tau abnormality, and, mostly, the location in   
   the brain where the abnormality and brain circuit disruption occurs.  In FTDs,   
   the brain circuit    
   disruptions occur in the frontal lobe or temporal lobes (which are the sides   
   of the frontal lobe).   
      
   The case described here, the dentist with the fresh mouth (uninhibited   
   speech), and sweet craving, is an example of the behavioral variant of FTD,   
   bvFTD, the most common FTD. Besides uninhibited behavior, signs and symptoms   
   associated with bvFTD often    
   include apathy and utilization behavior (doing something that is a normal   
   function, but not for any apparent reason, e.g., opening and closing a drawer,   
   or shuffling through a stack of papers). Some have suggested that most extreme   
   hoarders have some    
   frontal lobe abnormality.   
      
   Temporal Lobe Loss: Related Behaviors   
      
   Drs. Kluver and Bucy removed a large part of the temporal lobes of monkeys,   
   disrupting massive numbers of temporal (frontal) lobe circuits.  The monkeys   
   were found to masturbate (more than their usual amount); to be apparently more   
   fearless, ignoring    
   snakes;  to fail to recognize familiar objects, and to be hyper-oral, stuffing   
   objects into their mouths with great abandon. Kluver-Bucy syndrome can occur   
   in humans as a result of FTD. Also, herpes infection, Alzheimer's, and trauma   
   can cause Kluver-   
   Bucy syndrome.   
      
   The Red Baron's Brain Injury   
      
   The Red Baron was a flying ace in WW I. His flying skill and judgment were   
   excellent, until his judgment let him down. The Baron received a brain injury   
   in combat. He became sullen, withdrawn, and made poor judgments. Once he even   
   flew low over enemy    
   lines pursuing a damaged enemy plane, an action he warned his students never   
   to do.   
      
   He was trying to make another score, a score he did not need. His low flight   
   made him vulnerable to ground machine guns. He was hit and killed. It is   
   believed that his earlier brain trauma led to a change in his personality,   
   from an accurate but cautious    
   flyer to an immature poor decision-maker, a person with FTD from brain trauma.   
      
   Clearly, damage to the frontal lobe can cause distressing, even heartbreaking   
   changes in behavior. The monkeys who lost part of their frontal brain, the   
   people with Kluver-Bucy syndrome, the Red Baron, extreme hoarders, and those   
   with bvFTD are examples.    
   Since behaviors define personality, frontal lobe damage can change a person's   
   personality.   
      
   Treating FTD   
      
   The US Food and Drug Administration (FDA) has approved no medications for   
   treatment of FTD. Research has shown that Donepezil (Aricept), rivastigmine   
   (Exelon) and similar medications are not useful. While early studies were   
   encouraging, definitive    
   studies of memantine (Namenda) have shown it appears to have no value for   
   treating FTD.   
      
   However, there are treatments that are generally accepted as useful. These are   
   behavioral interventions. If the family understands the patient cannot help   
   his lack of inhibition, they can be supportive rather than critical.   
      
   Sometimes public explanations of the behavior will sooth an offended person.   
   Some families have cards printed, "My wife has a condition in which she may   
   say inappropriate things. We apologize if you are offended, and hope you will   
   understand." Knowledge    
   about this condition by the family can reduce embarrassment, safeguard   
   finances, and protect the person's quality of life.   
      
   Note: Cases described in this article are based on real cases and are meant to   
   be typical. However, details have been scrambled, so each case should be   
   considered fictional;  any similarity to any patient is purely coincidental.   
      
      
      
   http://www.decodedscience.org/strange-behavior-caused-frontotemp   
   ral-dementia-ftd/52536   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)