Understanding and managing fronto-temporal dementia

Fronto-temporal Dementia is a relatively common cause of dementia, usually beginning before the age of 65. The onset is insidious and patients commonly present with personality change and psychiatric problems such as depression. Personal and social awareness is lost at an early stage. Cognitive testing also reveals defects in planning, sequencing and judgement. Speech is affected with perseveration, loss of verbal fluency and anomia. There is focal brain atrophy of the frontal and temporal lobes and this is related to the pattern of clinical and behavioural presentation. Other areas such as visuospatial orientation and episodic memory are preserved and this distinguishes frontotemporal dementia from Alzheimer's disease. Accurate assessment and diagnosis involves detailed psychometric testing, psychiatric history and neuroimaging. Patients present a very different burden of care on relatives and may not be able to access local services. Management mainly involves supporting the carers. Illness progression is gradual and death typically occurs in 6-12 years