Synopsis
Recognise behavioural and language-led frontotemporal degeneration, distinguish it from psychiatric and Alzheimer presentations, and coordinate genetic, communication, safeguarding and multidisciplinary care.
- Frontotemporal dementia often begins before 65 and presents with progressive personality, behaviour, executive or language change while episodic memory and visuospatial skills can be relatively preserved early.
- Behavioural-variant FTD features early disinhibition, apathy, loss of empathy, stereotyped or compulsive behaviour, hyperorality and executive dysfunction.
- Primary progressive aphasia may be semantic, with loss of word and object meaning, or non-fluent or agrammatic, with effortful speech and impaired grammar or speech planning.
Key red flags
Fasciculation, weakness, spasticity, dysphagia, parkinsonism, apraxia or impaired vertical eye movement may reveal overlap with motor neurone or atypical parkinsonian degeneration.
Investigation priorities
Establish progressive change in social cognition, language, executive function and everyday risk beyond the clinic snapshot.
Management branches
Personality, conduct or language has changed progressively in adult life.
- Obtain private and joint collateral examples of timing, progression, empathy, inhibition, routines, eating, language, finances, driving and occupational performance.
- Assess attention, mood, psychosis, substance use, sleep and medicines, separating gradual network decline from delirium, primary psychiatric illness and situational conflict.
Key medicines
Selective serotonin reuptake inhibitorIf used off label, start the chosen SSRI at a low standard adult dose and titrate cautiously to a predefined behavioural target.
TrazodoneSpecialists may use a low evening dose and titrate within BNF limits when agitation or behavioural symptoms justify an off-label trial.