Types of Dementia and More

Just read an interesting article about a variation of Dementia/ Alzheimer's in which the person affected had difficulties with vision. I saw a lot of this with Gregory as he progressed through his journey. Sometimes he could not see the fork sitting next to the plate in front of him. In the later stages of his Dementia, he had a difficult time focusing on things like the TV, a book of photographs, and at times on me!

As I have continued to study his "symptoms" it looks to me like he was affected by several types of dementia at one time including: Posterior Cortical Atrophy, Lewy Body, Frontotemporal, and  Primary Progressive Aphasia which affects language. 

A new type of Dementia is being called "Mixed Dementia." In mixed dementia abnormalities linked to more than one type of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

Recently, there has been a lot of activity and discussion in the following areas: 1) Types of Dementia, 2) Appropriate language to discuss Dementia and the people affected with it, 3) Including people with Dementia in decisions about caring for the needs of people with Dementia, and 4) A more careful use (if any) of psychotropic drugs with people diagnosed with Dementia.

As recently as ten years ago, not much was known about Dementia/ Alzheimer's. People were embarrassed to discuss the disease. Little was known about how to care for people with Dementia. While the knowledge base is increasing exponentially, much still needs to be done to understand the disease and to support people who have been diagnosed with one form or another of Dementia.

Perhaps one of Gregory's legacy's, through my blogging, can be to help "fight these battles" for understanding, equality, and support!

Click here for this article which discusses Dementia with visual difficulties.

Click here for this article which talked about Primary Progressive Aphasia.

Click here for this article which discusses ten types of Dementia.

Frontal Lobe Dementia

Taken from depression-guide.com this information about Frontal Lobe Dementia seems to describe what I have seen Gregory experiencing rather than the typical Alzheimer's symptoms. I have mentioned this previously but wanted to do so again.

Frontal lobe dementia is the name given to any dementia caused by damage to this part of the brain. It includes Pick's Disease but can also be caused by other diseases. They all have similar symptoms and prognoses.


Pick's Disease (Frontotemporal lobar degeneration)


A progressive dementia occurring in middle life characterised by slowly developing changes in character and social behaviour, or impairment of language, due to degeneration of the frontal and temporal lobes of the brain.
Some dementias, however, do not follow this pattern. Vascular dementias have recently been characterized by specific diagnostic criteria. They can be summarized by sudden onset of dementia and step-wise progression with focal neurological findings and positive brain imaging. Lewy body dementia is characterized by early appearance of symptoms in the course of dementia, accompanied by progression and hallucinations. Primary progressive aphasia includes early dissolution of speech in an otherwise cognitively intact individual. They can become globally aphasic in spite of being able to continue to run a household or even work. Eventually 20% per year progress to dementia, which appears similar in the advanced states to Alzheimer's disease.

Frontal lobe dementias are characterized by early psychiatric symptoms followed later by cognitive impairments. Frontal lobe syndrome is therefore the presenting symptomatology: apathy, poor social judgment, and bizarre behavior. Histologically, the frontal lobe dementias are proven to be characterized by Pick's cells (Pick's disease). At the present time, these diverse histological types are clinically indistinguishable.

Symptoms of Frontal Lobe (aka Frontotemporal) Dementia:

• Impairments in social skills
  - inappropriate or bizarre social behavior (e.g., eating with one's fingers in public, doing sit-ups in a public restroom, being overly familiar with strangers)
  - "loosening" of normal social restraints (e.g., using obscene language or making inappropriate sexual remarks)
• Change in activity level
  - apathy, withdrawal, loss of interest, lack of motivation, and initiative which may appear to be depression but the patient does not experience sad feelings.
  - in some instances there is an increase in purposeless activity (e.g., pacing, constant cleaning) or agitation.
• Decreased Judgment
  - impairments in financial decision- making (e.g., impulsive spending)
  - difficulty recognizing consequences of behavior
  - lack of appreciation for threats to safety (e.g., inviting strangers into home)
• Changes in personal habits
  - lack of concern over personal appearance
  - irresponsibility
  - compulsiveness (need to carry out repeated actions that are inappropriate or not relevant to the situation at hand.
• Alterations in personality and mood
  - increased irritability, decreased ability to tolerate frustration
• Changes is one's customary emotional responsiveness
  - a lack of sympathy or compassion in someone who was typically responsive to others' distress
  - heightened emotionality in someone who was typically less emotionally responsive

Persons with this form of dementia may look like they have problems in almost all areas of mental function. This is because all mental activity requires attention, concentration and the ability to organize information, all of which are impaired in frontal lobe dementia. Careful testing, however, usually shows that most of the problems stem from a lack of persistence and increased inertia.


What are the differences between Pick's disease and Alzheimer's disease?
The main difference between Pick's disease and Alzheimer's disease is that the damage occurs in different areas of the brain, at least in the early stages. In most cases of Pick's disease, the frontal and temporal lobes of the brain are the areas affected and with Alzheimer's disease, the temporal and parietal lobes are affected.

Who gets frontal lobe dementia?

Frontal lobe dementia, including Pick's disease, can affect both men and women. Although it can affect people at any age, it usually begins between 40 to 65 years of age.

Duration and Treatment of Frontal Lobe Dementia - FLD

The length of FTD varies, with some patients declining rapidly over two to three years and others showing only minimal changes over a decade. Studies have shown persons with FTD to live with the disease an average of eight years, with a range from three years to 17 years.


No medications are known currently to treat or prevent FTD. Serotonin-boosting medications may alleviate some behaviors.

Facts and Tips about Frontal Lobe dementia

• Frontal lobe dementia is the form of dementia. It is degenerative disease which mainly affects frontal lobe of the brain.
• Change in personality, loss of language skills, ability to carry out difficult tasks are other features of frontal lobe dementia.
• Clinically, Pick disease may be identical or very similar to frontal lobe degeneration. 
• Persons having age between 40 to 65 years are mostly affected by frontal lobe dementia.
• Frontal lobe dementia causes slow decline in behavior and judgment. 
• Symptoms of frontal lobe dementia are very similar to vascular dementia and only brain image can make a distinction between them.

What Does One Call It?

I like referring to Gregory's dementia in a number of ways.

We were grateful to get an "Alzheimer's" diagnosis from his Neurologist as that helped with winning our disability claims, both with a private company and with Social Security. With most of our doctors and with family and friends it is easier to call it Alzheimer's as most people have more of an idea of what that means. 

I avoid using the term "Dementia" except with doctors and friends who are "in the field." Dementia seems to refer to "something that happens to old people" which Gregory is NOT. Using the term "Dementia" does not begin to suggest the true nature of the difficulties in dealing with the afflicted person on a day to day basis which is usually not at all imagined by others.

Sometimes I refer to it as "Our Situation," or "Our Condition" which emphasizes that it is at least as much of a problem for me (maybe more so) as it is for him. I sometimes refer to it as "The Big 'A.'" 

I find myself replying to people's remarks about their forgetting where they put their keys, etc: "Yes we all have those problems as we get older ... but that is nothing like what Gregory and I are going through." I find it is important to me (and hopefully to others) to respond in this way as it seems that people make "excuses" or try to "relate" as a way of making themselves feel more comfortable with OUR situation and/or to ME make me feel better. Doesn't help!

The more I study the disease, the more I think Gregory's is a Frontotemporal Disorder. There are many types, symptoms, and names for Frontotemporal, the names do not matter. Gregory's symptoms are by now scattered across the various types of the Frontotemportal Disorder labels and descriptions. 

I learned more about this particular dementia in a book I ordered from The National Institute on Aging/National Institute of Health at www.nia.nih.gov/Frontotemporal (or call 800-438-4380.) 

The book was very helpful in helping me understand the more specific changes that are taking place in Gregory and in being supportive of hium as the changes continue, intensify, and/or show up for the first time.

Frontotemporal Dementias

I have included this article because much of it speaks to the type of dementia with which Gregory is dealing. I have highlighted the parts that lead me to believe this and crossed out the parts that do not apply to Gregory.

Taken from "Perspectives: A Newsletter for People With Alzheimer's or a Related Disorder." Lisa Snyder, LCSW UCSD Shiley-Marcos Alzheimer’s Research Center 9500 Gilman Drive – 0948 La Jolla, CA 92093 Phone: 858-622-5800 Fax: 858-622-1012 email: lsnyder@ucsd.edu Click here to go to site.

Frontotemporal dementia (FTD), also known as frontotemporal lobar degeneration (FTLD), usually develops in individuals under the age of 65, the most common cause for young-onset dementia, and likely accounts for 10-20% of all dementia cases. Unlike Alzheimer’s that begins in areas of the brain responsible for memory, FTD damages the frontal and/or temporal regions of the brain that are associated with language, emotions, judgment, movement, and the abilities needed to complete complex tasks that require multiple steps.

There are many subtypes of Frontotempo-ral dementia that can affect behavior (behavioral variant FTD) and language (primary progressive aphasia, progressive non-fluent aphasia, or semantic dementia). Other more rare forms of frontotemporal disorders primarily affect movement (progressive supranuclear palsy, for example). People with all forms of FTD may also have some slowness or rigidity in their movements or a tremor similar to Parkinson’s disease.

Individuals with behavioral variant FTD can have very disruptive changes in social behavior and personality and may have little insight into these problems. These symptoms can be very challenging and they can struggle to function in social situations. Younger caregivers often have is difficulty managing these challenges at home especially with job commitments.

People who have FTD in the form of aphasia are unable to find the right words to communicate effectively and eventually are unable to speak, while people with semantic dementia tend to lose ability to understand the meaning of words and may not comprehend simple words. It may also be difficult for these individuals to recognize familiar people or objects.

Many people with FTD who have these language difficulties retain other thinking abilities and may try to develop ways to manage their communication challenges. Researchers at the University of California, San Francisco, have found that some individuals with semantic dementia can have considerable non-verbal creative abilities, including painting. 

In an article published in Alzheimer’s New Zealand’s, Alzheimer’s News, Graham, diagnosed with semantic dementia at age 59, states, “Dementia is like life: it never goes down a straight path for an individual of a family. I am currently following twists which were not planned for my future. It has been an in- teresting and challenging change.”

Since FTD can include a complex set of symptoms that vary considerably from person-to-person, strategies for managing the condition may vary and it is important to seek help from professionals and peers who are familiar with this dementia.

For more information on FTD, contact the Association for Frontotemporal Demen- tias on their toll-free help line at 866-507- 7222 or visit them online at their website: http://www.ftd-picks.org/