Series: What's Under the Dementia Umbrella?

Part 4.2: Pick's Disease Symptoms

In this series we are taking an in-depth look at the various types of dementia and how to improve treatment in a long-term care setting. There are several lesser known dementias affecting our seniors. As part of their care team we need to educate ourselves on how to better understand and meet their needs.

We have a large amount of important information to share with you concerning Pick’s Disease, or Frontotemporal Dementia, so we’ve broken it down into three shorter posts. Today, in part two, we’ll look at the symptoms associated with FTD. Refer to part one for an overview on FTD and its subcategories.

Symptoms of FTD

When one of your residents has FTD, expect to see symptoms that manifest across their behavior, language, emotions and movement. The following is a breakdown of symptoms provided by The National Institute on Aging.

Behavioral Symptoms

The following behavioral symptoms are common in residents with FTD.

• Problems with executive functioning: Patients will experience difficulty planning and sequencing (thinking through which steps come first, second, third and so on), prioritizing, multitasking, self-monitoring and correcting behavior.

• Perseveration: Patients with FTD have a tendency to repeat the same activity or to say the same word over and over, even when it no longer makes sense.

• Social disinhibition: This means acting impulsively without considering how others perceive the behavior. For example, a person might hum at a business meeting or laugh at a funeral.

• Compulsive eating: FTD patients often gorge on food, especially starches like bread and cookies, or take food from other people’s plates.

• Utilization behavior: Patients experience difficulty resisting impulses to use or touch objects within their reach. For example, a person may pick up a telephone receiver while walking past it, even though the phone is not ringing and the person does not intend to place a call.

Language Symptoms

Expect to see the following symptoms in your residents’ language abilities.

• Aphasia: This is a language disorder in which the ability to use or understand words is impaired but the physical ability to speak properly is normal.

• Dysarthria: With this language disorder, the physical ability to speak properly is impaired (e.g. slurring) but the message is normal.

Some people with PPA (Primary Progressive Aphasia, a subcategory of FTD) only have problems using and understanding words. Others experience this plus difficulty with the physical act of speaking. Patients experiencing both will also have trouble writing, and may become mute.

Language problems usually deteriorate at a faster pace than other thinking and social skills.

Emotional Symptoms

• Apathy: Patients experience a lack of interest, drive or initiative. Apathy is often confused with depression, but people with apathy may not be sad. They often have trouble starting activities but can participate if others do the planning.

• Emotional changes: Emotions are flat, exaggerated or improper. They may seem completely disconnected from a situation or be expressed at the wrong time or in the wrong circumstances. For example, a person may laugh at sad news.

• Social-interpersonal changes: Patients may have difficulty reading social signals and understanding personal relationships. They may lack the ability to understand how others are feeling (empathy) and come across as indifferent, uncaring or selfish. For example, the person may show no emotional reaction to the news that a family member has been in an accident.

Movement Symptoms

• Dystonia: This refers to the abnormal posture of parts of the body such as hands or feet. A limb may be bent stiffly or not used when performing activities that normally utilize that limb.

• Gait disorder: Abnormalities in walking, such as shuffling, are common in people with FTD and are sometimes accompanied by frequent falls.

• Tremor: Patients often experience shakiness, usually of the hands.

• Clumsiness: Patients will drop small objects or have difficulty manipulating small items like buttons or screws.

• Apraxia: Despite having normal strength, patients may lose the ability to make common motions, such as combing their hair or using a knife and fork.

• Neuromuscular weakness: You will likely observe severe weakness, cramps and rippling movements in the muscles of a patient with FTD.

In our next post, we’ll look at treatment for patients with FTD. In the meantime, you can learn more online with the Frontotemporal Disorders Guide from the National Institute on Aging (NIA).