Behaving Badly: Is It Mid-Life Crisis or Dementia?

One type of dementia affects your behavior more than your memory

When most of us think of dementia, we envision the symptoms of Alzheimer’s disease — memory loss, word-finding problems, difficulty with daily activities.

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But a different brain disorder, often discovered between ages 45 and 65  — officially called behavioral variant frontotemporal dementia (FTD) — causes other problems.

Men and women are equally vulnerable to the disorder. It is one of the many types of FTD affecting different regions of the brain.

“In this type of dementia, the memory is often quite good. It begins with changes in personality, emotional blunting, loss of empathy and lack of judgment or inhibitions,” says dementia specialist Jagan Pillai, MD, PhD.

“Those affected lose their ability to modulate their behavior. They can act out in public and be socially inappropriate, leading to embarrassing situations.”

Impulsive behavior

Instead of thinking through decisions, people with behavioral variant FTD often seem to act on a whim, which gets them into trouble.

“Families often describe them getting into arguments with expletive-laden speech, taking unwanted risks with money on the stock exchange or buying a sports car they can’t afford,” says Dr. Pillai.

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However, even as they’re making bad relationship decisions, rashly overspending and acting out, those affected are unaware of their personality and behavior changes — and how hurtful they are to close family members.

“Initially, people with this type of FTD can often work and do normal activities. But they can get themselves into a lot of trouble by their inability to conform to normal social courtesies,” says Dr. Pillai.

For some people, this type of FTD causes apathy and irritability rather than problems with acting out. This commonly leads to a misdiagnosis of depression or another mood disorder.

What happens in the brain

Among neurodegenerative illnesses that tend to strike before age 65, FTD is second only to early-onset Alzheimer’s disease.

“Neurologists often identify the type of FTD based on which region of the brain is affected, and which symptoms appear first and most prominently,” explains Dr. Pillai.

In behavioral variant FTD, shrinkage of the brain’s frontal and temporal lobes causes impulsivity and impairs social skills. In other types of FTD, the effects are different:

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  • Primary progressive aphasia primarily affects speech and language skills.
  • Corticobasal degeneration predominantly affects coordination of movements.
  • Progressive supranuclear palsy mainly affects walking and often leads to falls.

While some people with FTD have a strong family history of similar disorders, most of those affected do not.

When to see a doctor

Often, people with behavioral variant FTD don’t believe they need to see a doctor. And when they do, they may ace the standard memory tests for dementia.

“This type of FTD comes on slowly and progressively affects skills not often associated with a dementia, and those affected do not see that they have a problem. This can limit their early care,” says Dr. Pillai.

If someone in your life seems to have symptoms of FTD — acting out in uncharacteristic ways that gradually worsen — don’t wait to seek expert help.

“Detailed tests done in a specialty clinic can help make a clear diagnosis and rule out other conditions that mimic FTD,” he says.

While no treatment is yet available to cure FTD, medications can help manage some of the disabling behaviors.

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