Why Behavior Changes May Be Sign of Dementia

by Dorian Martin Patient Advocate

You often hear about a midlife crisis when a person's behavior changes radically. But in some cases, what's going on is not a midlife crisis, but instead a form of dementia. According to an article entitled "When Character Crumbles" in the November/December 2010 issue of Scientific American Mind, the early signs of frontotemporal dementia (FTD) have been incorrectly attributed to a midlife or marital crisis by family members and some doctors. It turns out that FTD also is misdiagnosed as other conditions. "Of the frontotemporal patients who come to U.C.S.F (University of California, San Francisco's Memory and Aging Center), roughly half are initially misdiagnosed, most commonly with Alzheimer's, depression, bipolar disorder or, occasionally, schizophrenia," Scientific American Mind writer Ingfei Chen noted.

So what is FTD (sometimes known as Pick's disease)? "Frontotemporal dementia (frontotemporal lobar degeneration) is an umbrella term for a diverse group of uncommon disorders that primarily affect the frontal and temporal lobes of the brain the areas generally associated with personality, behavior and language" the Mayo Clinic website states. In contract, Alzheimer's disease damages the posterior brain areas, which leads to cognitive lapses, Chen stated.

FTD is the most common type of dementia in people who are younger than 60, according to the Scientific American Mind article. This disease strikes earlier than Alzheimer's disease and results in death in approximately eight years. "By one estimate, 15 out of 100,000 people between the ages of 45 and 64 develop it. Patients lost the ability to connect with others, but because self-awareness also disappears, they remain ignorant of their deficits," Chen stated. While genetic mutations seem to be linked to FTD, "more than half the people who develop frontotemporal dementia have no family history of dementia," the Mayo Clinic noted.

According to the National Institute of Neurological Disorders and Strokes (INNDS), people who have FTD experience changes in behavior or problems with language. "The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation," the INNDS website stated. "The second type primarily features symptoms of language disturbance, including difficulty making or understanding speech, often in conjunction with the behavioral type's symptoms." However, memory and spatial skills remain intact. "About half of FTD patients had engaged in antisocial behaviors that could (or did) get them arrested, including shoplifting, running a stoplight or driving while drunk," Chen wrote.

MedlinePlus.gov provided a list of symptoms of FTD. Behavior changes include: the person can't keep a job; compulsive behaviors; inappropriate behavior; inability to function or interact in social or personal situations; problems with personal hygiene; repetitive behavior; and withdrawal from social interaction. Emotional changes include: abrupt mood changes; decreased interest in daily living activities; failure to recognize changes in behavior; failure to show emotional warmth, concern, empathy, and sympathy; inappropriate mood; and not caring about events or environment. Language changes include: inability to speak; decreased ability to read or write; difficulty finding a word; difficulty speaking or understanding speech; repeating anything spoken to the person; shrinking vocabulary; and weak, uncoordinated speech sounds. Neurological problems include: rigid muscle tone; memory loss that gets worse; difficulty with movement and coordination; and weakness. The person also may experience urinary incontinence.

As with other mental health concerns, if you are concerned about changes in a loved one's behavior, please visit with a doctor to get an accurate diagnosis. Additional information can be found at the Association of Frontotemporal Dementias website.

Dorian Martin
Meet Our Writer
Dorian Martin

Dorian Martin writes about various topics for HealthCentral, including Alzheimer’s disease, diet/exercise, menopause and lung cancer. Dorian is a health and caregiving advocate living in College Station, TX. She has a Ph.D. in educational human resource development. Dorian also founded I Start Wondering, which encourages people to embrace a life-long learning approach to aging. She teaches Sheng Zhen Gong, a form of Qigong. Follow Dorian on Twitter, Facebook or Instagram at @doriannmartin.