Published Feb 25, 2024 | 8:00 AM ⚊ Updated Feb 25, 2024 | 8:00 AM
FTD is seen in individuals between 45 and 64 years of age. (Representative image/Creative Commons)
At the age of 58, Professor Venkataswamy (name changed), found himself entangled in a perplexing series of events that shook the foundations of his family.
His son, Ramu, received a shocking call from a garment shop owner accusing his revered father of stealing lingerie. The respected professor was apprehended attempting to exit the store with an assorted collection of women’s innerwear without making a purchase.
Stunned and embarrassed, Ramu pleaded with the shop owner not to involve the police.
In the days that followed, Venkataswamy brought home a perfume bottle without paying for it, captured by the watchful eyes of a CCTV camera. Fortunately, the shop owner was known to the family, and the matter was resolved amicably.
However, these peculiar incidents left the family bewildered, especially since Venkataswamy had never exhibited such behaviour before. The family tried counselling him, but another mortifying incident involving his father unfolded shortly.
Venkataswamy made an inappropriate comment to his daughter-in-law, shocking and upsetting Ramu. He had entered her room and remarked, “You look so pretty, and you have a perfect figure.” Such incidents had never occurred in the two decades since his daughter-in-law joined the family.
It became evident that something was amiss with Venkataswamy, prompting the family to seek professional help.
Recognising a pattern of bizarre behaviour, Ramu realised that his father needed medical attention.
The family consulted Dr Sudhir Kumar, a renowned neurologist at Apollo Hospitals in Hyderabad, who delved into the patient’s history and identified cognitive abnormalities such as inappropriate dressing, wandering around the house semi-dressed, and passing lewd comments.
Upon examination, Venkataswamy displayed repetitive speech and actions, too.
The diagnosis was conclusive: behavioural variant of frontotemporal dementia (bvFTD), confirmed by detailed neuropsychological testing and MRI scans revealing frontal and temporal lobe atrophy.
This revelation shifted the perspective from criminal intent to a neurological disorder.
Explaining bvFTD, Dr Suryanarayana Sharma PM, Senior Consultant Neurologist and Stroke Specialist at Apollo Hospitals in Bengaluru, highlights to South First the insidious changes in personality and conduct associated with the disorder, reflecting progressive disintegration of the neural circuits involved in social cognition, emotion regulation, motivation and decision making.
He says, “Epidemiological studies suggest that FTD is the second-most common cause of young onset dementia after Alzheimer’s disease (AD). Two independent studies from the UK revealed a prevalence of around 15 per cases per 1,00,000 population aged between 45 and 64 years of age. Although regarded as a rare cause of dementia after 65 years, FTD may be more common than assumed.”
Dr Sharma explains that finding signs in the body to spot these brain changes early on is becoming more crucial because the healthcare sector is getting better at making medicines that can alter the course of the disease.
He also mentions that changes in our genes are responsible for about 10-20 percent of these cases, including a new kind of gene change found on chromosome 9, known as C9orf72, responsible for many cases of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD).
Detail-oriented history-taking from family members, coupled with neuropsychological testing and brain imaging, forms the basis of the diagnostic process. Carer education and support are also crucial, says Dr Sharma.
bvFTD is notorious for causing dramatic shifts in personality and decision-making abilities, often resulting in socially inappropriate actions, and in extreme cases, criminal behaviour.
“Criminal behaviour is a clinical feature of the behavioural variant of frontotemporal dementia (bvFTD), ranging from socially inappropriate behaviour and minor offenses (such as shoplifting, driving-related violations, housebreaking, trespassing) to the more extreme acts of sex crimes and violence,” explains Dr Sudhir.
The treatment for bvFTD focuses on managing symptoms, as there is currently no cure or direct treatment to halt the progression of the disease. Frontotemporal dementia (FTD), including bvFTD, occurs due to progressive nerve cell loss in the brain’s frontal and/or temporal lobes.
This cell loss is often associated with the accumulation of misfolded proteins in the brain, which can be linked to certain genetic mutations. Around 40 percent of FTD cases have a family history, suggesting a genetic component in many instances. However, mutations can also occur spontaneously. Other risk factors include a history of head trauma and thyroid disease.
Since FTD is a progressive and irreversible condition, treatment aims to alleviate specific symptoms. This might include medications to address certain behavioural symptoms or therapies to support communication skills.
It’s also important to focus on safety and support for the individual, as the disease can significantly impact daily functioning and independence over time.
