Comparing Alzheimer’s Disease and Frontotemporal Lobar Degeneration: Implications for Long-Term Care

Fri, 9/5/08 - 4:54pm
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Author(s):

Jennifer Merrilees, RN, MS, and Bruce L. Miller, MD

The cognitive impairments and behavioral symptoms associated with dementia have a progressive, negative impact on self-care abilities. Difficulty in managing self-care tasks, cognitive impairment, and the presence of one or more difficult behaviors are associated with long-term placement.1 It is estimated that approximately two-thirds of people residing in long-term care facilities are diagnosed with a dementing illness.2 As many as 90% of persons with dementia become institutionalized before death.3 Providing care to this population presents tremendous challenges. While much has been learned about Alzheimer’s disease (AD), the most common cause of dementia, less is known about frontotemporal lobar degeneration (FTLD). This article will explore differences that exist between the two types of dementia. Implications for long-term care are great, as many people with FTLD will require this type of care.

ALZHEIMER’S DISEASE
Alzheimer’s disease is the most common cause of dementia and is largely characterized as a cognitive disorder. The areas of the brain affected by AD produce common first symptoms of short-term memory loss, word-finding difficulties, and visual spatial problems.4 Alzheimer’s disease is caused by abnormal accumulation of the proteins A-42 and abnormally phosphorylated tau in the brain, leading to neuronal dysfunction and death. A depletion of the neurotransmitter acetylcholine is also implicated in AD and contributes to the short-term memory and attention problems experienced by people with AD.

Alzheimer’s disease is slowly progressive, and residents with this condition will have difficulty managing daily activities primarily due to cognitive deficits. The Mini-Mental State Examination (MMSE) is a standardized and widely used tool to assess cognitive function. Individuals with AD typically lose several points each year, although this rate of decline may be affected by current treatments targeted at acetylcholine and glutamate.5-7

Most cases of AD occur in persons over the age of 65. Although only a few people in their mid-30s or -40s are diagnosed with AD, one in every ten persons over the age of 65 has the disease, and nearly one-half of the population age 85 years or older has AD.8 Estimates of survival have been dependent upon factors such as symptom onset, time of diagnosis, and individual patient characteristics. In a recent study, median survival in AD from onset of first symptom was 11.7 ± 0.6 years.9

Alzheimer’s disease is associated with affective, behavioral, and personality features. Depression may occur in the early stages of AD.10 Hart et al11 retrospectively studied behavioral symptoms in AD and made the following conclusions: behavioral symptoms in AD emerged, on average, at 48 months in the disease; the most common behavioral symptoms were apathy, motor disruption, aggression, irritability, appetite changes, and sleep disturbances; with the exception of apathy, behavioral symptoms waned over time. Social skills, the ability to interact gracefully with others, are often retained late into the disease.12

FRONTOTEMPORAL LOBAR DEGENERATION
Frontotemporal lobar degeneration is the third most common cause of degenerative dementia, ranking only behind AD and dementia with Lewy bodies. The incidence is probably higher due to problems in recognition and diagnosis.13 FTLD can be mistaken for a psychiatric or mood disorder.14

FTLD focally affects the frontal and/or anterior temporal lobes of the brain. These structures have an important role in regulating behavior, judgment, language, and personality. FTLD is characterized by profound behavioral and personality changes resulting from deterioration of the frontal and/or anterior lobes of the brain. Three clinical subgroups of FTLD have been identified: frontotemporal dementia (FTD) and two speech and language conditions, termed progressive non-fluent aphasia (PNFA) and semantic dementia (SD).

References:

References

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