Frontotemporal Dementia

Frontotemporal dementia (FTD) is a group of neurodegenerative disorders characterized by progressive degeneration of the frontal and temporal lobes, with accumulation of abnormal tau protein (Pick bodies in Pick disease) or TDP-43 inclusions. Unlike Alzheimer disease, FTD typically presents with prominent behavioral changes (disinhibition, apathy, loss of empathy, compulsive behaviors, hyperorality) or language dysfunction (progressive nonfluent aphasia or semantic dementia) rather than memory loss, and onset is earlier (45-65 years). The behavioral variant involves degeneration of the orbitofrontal and anterior cingulate cortices, disrupting the neural circuits responsible for social cognition, emotional regulation, and executive function. The nurse assesses for behavioral changes using standardized tools, implements structured behavioral management strategies (maintaining routines, redirecting inappropriate behaviors, ensuring safety), manages nutritional needs (hyperorality can lead to overeating and choking), monitors for swallowing dysfunction, addresses caregiver burden and distress (behavioral symptoms are often more distressing to families than memory loss), and coordinates referrals to neuropsychiatry, speech therapy, and social services.