Frontotemporal Dementia (FTD)

This article provides a comprehensive overview of frontotemporal dementia, including the main features and symptoms, causes and risk factors, and how it’s diagnosed. This is followed by an overview of treatment and management options.

Key Takeaways:

• Frontotemporal dementia is a neurodegenerative disorder that affects the frontal and temporal lobes of the brain. This often causes disruptions in language ability, behavior, emotion, and other important functions.
• It usually appears in adults between ages 40 and 65. Initial symptoms often include behavior changes (e.g. impulsivity, disregard for social conventions), problems expressing oneself/communicating, and sometimes physical symptoms, such as spasms or muscle weakness.
• FTD is a progressive condition, in which symptoms get worse over time. However, there are a variety of available treatments, such as medication, at-home management strategies, and specific therapies, which may reduce symptoms and improve function and overall life quality.

Understanding Frontotemporal Dementia

Frontotemporal dementia (or FTD) is a neurodegenerative disorder. It is specifically characterized by the degeneration of the frontal and temporal lobes of the brain, which are key brain regions involved in behavior, language, motivation, emotion, and decision-making. Individuals with FTD experience a gradual loss of intellectual functions, which can lead to memory problems, loss of empathy, impaired decision-making, and other concerns. ^{[1] [2]}

FTD is classified into two distinct types: ^{[1] [2]}

• Language type, which is further classified into:
• Nonfluent variant primary progressive aphasia (nonfluent PPA)
• Characterized by loss of vocabulary and other language difficulties, but with fluent speech.
• Semantic variant primary progressive aphasia (semantic PPA)
• Characterized by jumbled words, effortful or halted speech, and difficulty with complex sentences.
• Behavioral variant:
• This type involves behavioral and personality changes earlier on in disease development, while memory problems typically develop much later.

How Common is It?

Frontotemporal dementia affects 15 to 22 out of every 100,000 people, or about 0.015 to 0.022% of the population. It is the second most common cause of early-onset dementia (individuals under 65 years old) and the third most common cause of dementia in individuals 65 and over. Additionally, FTD affects just as many people as Alzheimer’s in individuals aged 45-64. ^{[1] [2] [3]}

Who Does it Affect?

FTD primarily affects middle-age to older-aged adults. The mean age of onset is around 58 years old. Rates for different age groups are as follows: ^[1]

• 40-49 years: 2.2 out of every 100,000
• 50-59: 3.3 out of every 100,000
• 60-69: 8.9 out of every 100,000
• This is the age group with the highest rate

The behavioral variant and semantic variant are more common in men, whereas the non-fluent variant is more common in women. ^{[1] [4]}

Frontotemporal Dementia Symptoms

Frontotemporal dementia symptoms often vary depending on the specific type. Listed below are the main symptoms grouped by categories: ^{[2] [4] [5]}

Behavioral Symptoms

• Impulsivity
• Disinhibition
• Disregard for social conventions
• Loss of manners
• Sexually explicit or offensive language/behavior
• Decreased empathy and sympathy
• Loss of interest in socializing
• Change in food preferences
• Binge eating
• Increased alcohol or drug use
• Repetitive or ritualistic behaviors

Language/Cognitive Symptoms

• Difficulty naming objects
• Hard time expressing words
• Less frequent speech
• Hesitation when speaking
• Reduced attention span
• Problems with working memory and problem-solving
• Reduced mental flexibility
• Difficulty understanding the meaning of words
• Speech seems to require more effort

Emotional/Psychological Symptoms

• Agitation
• Frequent mood changes
• Loss of energy and motivation
• Apathy

Some individuals with FTD may also have physical symptoms, such as tremors, muscle spasms or weakness, stiffness, poor coordination, or trouble swallowing.

Causes

Frontotemporal dementia has a relatively high heritability rate compared to other disorders. In fact, around 40% of all cases of FTD involve family history of the disease. The behavioral variant of FTD has the highest heritability rate at 48%. ^{[1] [4]}

Researchers have identified mutations in over 20 genes that may be involved in the development and severity of FTD. The three most common genetic causes of FTD are related to mutations in microtubule-associated protein tau (MAPT), progranulin (PGRN), and chromosome 9 open reading frame 72 (C9orf72). These three alone account for about 30% of genetically determined FTD. ^{[1] [2] [4]}

Risk Factors

Having a family history of FTD is the biggest risk factor for developing FTD. Family history of psychiatric diseases and motor disorders also increases the risk. ^{[1] [4]}

Other risk factors include head trauma and thyroid disease. These factors increase the risk of developing FTD by 3.3 and 2.5-fold, respectively. However, these factors aren’t as significant or definitive as family history. ^[1]

Can it be Prevented?

Due to the strong influence of heritability, FTD can’t be fully prevented. Certain lifestyle changes may help reduce the overall risk, such as maintaining high levels of physical and cognitive activity. These factors may not prevent FTD from developing, but have been associated with a slower disease progression and reduced symptom severity. ^[6]

Diagnosing Frontotemporal Dementia

Diagnosing frontotemporal dementia can be difficult, which is why it requires a thorough, multi-step process. The overall diagnostic process includes a thorough history and physical examination, lab testing, neuroimaging, and neurocognitive assessment. ^[1]

The diagnostic criteria differ depending on the exact type of FTD.

For behavioral FTD, diagnosis is based on the criteria published by the International Behavioral Variant FTD Criteria Consortium, which requires three or more of the following symptoms: ^{[2] [4]}

• Behavioral disinhibition
• Apathy/inertia
• Loss of sympathy/empathy
• Perseverative/compulsive behaviors
• Hyperorality
• Dysexecutive neuropsychological profile

Diagnosis is also classified as “possible”, “probable”, and “definitive”, depending on the degree of evidence.

Non-fluent and and semantic PPA are also diagnosed based on specific established criteria.

The specific criteria for non-fluent PPA are: ^{[2] [4]}

• At least one of the following core features:
• Agrammatism in language production
• Effortful, halting of speech
• Two out of three of the following features:
• Impaired comprehension of complex sentences
• Spared single-word comprehension
• Spared object knowledge

The criteria for semantic PPA are:

• Impaired confrontation naming
• Impaired single-word comprehension
• At least three of the following:
• Impaired object knowledge
• Surface dyslexia or dysgraphia
• Spared repetition
• Spared speech production

Both of these types of PPA can be classified as clinical, imaging-supported, or definite pathologic diagnosis, depending on the degree of evidence. ^{[2] [4]}

Tests and Assessments

A variety of tests and assessments are often needed to confirm a diagnosis of frontotemporal dementia. Listed below are common types of tests and assessments used in the diagnostic process:

Laboratory Biomarker Tests

Laboratory tests can help analyze biomarkers that are indicated in FTD, such as neurofilament light chain and progranulin. They are also useful to rule out other disorders or causes. Examples of these tests are: ^{[1] [5]}

• Lumbar puncture (spinal tap), which analyzes the cerebrospinal fluid
• Blood testing

Neuroimaging Tests

Neuroimaging tests can be useful because they help to visualize and analyze key brain regions. In FTD, these tests are specifically used to identify atrophy or other abnormalities in the frontal and temporal lobes. Specific neuroimaging tests include: ^{[1] [2] [4]}

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan
• Single-photon emission computed tomography (SPECT)

Neurocognitive Exams

Neurocognitive exams are useful to analyze the patient’s cognitive functioning and overall profile of dementia symptoms. Common neurocognitive exams are: ^[1]

• Mini-Mental State Examination (MMSE): An 11-question assessment that measures five key areas of cognitive function, such as attention, recall, and orientation.
• Montreal Cognitive Assessment: This assessment consists of 10 different tasks that measure a variety of cognitive functions, such as attention, memory, and verbal fluency.
• Functional Cognitive Assessment Scale: This scale measures executive function abilities in daily life activities.

Misdiagnosis

FTD shares symptoms with some other disorders, which can lead to misdiagnosis, especially in younger individuals. Common misdiagnoses include Alzheimer’s disease, vascular dementia, Parkinson’s disease, and psychiatric disorders, such as major depression, schizophrenia, obsessive-compulsive disorder, and bipolar disorder. ^{[1] [3] [4]}

Treatment Options

Treatment options for frontotemporal dementia are generally grouped into non-pharmacological and pharmacological approaches. FTD is a progressive condition, so treatments are focused on reducing symptoms and improving overall life quality.

Non-Pharmacological Approaches

Non-pharmacological approaches are often the preferred treatment before resorting to pharmacological approaches, due to their lower risk of side effects and complications. Examples of non-pharmacological approaches to treatment are: ^{[1] [4]}

• Speech therapy: To help improve communication and language abilities
• Physical therapy: To help maintain balance, mobility, strength, and general physical function
• Occupational therapy: To help individuals maintain their independence and ability to carry out daily living tasks
• Cognitive behavioral therapy: To help with anxiety, depression, aggression, and other mental and emotional issues
• Social support services: To reduce isolation and loneliness, gain support, and improve independence and general life quality

Overall, these non-pharmacological approaches are mainly implemented to prevent or reduce disruptive behaviors, improve overall functioning and life quality , and reduce caregiver distress. ^[2]

Pharmacological Approaches

Several types of medications may be useful in reducing symptoms of FTD, including:

• Acetylcholinesterase inhibitors (e.g. galantamine)
• These increase acetylcholine, which is involved in memory, focus, and cognition
• N-methyl-D-aspartate (NMDA) inhibitors (e.g. memantine)
• Selective-serotonin reuptake inhibitors (SSRIs) (e.g. sertraline, paroxetine, citalopram):
• These increase serotonin, which may help with depressive or behavioral symptoms
• Atypical antipsychotics (e.g. risperidone, olanzapine)
• Used to reduce agitation, delusions, and behavioral symptoms

There are also a variety of treatments in development, some of which are targeted at reducing neurodegeneration. However, they’re not approved at this time due to lack of definitive evidence. ^[4]

At-Home Management for Frontotemporal Dementia

FTD can cause significant disruptions for patients, caregivers, and others in the home. There are several things that can be implemented to help minimize common issues when living with FTD. These should be primarily implemented and monitored by caregivers, and include: ^{[1] [2] [7]}

• Reducing noise and overall stimulation
• Limit interaction to small groups of people
• Regular exercise
• Maintain a consistent sleep schedule
• Reduce or remove any complicated activities that cause confusion and agitation
• Keep the home and surrounding environment safe
• Introduce games or old hobbies/familiar activities
• Use distraction methods when patients are agitated
• Try to avoid challenging and confrontational approaches
• Limit access to food (if overindulging)
• Use a journal to keep track of triggers
• Minimize these as much as possible
• Reinforce and reward positive behaviors

Support for Caregivers

Being a caregiver for someone with FTD can be stressful and overwhelming. If you’re a caregiver, it’s important to take care of yourself too, such as with regular exercise, engaging in enjoyable activities. Make sure to stay on top of your physical and mental health too, with regular health care check-ups and professional treatment as needed. ^[7]

There are also a variety of organizations that offer support and resources for caregivers of individuals with FTD, such as:

• The Association for Frontotemporal Degeneration (AFTD)
• Helpline: 1-866-507-7222
• Frontotemporal Lobar Degeneration Association
• Support Forum
• Family Caregiver Alliance
• Caregiver Action Network

Caregivers should also stay in close contact with other members of the treatment team, which may consist of neurologists, psychiatrists, nurses, social workers, and physical, occupational, and speech therapists. A therapeutic relationship between caregivers and the healthcare team can reduce caregiver burden while promoting more effective care.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on April 11, 2026 and last checked on March 19, 2026