Apr 6, 2018

Alzheimer's Disease Variation with Frontotemporal Dementia

Sometimes Alzheimer's comes with variations like Frontotemporal dementia.
Dear Bob,
My husband has Alzheimers and gulps his food down without stopping. and sometimes spills it on himself. 
When I try to correct him by saying eat slower, he gets agitated
It's embarrassing since we eat in public where we live. He's defensive whenever I try to correct him
His behavior with other women is very bold, hugging them and calling them darling. that's also embarrassing. 
I read your column but have never seen this in your informative advice. I would appreciate greatly your response. 
Thank you for all you do.
God bless .

In is not unusual for us to see variations in Alzheimer's patients. Some act different than others. These differences are called variations. Sometimes, variations are caused by what is going in in different parts of the brain; or, sometimes they are an indication of misdiagnoses.

Answer to our reader question from our expert Dr. Rita Jablonski:

Have you ever gone to the doctor and he or she hits your knee with the little hammer? Your leg kicks out without you thinking about it. Just happens. That movement is a reflex. Your brain can move body parts without you thinking about it—automatic reflexes protects you from harm. If you really concentrate, or stiffen your leg, you can over-ride the reflex and stop it from happening.

A similar “automatic” or “rapid” response occurs in our brains all the time. However, the brain performs a balancing act. The balancing act occurs between the front part of the brain, the frontal lobe, and the emotional part of the brain, the deep middle part.

Each of these parts of the brain has jobs.

The front part, or frontal lobe, helps with judgment and motivation. It is where the “will power” and the ability to delay gratification live.

The deep middle part controls our emotions and desires. This is where my anger, love, sadness, passion, and joy live.

The two parts work together to keep me balanced.
  • The front brain helps me to stick to healthy eating when I would rather munch cookies to satisfy my deep middle brain. 
  • The front brain helps me to get out of bed at 4:30 am to exercise, when the deep middle part wants to sleep. 
  • The front brain tells me to shut my mouth before I give in to my angry deep middle brain. 
  • The balancing act helps me to be a decent person and not a jerk.
Without getting too technical, there is a variation of Alzheimer’s that causes the front brain to shrink a little faster than the other parts.

This variation of Alzheimer’s is not the same as another type of dementia called “Frontotemporal dementia.” 

These individuals start out with unusual behavior changes before they start losing their memory.

Some people with AD do show the same behaviors because the patterns of brain shrinkage are similar to the patterns of brain shrinkage seen in people with FTD.

Neuropsychological testing combined with imaging (FDG-PET scan) can help tease out the correct diagnosis for persons living with dementia.

If you have not done this already, you may want to speak with your husband’s neurologist.
  • He may need to be evaluated to see if he has a variation of AD or if he has Frontotemperal dementia. 
Please Note: Some medications used to treat Alzheimer's disease can cause more impulsivity, anger, and aggression (among other things) if given to someone with FTD only.

The gulping down of food is pretty common when a person with dementia has front brain shrinkage.

The brakes are gone. Telling the person to “slow down” won’t help, either. It will just make them angry. In their mind, everything is fine and WHO ARE YOU to tell them differently? There are no medications and nothing you can do to stop him from gulping down the food. Period.

However, you can change the environment. If the food arrives more slowly, or in smaller portions, the gulping situation can be adjusted a bit.

One option may be to have a private conversation with the head of the dining area where you and your husband eat. Ask that food is brought to BOTH OF YOU in smaller portions and/or one course at a time, but a little slower than usual.

Why BOTH OF YOU? Because your husband does not see that he has a problem, and he may notice that he is receiving different treatment…which may cause more behavioral problems.

Now for the embarrassing part. If your husband were blind, or was paralyzed on one side, and he accidentally knocked items over or spilled food, would you feel embarrassed? Probably not. In fact, if anyone looked at you funny, you would probably ignore them. Your husband has a disease, a physical problem, with his brain. It is not immediately noticeable, like another physical problem would be.

Are people staring at you and your husband? If so, smile back. If you want, you can privately share with your fellow diners that your husband has dementia. Or share this article with them.

The second part of your question is related to the first.

We all have fleeting desires all the time. I see a really cute baby that I would love to hold…but my front brain says “NO” and squishes the impulse before I act.

This “back-and-forth” in the brain happens millions of times a day, but is so quick and subtle we do not pay it any attention. This happens in split seconds. But, if the front part of the brain is shrinking, it is no longer strong enough to squish the impulses.

The result is a lot of impulsive behavior.

Your husband’s “bold” behavior is linked to the shrinking of the frontal part of the brain. He sees other women, hugs them and calls them “darling,” because the BRAKES ARE GONE. The front part of the brain cannot stop the impulse.

I’ve seen some spouses become highly creative. One lady always holds her husband’s hand when they go out. He enjoys the affection and she can quickly maneuver him away if he starts to reach out to touch someone (or hug someone) that he shouldn’t be touching or hugging—like a complete stranger.

If they are among close friends, she relaxes a bit because her group all know about her husband’s brain shrinkage.

Another spouse had business cards printed out: “My spouse has a brain disease. Please excuse the weird behavior. Thank you for your kindness.”

Cards like these can be ordered on-line or ordered at a business supply store, if you don’t want to print them yourself.

I hope this helps.

Note from Bob DeMarco. It isn't easy be one of us. It isn't easy caring for someone living with dementia. As the disease stages we continue to face newer and different problems. It is like a never ending cascade of new and different problems - change. In the end, even those who did not help us refer to us as: good sons/daughters, good husbands/wives, or a good person.

Many times they call us Saints. Saints? From my own catbird seat, now, in the Alzheimer's Reading Room I continue to believe, maybe we are saints in our own special way. God Bless all the caregivers. I know how you feel.

Rita Jablonski, PhD CRNP is an internationally recognized expert in dementia behaviors. She is tenured professor at the University of Alabama at Birmingham and a funded researcher, with over 50 publications and book chapters to her credit. She is a nurse practitioner in a Memory Disorders Clinic, where she helps people with dementia and their care partners. She shares her wisdom on her blog, Make Dementia Your B*tch.

Related Articles

How to Test Your Memory for Alzheimer's and Dementia (5 Best Tests)

4 Memory Systems of the Brain and Dementia

How the Loss of Memory Works in Alzheimer’s Disease, and How Understanding This Could Help You

How to Use Ice Cream as a Memory Care Tool

6 Reasons Why You Might Have to Put Someone with Dementia in a Memory Care Facility or Nursing Home

How to talk and communicate with dementia patients

Topics Pages for Caregivers - Learn More from Our Topics Pages

How to Embrace Reality in Dementia Care

Dementia Care, Do You Need to Change?

How to deal with an Alzheimer's Patient who is mean

Alzheimer's Communication is Important

Did you know the Alzheimer's Reading Room contains more than 5,000 articles and has been published daily since July, 2009? The website is designed to help caregivers deal with the problems they face each day.

Need Help? Search Our Award Winning Knowledge Base for Answers to Your Questions About Alzheimer's and Dementia

You are reading original content the Alzheimer's Reading Room

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.

In frontotemporal dementia, portions of these lobes shrink (atrophy). Signs and symptoms vary, depending upon the portion of the brain affected.

Some people with frontotemporal dementia undergo dramatic changes in their personality and become socially inappropriate, impulsive or emotionally indifferent, while others lose the ability to use language.

Frontotemporal dementia is often misdiagnosed as a psychiatric problem or as Alzheimer's disease. But frontotemporal dementia tends to occur at a younger age than does Alzheimer's disease, generally between the ages of 40 and 45.
~ Frontotemporal dementia care at Mayo Clinic

Alzheimer's is a type of dementia that typically causes problems with memory, thinking and behavior. Alzheimer's disease is the most common form of dementia.
~ What is Alzheimer's disease - Alzheimer's Reading Room