Coping with dementia: strategies and approaches

Frontal-Temporal Dementia (Frontotemporal Dementia)

Frontal-Temporal Dementia

Dementia is a collective term, which includes chronic cognitive disorders, which lead to loss of independent functioning. There are different types of dementia, and statistics show that it affects 3.4 million people in the United States alone (DiZazzo-Miller et al., 2014). Notably, the most affected people are the elderly, which suggests that the risk of dementia increases with age, and this further show that dementia is a significant health challenge. Disorders in this line show a progressive nature and this makes it difficult to provide care. FTD is a familiar variety of dementia, and its pathology varies when compared to the commonest form of dementia, which is Alzheimer's disease.

In comparison, FTD is prevalent on the frontal or temporal lobes, and it is more prevalent than Alzheimer disease (Riedjik et al., 2006). Patients suffering from FTD show alterations in behavior, personality and impaired insights. In addition, the patients show signs associated with deficits in the frontal lobe. As FTD progresses, the patient also will develop progressive disturbance of executive functions, initiative loss, loss of mental flexibility and organization. Afterwards, the patient will experience loss of language, which results in aphasia (Scarmeus & Honig, 2004).

Additionally, the patient also experiences behavior changes, for example, pacing and repetitive behaviors advance gradually (DiZazzo-Miller et al., 2014). Sadly, the burden of providing care to patients with FTD is unknown. On the other hand, the healthcare system does not have a comprehensive awareness of FTD, which has contributed to misdiagnosis. This has further contributed to the inadequate knowledge on developing working interventions to relieve the caregivers the burden they go through in their efforts to help. Therefore, FTD is a significant problem. This study's objective is to present an insight into the disorder by borrowing from recent literatures touching on the disorder (Scarmeus & Honig, 2004).

Background

Apparently, many studies use the term frontotemporal lobar degeneration to include the behavioral disturbance in terms of social conduct and executive function, but more recent literature use the term FTD to include the behavioral and degenerative syndromes associated with the frontal and temporal lobes (DiZazzo-Miller et al., 2014). Currently, the usage of the term allows for clinical representations of FTD, but this come in two divisions that constitute dominant behavioral alterations and language symptoms. The language symptoms are further categorized as those with anterior, aphasia, expressive, and those that show posterior language deficits.

Nonetheless, it is allowable either to use the term FTD for the entire set of disorders, or to show the behavior change of FTD alone. FTD mostly occurs in the tender ages, and some studies report that individual cases show onset of the same aspects of the FTD disorder when one was 21 years. However, the mean ages of 50-65 show onset of the disorder. Unlike other disorder, FTD is different in that there has been no reports concerning the predominance on either males or female (Scarmeus, & Honig, 2004).

In addition, the disorder has aspects of the genetic contribution. This has been the case on chromosomal, 17 locations that show mutations in the tau gene. There is evidence on this after a study on a Danish family with DLDH pathology. Another study links chromosome 9 to a family with FTD-MNG pathology. Initially, evidence linked FTD to different families in chromosome 17, and in most cases, mutations were present in the formerly mentioned gene (tau gene). The cases reveal the clinical phenotype of behavioral FTD.

How it affects Executive Functions

Executive functions refer to the cognitive ability used in controlling and coordinating other cognitive abilities and behaviors in general. Executive functions occur in two groups and they are organizational and regulatory abilities. In the context organization, functions include attention, planning, solving problems, cognitive flexibility, and many others. In the context of regulation, functions include self-control, emotional control, behavioral control, decision-making, and many others. The cognitive skills incorporate information at higher level across other cognitive domains (Giovagnoli et al., 2008; Riedjik et al., 2006). This means that any damage to the executive system will include deficiencies and this will result to loss of administrative control, which will further result to the loss of ability to control, organize, and regulate various forms of information, including behaviors.

Damage to the executive functioning system will result to socially inappropriate behavior, challenges in the verbal fluency, disinhibition, inactiveness, and many others. Damage to the most forward sections of the frontal lobes, including the cortical and sub-cortical structures that link to the frontal lobes have a link to executive dysfunction (Matuszewski et al., 2006). It is essential to recognize that the frontal lobes are among the last areas of the brain to achieve full growth, and they account for around 40% of the brain. FTD is characterized by a continuous attenuation of the tissue in the front and fore temporal lobes of the brain. The alterations such as loss of social skills, loss of emotions (Vugt et al., 2006), disinhibition, poor moral judgments, and some patients of FTD show pain tolerance later in life.

Research has shown that executive functions may be affected by a wide range of other dementia disorders, and, therefore, should not be used to identify the type of disorder. In this case, executive functions should not be the main test of diagnosis of FTD because the same impairments are similar to those caused by AD (Riedjik et al., 2006). In an attempt to identify how FTD influences the executive functions, scholars have followed different approaches. Piolino et al. (2007) used the trail-marking test, stroop test, running span and categorical and phonetic fluency tasks to find out the same. In the study, it is apparent that patients suffering from FTD had gone through severe executive function impairment in terms of shifting, inhibition, and strategic processes from the results obtained (Piolino et al., 2007).

Etiology in relation to Occupational Profile

Impact on Student

Prior studies report that FTD influences the well-being of an individual. Although the disorder shows onset at late ages, it can affect anyone, including students. Owing to the age of students, which may range between 10-23 years of age, initially, they will face major setbacks in their school life. As the disorder progresses, the student will meet personality and behavioral changes (Giovagnoli et al., 2008; Riedjik et al., 2006). This will include emotional alterations, which will influence their learning and interactions with other students.

In addition, the student will experience poor decision-making, an important aspect in learning. The temporal lobe supports basic learning and the retrieval aspect of the memory (Giovagnoli et al., 2008). Through a combination of stimuli, encoding memoranda, and inhibiting interference, the hippocampus has the capacity to find out new memory traces, and helps to maintaining the memory traces for subsequent consolidation and storage. This is very important, but deficits in the temporal lobe will deprive the student such an important capability, and in the end, the student may drop out of school (Giovagnoli et al., 2008).

Impact on Community

The community has felt the impact of FTD, especially through costs, and the challenges the family faces when caring for their suffering loved ones. On one hand, there are few workers designed to care for the patients, and on another hand, the FTD is progressing meaning that the existing caregivers will assume extra responsibilities (Vugt et al., 2006). Caregivers undergo physical, social, and psychological, including financial challenges, particularly because the community was not anticipating for such a burden (Riedjik et al., 2006). For the elderly patients, it becomes hard because their responsibilities are far much many, and include toileting, bathing and feeding. The community, particularly the family has to cope with the neuropsychiatric disturbance from the patients. This resulted to emotional burdens (Vugt et al., 2006). Efforts to seek help from the healthcare system often failed because FTD prevalence is less and not widely known.

Impact on Life

FTD is a severe disorder, which results to a variety of adverse effects on the person diagnosed with the disorder. In the real life situation, the various effects will result to undesirable characteristics. Although there have been efforts to train the patients on how to survive with the disorder, the issue of memory lapse obstructs every effort (Scarmeus & Honig, 2004). This is because the patients often fail to remember what they learn, which means that efforts are futile. People become inactive, they are not capable of working and live their lives depending on other people, and hence, they gradually become burdens to the society and themselves (Matuszewski et al., 2006).

As the disorder, progresses the patients become irresponsible in all aspect of life, including talking, behaving, and others. They often behave impulsively, show inappropriate sexual behavior and labile emotionality (Malloy et al., 2007). The damage of the frontal and temporal lobe result to the alterations of the executive functions, which are many, and they play an important role in human development (Malloy et al., 2007). Therefore, when an individual lacks the control or capability to regulate their behaviors, they tend to be more of socially misfit. Therefore, FTD has adverse effects on life, and lack of appropriate therapeutic technique or approach means that people cannot cope with life (Matuszewski et al., 2006).

Leisure Time

FTD, as seen in the previous sections of this study has adverse influences on the well-being of a person. This means that the person cannot cope with life when compared to the other people (Matuszewski et al., 2006). Apparently, such people tend to spend most of their time alone, become antisocial, and hardly capacitated to perform any task independently. Therefore, during their leisure time, they are not even aware of such. Instead, they engage in childlike behaviors, and inappropriate social behaviors. This means that they cannot use their leisure time with people because they lack control of their cognitive abilities. In addition, the damage on the frontal lobe means that they fall short of associative abilities, which are important in socialization, and other activities (Giovagnoli et al., 2007).

Occupational Therapy

Therapists agree that there is no therapeutic approach, which is effective in the management of FTD. Although the disorder has no cure, therapists have suggested that it is important to access patient's muscle strength, swallowing capability and gait balance to enhance functionalities in the course of disorder (Johnson, Griffin, & McArthur, 2006). Occupation therapy is a profession, which is the core to the provision of help to others through a holistic approach. The term occupation describes the daily activities that the therapists engage an effort to provide care to patients in need (American Occupational Therapy Association, 2002). In the management of FTD, occupational therapists prefer to have a broad view of the patient.

This includes the use of other people such as a family, or any other person who has an insight into the patient's problem. In addition, there are many considerations to make when dealing with FTD, especially because of the clinical aspect of the disorder (Jicha & Nelson, 2011). Therapists often check for the cognitive symptoms that arise from the disorder, and use a cognitive management approach, specifically to manage the cognitive disabilities. Cognitive management involves cognitive training, cognitive simulation, and cognitive rehabilitation. In simulation, patients take part in engagement activities, which are often enjoyable.

In training, the patient often practice speech repetition, which might be computer assisted or group based. In rehabilitation, the patient sets their own goals, which they opt to fulfill. The therapists focus on cognitive symptoms such as dysexecutive, attention, or language symptoms (Jicha & Nelson, 2011). Moreover, therapists often recommend pharmacological interventions and this includes the use of galantamine, or rivastigimine, which can treat behavioral changes in the patients. However, patients should undergo evaluation after six months of using the drugs to establish whether the patients have changed the behaviors associated with FTD. In medical management approach, therapists often confuse FTD with AZ.