It’s Not Alzheimer’s

It’s Not Alzheimer’s
The condition known as FTD is little known, but devastating.

Psychiatrist Chiadi Onyike. FTD Specialist

Psychiatrist Chiadi Onyike remembers it vividly: A middle-aged woman sitting quietly at a dining table and repeatedly picking up her glass for a sip. Yet her plate was bare, her glass empty. “It’s the small scenerios,” he explains, “that give you a sense of frontotemporal dementia (FTD).”

Onyike, who heads the FTD clinic here, aims to increase awareness of this type dementia—often wrongly diagnosed as Alzheimer’s. “Up to 20 percent of middle-aged patients who seek memory or dementia help, ” he says, “have some form of FTD, but few physicians other than neuropsychiatrists or behavioral neurologists are aware of it.”

FTD covers up to seven fatal diseases all marked by dementia and atrophy of the brain’s frontal and/or anterior temporal lobes. The illnesses can affect behavior by causing what Onyike calls “a history of social miscues and misdemeanors:” (Uncle George’s wanting to wear sweatpants to work seems odd, but his rude remarks, his repeated hair-combing and overblown jolliness cross the line.)

Patients’ speech also deteriorates: They may become mute, even lose their ability to comprehend language. In some cases, brain cells carry telltale tau or beta-amyloid proteins; others may display different signs or none at all. Some 40 percent of cases are familial, but even then, members of one family can have different types of the condition.

At the clinic, patients (with caregivers) initially spend two to three hours giving a detailed history and undergoing cognitive and neurological testing that may include brain imaging and EEGs. They receive a prognosis and also get help in knowing what to expect and how to handle care and other issues.

Families need calmness, because there’s no cure, Onyike says, “an ability to accept things as they are.” Growing up in Nigeria, he says, “I never knew the main role of medicine as providing a cure,”  I came to know it as providing clarity, comfort and guidance and—if you’re fortunate—a cure. In that case, you only walk a short way before you and patients shake hands. With FTD, you walk a longer distance, sometimes the whole way, with the family.”