What is frontotemporal dementia?
When dementia changes who someone seems to be before it touches memory.
Frontotemporal dementia (FTD) is a group of brain diseases that shrink the frontal and temporal lobes, the areas that guide personality, behavior, judgment and language. It often begins between about ages 40 and 65. Early signs are usually changes in behavior or speech rather than memory loss.
What FTD looks like day to day
The first person to notice is often a spouse or coworker.
A careful, polite man starts making crude jokes to strangers, spends money impulsively, or stops caring about his grandchildren’s visits. A woman who loved cooking now eats only sweets, or pockets food. Some people lose interest in everything, which looks like depression. Others develop rigid rituals, such as tapping, clapping or walking the same route. In the language forms, speech becomes halting or words lose their meaning while memory for recent events can stay fairly good.
These changes are described by Mayo Clinic, which notes FTD is sometimes misdiagnosed as a psychiatric condition or as Alzheimer’s.
7 early signs of frontotemporal dementia
Mayo Clinic describes behavior changes as the most common way frontotemporal dementia starts. Watch for a lasting pattern of:
- Saying or doing things that are socially out of character
- Less warmth or empathy toward family
- Poor judgment, especially with money
- Loss of interest and drive
- Repetitive or compulsive habits
- New eating patterns, such as bingeing on sweets
- Trouble finding or understanding words
Any one of these can have other causes. Several together, in a person in their 40s, 50s or early 60s, deserve a specialist’s look.
Types of frontotemporal dementia
| Type | Main changes |
|---|---|
| Behavioral variant | Personality, judgment, empathy and habits |
| Semantic variant PPA | Losing the meaning of words and names of things |
| Nonfluent variant PPA | Halting speech and grammar errors |
| Primary progressive apraxia of speech | Trouble coordinating mouth and jaw to speak, with understanding kept at first |
| Movement-related (rare) | Features like Parkinson’s disease or ALS: tremor, stiffness, weakness, falls, swallowing trouble |
PPA stands for primary progressive aphasia; see our entry on aphasia. Mayo notes that some gene changes linked to FTD are also seen in ALS.
Why it happens
Nerve cells in the frontal and temporal lobes are damaged and the tissue shrinks, often with abnormal buildups of proteins such as tau or TDP-43. The underlying cause is usually unknown. FTD can run in families, and the CDC reports that about one-third of cases are inherited. Mayo Clinic estimates FTD accounts for roughly 10% to 20% of dementia cases.
What helps at home
- Remind yourself the behavior comes from the disease. Your loved one has lost the brain “brakes,” not their love for you.
- Manage the environment rather than the person: limit access to credit cards, online shopping and car keys; store sweets out of sight.
Daily structure and simpler communication also help:
- Keep a structured day with physical activity; boredom fuels compulsive behavior.
- Use short, concrete sentences, gestures and pictures when language fades.
- Carry a small card that explains the diagnosis for awkward public moments.
When to call the doctor
Ask for an evaluation, ideally with a neurologist or a memory clinic, when personality or language changes persist in someone in midlife. Florida’s state-funded Memory Disorder Clinics are listed in our Florida dementia resources directory. After diagnosis, call about unsafe behavior, weight changes, choking, or new movement problems, which can occur in some subtypes.
FTD vs. Alzheimer’s
Alzheimer’s usually starts later in life and with memory loss. FTD typically starts younger, and memory may be relatively spared early while behavior, judgment or language change first. Mood disorders are another common mix-up, since apathy can look like depression.
Florida help for younger families
Because frontotemporal dementia often starts in working years, families face job loss, teenagers at home and a spouse caring while still employed. Florida’s 17 state-funded Memory Disorder Clinics, part of the Alzheimer’s Disease Initiative, provide diagnosis and referral, and the program’s respite services are open to adults 18 and older with a dementia diagnosis. The Alzheimer’s Association Helpline (800-272-3900) also supports families living with other dementias. Read more in our guide to early-onset dementia care.
Care that fits a younger, active person
People with FTD are often physically strong and restless, and many are still in their 50s. Families tend to look for a companion who can keep up: long walks, the gym, errands, hands-on projects. See our page on in-home care for FTD and on early-onset dementia. Our memory and engagement visits are built around exactly that kind of purposeful activity, and spouses often pair them with respite care.
Related terms
A companion with energy to match
We match active, patient companions for younger people with FTD. 3-5 profiles in 48 hours, $35/hour for 40+ hours a week.
Frequently asked questions
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At what age does frontotemporal dementia start?
It often begins between about 40 and 65, according to Mayo Clinic, though it can start later.
Is frontotemporal dementia inherited?
Sometimes. The CDC reports about one-third of cases are inherited, and many people have no family history.
Why is FTD often misdiagnosed?
Early symptoms are behavioral or language changes that can look like depression, a midlife crisis or another psychiatric condition.
Does FTD affect memory?
Memory is often relatively preserved early on. Behavior, judgment and language usually change first.
What are the types of frontotemporal dementia?
The behavioral variant changes personality, judgment, empathy and habits. Two language forms, called semantic and nonfluent variant primary progressive aphasia, cause loss of the meaning of words and names, or halting speech and grammar errors. Primary progressive apraxia of speech causes trouble coordinating the mouth and jaw to speak, and rare movement-related forms bring features like Parkinson’s disease or ALS. See our entry on aphasia.
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