Frontotemporal dementias are not a single neurological disease, but rather a family of diseases that share certain features, such as selective neurodegeneration and atrophy of the brain's frontal and temporal lobes. Their main clinical forms are behavioural variant frontotemporal dementia (BvFTD), agrammatical primary progressive aphasia (naPPA) and semantic variant primary progressive aphasia (svPPA).
On the other hand, Alzheimer's is a neurodegenerative disease that prevents the nervous system from performing its function normally. The parts of the brain affected by this disease appear on the inner side of the temporal lobe, especially in the hippocampus, from where it spreads to the temporal, parietal and frontal lobes.
Both cause the progressive loss of neurons in the nervous system, but they have different symptoms: frontotemporal dementia, which affects around 1,000 people in Catalonia, is notable for behavioural changes or language difficulties; while in Alzheimer's, a disease that 100,000 patients in Catalonia have, the most common symptoms are forgetfulness and impairment of the areas responsible for language, orientation and the ability to do things.
What are the differences in the treatment of these dementias?
Frontotemporal dementia, Alzheimer's disease and other neurodegenerative diseases have no cure or specific treatment that can prevent their progress; however, there are treatments that help control their symptoms.
Non-pharmacological treatments
In the non-pharmacological approach to frontotemporal dementia, managing behaviours requires understanding that these are symptoms of the disease and not traits of the patient; caregivers often have the feeling that the patient "is not the person they knew." For apathy, typical of the disease, there are proactive strategies, such as asking open questions and modifying environments. Finally, speech therapy is recommended to address speech disorders to recover linguistic abilities.
For Alzheimer's, there are regular mental and physical exercise programmes, adapted to the different phases of the disease, which prove to be crucial in slowing down cognitive decline. Additionally, maintaining an adequate diet and controlling vascular risk factors contribute significantly to the patient's well-being.
Pharmacological treatments
The drugs available for frontotemporal dementia are focused on symptomatic options and are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), which seek to stabilise emotions and facilitate the management of challenging behaviours. In addition, antipsychotics such as quetiapine, risperidone and olanzapine are also useful in controlling behavioural symptoms.
There are currently two groups of drugs available, specifically for the treatment of Alzheimer's disease, which act on the consequences of the neurodegenerative process. Firstly, acetylcholinesterase inhibitors, such as donepezil, rivastigmine and galantamine, provide symptomatic relief, although with possible gastrointestinal side effects; and memantine, which is effective in the moderate and severe stages, despite the possibility of causing dizziness and confusion.
Therefore, the confusion between Alzheimer's and dementia, from a scientific perspective, can be attributed to the diversity of causes, the overlap of symptoms and the gradual progression of the diseases. Both are diseases that can have a significant emotional impact on both the patients and their families, who can see the effects that neurodegeneration has on the character and personality of the person suffering from it.
