Dementias that affect the frontal and temporal areas, as in the case of actor Bruce Willis, are initially characterized by disorders that pertain to these areas – explains Camillo Marra, clinical director of memory at the Gemelli Polyclinic Foundation in Rome and president of Sindem (Italian Society of Neurology for Dementia) – So there is not a single clinical picture”.
Frontotemporal dementia, what is the disease that struck Bruce Willis: the differences with Alzheimer’s disease
Bruce Willis, the disease: frontotemporal dementia diagnosed. The family: “There is no cure, help us”
Is it therefore a degenerative form different from Alzheimer’s?
“There are a number of conditions that can lead to dementia. Alzheimer’s is certainly the best known, and is the most frequent in the elderly population. While there are other forms of cerebral degeneration with different characteristics. In particular, we mean by fronto-temporal dementia not a single clinical picture, but various forms that affect the frontal and temporal areas of our brain”.
Could the symptoms be confused?
“Yes, because the recognition of one type or another of dementia is often linked to the execution of a very accurate neuropsychological test. The family member can apparently perceive symptoms of cognitive decline which can then be confused in their generality. The patient is however inattentive, may have difficulty using words and may even have memory impairment as well.”
What characterizes these dementias?
“It depends, there are dementias in which aphasias occur, disorders that mainly affect language: the patient progressively loses the ability to access linguistic forms, i.e. he cannot find the words when he has to speak; moreover, he is no longer able to access semantic knowledge, that is, of the world. For example, he doesn’t know what a certain object is. So he loses speech and also the concept of speech ”.
How do you recognize this disease?
“The patient is less able to understand social situations, does not take into account his own and others’ needs, is less able to perceive emotions. And then he loses the ability to have good manners in public, to follow the normal rules of social life, he becomes agitated, impulsive. Or, on the contrary, he has negative symptoms: that is, he can become apathetic, with a progressive reduction in the loss of interest, he no longer has the motivation and ability to do things, to take initiatives, he doesn’t want to have a conversation”.
So one might think that these are psychological problems?
“Yes of course. The form of dementia that does not initially affect language is that which affects behavior. And, in this case, the disorder can also be very subtle at first: the patient changes character, seems strange, does not take care of his hobbies, tends to behave inappropriately in public at times. Therefore, the patient usually goes to the psychiatrist”.
At what age does it strike?
“Unlike Alzheimer’s, which can affect an age group between 60 and 90 years, this disease can also start ten years earlier, therefore in the age group from 45-50 to 60 years”.
But what does it depend on?
“Compared to Alzheimer’s, frontotemporal dementia is characterized by a greater genetic component. But not all dementias are genetic, more than half are in fact sporadic, that is, they are linked to the alteration of proteins that are fundamental for the functioning of neurons”.
Can it be cured?
“There are no specific drugs for this pathology, but the symptoms are treated as they appear. And then rehabilitative linguistic interventions can be useful, while pharmacological treatments can be used for behavioral disorders”.
What is the course of this disease?
“It can happen that the person becomes very apathetic, unable to manage emotions, absent, remains inert more and more often in most of the day. Let’s not forget that this disease is also associated with the development of movement disorders, which can then determine the complications that lead to death: it can happen from 5 to 20 years from the onset and especially in relation to how early the movement complications arise”.
But can prevention be done?
“Since this disease has a stronger genetic component than Alzheimer’s, prevention is obviously less effective. In any case, an increase in cognitive activity, dietary control and then physical activity are important”.
From what age?
“Prevention hypothetically starts at school. Indeed, if we had the average population in Italy one year more educated – and instead we are one of the countries with the lowest average education, which is around 9.7 years – we would have 100,000 less demented people. Let’s not forget that the amount of cognitive reserve is protective for the development of dementias.”
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