we are already at risk at 45 years old

Personality changes and difficulty speaking or understanding are some of the typical symptoms of frontotemporal dementia. This degenerative disease has an onset at a younger age than other forms of dementia. Recently the family of American actor Bruce Willis, who has long since retired from the public eye, announced that the man was diagnosed with this pathology.

“Frontotemporal dementia – explains Professor Cecilia Perin, head of the specialist Rehabilitation Unit for severe brain injuries at the Zucchi Clinical Institutes in Carate Brianza and professor of Rehabilitation Medicine at the Bicocca University of Milan – is a degenerative disease and precisely for this reason it involves the progressive death of neurons. To date, speaking of dementia, we do not know the cause of this degenerative process, but research continues in several directions, from genetics to inflammatory or immune systems”.

Neurons are a precious part of our brain as, as the professor points out, they are the constituents of the substance that allows us to perform various actions such as thinking, moving, as the brain governs everything else. « The neurons that die due to a form of dementia – continues Perin – are those of the areas of the brain that deal with complex and at the same time precious actions as they concern thought, the modality of action and decision, but also the word”.

Despite greater information and awareness still today in the general population the idea of ​​dementia is associated exclusively with Alzheimer’s, undoubtedly the most widespread form, but it is not the only one. Consequently, the only alarm bell that is taken into consideration is that linked to the progressive loss of memory. «In frontotemporal dementia – explains the professor – the areas affected are mainly others. In this case the neurons that die are related to the frontal cortex and the anterior temporal cortex. The temporal lobe, for example, is the part of the brain that regulates fundamental functions such as speech, language, memory, but also hearing. We must not forget, in fact, that it is true that we hear with our ears but it is the brain that deciphers what we hear».

Unlike other dementias, which generally afflict people over 65, frontotemporal dementia tends to occur in younger people. Most of the confirmed and diagnosed cases concern people between 45 and 65 years of age, although it can also occur in younger or older people. Like other forms of dementia, frontotemporal dementia tends to progress and become more severe over time.

Diagnosis is not simple since the symptoms can be confused for other pathologies such as, for example, depression, as the manifestations can be linked to a change in personality. «Rather than with memory disturbances – Perin confirms – this disease can start with mood disorders with changes in personality and behavior. In other cases, however, with problems speaking and understanding language. Over time, the symptoms overlap and unfortunately the situation tends to progressively worsen.

Symptoms include the appearance of apathy, lack of initiative, impulsive or inappropriate behavior, but also progressive changes in speech, speaking slowly, having difficulty pronouncing a word correctly, putting words in the wrong order in a sentence, using a for another, having difficulty understanding sentences heard or read, unable to read and write.

Over time, problems with mental abilities also arise, being easily distracted, having difficulty planning and organizing activities. Problems related to the sphere of memory, as mentioned, tend to arise later than other forms of dementia such as, for example, Alzheimer’s disease. The diagnosis of this disease starts with a careful medical history and some neurological tests to exclude, for example, the presence of ischemia or other pathologies. «Blood tests are prescribed – continues the professor – to verify the correct functioning of the thyroid, the lack of vitamins or the presence of possible inflammation or infection. At the same time, neuropsychological tests and standard neuroradiological investigations are performed, such as magnetic resonance capable of highlighting an atrophy at the frontal and anterior temporal lobe levels. If the diagnosis is not confirmed, the patient’s progress is monitored over time». Among the analyzes that can be performed to determine more precisely which dementia it is (fronto-temporal dementia, Alzheimer’s disease, Lewi body dementia, vascular-based dementia, corticobasal degeneration), there are those relating to the determination of some substances present in the cerebrospinal fluid and blood, including the tau protein and beta amyloid (commonly altered in Alzheimer’s). Another important diagnostic exam is the PET or the brain Spect which allow you to see which areas of the brain have a lower metabolism than the others. «If they have a lower metabolism – specifies Perin – it means that they work less. Based on the area affected by this malfunction, we are now able to make a more precise diagnosis of dementia. Unfortunately, even today, a certain diagnosis does not correspond to a therapy capable of curing the disease».

The only drugs available are those also used for Alzheimer’s and which should make it possible to delay the worsening of dementia by about six months. “These drugs, however – adds the specialist – do not seem to give results with regard to frontotemporal dementia. However, taking charge of the patient is overall in the sense that on the one hand, neuropsychological, speech therapy and occupational therapy cognitive activation is attempted, on the other, advice and support are given to the patient’s family who must and will have to face a complex path”.

In fact, the caregiver today is often a family member and it is not uncommon for relatives to run the risk of feeling alone or isolated as most of the time is dedicated to caring for the person with dementia. «It is essential not to make families feel alone – continues the professor – therefore the network in the area must be a central point in terms of dementia. At the Zucchi Clinical Institutes we have activated a collaboration with a dedicated association (Felicementeseguilonda) and with the Social Services of the Municipality to guarantee the necessary assistance to patients and families».

In terms of prevention, scientific literature highlights how healthy lifestyles can help delay or avert the risk of dementia. «Several studies demonstrate how – concludes Perin – the Mediterranean diet and constant physical activity, as well as correct lifestyles, are able to lower the levels of brain inflammation and therefore delay the onset of dementia. Reading and keeping the brain in training also allows you to build a cognitive reserve. The greater this is, the better the person’s ability to withstand the shocks of brain aging».