Sexuality and Dementia by Douglas Wornell

Author:Douglas Wornell
Language: eng
Format: epub
Publisher: Springer Publishing Company

FRONTOTEMPORAL DEMENTIA

The classic early onset or presenile dementia is called frontotemporal dementia (FTD). Second to early onset Alzheimer’s disease, it accounts for about 20 percent of dementia in the earlier age groups. FTD typically affects 40- to 65-year-olds but may occur in those as young as 20. The illness is aggressive. Many patients die in the first two to three years; the condition is almost 100 percent fatal after ten years. Specific atrophy, or shrinkage, of the frontal and then temporal lobes of the brain are the hallmark of the disease. This dementia was originally known as Pick’s disease; however, variants of FTD have been identified.

The behavioral subtype remains more closely linked with the term Pick’s disease. It is typified by a change in personality and a general apathy that usually predates any memory loss, thus clinically distinguishing it from Alzheimer’s disease. Hoarding and gluttony can occur as well. This form of FTD can be genetically determined. A dysfunction of tau protein, which is intrinsic in the microtubule transport system between nerve cells in the brain, is common to this form. “Pick’s bodies,” seen under the microscope, are intracellular inclusions of tau protein and are markers of Pick’s disease.

Other subtypes include one with a nonfluent aphasia, where the patient can no longer form sentences, and another with a fluent aphasia, where word finding or word recognition is the hallmark. The latter, also known as semantic FTD, is the least genetic form of the illness and the least related to classic Pick’s disease.

John, who had the behavioral variant of FTD, was referred to us for inpatient hospitalization from the outpatient geriatric psychiatry clinic at the University of Washington. He was young, around 40, and already had the illness for a couple of years. His wife, Julie, and his teenage kids were devastated at the dramatic decline in this otherwise healthy engineer/marathon runner. Julie had been trying to manage him at home, but his inappropriate behavior was not meshing well with the teenagers, and particularly their friends. The effect was so severe that neither his son nor daughter was comfortable inviting anyone over. The friends had spread the word in school that John had touched them and made inappropriate comments. A few even said that he was a pervert. It was extremely embarrassing for his kids, as well as for Julie, who was forced to explain the situation to other parents.

Julie told me, “The whole thing turned me off to him. Finally I refused to have sex. It makes me feel like a participant in this circus. But at the same time it kills me because I love him so much. It’s why we’re here. I don’t know where else to turn. I must go to work, and yet he can’t be left alone. Besides, with his behaviors, who would stay with him? I don’t think ‘home’ is going to work anymore.”

Unfortunately, we had a terrible time with John, too. The behaviors became unmanageable soon after admission. He was strong and constantly fought with us, all the while refusing medications and any other help we offered.

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