Forms of the disease
There is a behavioral variant, in which the frontal lobes are primarily affected, and speech variants, associated primarily with the temporal regions. In the behavioral form, personality, motivation, and social skills change. With primary progressive aphasia, the ability to select words and construct phrases or understand their meaning is gradually lost, while memory and orientation are preserved for a long time. Some cases are combined with damage to motor neurons, then muscle weakness, twitching and swallowing disorders are added.
- Behavioral option - changes in personality and actions
- Speech Variations—Progressive Aphasia
- Combination with motor neuron damage
- Possible features of parkinsonism
- Hereditary forms with familial accumulation of cases
What does it look like from the outside
Relatives describe that the person has become different: sympathy and interest in the family have disappeared, rudeness, inappropriate jokes, sloppiness, strange habits and stereotypical actions have appeared, food preferences have changed with a craving for sweets. Some patients, on the contrary, become lethargic, lack initiative, and sit around all day doing nothing, which is mistakenly taken for depression. There is no criticism of their condition, so such people are usually brought to the doctor by their relatives.
- Loss of tact and empathy
- Impulsive actions and thoughtless spending
- Apathy and loss of interests
- Stereotypical repetitive actions
- Overeating, especially sweets
- Lack of illness awareness
Diagnostics
The doctor questions the relatives in detail, since the patient himself does not notice the changes. Neuropsychological testing reveals disturbances in the regulation of behavior, planning and speech with relatively intact memory. Magnetic resonance imaging shows selective atrophy of the frontal and temporal lobes, which provides important confirmation. Conditions that give a similar picture must be excluded: depression, bipolar disorder, frontal lobe tumors, hydrocephalus, hypothyroidism, vitamin B12 deficiency, consequences of alcohol abuse. In familial cases, genetic counseling is discussed.
- Interviewing relatives about behavior changes
- Neuropsychological testing
- MRI of the brain with assessment of the frontal and temporal lobes
- EEG according to indications
- TSH, vitamin B12, blood biochemistry
- Psychiatrist consultation
- Genetic counseling for familial cases
Treatment and care
There are no drugs that stop the death of neurons yet, and drugs used for Alzheimer's disease usually do not help with this form and sometimes increase agitation. Therefore, non-drug approaches become the basis: a structured day, elimination of provoking situations, switching attention, a safe environment. If there is severe impulsiveness and aggression, the doctor may prescribe medications that affect behavior, selecting the minimum effective dose. With speech forms, classes with a speech therapist and auxiliary means of communication - cards, notes, simple phrases - help.
- Clear daily routine and predictable environment
- Eliminating situations that provoke conflicts
- Classes with a speech therapist for speech forms
- Symptomatic therapy as prescribed by a doctor
- Control access to money, documents and car
- Monitoring feeding and swallowing
- Education and psychological support for families
Practical questions for families
Since the disease often begins during working age, issues of work, finances and legal protection arise early. It is reasonable to discuss in advance with relatives the restriction of access to large sums and execution of transactions, driving issues, and preparation of necessary documents. It is important to explain to those around you that rudeness and indifference are manifestations of illness, and not malicious intent: this reduces tension in the family. Caregivers need rest and support as much as the patient, and it is normal to ask for help.
- Early resolution of legal and financial issues
- Stop driving when driving dangerously
- Explaining the diagnosis to others
- Division of responsibilities between relatives
- Support groups and psychological consultations
- Planning for future care
- Regular observation by a neurologist