The Early Warning Signs of FTD—A Type of Dementia Doctors Say Is Easy to Miss
While symptoms may mimic Alzheimer's, aging or stress, there are key differences to watch for
Have you ever noticed subtle changes in a loved one’s personality or behavior and wondered if it’s more than just aging? Frontotemporal dementia (FTD) is the most common type of dementia for people under 60, and it often starts with easy-to-miss early warning signs. These early changes can sometimes be mistaken for stress, mood swings or even normal aging, which is why it’s important to know what to look for. To help, we spoke with healthcare experts about what FTD is, the early symptoms to watch for and what to do if you’re concerned.
What is frontotemporal dementia (FTD)?
“FTD is a type of dementia that occurs when there is damage to two lobes in our brains—the frontal and temporal lobes,” explains Elaine Healy, MD, Medical Director at United Hebrew. These areas of the brain primarily control our behavior.
“Damage to these lobes may lead to dramatic changes in personality and behavior as well as the ability of the person to make decisions, problem solve and control impulses,” Dr. Healy adds. Unlike Alzheimer’s, someone with FTD usually retains their memory.
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A rare type of dementia, FTD accounts for less than one in 30 dementia cases. The cause is mostly unknown and it’s often misdiagnosed due to overlapping symptoms with other conditions like Alzheimer’s or depression. However, Rostislav Ignatov, MD, Chief Medical Officer at The Haven Detox, underscores that it more commonly develops earlier in life. Most cases include “people between the ages of 45 and 65, though it can also affect others outside this age range,” he says.
People with a family history of dementia may also have an increased risk of developing FTD. That said, Mayo Clinic experts note that more than half of people with FTD have no family history of the condition.
Early warning signs of FTD
The early symptoms of FTD can vary depending on which areas of the brain it affects. Below, Dr. Healy and Dr. Ignatov share some of the most common signs, many of which tend to get worse over time:
Personality changes
People with FTD may lose the ability to control their impulses. This can result in “shockingly socially inappropriate behavior,” says Dr. Healy. “[They] may suddenly blurt out what they are thinking, even if inappropriate to say, kiss or touch a complete stranger, urinate in public or laugh uncontrollably in a solemn situation.”
They may also “struggle with planning or organizing tasks that were once easy for them,” adds Dr. Ignatov.
Emotional detachment
“Often, they become apathetic towards their loved ones and disinterested in things and activities that used to be important to them,” says Dr. Healy.
Obsessive behaviors
You may notice someone with FTD develop compulsive and repetitive actions. This can include following a rigid routine or hyper-focusing on specific topics. “Patients may become ‘hyperoral’—developing food cravings or start to binge eat or put objects in their mouths,” adds Dr. Healy.
Speech and language difficulties
“Early signs might include difficulty finding the right words or using very simple speech,” says Dr. Ignatov. Additionally, you may notice language problems such as “misusing words or making grammatical errors they wouldn’t have made before.” Or they might have “trouble following conversations or understanding complex sentences.”
How early FTD symptoms differ from Alzheimer’s
One of the key distinctions between FTD and Alzheimer’s is how they present early on. “FTD is usually not associated with memory problems, which is always a feature of Alzheimer’s disease,” explains Dr. Healy. “The personality changes and behavioral symptoms in FTD occur relatively suddenly. With Alzheimer’s disease, personality changes may be relatively mild and progress more slowly.”
Similarly, age-related forgetfulness or personality quirks don’t affect daily functioning or interfere with someone’s personal life. “We all have personality traits or experience mild forgetfulness as we age, but FTD symptoms go beyond these normal changes,” says Dr. Ignatov. He provides an example below:
- Typical aging or personality quirk: “A normally reserved person may avoid large gatherings, which is consistent with their usual behavior.”
- Symptom of FTD: “A person who’s always been polite and cautious might suddenly act recklessly or behave rudely without realizing the impact of their actions.”
What to do if you notice early warning signs of FTD
If you or a loved one is experiencing these symptoms, it’s important to see a neurologist or psychiatrist promptly. Dr. Healy shares a key point: “FTD often goes unnoticed by the individual experiencing it, as they typically don’t recognize changes in their behavior. It’s usually their loved ones who first observe signs that something is off.”
Before speaking with a doctor, Dr. Ignatov recommends preparing in advance. “Start by keeping a detailed record of the changes you’ve noticed, including when they began and how they’ve progressed. This helps the doctor get a clearer picture of what’s happening,” he says.
Other steps in diagnosing FTD involve ruling out other potential causes, including depression or side effects from medications. “Diagnosing FTD often involves a combination of medical history, cognitive testing, imaging studies like MRIs and blood work,” says Dr. Ignatov.
“While there’s no cure for FTD, early diagnosis allows family members to access resources, plan for the future and find support to navigate this journey together,” says Dr. Ignatov. Joining a support group, seeking therapy and learning about communication strategies can help caregivers and families.
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