Home > Diagnosis, Dining, Dysphagia, Types of dementia > Dysphagia in Frontotemporal Dementia

Dysphagia in Frontotemporal Dementia

Most persons with dementia, regardless of the disease process involved, develop significant swallowing difficulties (dysphagia).  As a speech pathologist, this is often a problem that I get involved with.  These difficulties can be caused by a number of different factors.  There can be generalized weakness which, in addition to problems with using the arms and legs, can also cause problems with the muscles that we use for chewing and swallowing.  There can also be behavioral changes which can produce bolting of food, poor monitoring of self-performance, or limited self-awareness of problems.  Most often, as cognitive function declines, the brain becomes unable to coordinate all of the complicated muscular and neurological processes used in the process of chewing and swallowing.

Most of the patients with swallowing problems, that I see in my work, have one of the more common forms of dementia — Alzheimer’s disease, vascular dementia, Lewy Body Dementia, or other degenerative diseases such as Parkinson’s or Huntington’s.  When I’ve been requested to evaluate those with frontotemporal dementia, most of the problems that I’ve noted have been more of a behavioral nature — such as compulsive eating or food gorging (or refusing to eat at all, as with one particularly memorable patient).  The problems they exhibited had more to do with the behaviors of HOW they ate, rather than the physical process of getting the food from the mouth to the stomach safely.  But, then, I have to admit that the persons with FTD that I’ve worked with are primarily in the early stages of the disease.

Earlier today, I ran across an article that discussed the results of a number of studies pertaining to the swallowing difficulties found in persons with FTD.  The article is a few years old, but the information provided should still prove to be useful.  The first study reported involved a group of 21 patients, exhibiting three different forms of FTD.  All participated in an instrumental examination of their swallowing status, and 12 were found to have a moderate degree of dysphagia.  On further investigation, these swallowing problems were not strictly behavioral in nature, but had to do with real neurological deficits involving the brainstem swallowing center.

Most persons with frontotemporal dementia present with problems in the areas of behavior or language.  Most do, eventually, progress to where they exhibit abnormal neurological symptoms such as Parkinsonism or motor neuron disease.  A few do show neurological symptoms early, but many of these are eventually diagnosed as having amyotrophic lateral sclerosis, progressive supranuclear palsy, or cortical basal ganglionic degeneration.

Another study, which was conducted through search of medical records of 96 persons with FTD, showed that those who exhibited neurological symptoms prior to the development of abnormal behaviors generally had a shorter lifespan.  (Such symptoms included mutism and dysphagia.)  As a result, it was speculated that those persons who developed neurological symptomology early on have a more rapidly progressive neurological disorder which involves more aggressive deterioration of cortical and subcortical structures.  All of those who displayed dysphagia were eventually diagnosed with ALS, which suggests that the presence of early neurological symptoms in patients with FTD may actually be indicative of the presence of another disorder.

Researchers looked at 73 deceased persons who had exhibited FTD, and found that 18 of them died from pneumonia, with 37 dying from other neurological disorders.  It was suggested that the pneumonia was caused by aspiration due to swallowing problems, but this hypothesis was not tested.  Pneumonia is also a common cause of death for persons with many other progressive neurological diseases, as well as many forms of dementia.

There are few reports of swallowing problems in persons with FTD in the absence of other neurological disorders.  One article did describe a person who exhibited an “apraxia of swallowing,” which included a difficulty initiating the swallow, with both foods and liquids being held in the mouth for long periods of time.

Another study examined the differences in eating and swallowing patterns between persons with FTD and Alzheimer’s disease, through a questionnaire completed by the relatives of 91 persons.  While the severity of the dementia was similar for both groups, problematic eating behaviors were reported much more frequently in the FTD group.  Those with AD were reported to exhibit dysphagia symptoms earlier than those with FTD, with about 20% of persons in both groups reported as having concerns in this area.  It should be noted that no formal evaluation was conducted on these patients.

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