Frontal Alzheimer's disease

French

The geriatrician who saw my partner last week told me that he has frontal Alzheimer's disease. Not frontotemporal dementia but frontal Alzheimer.

She sees it in his impulsiveness, the fact that he brings everything to him roughly, that he puts things in his mouth, that he screams...

I feel like this is bad news because it's one of the hardest forms to deal with. 

Those whose loved ones also have a frontal form, can you please tell me your experience? Evolution, risks...

jfkoc

Interesting. See if this helps;

https://pubmed.ncbi.nlm.nih.gov/28265458/

Jo C.

A Case discussion re frontal variant AD:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078674/

The most interesting paragraph was the Conclusion:

"FvAD is a rare form of AD which can masquerade as an fvFTD-like syndrome. In the reported case, neither clinical examination nor MRI could definitively differentiate fvAD from fvFTD. Ultimately, these tools, in combination with PIB PET, allowed us to make the diagnosis of fvAD. A multimodal approach is therefore crucial when assessing rare forms of dementia."  

 I had even been wondering about the possibility of your Partner having a prion disease such as spongiform encephalopathy.  A healthcare professional I worked with and knew developed this and the diagnosis eluded the specialists for quite some time until the markers were finally found; the symptoms were similar to your Partners.

My Loved One had a behavioral variant of FTD; it was as they say, like Alzheimer's on steroids.   The only relief came with Risperdal, (Risperidone), which had to be titrated up for the effective dose.

 My LO lived for over eight years after diagnosis, but we think the early symptoms were not caught.  Behaviors were the main issue and they were terrible; then came losing physical abilities and later, even  speech was affected.  When the disease advanced, the behaviors became not so florid as long as the Risperdal continued.  When my LO seemed in good control, after some time passed, we tried to taper the Risperdal, but symptoms recurred quickly; so the medication stayed.

Truly, I am so very sorry; I can only imagine the heartbreak and stress this is causing.  It is good you brought him home to France; I cannot imagine trying to get this diagnosed and treated so far away from where you and his sons were.

Let us know how you are and how things are developing; as always, we truly do care.

J.

French

Thank you both for your reference. 

Yes Jfkoc, both the schemes to compare the evolution of fvAD and FTD are very interesting and the drawing clearly illustrate the fvAD. This kind of description is speaking to me. 

Also Jo C, the paper you sent seeems to describe my partner’s evolution. Same age…

He had MRI, pet scan and LP, no doubt it is AD.

From February to May he was on quietapine till 300mg per day, with less and less effect.

Then they tried olanzapine. It worked well during 3 months but then he refused to sit and had more and more tremulous legs. 

End of July they tried risperdal (respiridone) but stopped after 9 days because of more extreme behavioral issues. Then they suspected the malignant syndrome of neuroleptic.

Now, French doctors think there is no malignant syndrome of neuroleptic because had no fever. He is now on quietapine again, 100mg per day. Compared to what he had before I would call that cat pee. Something new, he is screaming a lot « No » «  sh-- » «  bitch « . When I enter in the corridor I can ear him and knows how he is. 

I think they will have to increase a lot the medication before a result, and perhaps change. Not sure he will be discharged in September.

Jo C.

I can only imagine what it must be like to visit when one can hear the shouting from down the hall before even getting to his room.  What a helpless feeling.

Not only is the Partner Caregiver suffering; but the person with dementia also suffers horribly.  Imagine living inside his head not only believing all the thoughts that are whirling about and driving him; but actually feeling them.  It must be hellish.

May the physicians soon find the correct medications to help and bring him some peace. I agree; it does not seem as though he will be discharged in September unless there is a major change. 

My heart feels for you and for him; thank you for keeping in touch letting us know how things are; I will be looking for your next Post.

J.

M1

French I pray that they will find a combination that works.  If it helps at all, doses of quetiapine can go as high as 800 mg (used in schizophrenia), so there's room to move still.  Thinking of you.  Nightmare-ish I'm sure.  thank you for the update.