How can I tell FTD apart from depression or a “midlife crisis”?

The distinction can be difficult at first. A few clues: in depression, the person is often aware of the changes and suffers because of them; in FTD, the person does not recognise the changes. In depression, the changes may respond to interventions; in FTD, they progress despite interventions. In depression, the underlying personality is preserved; in FTD, it gradually changes. A specialist assessment helps clarify the diagnosis.

In about 30–40% of cases there is a genetic component, and a family history is a significant risk factor. In cases with a strong family history, genetic testing may be recommended.

How long does FTD take to progress?

It varies. The average is 8–10 years from the first symptoms, but it can be shorter or longer. The course tends to be faster in forms with a very early onset.

How do I support someone close to me who has FTD?

In FTD, things are different from Alzheimer’s. Because the patient does not recognise the changes, trying to reason with them or to remind them “how things used to be” rarely works. It helps more to accept the new reality, to organise their everyday surroundings so that problem behaviours occur less often, and to seek specialist support for the family. Looking after yourself matters too: in FTD, the family carries a very heavy burden.

I feel guilty for getting angry with my loved one. Is something wrong with me?

No. The behaviour changes in FTD are hard for anyone to cope with. It is worth asking for support yourself: talking to a specialist helps you understand what is happening.

Frontotemporal dementia

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What is frontotemporal dementia

Frontotemporal dementia (FTD) is a group of neurodegenerative conditions that mainly affect the frontal and temporal lobes of the brain, the areas responsible for personality, behaviour, language and social judgement.

FTD is rarer than Alzheimer’s disease (it accounts for about 5–10% of all forms of dementia), but it has distinct features that make it important to recognise:

It often begins before the age of 65, usually between the ages of 40 and 60
Changes in personality and behaviour appear before memory problems or alongside them, the opposite of the typical picture in Alzheimer’s
Memory is relatively preserved in the early stages
There is often a family component: a history of FTD in first-degree relatives is an important risk factor

Why FTD is often misdiagnosed

FTD, especially the form that mainly changes behaviour (the behavioural variant), is among the hardest forms of dementia to diagnose. The reasons:

The age of onset (40–60 years): at this age, dementia is rarely considered
Personality changes are often attributed to stress, depression, a “midlife crisis”, relationship problems or addictions
Because memory is preserved at first, standard cognitive tests may be normal
The patient does not complain: they are not aware of the changes, so they do not seek an assessment themselves
The family often realises only late that the changes are caused by an illness, after months or years of supposed “behaviour problems”

A correct diagnosis requires expertise and specific investigations: a brain MRI, a detailed neuropsychological assessment and, sometimes, genetic testing.

When to see a specialist

An assessment is worthwhile if, in a middle-aged person (usually between 40 and 60), significant and persistent changes have appeared in:

personality or behaviour (visible to those close to them, but not recognised by the person)
social inhibition (inappropriate comments or actions, out of character for that person)
empathy (a new coldness or detachment towards those close to them)
language (new difficulties expressing themselves or understanding)
eating (marked changes in appetite or preferences)
motivation (significant apathy, loss of initiative)

Important: the person may refuse a consultation precisely because they do not see these changes. What helps: a calm conversation without reproach, suggesting a “routine check-up” and involving the GP.

If there is a known family history of FTD, it is worth watching for these signs even more closely.

Together with the doctor, the family can find ways to cope more easily with the day-to-day changes.

See also: The brain and inflammation

The first step

If you recognise these changes in someone close to you, book a conversation with one of our specialists. Together, we’ll look at what’s going on and what your options are.

For the assessment, we recommend that the patient comes with someone close to them, with the patient's agreement. If that is you, what you have noticed over the past months matters for the diagnosis.

Besides the psychiatric consultation, the assessment can include tests of thinking, language and behaviour, carried out by the team’s clinical psychologists. If getting to the clinic is difficult, the psychiatrist can also do the consultation as a paid home visit in Bucharest and Ilfov.

Services: Psychiatry · Psychological assessment
See our team and pricing.

This information is for educational purposes and does not replace a specialist consultation.