Frontotemporal dementia and its relationship with language
Introduction
DFT is defined as a neurodegenerative disease that is characterized by a progressive change in personality, behavior and language, in which visuospatial memory and abilities are relatively present in the initial stages. Regarding prevalence data, 10% of primary degenerative dementia cases correspond to DFT and the second most frequent cause of dementncia in 65 -year -old and minor people are considered. The DFT differs by three basic syndromes: frontal variant, non -fluent primary aphalanguage. The classification of DSM V disorder is carried out where the behavior and language variants will be analyzed. In our report we will focus mainly on the affectation of the DFT disorder in the progressive deterioration of language in terms of understanding, articulation of words and speech production, treatments will be presented from the therapeutic point of view and a review of the work will be carried outProfessional in charge.
Frontotemporal dementia
Frontotemporal dementia is a neurodegenerative disease that affects the front and temporal lobes. Its main characteristic is the obvious change in personal behavior, unusual changes in behavior, differences in their social behaviors, which can reach antisocial behaviors, alterations of totality of their autonomy and language, memory and visospatial skills are seen.
Epidemiology
Frontotemporal dementia is the third most common dementia in 65 -year -old people. It is similar in both sexes and can be manifested in people younger than other dementias, between 45 and 65 years. Currently in the Chilean population, dementias affects between 24 to 37 million people, which would be 1.06% of the population, among these DFT has an incidence of 8%.
Dementia is an acquired and chronic condition that is characterized by the deterioration of various brain functions that are accompanied by cognitive, psychological symptoms and behavioral changes, these have an impact on the ability of people to carry out daily activities thus compromising the
DFT pathophysiology
There are different causes of dementia, some can be caused by the abnormal death of neurons in certain areas of the brain, without knowing the mechanism that causes it. On the other hand they can be evidenced after a stroke or cerebral trauma, infections, herpes, AIDS, thyroid, kidneys in kidneys or by the consumption of substances such as alcohol or drugs.
The etiology of this disease is unknown and its cases are sporadic. It has been shown that many of these cases have a probability of 40 % product of a family incidence. This particular disorder is related to
The mutations of the tau and progranulin genes on chromosome 17 of the protein gene containing P97/Valosin on chromosome 9 and that of the chMP2b protein of chromosome 3, which are associated with the atrophy of pathology of the pathology.
Chemically speaking the disorder is explained by the alteration of neurotransmitter gestures such as cholinergic, serotonergic, dopaminergic, noradrenergic and glutamericics, all involved in the demential picture.
DFT variants
In this pathology there are three clinical variants such as frontal variant, semantic dementia and non -fluent progressive aphasia:
Front variant (VF): represents 90% of DFT cases and their frequent manifestations are the early deterioration of social behavior, decreased regulation of personal behavior, emotional deficiency, all this in a gradual and insidious process.
Semantic dementia (DS): The term "semantic memory" is part of long -term memory, characterized by an empty discourse, the loss of the meaning of words even when the phonological and syntactic aspects of language are preserved, rather than aLexical difficulty of words, the deterioration in this memory mainly affects nouns, with a poor level of cognitive performance, even with phonological aids, presence of omissions, categorical semantic errors ("apple" by "pear"), superordinals ("animal "by" rhino ") or circumlocutions (" serves to comb "for" comb "). Semantic memory is the one that is most altered in users with DFT, it also presents conflicts for recognition of family faces and objects. This variant is an important condition of the lower and medial temporal turns.
Non -fluente progressive aphasia (APNF): APNF is less common dementia that affects the ability to speak fluently, when dementia advances an aggressive loss of language begins, language atrophy is due since the drill area of the drillleft hemisphere, which causes a mixture of agramatism, dysarthria and anomia. Users present difficulties to communicate due to the distortions of expression characterized by slow and laborious speech and a tendency to incorrectly pronounce words. Some patients have a blurred speech while others are able to articulate words with frequent errors such as substitutions, omissions or exchange of fragments within them (for example "domindo" by "Sunday", "Zanaria" for "carrot") thatThey hinder communication becoming unintelligible.
Frontotemporal neurocognitive disorder DSM V
According to DSM V* a frontotemporal neurocognitive disorder is classified as larger or mild, in which different variants can be appreciated:
- Behavior variant: with the following behavioral symptoms:
- Behavior disinhibition
- Apathy
- Loss of sympathy
- Conservative, stereotyped or compulsive and ritualist behavior.
- Hyperoraity and dietary changes.
- Decrease in social cognition or executive capacities.
two. Language variant:
It presents a decrease in the ability to use language, either in the form of speech production, choice of words, denomination of objects, grammar or comprehension of words.
Relative absence of motor perceptual, learning and memory functions.
The alteration is not best explained by a cerebrovascular disease, another neurodegenerative disease, the effects of a substance or some other mental, neurological or systemic disorder.
And this is diagnosed with a probable frontotrophnitive neurocognitive disorder if something appears as follows:
- Evidence of a genetic mutation causing a frontotemporal neurocognitive disorder, either in family history or genetic test.
- Evidence of disproportionate affectation of the frontal or temporal lobe in the diagnosis of neurological image.
A frontotemporal neurocognitive disorder is diagnosed if there is no evidence of a genetic mutation and a diagnosis has not been made by neurological image.
DFT language
Language is the tool that has led the human species to transformation, since it has allowed us to develop new knowledge, which leads us to a theoretical explanation about the relationships between thought, language and the relationship with the receiver.
The upper brain functions such as language work together with a whole group of cortical and subcortical areas to contribute to a final result, if one of these is altered will produce chain problems for the entire system.
In the left hemisphere are the main components of language, such as the Broca area (at the foot of the third circumvolution, area 44 and 45 according to Brodmann) in this functions are developed as verbal formulation, participates in planning and programming to the programming to thearticulate and in sequence processes. When this area fails with the functions specified above, they are called "drilling apha. As a consequence of this we can observe failures in formulating sentences, support to start a production series and deficit.
Treatment
For the language in frontotemporal dementia there is no cure but if one works with pharmacological therapy and complementary therapy for the effects associated with this disease.
In medications we find atypical neuroleptics that act on serotonin receptors as well as dopaminergic receptors. There are also serotonin reuptake inhibitors (antidepressants) is used to increase serotonin levels inhibiting their reuptake. There are also benzodiazepines psychotropic drug that is characterized by its sedative effects, is used to cushion insomnia, anxiety and anguish.
Speech and language therapy work mainly in ways of compensating the loss of linguistic skills, although this therapy will not stop the advance of this disease can help control the condition and can make the evolution of some symptoms slower.
Professionals
To treat the language in frontotemporal dementia, a team of different professionals such as a doctor to do neurological examination, speech and language evaluation and also neuropsychological evaluation are needed where speech, understanding and language skills are measured, recognition and designation ofobjects.
Fonoaudiologist considered very important for the first diagnostic phase where mainly work of expressive and comprehensive oral and written language, treatment centered on compensatory work to improve communication is worked.
Specialist in neuropsychology when cognitive and/or behavioral alterations occur.
Occupational therapy which works in self-care creating activities aimed at achieving maximum personal autonomy, productivity to maintain labor or training skills, leisure creating means and activities that favor social relations, the use and enjoyment of free time.
conclusion
At the end of this work we realize the variants that the frontotemporal dementia presents and the close relationship that it has with language, which is a disease that has an unknown etiology, has no cure, nor can it be stopped but if it is diagnosed in timeAnd it works with a multidisciplinary team of professionals, the patient’s skills can be compensated, and no less important the reeducation of this and his family to be able to face the different changes that this will suffer.
Leave feedback