Frontal Temporal Lobe Dementia
The condition of dementia is about physical changes in the brain. Depending on where these changes take place in the brain, will depend on how this impacts on the health and wellbeing of the person with dementia. Dementia can impact physical, mental or psychological health and is not just about confusion or memory loss.
When someone has damage to their frontal temporal lobe, this is the part of the brain that deals with “executive function”, which is about an ability to plan and sequence things and is also the part of the brain that filters thoughts before they are spoken or acted upon.
People with damage to this part of the brain may still have very good language skills and can make sense when they talk, which can make diagnosis difficult, as they appear in many ways “normal”. However the ability to understand that if they are getting dressed, they need to put on their underwear first or before making a cup of tea, they must boil the water. These basic skills of understanding a sequence in which things need to be done, make functionally living their lives very difficult.
In addition, taking off the filters from their thoughts can have significant implications, as their words or behaviour will be out of character and additionally can be very socially inappropriate, which when added to a confusion about who some people are, can lead to a very distressing situation for all involved, with the person with dementia not being able to understand what is happening to them or why people are behaving towards them in the way that they do. I have been involved in a case when the Mum of the family became “flirty” with her son, who looks like his father! I have also been to see a client to discuss his affairs with him and after introducing myself to him, one of his first comments to me, was “aren’t you pretty”! He intended it as a compliment, but as a solicitor, this is not something that I often get told, as I am instructed due to my knowledge and not to do with my appearance. I have also heard of other cases where the socially inappropriate behaviour would be bordering on criminal or in other cases very definitely criminal, if they understood what they were doing, but in a Court, the Crown Prosecution Service would have difficulty getting a conviction due to mental incapacity.
This presentation of frontal lobe dementia and fortunately the potential criminality that is associated with it is rare, but it can nevertheless be very challenging to care for by those around that person.