Managing Behavioral & Executive Symptoms

Managing Behavior Symptoms

Behavioral symptoms such as disinhibition, hyperorality (putting inappropriate things in the mouth), aggression and apathy are often very distressful to loved ones and caregivers of persons with Frontotemporal degeneration (FTD).  In a social setting, they are embarrassing and are often a source of anxiety for care providers.  Behavioral interventions may be useful in preventing or reducing these behaviors.  For example, avoid social situations that can lead to inappropriate behavior, such as crowded places, loud parties or events accompanied by long waits.  These settings can promote distractibility and lead to exploratory behaviors. Keep a behavior log, documenting the frequency of your loved one’s behavior and identify any precipitating factors that might have lead to the behavior.  This log will help you to identify situations that should be avoided in the future (1).  Substitute a positive behavior for the negative behavior.  Rewarding good behaviors may be helpful as persons with FTD are less likely to respond to negative feedback.  For persons who have a “sweet tooth” or hyperoral behavior, limit access to sweets and alcohol.  Structure the environment so it will constrain choices, limiting the burden of decision-making and distractions.  Create a regular schedule to promote involvement in activities for those who are apathetic and poorly organized.  A daily schedule will keep the person with FTD occupied and will help with sleep at night.  In addition, understimulation can also lead to behavioral symptoms. If your loved one is agitated, approach them in a calm, non-threatening manner using a reassuring and gentle voice. Always make your own safety your first priority.

Managing Executive Difficulties

Executive function refers to cognitive processes that are important for planning and organizing, and maintaining attention.  Problems with executive function can manifest in your loved one as perseveration, echoing gestures (echopraxia) or phrases (echolalia), inability to perform tasks that involve multiple steps, and/or limited capacity for planning that manifests as apathy or absent motivation.  These behaviors can be burdensome to caregivers who have to take on many responsibilities that were once shared.  Persons with Frontotemporal degeneration may be able to perform simple tasks with a little guidance.  Make lists of tasks and cross off tasks as they are completed.  Give your loved one explicit step-by-step directions of tasks to be completed.  If they become distracted, redirect to the desired task.  You may find yourself doing this a few times.  Reducing options may be necessary to minimize decision-making which can put stress on the person with FTD who has limited executive function.