Complications
Financial crisis may result from irrepressible spending or compulsive gambling. Caregivers should be counseled to limit the patient's access to money and opportunity. Referral to social work and legal assistance is recommended. It is good practice to routinely counsel patients and caregivers soon after diagnosis to take steps to safeguard financial assets.
Dangerous driving may manifest as speeding, aggressive driving, disregard of traffic rules, and accidents (or close calls) attributable to distractibility or loss of competence. In these circumstances, immediate steps should be taken to limit or revoke driving privileges.
People with dementia, particularly those living in long-term facilities, may develop eating and drinking difficulties, therefore increasing malnutrition risk. As malnutrition can be preventable with early detection and intervention, nutritional screening and assessment is recommended for all people with dementia. Medical nutrition therapy may be instituted with those with malnutrition.
Patients with frontotemporal dementia (FTD) frequently have impairments in temperature and pain perception, particularly those with behavioral variant FTD (bvFTD) and semantic dementia, and most frequently in the molecular subtype represented by C9orf72 mutations. One study involving 58 patients with FTD found that 71% of those with bvFTD, 65% of those with semantic dementia, and 25% of those with nonfluent primary progressive aphasia developed pain and temperature perception impairments. Patients with semantic dementia reported heightened responsiveness most frequently; blunted responsiveness to pain and temperature was particularly associated with bvFTD (40% of symptomatic cases).[241][242]
Management of pain is an important aspect of the management of behavioral and psychologic symptoms of dementia. One Cochrane review showed that an algorithm-based pain management intervention may reduce proxy-rated pain compared with usual care. However, the certainty of evidence was low because of the small number of studies.[243]
Patients may have dependent children. Routine inquiry regarding the coping of each child, the patient's parenting, and parent-child relations is recommended. Depending on the context, counseling services and social work interventions may be needed.
Falls are frequent among patients with frontotemporal dementia (FTD) so screening for risk of falls is advised.[224] Cognitive impairment is associated with falls generally, but motor symptoms and signs, as seen in patients with FTD that overlaps with atypical parkinsonian disorders (e.g., progressive supranuclear palsy [PSP], corticobasal degeneration, or motor neuron disease), appear to be associated with the greatest risk. The falls rate for patients with behavioral variant FTD was reported to be 16% whereas that for patients with PSP was 90% to 100%.[4][239][240]
Legal trouble may result from compulsive shoplifting, reckless driving, aggressive behavior, or sexually inappropriate behavior. The physician should ensure the authorities are promptly notified of the frontotemporal dementia diagnosis and its relation to the incident. Urgent admission to a neuropsychiatric floor may be warranted, as may be long-term care in specialized dementia units, depending on the context.
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