Frontotemporal Dementia (FTD) gained attention in the American news when the famous actor Bruce Willis progressed rapidly to aphasia (inability to speak) and was diagnosed with FTD in 2023.
Since we announced Bruce’s diagnosis of aphasia in spring 2022, Bruce’s condition has progressed and we now have a more specific diagnosis: frontotemporal dementia (known as FTD).
Statement from the Willis Family February 16, 2023 theaftd.org
Recent JAMA NEUROLOGY review provided here (PDF):
Frontotemporal dementia (FTD) encompasses a group of clinically and pathologically heterogeneous neurodegenerative disorders characterized by progressive decline in behavior and language. The behavioral variant of FTD (bvFTD) predominantly presents with alterations in personality, executive dysfunction, and social behavior, whereas primary progressive aphasias (PPA) are defined by selective impairments in language, with subtypes including the semantic variant (svPPA) and the nonfluent/agrammatic variant (nfPPA). These syndromes share a common pathological hallmark of degeneration primarily affecting the frontal and anterior temporal lobes. FTD is a leading cause of early-onset dementia, defined as symptom onset before the age of 65 years, and accounts for a substantial proportion of neurodegenerative dementias within this age group. However, as with other neurodegenerative conditions, the incidence of FTD appears to increase with advancing age.
Three of the most common subtypes of FTD are 1) aphasia, 2) movement, and 3) behavioral:
APHASIA: primary progressive aphasia (PPA) with impaired language abilities
MOVEMENT: slow, stiff movements (bradykinesia, rigidity) or tremors,
BEHAVIOR: behavioral variant frontotemporal dementia (bvFTD), with substantial personality and behavior changes.1
I have personally known only one person with this disorder—a colleague with whom I worked for 18 years; she progressed fairly rapidly from impairment to death.
FTD is caused by brain/neuron damage characterized by the abnormal accumulation of two proteins: tau and TDP-43 (Transactive Response DNA-binding Protein 43 kDa)
Most cases of FTD—roughly 2/3 or 66%—occur spontaneously, with the other one-third being familial/inherited and connected with specific gene mutations.2
Checklist for Behavioral Variant Frontotemporal Degeneration (bvFTD)
Association for Frontotemporal Degeneration (theaftd.org) has provided a description and a diagnostic checklist, both of which I have included here:
Differentiating and Overlapping Stroke, TIA, and FTD
America’s President Trump occasionally shows signs of having had a stroke or at least a “small temporary stroke” called a TIA—transient ischemic attack. Signs of TIA/stroke include facial drooping (seen in the photo below), gait abnormalities (he clearly has difficulty walking at times), difficulty speaking clearly (common and getting worse), and cognitive impairments (daily).
We might see more conversation about FTD in 2026 as Trump shows signs of this condition, including:
Saying things that are uncharacteristically rude or offensive
Uncharacteristic touching, sexual behavior, or violation of others’ personal space
Difficulty planning
Blaming others for consequences of their own behavior
Loss of empathy
Obviously, all five of those signs overlap with other disorders including combinations of dementia and narcissism, and—also obviously—a person could have several neuropsychiatric problems concurrently. However, FTD has a few somewhat unique characteristics that differentiate it from other conditions; these include:
Confabulation, also seen with thiamine deficiency, as I discussed in my Nutritional Pharmacology review
Phonemic paraphasia, which is basically mixing-up sounds—substitutions or transpositions—in words such that the resulting sound approximates the intended word but is clearly in error.
Wide-based gait, also seen with stroke and hydrocephalus affecting the frontal lobes of the brain
Forward-leaning posture, not (hyper)kyphosis
Diagnostic pictures become more clear with time as the disease develops more fully, so we will have to “stay tuned” in 2026 to see if things get better (unlikely) or worse (probable).
Who is at risk for Wernicke-Korsakoff syndrome? What concomitant diseases would you expect to see with it?
Clinical manifestations of thiamine (vitamin B1) deficiency
https://www.betterhelp.com/advice/dementia/frontotemporal-dementia-posture-and-movement-understanding-the-connections/
https://www.nia.nih.gov/health/frontotemporal-disorders/what-are-frontotemporal-disorders-causes-symptoms-and-treatment