Bruce Willis' diagnosis of frontotemporal dementia explained by local neurologist

AUSTIN, Texas - Last year, the family of Bruce Willis announced he’d been diagnosed with aphasia, which is the loss of the ability to understand or express language. Then, this past February, they revealed the 68-year-old actor has frontotemporal dementia or FTD.

"If you look at a brain, you’ll see space, more space than you should, in the front and on the side," explained Dr. Trent Roubleau, a neurology specialist at St. David’s Round Rock Medical Center. "So, you’ll see less brain volume on the sides where the temporal lobes are and on the front where the frontal lobes are."

He said there are two forms of frontotemporal dementia – a behavioral variant and a language, or aphasia variant.

Dr. Roubleau said the temporal lobes of the brain are responsible for processing language.

"You can imagine, if someone says something to you, asks you a question, a person with aphasia, they can’t receive that information and make sense of it," he said. "They can’t formulate a sentence and reply back in the world in a meaningful way."

Meanwhile, the frontal lobes – which are affected in the behavioral variant of FTD – are very important for executive function: planning, following directions, essential daily tasks, also judgment and suppression of socially-inappropriate behavior.

"The person will develop both," Dr. Roubleau explained about the progression of FTD. "If they start out with the behavioral variant, they will get more of the aphasia later. It’s just in what order it happened."

He said unlike Alzheimer’s Disease, which usually affects people later in life, most FTD patients are diagnosed in their early to mid-60s. And, for the most part, memory is spared.

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"Alzheimer's Disease affects the parietal lobes first or the hippocampus, or the deep memory centers," said Roubleau. "It also affects the temporal lobes. So, Alzheimer’s Disease affects the whole brain."

At this time, there aren’t any treatments that will stop the progression of FTD. But, Dr. Roubleau said intensive speech therapy can help someone with the language or aphasia variant retain language for a longer amount of time. He recommends physical and occupational therapy, as well. 

When it comes to managing the symptoms of the behavioral variant, medication is often used, including mood stabilizers, antipsychotics or antidepressants.

"All neurodegenerative disorders are, you know, they have a serious prognostic implication," he said. "They are going to impact the patient, some at different rates than others. FTD is one of the more severe dementias, actually. Usually, that person will need some form of around-the-clock care. And, the prognosis is typically, after diagnosis, is 2 to 10-years life expectancy. So this is a very serious disease."

Dr. Roubleau said cases of FTD can be sporadic, while others, roughly one in five, are genetic. And, there are tests for this.

"It’s an autosomal dominant disorder actually," he said. "So, meaning, that if you have a family member, a parent that has FTD, you have roughly a 50-percent chance of having it yourself."

To learn more about FTD, find support or clinical trials, visit The Association of Frontotemporal Degeneration website.