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Conceptual feature of dementia [FTLD]

Understanding of conceptual feature, or spectrum of dementia is necessity for dementia treatment.
Simple type of dementia exists. However, it progresses other types as shown below.

LPC(Lewy-Pick Complex) includes the overlapping syndromes of FTLD and DLB.
FTLD-LPC-DLB.JPG
DLB includes the overlapping syndromes of ATD and PD.
CBD or PSP includes the overlapping syndromes of FTLD and PD.

ATD-DLB-PD.JPG

It's a keyhole medication. [FTLD]

General recommended amount of chlorpromazine is 30 to 100 mg/day. Especially in antipsychotic medication, chlorpromazine of 50 to 450mg/day is prescribed.
Needless to say, the elderly patients should not take such amount of chlorpromazine. Of course, other drugs, too.

The Kono method shows the best choise for BPSD of FTLD.

Keyhole medication.JPG

Family-balance method
In case of chlorpromazine, through Dr.Kono's thousands of clinical experiences, it is practical that most effective amount is 10 to 15mg.  However, a patient individually requires further more adjustment.

Letting caregiver or family to adjust the dosage of psychotropic medications without consultation of the doctors to fit the symptoms of the patients as needed.

Family-balance method.JPG


Difference between ATD and FTLD [FTLD]

How to identify ATD( Alzheimer's type disease) and FTLD(semantic dementia, Progressive nonfluent aphasia,frontotemporal dementia ) is shown below flowchart. These dementia show same symptoms, and should be correctly diagnosed and prescribed.

Difference between ATD and FTLD.JPG


Ordinary person
At first impression, a person is very normal and seems to have no dementia symptom.

Patch things up for the moment
・As talking with a person, he/she talks inconsistent contents.
・What he/she said before is different from what he/she says now.

No abnormal behavior
A person behaves with well grown‐up manners. He/she has social manner.

Abnormal behavior (social disinhibition)
A person dose what described below,
・Not doing(following) as suggested 
・Going one's (own) way without thinking about others or  situation
・Lacking of social manner or common sense.


Pick's disease tends to be wrongly diagnosed with ATD, and prescribed Aricept(donepezil).  As a worst result, patients with Pick's disease become violent or do antisocial behavior, because of Aricept.
At an early stage, if at all possible, diagnose correctly Pick's disease and stop taking Aricept.

Even I, not a doctor, can find out this worst prescription. These kinds of medical malpractice can be seen around Japan.



Kono method typical prescription:
 Chlorpromazine(4+6mg) + ferulic acid(Feru-guard 100M) 




Strategy for FTLD treatment [FTLD]

There is no specific treatment for FTLD. Such description is easily found.
At present, FTLD can not be cured completely. However, symptoms of FTLD can be treated.
In some cases, core symptoms might be treated by Kono Method, although brain atrophy progresses can not be treated.

Strategy for FTLD treatment.JPG


At first phase, dose drug of moderation type and suppress(or calm down)  the BPSD.
Chlorpromazine
Diazepam
Quetiapine
Yokukansan
Propericiazine
Risperidone
Perospirone
Chlorpromazine

Although most of those are conventional drugs for schizophrenia treatment, chlorpromazine is the best choice for FTLD treatment through Dr.Kono's thousands of clinical experiences.
This medical prescription can not be found on internet, nor on  monographs. It is very unfortunate for FTLD patients.

And, at second phase, dose drug of core type to treat the core symptoms.
Rivastigmine
Galantamine hydrobromide
Memantine hydrochloride

Those are drugs for others types of dementia.


Pick Score [FTLD]

The Pick Score is a practical and easy diagnostic criteria for FTLD (Pick's disease). It is contrived by Dr. Kono through his outpatient consultations.
Although it is not based on severe statistical evidence, it is a practical method to diagnose FTLD as a 'rule of thumb'.

Pick Score.JPG

Phase: Attitude
Scrutinize the patient who is in front of doctor.  The patient refuses to medical examination, is displeased, or feared of collecting blood.
No greeting, crossing his/her legs or arms in front of doctor, or being immature(doing as a child).
Not sitting down easily, standing up without purpose, misunderstanding the place to sit down, getting out without permission.

Phase: Consultation
Scrutinize the patient who has semantic aphasia or not.
In this case, commonly known proverb is useful. This is called 'FTLD check set'.
1. Which is your dominant hand?
2. Tap your left shoulder with right hand.
3. What dose this proverb mean, ' Seeing is believing'?
4. What dose a word follow 'Experience is the best ・・・'?

If he/she makes one mistake, point is 1.  If more than two mistakes, point is 2.

Note: In original Japanese edition, the proverb 'Seeing is believing' is 'Even monkey falls down from a tree' which means that even veteran makes a mistake.  'Even Homer sometimes nods' is also same meaning. 

Phase: Interview
Antisocial behavior such as kleptomania, stealing food, skipping out on a restaurant bill, or quarreling with neighbors, those are added 2 points.

Abnormal feeding behavior is over-eating, quick eating (chain eating), unbalanced diet, or allotriophagy.  For instance, feeding behavior is eating same dish only, then another dish only.  This behavior can be seen by patients with FTLD.
Although feed behavior is normal, an overactive sexuality should be counted.
Saccadic is getting angry like switching, and getting calm quickly. This symptom is to be counted by 1 point.

Phase: CT(Computed Tomography)
Doctor with no CT nor MRI, should diagnose FTLD and prescribe, if the patient who has more than 4 points.
 
Kono method typical prescription:
 Chlorpromazine(4+6mg) + ferulic acid 


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