Most people are familiar with the common forms of dementia that are involved with will contests, and those that we have talked about here on this blog — Alzheimer’s Disease, Dementia with Lewy Body and Vascular Dementia. But there is another type of dementia that is quite common and often eludes diagnosis. Frontotemporal dementia (FTD), formerly called Pick’s Disease, is a form of dementia centered in the brain’s frontal lobe. Unlike Alzheimer’s disease, which attacks the brain’s memory centers, FTD causes atrophy in the part of the brain that controls judgment, behavior and executive function.
FTD is particularly devastating because it strikes at an early age, usually in the 40s or 50s. And because of early onset, it is often misdiagnosed as a psychiatric disorder — or not diagnosed at all. Because the disease alters its sufferers’ personality and robs them of reason, people with FTD are often described as apathetic, lacking in empathy, and exhibiting an impaired social filter.
“They lose their insight, so they could be like a 3-year-old, blurting out, ‘Your dress is ugly.’ They lose impulse control, so they might just take a candy bar at a store,” Susan Dickinson, CEO of AFTD, the Association for Frontotemporal Degeneration explains. “They lose their understanding of what is acceptable. You’ll see people who spend the kids’ college fund on a sports car or fall for a scam.”
FTD, the most common form of dementia in people under 60, has dire consequences because its sufferers are often still working and can make illogical decisions that can destroy their family’s financial security and disrupt their closest social connections. Furthermore, most family doctors treat patients for a psychiatric disorder. “If someone makes an inappropriate sexual advance or shoplifts, you don’t think to take them to a neurologist,” Dickinson says. “On average, it takes three and a half years from when symptoms are noticed until the patient is diagnosed. This gap is tragic.”
Like Alzheimer’s disease, there is no cure for FTD, and no FDA-approved treatment to reverse or even slow the disease’s progression. But there is a groundswell of attention focused on the disease, partially spurned by a moving TED talk in December 2017, shared by a daughter whose father suffered from FTD. And last November, the family of U.S. Rep. Maurice Henchley, who represented New York in Congress for 20 years, revealed FTD as his cause of death.
As pertains to this blog, what of the young person, unwittingly suffering from FTD, who wants to engage in estate planning? Generally, in younger people, dementia is not the “go to” assumption for aberrant behavior. For that reason, the potential for an inheritance dispute—be it a will contest, trust contest, or other probate related litigation—is very real. This is precisely why accurate diagnosis of dementia when it arises is so important to avoid challenges to the estate planning.
The hallmarks of an FTD patient vary from that of other dementias; for example, FTD patients commonly experience early, socially inappropriate behavioral problems as compared to Alzheimer’s, which see that type of hallmark later and in severe cases. Another distinctive hallmark in FTD patients (when compared to Alzheimer’s) is increased appetite and weight gain, as opposed to Anorexia and weight loss in Alzheimer’s. For a lawyer to challenge a will, or defend against a will challenge, the lawyer must be able to identify what information he or she is attempting to discover before it can be discovered (unless the lawyer prefers to stumble into things blindly, which would be an odd trait for a diligent will contest trial lawyer).
There is still much to be learned about treating this disease and, hopefully, slowing its progression. But for now, awareness of the disease is key, as is a proper diagnosis. This is of particular interest to those of us involved with the law, especially inheritance dispute attorneys. The focus of my efforts is to eliminate the indistinction between various forms of dementia in will contest and trust contest cases. When an inheritance dispute arises, an accurate diagnosis of the cause of cognitive deficits is important – as a basic example, how can justice prevail if the court system is not looking at the correct dementia, and therefore not fully understanding it?
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