Dear Doctor: Can you talk about FTD dementia, especially the type that affects behavior? I am sure that a close acquaintance has it, although she is clear-minded. Her symptoms involve increasingly strange behavior and, lately, social withdrawal.

Dear Reader: You’re referring to a group of brain disorders known as frontotemporal dementia, or FTD. Originally identified about a century ago, the condition is caused by damage to the nerves, also known as neurons, in the frontal and temporal lobes of the brain. For reasons that are not yet understood, people with FTD experience a buildup of certain proteins within these two areas of the brain. This leads to the progressive loss of structure, and even death, of the neurons, which causes these lobes of the brain to shrink.

Unlike Alzheimer’s disease, which typically begins with cognitive problems and memory loss, the onset of FTD is marked by changes to the individual’s personality, social behavior or language abilities. This is due to the specific functions performed by the areas of the brain affected by FTD. The frontal lobe, one of the four lobes of the human brain, is involved in mood, personality, emotional expression, self-awareness, language and judgment. The temporal lobe, which processes sound, also plays a key role in understanding and using language, and in the management of sensory input, including pain, visual stimuli and emotion.

Depending on the specific site of the nerve damage, symptoms of FTD can show up as either problems with language or changes to behavior and personality. The type of FTD that you’re asking about, known as behavioral variant FTD, affects about half of all people with the condition. In this type of FTD, an individual’s personality begins to gradually change. They lose inhibitions, which leads to inappropriate social behavior. They can become impulsive and tactless; lose the ability to feel sympathy or empathy; can’t think logically or solve problems; and are unable to plan ahead. They also lose self-awareness, so they’re unable to recognize the changes that are taking place.

The second major type of FTD features disturbances to the ability to speak, read and understand language. It can also include behavioral changes. Some people diagnosed with FTD also experience changes to reflexes, muscular weakness and a slowing of their movements.

FTD is the most common type of dementia in people under the age of 60. About two-thirds of cases of FTD occur between ages 45 and 65. Diagnosis includes a detailed medical history; tests to assess behavior, memory, language and neurological function; and brain scans to look for atrophy. The cause of this type of dementia is unknown, but researchers have connected it to certain genetic mutations. It’s not inherited, but FTD does run in families. Up to 40% of diagnosed patients have a family history of the condition.

Unfortunately, there is no cure at this time. Although your friend’s behavior does match certain symptoms of FTD, other potential causes can include physical illness, substance abuse and mental illness. If you’re interested in additional information and support relating to FTD, visit theaftd.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Why do the elderly often have a hard time swallowing, and sometimes experience a feeling that food is stuck in their throats? I heard there’s a procedure to stretch the throat. Does it help?

Dear Reader: The condition you’re asking about is known as dysphagia, which refers to difficulty in swallowing. Patients may have trouble starting a swallow, or problems with the esophagus, which is the muscular tube that connects the throat with the stomach.

The origins of the disorder fall into several basic categories. There are neurological causes, such as stroke, Parkinson’s disease, multiple sclerosis, dementia and head injury. Certain muscular conditions can affect the proper functioning of the esophagus. So does obstruction, which can result from a narrowing of the esophagus, or from inflammation. These can be caused by head and neck cancers, radiation therapy, tuberculosis and chronic acid reflux.

Although dysphagia can affect people of all ages, you’re correct that it’s seen more often in older adults. This is commonly due to age-related changes in the body, such as loss of muscle tone, mass and strength, and changes to nerve function. Still, dysphagia is not considered to be a normal sign of aging.

Understanding dysphagia starts with the mechanics of swallowing. We tend to think of it as the “gulp” that empties the mouth. But that’s just the first step of a complex process. A successful swallow moves the contents of your mouth through the throat, and all the way down to the stomach. This happens when a ring of muscles known as the upper esophageal sphincter and located at the lower end of the throat, open. Next, coordinated contractions along the length of the esophagus send the food to a second ring of muscles known as the lower esophageal sphincter. This leads to the stomach. At the same time, muscles and specialized structures within the throat prevent anything from getting into the nose, voice box and windpipe.

Symptoms of dysphagia can include pain while swallowing, struggling or being unable to swallow, feeling as though food is stuck in the esophagus, coughing or gagging when trying to swallow, regurgitation or frequent heartburn. Some people may experience drooling or develop a hoarse voice. Diagnosis of the condition includes a physical exam and any of a variety of tests that may include X-rays, muscle tests and swallowing studies.

Treatment depends on the specific cause of the condition. Patients may be asked to change their diet, use certain exercises and techniques that help with swallowing coordination, or manage acid reflux with medication.

The procedure you asked about, known as esophageal dilation, is useful when dysphagia results from a narrowing of the esophagus. It involves the use of an endoscope and either plastic dilators or a special balloon to slowly and gradually stretch the esophagus. Complications, which are rare, include bleeding and tears or holes in the esophagus. In most cases, the patient is able to resume normal eating and drinking the following day.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I have Morton's neuroma in both feet, and my podiatrist has recommended surgery. I really don’t want to have surgery, so I am desperately looking for another remedy. I read about a drug that was being fast-tracked by the FDA. Has it been approved yet?

Dear Reader: Morton’s neuroma is basically a pinched nerve in the ball of the foot, most often between the third and fourth toes. The nerve, which carries sensation from the toes, becomes swollen due to a benign growth. This allows the nerve to rub against, bump into or become trapped by the bones and connective tissues of the mid-foot. This results in sensations ranging from numbness, burning and tingling in the forefoot, the toes or both, all the way to outright -- and sometimes significant -- pain. Some people also experience swelling between the toes.

The cause for Morton’s neuroma isn’t fully understood. However, contributing factors include narrow shoes, which squeeze the toes; high-heeled shoes, which exponentially increase the pressure exerted on the ball of the foot; and damage to the nerve due to trauma, inflammation and illness. Biomechanical issues such as flat feet or high arches, which can lead to instability around the joints of the toes, are believed to play a role. Bunions or hammer toes are also considered to be risk factors for developing Morton’s neuroma. The repeated stress associated with high-impact sports, such as running and basketball, can also give rise to a neuroma.

Some neuromas can be diagnosed with a physical exam to locate tenderness in the ball of the foot, or to identify a mass. Some people report a sensation of clicking between their toes. Imaging tests such as ultrasound can isolate tissue abnormalities associated with a neuroma. Although an X-ray won’t diagnose the condition, it can rule out other potential causes, such as a stress fracture.

Treatment depends on the severity of the condition. Many people find relief with a change of footwear. Flat-soled shoes with a roomy toe box and adequate padding beneath the ball of the foot can relieve pressure and protect the affected area. Custom shoe inserts, known as orthotics, can also offer relief. Some people require anti-inflammatory medications or cortisone injections to manage pain and inflammation. In severe cases, an outpatient surgery to remove the inflamed and enlarged nerve may be necessary.

The drug you’re asking about, known as CNTX-4975, is being developed to address moderate and severe knee pain associated with osteoarthritis. It’s an intriguing approach to pain management, which uses a laboratory-derived version of a substance called capsaicin, one of the compounds that give chili peppers their heat. The idea is that when delivered via an injection, the capsaicin will interfere with the neurological process that transmits pain signals to the brain.

You’re correct that at one point, the drug was being considered for use in Morton’s neuroma. However, the company developing the drug has decided to focus its use for knee pain due to osteoarthritis. Clinical trials of the drug are ongoing.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)