Dementia Patients Show Alarming Surge in Compulsive Internet Use, Study Finds

A quiet revolution is unfolding in the clinics where specialists diagnose and treat frontotemporal dementia, one of the most devastating neurodegenerative conditions known to medicine. A new case series published in Annals of Clinical and Translational Neurology suggests that patients with this disorder are developing compulsive, addiction-like relationships with their smartphones and the internet at rates far exceeding those seen in other dementias. The finding points to an emerging behavioral phenotype that the field’s diagnostic criteria, drafted long before Wi-Fi-enabled devices became ubiquitous, were never designed to capture.

Frontotemporal dementia, or FTD, belongs to a spectrum of disorders called frontotemporal lobar degeneration, which primarily strikes the frontal and temporal lobes of the brain. Unlike Alzheimer’s disease, which typically announces itself through memory lapses, FTD often begins with changes in behavior, personality, and social cognition. The behavioral variant of the disease, known as bvFTD, is particularly notorious for producing stereotyped, compulsive, and ritualistic behaviors, along with a striking vulnerability to addiction-related conduct such as excessive alcohol and tobacco use. Primary progressive aphasia, which includes the nonfluent and semantic variants, erodes language abilities while leaving other functions relatively intact for longer periods.

Researchers at the Center for Neurodegenerative Diseases and the Aging Brain at the University of Bari Aldo Moro, working with the Pia Fondazione Card. Panico Hospital in Tricase, Italy, set out to determine whether patients with FTD are prone to problematic internet and social media use. Between January 2023 and December 2024, they retrospectively screened consecutive patients diagnosed with mild cognitive impairment or Alzheimer’s disease, behavioral variant FTD, and primary progressive aphasia. Diagnoses followed established consensus criteria, and patients with documented histories of overuse, compulsivity, or dependency on digital technologies were identified through clinical records and caregiver interviews.

To characterize these behaviors rigorously, the team administered a semi-structured interview grounded in the biopsychosocial model of addiction developed by Griffiths, probing six core components of behavioral addiction: salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse. Overuse was operationally defined as quantitatively excessive time online, often exceeding twelve hours per day, that disrupted daily routines. Compulsivity captured repetitive, ritualistic digital behaviors lacking any functional goal, such as constant nonfunctional scrolling or repetitive video streaming. Dependency required the presence of the six-component addiction profile. Because patients with FTD frequently lack insight into their own behavior, interviews were conducted separately with patients and caregivers.

The results were striking. Of 61 patients evaluated in the FTD group, 14, or 22.9 percent, exhibited problematic internet or social media use. Ten of these had behavioral variant FTD and four had primary progressive aphasia, with three carrying pathogenic genetic variants, two in C9orf72 and one in GRN. By contrast, in a control cohort of 354 patients with Alzheimer’s disease or mild cognitive impairment, only three patients, or 0.8 percent, showed comparable behaviors. The difference between the groups was highly significant, and the contrast with estimated general-population prevalence figures of roughly six to seven percent for problematic internet use reinforces the notion that this is a specific behavioral feature of FTD rather than a general consequence of cognitive decline.

The clinical pictures described in the series are vivid and unsettling. Excessive social media use affected six patients, producing sleep deprivation, religious obsessions, extensive dating app use that led to extramarital affairs and divorce, and hours spent browsing job portals without any genuine intention of seeking employment. Four patients engaged in problematic gaming, with sessions exceeding twelve hours a day and accompanied by social withdrawal and severely disrupted daily routines. Two patients became trapped in binge-watching cycles of repetitive video streaming, and two displayed impulsive online buying that drew them into scams and unnecessary purchases. Half of the problematic-use group showed overlapping behaviors, and social isolation emerged as a pervasive consequence across nearly every case.

Perhaps most telling were the relational dynamics that surrounded these behaviors. Nine of the fourteen patients reported preferring online interactions to face-to-face communication, deepening their withdrawal from family and social life. Six became frustrated and angry when caregivers attempted to limit smartphone access, echoing the agitation commonly seen when substance-dependent individuals are denied their drug of choice. Within the FTD group, patients exhibiting problematic internet use were significantly younger and had an earlier disease onset than those without such behaviors, though education, sex distribution, global cognition as measured by the Mini-Mental State Examination, and overall disease severity did not differ between the groups.

Subgroup analyses hinted at divergent mechanisms driving the behavior across the FTD spectrum. Among patients with behavioral variant FTD, problematic internet use was associated with a younger, early-onset phenotype, potentially reflecting a generational familiarity with digital technology or a specific behavioral trait independent of cognitive decline. Among patients with primary progressive aphasia, by contrast, problematic use correlated with greater disease severity, suggesting that in the language variants these behaviors may emerge as a nonverbal outlet, a way of compensating for the progressive loss of linguistic and social communication abilities as conversation becomes increasingly difficult.

The neurobiological plausibility of these findings is considerable. Previous research indicates that the neural circuits implicated in substance addictions, involving reward processing, impulse control, and decision-making, may also underlie problematic internet-related behaviors. These are precisely the circuits that deteriorate in FTD, particularly in the behavioral variant, where impulsivity, disinhibition, and compulsivity are hallmark features. The parallels between online addiction and more traditional forms of addiction support the hypothesis that both stem from shared neurobiological mechanisms, and the new series adds ecological validity to that framework by documenting real-world cases in a neurodegenerative population.

The authors acknowledge limitations, including the retrospective design, reliance on clinical records and caregiver report, inconsistent recording of specific applications and platforms, and the need for longitudinal research to track how these behaviors evolve as disease progresses. Even so, the societal implications are difficult to ignore. As internet use becomes ever more pervasive, patients with FTD may be especially vulnerable to maladaptive online behaviors that complicate clinical management, deepen social isolation, and increase caregiver burden. The researchers argue that as society adapts to new technologies, clinical frameworks for dementia must evolve in parallel, ensuring that emerging digital-age behavioral patterns are recognized in diagnosis and addressed in care.

Subject of Research: Problematic internet use as an emerging behavioral feature of frontotemporal dementia

Article Title: Problematic Internet Use in Frontotemporal Dementia: A Case Series

Article References: Urso, D., Volpe, G., Valguarnera, A., Vilella, D., Vitulli, A., Gnoni, V., Giugno, A., Rollo, E., Griffiths, M. D., & Logroscino, G. (2026). Problematic Internet Use in Frontotemporal Dementia: A Case Series. Annals of Clinical and Translational Neurology, 13(9), 1947-1950. https://doi.org/10.1002/acn3.70417

Image Credits: AI Generated

DOI: 10.1002/acn3.70417

Keywords: frontotemporal dementia, behavioral variant FTD, problematic internet use, behavioral addiction, primary progressive aphasia, social media, neurodegenerative disease, caregiver burden, compulsivity, digital behavior, Problematic, Internet