Frontotemporal dementia: Treatment
- Suzee E Lee, MD
Suzee E Lee, MD
- Assistant Professor of Neurology
- UCSF Memory and Aging Center
- Bruce L Miller, MD
Bruce L Miller, MD
- A.W. Clausen Distinguished Professor of Neurology
- UCSF Memory and Aging Center
Frontotemporal dementia (FTD) is a neuropathologically and clinically heterogeneous disorder characterized by focal degeneration of the frontal and/or temporal lobes . Age of onset is typically in the late 50s or early 60s. The primary initial clinical manifestations include changes in personality and social behavior or language, progressing over time to a more global dementia affecting cognitive domains as well. A subset of patients may also exhibit symptoms of extrapyramidal or motor neuron involvement at some point in the disease process.
There are no currently FDA-approved disease modifying treatments for the treatment of frontotemporal dementia (FTD). Since the underlying pathology of FTD most often consists of abnormal tau or TDP-43 protein aggregates, treatments geared toward beta-amyloid reduction that appear promising in Alzheimer disease (AD) are not expected to be effective for FTD.
Symptomatic relief can be provided by a variety of agents; these medications should be considered in conjunction with non-pharmacologic interventions, such as thoughtful evaluation of the patient's living environment.
This topic discusses treatment issues specific to patients with FTD. Epidemiology, pathology, clinical features and diagnosis of FTD, and the management of other forms of dementia are discussed separately. (See "Frontotemporal dementia: Epidemiology, pathology, and pathogenesis" and "Frontotemporal dementia: Clinical features and diagnosis" and "Treatment of dementia" and "Treatment and prevention of vascular dementia" and "Prognosis and treatment of dementia with Lewy bodies" and "Management of neuropsychiatric symptoms of dementia".)
Pharmacologic treatment in FTD is symptomatic and aimed at alleviating neurobehavioral symptoms. However, despite the fact that they are commonly used, there is limited evidence of the efficacy of pharmacologic treatments in FTD .
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- PHARMACOLOGIC TREATMENT
- Neurotransmitter systems
- Behavioral changes
- - General principles
- - Serotonergic medications
- - Antipsychotic medications
- - Stimulants
- - Cholinesterase inhibitors
- - Other agents
- Cognitive dysfunction
- NONPHARMACOLOGIC INTERVENTIONS
- Safety and driving
- Exercise and mobility
- Speech therapy
- Behavioral modification
- FUTURE APPROACHES
- PALLIATIVE CARE
- SUMMARY AND RECOMMENDATIONS