This review ofpharmacotherapyforfrontotemporal lobar degeneration describes the chemical rationale for agents used and reports observed responses to psychotropic medications. Paroxetine addressed anxiety and repetitive, ritualistic behaviors. Depression was resistant to treatment. Valproic acid and quetiapine calmed agitated subjects without exacerbating Parkinsonism. Donepezil has not emerged as a beneficial medication for this group of subjects. Behavioral disturbances can be alleviatedpharmacologically, but further research might determine guidelines for management of this non-Alzheimer's dementia syndrome that could decrease the frequency of adverse drug events.
[Show abstract][Hide abstract] ABSTRACT: This research investigated two groups of patients diagnosed with dementia before the age of sixty-five. The patients were diagnosed with Alzheimer's Disease (AD, n = 25) and Frontotemporal Dementia (FTD, n = 37). Patients were assessed for approximately 3 years. The study found that FTD is a valid and useful diagnostic category, and can be reliably differentiated from AD. A combination of behavioural, neurological, and neuropsychological assessments were found to be complementary in the early and accurate diagnosis of early-onset dementia, and the differential diagnosis of FTD from AD. FTD patients were found to have relatively preserved visuo-spatial abilities compared to the AD patients. Problems associated with administering neuropsychological tests to early-onset dementia patients were highlighted. FTD patients were found to deteriorate more rapidly than AD patients, and to have significantly increased behavioural disturbances throughout the course of the illness in comparison with the AD patients. Practical guidelines to assist with care and management of early-onset dementia patients were presented. A strengths-based model of care was outlined. Individualised assessments and care plans were recommended for the development and provision of humane services to early-onset dementia patients. Issues surrounding providing palliative care were discussed.
[Show abstract][Hide abstract] ABSTRACT: Frontal lobe dementia, or more generally frontotemporal dementia (FTD), includes several clinical entities and, although highly prevalent, lacks any codified therapeutic strategy. The present review is an attempt to depict the main neurochemical correlates of FTD and, as a consequence, to propose the most sound targets for symptomatic drugs. Large scale double-blind controlled clinical trials should be carried out to test any hypothesis: serotonergic agents, glutamate neurotransmission enhancers, monoamine oxidase inhibitors. The recent discovery of tau gene mutations in FTD with Parkinsonism linked to chromosome 17 has reinforced the direct role attributed to abnormal tau proteins (hyperphosphorylation) and thus raised the possibility to target specifically these processes by drugs (aetiopathogenic compounds).
Human Psychopharmacology Clinical and Experimental 05/2003; 18(3):221-5. DOI:10.1002/hup.472 · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A wide range of psychiatric symptoms occurs in the non-Alzheimer dementias. These symptoms frequently cause distress for the patients themselves and their caregivers, and are thus important targets for therapeutic interventions. Quantitative psychiatric assessments are emerging for most dementing conditions with potential relevance in guiding practitioners in differential diagnosis. Neuroanatomical systems with shared metabolic characteristics, and common vulnerabilities to abnormal protein aggregation, may provide the basis for characteristic phenotypes of the neurodegenerative dementias that reflect the underlying prototype. Key systems include the parallel frontal–subcortical loops, linking frontal lobe regions to subcortical structures and back to frontal lobe areas, with important limbic and brain stem connections. Dementia with Lewy bodies and Parkinson's disease are synucleinopathies and typically exhibit visual hallucinations and rapid eye movement sleep disorders. Abnormalities of tau-metabolism are implicated in the frontotemporal dementias and progressive supranuclear palsy, and these patients frequently exhibit apathy and disinhibition. Psychiatric symptoms are also common in vascular dementia, depending on the location of the brain injury. Few controlled trials have focused upon the treatment of psychiatric symptoms in non-AD dementias. However, there is evidence that cholinesterase inhibitors, atypical antipsychotics and antidepressants can improve some of the psychiatric manifestations of patients with non-AD dementias.
Clinical Neuroscience Research 03/2004; 3(6-3):397-412. DOI:10.1016/j.cnr.2004.04.006 · 0.80 Impact Factor
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