Medical Management of Frontotemporal Dementias: The Importance of the Caregiver in Symptom Assessment and Guidance of Treatment Strategies

Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Room 223, 800 South Limestone Street, Lexington, KY 40536, USA.
Journal of Molecular Neuroscience (Impact Factor: 2.34). 06/2011; 45(3):713-23. DOI: 10.1007/s12031-011-9558-7
Source: PubMed


There are no currently Food and Drug Administration-approved or proven off-label treatments for the frontotemporal dementias (FTD). Clinicians, caregivers, and patients struggle regularly to find therapeutic regimens that can alleviate the problematic behavioral and cognitive symptoms associated with these devastating conditions. Success is "hit or miss" and the lessons learned are largely anecdotal to date. Drug discovery in this area has been largely hampered by the heterogeneous clinical presentations and pathological phenotypes of disease that represent significant obstacles to progress in this area. Biologically, plausible treatment strategies include the use of antidepressants (selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor and monoamine oxidase inhibitors), acetylcholinesterase inhibitors, N-methyl-D-aspartic acid antagonists, mood stabilizers, antipsychotics, stimulants, antihypertensives, and agents that may ameliorate the symptoms of parkinsonism, pseudobulbar affect, and motor neuron disease that can often coexist with FTD. These medications all carry potential risks as well as possible benefits for the person suffering from FTD, and a clear understanding of these factors is critical in selecting an appropriate therapeutic regimen to maximize cognition and daily functions, reduce behavioral symptoms, and alleviate caregiver burden in an individual patient. The role of the caregiver in tracking and reporting of symptoms and the effects of individual therapeutic interventions is pivotal in this process. This manuscript highlights the importance of establishing an effective therapeutic partnership between the physician and caregiver in the medical management of the person suffering from FTD.

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    • "Partners describe a lack of listening by specialists, and of opportunity to discuss their changing roles, or voice their own needs. [9] The importance of being the focus of concern, and being " informed, addressed and consulted " by health professionals has been clearly articulated (pp 626), [8] as has the necessity of establishing a strong relationship between Health professionals and primary caregivers in the management of PD. [12] The Alzheimer " s literature [11] has described micro-level interactions (the subtleties of engagement) experienced between partners of people with Alzheimer " s disease and Alzheimer " s health professionals. However, no studies have focused at this level on the engagement between partners and Parkinson " s health professionals. "
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    ABSTRACT: Relevant conflicts of interest/financial disclosures: Nothing to report.
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