eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Frontotemporal Lobe Dementia: Treatment & Medication

Author: Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Feb 11, 2009

Treatment

Medical Care

To date, most efforts have concentrated on diagnosing frontotemporal dementia and understanding its pathogenesis. Medical treatment is largely nonexistent.

  • Social interventions, counseling, and speech/language/cognitive therapy to facilitate the use of spared functions may make the condition easier to bear for the patient, caregivers, and family members.
  • Treatment of depression with a selective serotonin reuptake inhibitor (SSRI), such as sertraline or escitalopram, is frequently helpful. Trazodone may be helpful for sleep. These agents have been shown effective in small clinical trials.
  • Neurotransmitter-based treatments, analogous to the use of dopaminergic agents in Parkinson disease or anticholinesterase agents in Alzheimer disease, have not proven beneficial in frontotemporal dementia. Anecdotal experience, including that of the author, has not suggested a benefit similar to that of Alzheimer disease with anticholinesterase agents or memantine, but clinical trials have not been reported.
  • All of the pharmacologic treatments listed below must be considered investigational and not recommended for general use.
    • Anticholinesterase therapy generally involves donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). As stated above, only occasional patients appear to respond. The same is true of attempted treatment with the drug memantine (Namenda), Food and Drug Administration (FDA)–approved in January 2004 for Alzheimer disease. This drug may improve the signal-to-noise ratio of glutamatergic transmission.
    • Dopaminergic drugs have been tested in patients with transcortical motor aphasia secondary to strokes. Anecdotal experience with dopamine agonist agents such as bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex), and ropinirole (Requip) has been unimpressive.
    • Stimulant drugs such as amphetamines and antidepressant agents may benefit patients with frontal lobe syndromes. Large, randomized, double-blind studies are lacking, but a few small trials are cited in the references.

Medication

All current pharmacologic treatments are unproven, but SSRI antidepressants and trazodone are widely recommended. As discussed above, the cholinesterase inhibitors and memantine have not been shown to be effective in primary progressive aphasia or frontotemporal dementia (see Treatment).

More on Frontotemporal Lobe Dementia

Overview: Frontotemporal Lobe Dementia
Differential Diagnoses & Workup: Frontotemporal Lobe Dementia
Treatment & Medication: Frontotemporal Lobe Dementia
Follow-up: Frontotemporal Lobe Dementia
Multimedia: Frontotemporal Lobe Dementia
References
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Further Reading

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Keywords

frontotemporal dementia, frontal dementia, semantic dementia, nonspecific dementia, Pick's disease, Pick disease, primary progressive aphasia, FTD, PPA, tauopathy, motor neuron disease, Alzheimer disease, Alzheimer's disease, AD, fluent aphasia, nonfluent aphasia

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Contributor Information and Disclosures

Author

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Medical Editor

Robert A Hauser, MD, MBA, Professor of Neurology, Molecular Pharmacology and Physiology, Director, Parkinson's Disease and Movement Disorders Center, University of South Florida; Clinical Chair, Signature Interdisciplinary Program in Neuroscience
Robert A Hauser, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, and Movement Disorders Society
Disclosure: Allergan Sales, LLC Honoraria Speaking and teaching; Bayer Shering Pharma AG Honoraria Consulting; Boehringer Ingelheim France Honoraria Consulting; Centapharm Honoraria Speaking and teaching; Genzyme Corporation Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; IMPAX Laboratories, Inc.  Consulting; Kyowa Pharmaceuticals, Inc. Honoraria Consulting; Novartis Pharmaceuticals Corp. Honoraria Consulting; Prestwick Pharmaceuticals, Inc. Honoraria Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

 
 
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