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

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Abstract

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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Acknowledgments

Dr. Jicha is supported by funding from the NIH/NIA 1 P30 AG028383 & 2R01AG019241-06A2, NIH LRP 1 L30 AG032934, and the Sanders-Brown Foundation. Dr. Jicha has also received research support for clinical trial activities from NIH/NIA ADCS U01AG010483, Pfizer, Elan, Jannsen, Medivation, and Baxter and has consulted for Pfizer and Avanir.

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The author reports no conflict of interest. This manuscript is based on the presentation designed for caregivers from the 2010, 7th International Conference on Frontotemporal Dementias, Indianapolis, IN, USA.

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  1. Sanders-Brown Center on Aging and the University of Kentucky Alzheimer’s Disease Center, University of Kentucky College of Medicine, Room 223, 800 South Limestone Street, Lexington, KY, 40536, USA

    Gregory A. Jicha

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Jicha, G.A. Medical Management of Frontotemporal Dementias: The Importance of the Caregiver in Symptom Assessment and Guidance of Treatment Strategies. J Mol Neurosci 45, 713–723 (2011). https://doi.org/10.1007/s12031-011-9558-7

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