Frontotemporal Dementia: Identification and Management

Leah Wilfong, MS, AGPCNP-BC; Nancy E. Edwards, PhD, ANP-BC; Karen S. Yehle, PhD, FAHA; Karla Ross, MSN, ANP

Disclosures

Journal for Nurse Practitioners. 2016;12(4):277-282. 

In This Article

Treatment

To date, no United States Food and Drug Administration–approved treatment exists specifically for FTD. Treatment is aimed at symptom management, not at curing or even slowing progression of the disease.[15] Medications may be used to improve behavioral, cognitive, and motor symptoms. Drug classes frequently used include N-methyl D-aspartate glutamate (NMDA) receptor antagonists, acetylcholinesterase inhibitors, selective serotonin reuptake inhibitors, antidepressants, and central nervous system stimulants.[15,16] Often specialists initiate the pharmacologic treatment, so it becomes crucial for primary care providers to take a complete medication history to monitor the effectiveness of these medications.

Historically, treatment has included use of glutamate NMDA receptor antagonists, such as memantine HCl, and acetylcholinesterase inhibitors, such as rivastigmine, galantamine, and donepezil.[7,15,16] Some success has been seen with these medications in the treatment of AD. Because individuals with FTD may have been diagnosed with AD, they may have already been trialed on these medications. However, for many of those with FTD, behavioral symptoms have been shown to worsen on acetylcholinesterase inhibitors and NMDA receptor antagonists.[16] For a patient who has a current diagnosis of AD, monitoring the effect these medications on behavior is important. A worsening of behavioral symptoms may warrant reexamination of the diagnosis of AD and consideration for FTD.

Recent reviews of pharmacotherapy research indicate improved behavioral symptoms with trazodone HCl and select selective serotonin reuptake inhibitors (fluoxetine, paroxetine, fluvoxamine, and sertraline).[7,15,16] These medications also showed improvements in eating disturbances with diminished cravings commonly associated with hyperorality.[16] Central nervous system stimulants, dextroamphetamine and methylphenidate, have resulted in improved decision-making, less apathy, and less disinhibition.[15,16] Cognitive improvements in individuals with FTD were inconsistent across medication trials and evaluation is limited by the use of variable outcome measures.[15,16]

Nonpharmacologic Treatment

Nonpharmacologic intervention should be considered. The emotional, mental, and physical benefits of physical activity have been widely studied, resulting in an incorporation of exercise into many treatment regimens for individuals with dementia.[17] Associated benefits of routine exercise for individuals with all types of dementia include slowed cognitive decline, and protection through increased neural connections for those at risk for dementia.[17]

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