I have been reading an extensive review of behavioural variant frontotemporal dementia which features in the January issue of the Lancet Neurology journal. The authors provide a comprehensive overview of the literature of this condition, as it currently stands, and I thought that the paper was interesting. Indeed, Piguet and colleagues are correct to discuss caregiver stress in the management of behavioural variant frontotemporal dementia. However, I would like to point out that it is the impulsivity and risk-taking behaviours of such patients which can be very distressing to the carers of such patients, particularly since the patients themselves tend not to have much insight into their behaviour and personality changes. It is precisely these types of symptoms which I showed could be treated using a psychostimulant, methylphenidate, in a placebo-controlled double-blind study, albeit with a small sample size. The full paper is visible HERE.

It is important to note however that methylphenidate has never been licensed routinely for this indication, and any individuals on pharmacological treatment for dementia should be entirely guided by their own physician.

Currently, no disease-specific treatment interventions for FTD exist. Consequently, treatment largely remains supportive and involves a combination of non-pharmacological and pharmacological measures aimed at reducing the effect of distressing symptoms.120 The role of pharmacological interventions in FTD remains uncertain, and only small and often conflicting treatment trials have been done so far; these studies have not considered the effect on carer stress as a major outcome variable. Selective serotonin reuptake inhibitors have been used to treat disinhibition and challenging behaviours, but evidence for their use remains contradictory.121, 122 Atypical antipsychotics such as olanzapine have been used for patients with prominent agitation, aggressive behaviour, or psychosis.123 Anticholinesterase inhibitors, the mainstay of AD therapy, do not have an established role in the treatment of FTD. One study reported improvement in measures of behavioural disturbance and carer stress with rivastigmine,124although deterioration in neuropsychiatric symptoms without cognitive improvement was shown with donepezil.125 Several drugs under development attempt to reduce aggregation of tau or TDP-43 and hence slow the fundamental pathological process in FTD.120, 126

Piguet O, Hornberger M, Mioshi E, Hodges JR.Behavioural-variant frontotemporal dementia: diagnosis, clinical staging, and management. Lancet Neurol. 2010 Dec 10. [Epub ahead of print] Neuroscience Research Australia, Randwick, NSW, Australia.

Abstract on MEDLINE here.