Abhorring the vacuum: use of Alzheimer’s disease medications in frontotemporal dementia

Abstract

There is no dedicated therapy for frontotemporal dementia (FTD). In order to treat the often devastating behavioral disturbances that interfere with both normal social functioning and the ability of caregivers to provide needed support, off-label medication usage is frequent. In addition to antidepressant and antipsychotic medications, which afford some benefits, US FDA-approved treatments for Alzheimer’s disease are often used, including both cholinesterase inhibitors and memantine. Here, we review the various clinical manifestations of FTD, a general approach to treatment and the goals of any potential therapies. We review all of the existing literature on the use of cholinesterase inhibitors and memantine in FTD. While cholinesterase inhibitors do not currently have a place in FTD treatment, memantine may be helpful, although the results of two placebo-controlled trials with this agent are not yet available. Finally, we discuss our view that such approaches will probably become supplanted by rational, molecularly-based therapies currently in development.

Keywords::

• Alzheimer’s disease
• frontotemporal dementia
• frontotemporal lobar degeneration
• FUS
• progressive nonfluent aphasia
• semantic dementia
• Tau
• TDP-43

Financial & competing interests disclosure

Maria Carmela Tartaglia is supported by a grant from Fonds de la Recherche en Santé du Québec (FRSQ). Adam L Boxer was supported by NIH grants K23NS48855, R01AG031278 and R01AG038791, and grants from the John Douglas French Foundation, the Hellman foundation and the Tau Research Consortium. Adam L Boxer has received research funding from Allon, Avid, Elan, Forest, Genentech, Janssen, Medivation, Merck, Novartis and Pfizer. He has been a consultant for Accera, Bristol Myers Squibb, Genentech, Medivation, Novartis and TauRx. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.