Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Room 223, 800 South Limestone Street, Lexington, KY 40536, USA.
J Mol Neurosci. 2011 Nov;45(3):713-23. doi: 10.1007/s12031-011-9558-7. Epub 2011 Jun 7.
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.
目前，尚无经食品和药物管理局批准或证实的可用于治疗额颞叶痴呆（FTD）的药物。临床医生、护理人员和患者经常努力寻找能够缓解这些破坏性疾病相关的行为和认知症状的治疗方案。成功是“碰运气”，到目前为止，所获得的经验教训主要是轶事。由于代表该领域进展的重大障碍，该疾病的临床表现和病理表型存在很大的异质性，因此该领域的药物发现受到了很大的阻碍。从生物学角度来看，合理的治疗策略包括使用抗抑郁药（选择性 5-羟色胺再摄取抑制剂或 5-羟色胺特异性再摄取抑制剂和单胺氧化酶抑制剂）、乙酰胆碱酯酶抑制剂、N-甲基-D-天冬氨酸拮抗剂、情绪稳定剂、抗精神病药、兴奋剂、降压药以及可能改善帕金森病、假性延髓情绪和运动神经元病症状的药物，这些疾病常与 FTD 共存。这些药物对患有 FTD 的人都有潜在的风险和可能的益处，因此，在选择适当的治疗方案以最大程度地提高认知和日常功能、减轻行为症状和减轻患者护理人员负担时，了解这些因素至关重要。护理人员在跟踪和报告症状以及个体治疗干预措施的效果方面发挥着关键作用。本文强调了在 FTD 患者的医疗管理中，医生和护理人员之间建立有效的治疗伙伴关系的重要性。
