Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.
Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland.
J Alzheimers Dis. 2023;95(2):677-685. doi: 10.3233/JAD-230494.
Due to the significant presence of neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) spectrum disorders, psychiatric misdiagnoses, diagnostic delay, and use of psychiatric treatments are common prior to the FTD diagnosis. Furthermore, treatment of diagnosed FTD patients mainly relies on off-label psychopharmacological approaches. Currently, limited real-world data are available regarding the actual use of psychopharmacological medications in FTD.
To evaluate psychopharmacological medication use at the time of FTD diagnosis.
Psychopharmacological medication use was evaluated in a Finnish FTD cohort containing 222 FTD patients, including the major clinical disease phenotypes (behavioral, language, and motor variants) and genetic patients carrying the C9orf72 repeat expansion. A cohort of 214 Alzheimer's disease (AD) patients was used as a neurodegenerative disease reference group.
Active use of psychopharmacological medications at the time of diagnosis was significantly more common in FTD compared to AD, especially in the case of antidepressants (26.1% versus 15.0%, OR = 2.01, p = 0.008), antipsychotics (23.9% versus 9.3%, OR = 3.15, p < 0.001), and mood-stabilizers (6.3% versus 1.9%, OR = 2.93, p = 0.085; not statistically significant), whereas the use of cholinesterase inhibitors or memantine was nearly nonexistent in FTD patients. Female gender and behavioral variant of FTD phenotype alongside with depressive and psychotic symptoms were the most prominent factors associating with the use of these medications among the FTD spectrum patients.
Use of off-label psychopharmacological medication and polypharmacy is substantially common at the time of FTD diagnosis. This likely reflects the challenges in using symptom-driven treatment approaches, especially prior to the eventual diagnosis.
由于额颞叶痴呆（FTD）谱系障碍患者存在明显的神经精神症状，因此在 FTD 诊断之前，常见精神科误诊、诊断延迟和使用精神科治疗。此外，诊断为 FTD 的患者的治疗主要依赖于标签外的精神药理学方法。目前，关于 FTD 中实际使用精神药理学药物的真实世界数据有限。
评估 FTD 诊断时的精神药理学药物使用情况。
评估了包含 222 名 FTD 患者的芬兰 FTD 队列中的精神药理学药物使用情况，包括主要的临床疾病表型（行为、语言和运动变异型）和携带 C9orf72 重复扩展的遗传患者。将 214 名阿尔茨海默病（AD）患者作为神经退行性疾病参考组。
与 AD 相比，FTD 患者在诊断时使用精神药理学药物的情况明显更为常见，尤其是抗抑郁药（26.1%比 15.0%，OR=2.01，p=0.008）、抗精神病药（23.9%比 9.3%，OR=3.15，p<0.001）和情绪稳定剂（6.3%比 1.9%，OR=2.93，p=0.085；无统计学意义），而 FTD 患者几乎不使用胆碱酯酶抑制剂或美金刚。女性性别和 FTD 行为变异型表型以及抑郁和精神病症状是 FTD 谱系患者使用这些药物的最突出因素。
在 FTD 诊断时，使用标签外精神药理学药物和联合用药的情况非常普遍。这可能反映了在最终诊断之前，使用以症状为导向的治疗方法的挑战。
