van Paassen Dirk, Hartog Luc, de Boer Sterre, Vijverberg Everard, Ducharme Simon, Pijnenburg Yolande, Santillo Alexander
Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
Eur J Neurol. 2025 Jan;32(1):e16537. doi: 10.1111/ene.16537. Epub 2024 Nov 28.
Behavioral variant frontotemporal dementia (bvFTD) is essentially characterized by progressive changes in personality and cognition. Clinically, bvFTD presents with often profound behavioral symptomatology. Despite the high burden of these symptoms for both patients and caregivers, there is no general consensus on an effective pharmacological symptomatic treatment. Interestingly, for multiple similar symptoms in primary psychiatric disorders, there is consensus on an effective pharmacological treatment. The aim of this study is to explore currently preferred clinical practices in the pharmacological treatment of specific core behavioral symptoms in bvFTD by world-leading clinical experts.
A digital survey was conducted among members of the Neuropsychiatric International Consortium on Frontotemporal Dementia, comprising neurologists, psychiatrists, and neuropsychiatrists. Respondents recommended pharmacological treatments targeting symptoms including disinhibition, apathy, loss of empathy, hyperorality, perseverative/compulsive behaviors, and positive psychotic symptoms.
Of 48 respondents with a median experience of 11.5 years in treating bvFTD, disinhibition was most frequently targeted (58.4%), followed by perseverative/compulsive behaviors (46.5%). Recommended drug classes included atypical antipsychotics (35.1%), selective serotonin reuptake inhibitors (31.2%), antiepileptics (10.0%), serotonin antagonist and reuptake inhibitors (8.4%), benzodiazepines (4.0%), and others (11.4%).
Our survey revealed diverse pharmacological treatment practices for behavioral symptoms in bvFTD, reflecting the expected radical heterogeneity in pharmacological treatment strategies. Notwithstanding this, results from this explorative survey could further inform future research directions, and thus in turn potentially aid in establishing more consensus on effective pharmacological management of bvFTD, while the field awaits the development of highly anticipated disease-modifying treatment(s).
行为变异型额颞叶痴呆（bvFTD）的本质特征是人格和认知的渐进性变化。临床上，bvFTD常伴有严重的行为症状。尽管这些症状给患者和照料者带来了沉重负担，但对于有效的药物对症治疗尚无普遍共识。有趣的是，对于原发性精神障碍中的多种类似症状，在有效的药物治疗方面存在共识。本研究的目的是探讨世界领先的临床专家目前在bvFTD特定核心行为症状药物治疗中的首选临床实践。
对额颞叶痴呆神经精神国际联盟的成员进行了一项数字调查，这些成员包括神经科医生、精神科医生和神经精神科医生。受访者推荐了针对包括脱抑制、冷漠、共情缺失、口欲亢进、持续性/强迫性行为以及阳性精神病性症状等症状的药物治疗。
在48名治疗bvFTD中位经验为11.5年的受访者中，脱抑制是最常针对的症状（58.4%），其次是持续性/强迫性行为（46.5%）。推荐的药物类别包括非典型抗精神病药（35.1%）、选择性5-羟色胺再摄取抑制剂（31.2%）、抗癫痫药（10.0%）、5-羟色胺拮抗剂和再摄取抑制剂（8.4%）、苯二氮䓬类药物（4.0%）以及其他药物（11.4%）。
我们的调查揭示了bvFTD行为症状的多种药物治疗实践，反映了药物治疗策略中预期的根本异质性。尽管如此，这项探索性调查的结果可为未来的研究方向提供进一步信息，从而反过来可能有助于在bvFTD有效的药物管理方面达成更多共识，而该领域正在等待备受期待的疾病修饰治疗的开发。
