Swartz J R, Miller B L, Lesser I M, Darby A L
Department of Psychiatry, UCLA School of Medicine 90509, USA.
J Clin Psychiatry. 1997 May;58(5):212-6.
Patients with frontotemporal dementia (FTD) present initially with primarily behavioral rather than cognitive symptoms. Decreased serotonin receptor binding has been reported in the frontal lobes, temporal lobes, and hypothalamus in autopsy-proven FTD cases. This study tests the hypothesis that many of the behavioral symptoms of FTD (including disinhibition, depressive symptoms, carbohydrate craving, and compulsions) will respond to serotonin selective reuptake inhibitors (SSRIs).
Eleven subjects meeting the Lund-Manchester clinical, neuropsychological, and neuroimaging criteria for FTD were treated with SSRIs (fluoxetine, sertraline, or paroxetine). After 3 months, treatment responses for disinhibition, depressive symptoms, carbohydrate craving, and compulsions were evaluated prospectively without placebo control.
After treatment, disinhibition, depressive symptoms, carbohydrate craving, and compulsions all showed improvement in at least half the subjects in which they had been present. One subject stopped sertraline treatment because of diarrhea, while another stopped paroxetine treatment due to increased anxiety. The presence of individual behavioral symptoms and also the response of each symptom to SSRIs were unrelated to cognitive impairment as measured by baseline Mini-Mental Status Examination (.07 < or = p < or = 1.00) [corrected].
The behavioral symptoms of FTD may improve after treatment with SSRIs. Future neurochemical studies and controlled pharmacologic trials may improve available treatments.
额颞叶痴呆（FTD）患者最初主要表现为行为症状而非认知症状。在经尸检证实的FTD病例中，已报告额叶、颞叶和下丘脑的5-羟色胺受体结合减少。本研究检验了这样一个假设，即FTD的许多行为症状（包括去抑制、抑郁症状、碳水化合物渴望和强迫行为）对5-羟色胺选择性再摄取抑制剂（SSRI）有反应。
11名符合FTD的 Lund-曼彻斯特临床、神经心理学和神经影像学标准的受试者接受了SSRI（氟西汀、舍曲林或帕罗西汀）治疗。3个月后，在无安慰剂对照的情况下，前瞻性评估去抑制、抑郁症状、碳水化合物渴望和强迫行为的治疗反应。
治疗后，去抑制、抑郁症状、碳水化合物渴望和强迫行为在至少一半出现这些症状的受试者中均有改善。一名受试者因腹泻停止了舍曲林治疗，另一名受试者因焦虑增加停止了帕罗西汀治疗。个体行为症状的存在以及每种症状对SSRI的反应与通过基线简易精神状态检查测量的认知损害无关（.07≤p≤1.00）[校正后]。
FTD的行为症状在接受SSRI治疗后可能会改善。未来的神经化学研究和对照药物试验可能会改善现有治疗方法。
