Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN‐RND)

• Published in: European journal of neurology 2024-12, Vol.31 (12), p.e16446-n/a
• Main Authors: Wittebrood, Casper, Boban, Marina, Cagnin, Annchiara, Capellari, Sabina, De Winter, François‐Laurent, Djamshidian, Atbin, González, Manuel Menéndez, Hjermind, Lena E., Krajcovicova, Lenka, Krüger, Johanna, Levin, Johannes, Reetz, Kathrin, Rodriguez, Eloy Rodriguez, Rohrer, Jonathan, Van Langenhove, Tim, Reinhard, Carola, Graessner, Holm, Rusina, Robert, Saracino, Dario, Houot, Marion, Seelar, Harro, Vandenberghe, Rik
• Format: Article
• Language: English
• Subjects: Aggression; Aggression - drug effects; ALS and frontotemporal dementia; Antipsychotic Agents - therapeutic use; Antipsychotics; Bupropion; Caregivers; Consensus; Dementia; Dementia disorders; Disturbances; Drug delivery; Drug development; Drug therapy; Emotional behavior; Europe; expert testimony; Frontotemporal dementia; Frontotemporal Dementia - drug therapy; Health services; Humans; Hyperphagia; Impulsive behavior; Impulsive Behavior - drug effects; Impulsivity; Medical treatment; Methylphenidate; neurobehavioural manifestations; Neurodegenerative diseases; Neurological complications; Neurological diseases; Original; Patients; Pharmacology; Quetiapine; Rare diseases; Rare Diseases - drug therapy; Rigidity; Risk taking; Selective Serotonin Reuptake Inhibitors - therapeutic use; Serotonin; Serotonin uptake inhibitors; Signs and symptoms
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.16446

Background and Purpose Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial‐based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. Method The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN‐RND). Results The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self‐injury and self‐harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases. Conclusions The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.