FRONTOTEMPORAL DEMENTIA - TREATMENT RESPONSE TO SEROTONIN SELECTIVE REUPTAKE INHIBITORS

Background: Patients with frontotemporal dementia (FTD) present initia lly with primarily behavioral rather than cognitive symptoms. Decrease d serotonin receptor binding has been reported in the frontal lobes, t emporal lobes, and hypothalamus in autopsy-proven FTD cases. This stud y tests the hypothesis that many of the behavioral symptoms of FTD (in cluding disinhibition, depressive symptoms, carbohydrate craving, and compulsions) will respond to serotonin selective reuptake inhibitors ( SSRIs). Method: Eleven subjects meeting the Lund-Manchester clinical, neuropsychological, and neuroimaging criteria for FTD were treated wit h SSRIs (fluoxetine, sertraline, or paroxetine). After 3 months, treat ment responses for disinhibition, depressive symptoms, carbohydrate cr aving, and compulsions were evaluated prospectively without placebo co ntrol. Results: After treatment, disinhibition, depressive symptoms, c arbohydrate craving, and compulsions all showed improvement in at leas t half the subjects in which they had been present. One subject stoppe d sertraline treatment because of diarrhea, while another stopped paro xetine treatment due to increased anxiety. The presence of individual behavioral symptoms and also the response of each symptom to SSRIs wer e unrelated to cognitive impairment as measured by baseline Mini-Menta l Status Examination (.07 p 1.00). Conclusion: The behavioral symptoms of FTD may improve after treatment with SSRIs. Future neurochemical s tudies and controlled pharmacologic trials may improve available treat ments.