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Cole RH, Clark CN, Poole NA. Semantic dementia: a complex and culturally influenced presentation. BJPsych Bull 2024; 48:44-50. [PMID: 36718490 PMCID: PMC10801360 DOI: 10.1192/bjb.2022.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023] Open
Abstract
SUMMARY The variants of frontotemporal dementia (FTD) require careful differentiation from primary psychiatric disorders as the neuropsychiatric manifestations can overshadow the unique cognitive deficits. The language variants of FTD are less readily recognised by trainees despite making up around 43% of cases. This educational article presents an anonymised case of one of the language variants: semantic dementia. The cognitive deficits and neuropsychiatric manifestations (delusions and hyperreligiosity) are explored in terms of aetiology and management. By the end of the article, readers should be able to differentiate FTD from Alzheimer's disease, understand the principles of management and associated risks, and develop a multifaceted approach to hyperreligiosity in dementia.
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Affiliation(s)
- Richard H. Cole
- Camden and Islington NHS Foundation Trust, London, UK and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Norman A. Poole
- South West London and St George's Mental Health NHS Trust, London, UK
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2
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Llorca-Bofí V, Batalla I, Ruiz-Julián M, Adrados-Pérez M, Buil-Reiné E, Piñol-Ripoll G, Gallart-Palau X, Torrent A. Lithium management of periodic mood fluctuations in behavioural frontotemporal dementia: a case report. Front Psychiatry 2024; 14:1325145. [PMID: 38264640 PMCID: PMC10804947 DOI: 10.3389/fpsyt.2023.1325145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances, including manic-like episodes, can occur in bvFTD, posing diagnostic and therapeutic challenges. This case report presents a 62-year-old male with bvFTD exhibiting weekly mood fluctuations alternating between manic and depressive-like states. While initial treatment with quetiapine and trazodone showed partial improvement, the periodicity of mood fluctuations persisted. Subsequently, lithium was introduced, resulting in a notable reduction in symptom severity for both manic and depressive episodes. This report highlights the potential use of lithium as a mood stabilizer in bvFTD patients with periodic mood fluctuations, refractory to standard treatments. Further research is needed to elucidate the mechanisms underlying lithium's efficacy in bvFTD and to establish treatment guidelines.
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Affiliation(s)
- Vicent Llorca-Bofí
- Department of Medicine, University of Barcelona School of Medicine, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Santa María, Lleida, Spain
| | - Iolanda Batalla
- Department of Psychiatry, Hospital Universitari Santa María, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
- Medicine Department, Universitat de Lleida (UdL), Lleida, Spain
| | - Maria Ruiz-Julián
- Cognitive Disorders Unit, Hospital Universitari Santa Maria, Lleida, Spain
| | | | - Esther Buil-Reiné
- Department of Psychiatry, Hospital Universitari Santa María, Lleida, Spain
| | - Gerard Piñol-Ripoll
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
- Medicine Department, Universitat de Lleida (UdL), Lleida, Spain
- Cognitive Disorders Unit, Hospital Universitari Santa Maria, Lleida, Spain
| | - Xavier Gallart-Palau
- Biomedical Research Institute of Lleida Dr. Pifarré Foundation (IRB Lleida), Neuroscience Area, +Pec Proteomics Research Group (+PPRG), University Hospital Arnau de Vilanova (HUAV), Lleida, Spain
- Psychology Department, University of Lleida (UdL), Lleida, Spain
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
| | - Aurora Torrent
- Department of Psychiatry, Hospital Universitari Santa María, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
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3
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Huang MH, Zeng BS, Tseng PT, Hsu CW, Wu YC, Tu YK, Stubbs B, Carvalho AF, Liang CS, Chen TY, Chen YW, Su KP. Treatment Efficacy of Pharmacotherapies for Frontotemporal Dementia: A Network Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2023; 31:1062-1073. [PMID: 37633762 DOI: 10.1016/j.jagp.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The neuropsychiatric symptoms of frontotemporal dementia (FTD) have a profound negative impact on disease outcomes and care burden. Available pharmacotherapies might be supported by small-scale randomized controlled trials (RCTs); however, clinical recommendations might not be conclusive. METHODS We systematically searched several databases from inception to April 30, 2022, for RCTs of drug therapy in patients with FTD and neuropsychiatric symptoms (primary outcome). Secondary outcomes included changes in caregiver stress, daily interactive activities, cognitive function, and acceptability (adverse event or dropout rates). The network meta-analysis (NMA) procedure was performed under the frequency model, showing effect sizes as standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (95% CIs). RESULTS Seven RCTs with 243 participants were included. Compared with placebo, high-dose oxytocin (72 international units) was associated with the greatest improvement in patients' neuropsychiatric symptoms (SMD = -1.17, 95% CIs = -2.25 to -0.08, z = -2.10, p = 0.035). Piracetam significantly worsened neuropsychiatric symptoms (SMD = 3.48, 95% CIs = 1.58 to 5.37, z = 3.60, p < 0.001) and caregiver stress (SMD = 2.40, 95% CIs = 0.80-4.01, z = 2.94, p = 0.003). Trazodone had significantly higher rates of adverse events (OR = 9.53, 95% CIs = 1.85-49.20, z = 2.69, p = 0.007). No pharmacological intervention significantly benefited cognitive function. CONCLUSIONS This study provides the first NMA for clinical recommendation to support the use of high-dose oxytocin and caution regarding the use of piracetam for neuropsychiatric symptoms in patients with FTD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of psychiatry (M-HH), Yuanshan and Suao branches of Taipei Veterans General Hospital, Ilan, Taiwan; Division of Psychiatry (M-HH), Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bing-Syuan Zeng
- Institute of Biomedical Sciences (B-SZ, P-TT), National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine (B-SZ), E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Institute of Biomedical Sciences (B-SZ, P-TT), National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology (Y-WC, P-TT), Kaohsiung City, Taiwan; Department of Psychology (P-TT), Collage of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Precision Medicine (P-TT), National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry (C-WH), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine (Y-CW), Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine (Y-KT), College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry (Y-KT), National Taiwan University Hospital, Taipei, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine (BS), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Physiotherapy Department (BS), South London and Maudsley NHS Foundation Trust, London, UK; Positive Ageing Research Institute (PARI) (BS), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre (AFC), School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Chih-Sung Liang
- Department of Psychiatry (C-SL), Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences (C-SL), National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry (T-YC), Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science (T-YC), National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology (Y-WC, P-TT), Kaohsiung City, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab) (K-PS), China Medical University Hospital, Taichung, Taiwan; College of Medicine (K-PS), China Medical University, Taichung, Taiwan; An-Nan Hospital (K-PS), China Medical University, Tainan, Taiwan.
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4
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Bruffaerts R, Crosiers D. Multicentric Clinical Data Collection: A Game-Changer for Rare Neurological Diseases. J Alzheimers Dis 2023; 95:687-689. [PMID: 37661890 DOI: 10.3233/jad-230788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Although neuropsychiatric symptoms are a hallmark of the behavioral variant of frontotemporal degeneration (FTD), there is limited evidence on the optimal therapeutic management of these symptoms. In this issue, Katisko et al. report real-world multicentric data on the use of psychopharmacological medication in newly diagnosed patients with FTD. Such reports contribute to knowledge sharing between clinicians caring for patients with FTD. Here, we outline how improved collection of clinical data can assure more robust evidence for future therapies in FTD and other rare neurological diseases.
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Affiliation(s)
- Rose Bruffaerts
- Department of Biomedical Sciences, Computational Neurology, Experimental Neurobiology Unit (ENU), University of Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Belgium
| | - David Crosiers
- Department of Neurology, Antwerp University Hospital, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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Katisko K, Krüger J, Soppela H, Hartikainen P, Haapasalo A, Remes AM, Solje E. Psychopharmacological Medication Use in Frontotemporal Dementia at the Time of Diagnosis: Comparison with Alzheimer's Disease. J Alzheimers Dis 2023; 95:677-685. [PMID: 37574738 DOI: 10.3233/jad-230494] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND 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. OBJECTIVE To evaluate psychopharmacological medication use at the time of FTD diagnosis. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Helmi Soppela
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences - University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
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6
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Johnson EG, Kuiper W, Ahmed RM, Halliday GM, Burrell JR, Hodges JR, Guastella AJ, Piguet O, Kumfor F. Plasma Oxytocin Is Not Associated with Social Cognition or Behavior in Frontotemporal Dementia and Alzheimer's Disease Syndromes. Dement Geriatr Cogn Disord 2022; 51:241-248. [PMID: 35705005 DOI: 10.1159/000525087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Changes in social behavior and emotion processing are common in frontotemporal dementia (FTD) and semantic dementia (SD), and less so in Alzheimer's disease (AD). Recent research has investigated oxytocin as a potential treatment for these symptoms; however, whether plasma oxytocin is associated with social-emotional symptoms of dementia remains underexplored. METHODS Thirty behavioral-variant FTD (bvFTD), 28 SD, 39 AD, and 24 controls underwent blood sampling to measure oxytocin. Participants completed an emotion processing battery. Carers completed the Cambridge Behavioral Inventory and the Neuropsychiatric Inventory. RESULTS Patients with bvFTD were severely impaired in emotion processing and behavioral ratings, with milder impairment in SD and AD. No difference in plasma oxytocin was observed between groups (p = 0.632). No significant associations were found between oxytocin and social behavior or emotion processing (r values between -0.241 and 0.227, all p values >0.099). CONCLUSION Our results indicate that plasma oxytocin is not reduced in dementia and is unrelated to social, emotional, and behavioral features. We noted high interindividual variability in our data; hence, future investigations should consider methodological influences such as serum versus saliva and diurnal variation on oxytocin function. These results demonstrate that current measurement measures of plasma oxytocin have limited utility in determining the role of oxytocin in FTD. Alternative oxytocin measures may prove more sensitive and should be considered when conducting clinical trials.
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Affiliation(s)
- Emma G Johnson
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Wytse Kuiper
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rebekah M Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
| | - Glenda M Halliday
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney Concord Clinical School, Sydney, New South Wales, Australia.,Concord General Hospital, Sydney, New South Wales, Australia
| | - John R Hodges
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Da Silva TBL, Ordonez TN, Bregola AG, Bahia VS, Cecchini MA, Guimarães HC, Gambogi LB, Caramelli P, Balthazar MLF, Damasceno BP, Brucki SMD, de Souza LC, Nitrini R, Yassuda MS. Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease: A 12-Month Follow-Up Study. Front Neurol 2021; 12:728108. [PMID: 34659093 PMCID: PMC8515178 DOI: 10.3389/fneur.2021.728108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) are highly prevalent and may complicate clinical managements. Objective: To test whether the Neuropsychiatry Inventory (NPI) could detect change in neuropsychiatric symptoms and caregiver's distress in patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) from baseline to a 12-month follow-up and to investigate possible predictors of change in NPI scores. Methods: The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), the INECO Frontal Screening (IFS), the Frontal Assessment Battery (FAB), the Executive Interview (EXIT-25) and the NPI were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) test and Linear Regression Analysis were used. Results: NPI total and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. MMSE, ACE-R scores significantly declined and NPI Total and Distress scores significantly increased in both groups. In the bvFTD group, age was the only independent predictor variable for the NPI total score at follow up. In the AD group, ACE-R and EXIT-25, conjunctively, were associated with the NPI total score at follow up. Conclusions: In 12 months, cognition declined and neuropsychiatric symptoms increased in bvFTD and AD groups. In the AD group only, cognitive impairment was a significant predictor of change in neuropsychiatric symptoms.
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Affiliation(s)
- Thais Bento Lima Da Silva
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | - Tiago Nascimento Ordonez
- Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil.,Graduate Program in Applied Statistics, University Center of United Metropolitan Colleges, São Paulo, Brazil
| | - Allan Gustavo Bregola
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Valéria Santoro Bahia
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mário Amore Cecchini
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Leandro Boson Gambogi
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Leonardo Cruz de Souza
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Monica Sanches Yassuda
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
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Behavioral and Cognitive Response to Selective Serotonin Reuptake Inhibitors in Frontotemporal Lobar Degeneration: A Systematic Review and Meta-analysis. Clin Neuropharmacol 2021; 44:175-183. [PMID: 34542955 DOI: 10.1097/wnf.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article systematically reviews current literature on the efficacy and efficiency of selective serotonin reuptake inhibitors (SSRIs) in the treatment of patients with frontotemporal lobar degeneration (FTLD), with a particular focus on behavior and cognitive functions. METHODS A search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using CENTRAL, MEDLINE, and Cochrane Library databases. Eleven randomized controlled trials and open-label studies looking at the effects of SSRIs on FTLD patients were included. A random-effects meta-analysis was performed, consisting of 3 randomized and controlled studies that used the neuropsychiatric inventory to assess SSRI intervention. RESULTS The meta-analysis shows a combined mean reduction of 10.17 points (95% confidence interval, 18.14-2.19; P = 0.01) on the neuropsychiatric inventory with SSRI treatment in FTLD patients. The I2 calculated for this study was 62% (P = 0.07), which represents moderate heterogeneity among the studies. The Egger regression test (P = 0.526) did not show a publication bias. Sensitivity analysis showed no significant change. CONCLUSIONS The current meta-analysis supports SSRIs as an intervention for management of behavioral symptoms of FTLD. Marked improvements were seen in disinhibition, irritability, aggression, and aberrant motor activity across studies. However, apathy/loss of empathy did not show similarly promising results. A deteriorative effect on cognition was seen associated with SSRI use.
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Vasenina EE, Levin OS. [Speech disorders in neurodegenerative diseases as dysphasia manifestation]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:50-59. [PMID: 32621468 DOI: 10.17116/jnevro202012005150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop the classification and methodology for assessment of speech disorders in neurodegenerative diseases, and to identify the characteristics of speech disorders for various forms. MATERIALS AND METHODS The study included 1016 patients with neurodegenerative diseases. Screening assessment identified 42.1% patients with speech disorders exceeding isolated dysarthria. Patients were assessed using the speech disorder test battery developed by the authors. Cluster, multifactor and contingency analyses were performed. RESULTS Nine subtypes of speech disorders were identified in neurodegenerative diseases that we denominated as dysphasia. Based on contingency analysis, the principal and the additional dysphasia variants were identified for each form of neurodegenerative pathology, which may contribute to better understanding of various phenotypes. Based on the general scheme of speech origination, the level of disorders typical for a given dysphasia subtype was identified. CONCLUSION The proposed classification enables identification of the subtypes of speech disorders for individual forms of neurodegenerative diseases. Introducing dysphasia concept to clinical practice will improve differential diagnosis and understanding of phenotypical heterogeneity of each nosological form as well as will facilitate therapy optimization.
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Affiliation(s)
- E E Vasenina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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10
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Vismara M, Cirnigliaro G, Piccoli E, Giorgetti F, Molteni L, Cremaschi L, Fumagalli GG, D'addario C, Dell'Osso B. Crossing Borders Between Frontotemporal Dementia and Psychiatric Disorders: An Updated Overview. J Alzheimers Dis 2020; 75:661-673. [PMID: 32310172 DOI: 10.3233/jad-191333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Frontotemporal dementia (FTD) includes a group of neurocognitive syndromes, clinically characterized by altered behaviors, impairment of language proficiency, and altered executive functioning. FTD is one of the most frequently observed forms of dementia in the elderly population and the most common in presenile age. As for other subtypes of dementia, FTD incidence is constantly on the rise due to the steadily increasing age of the population, and its recognition is now becoming a determinant for clinicians. FTD and psychiatric disorders can overlap in terms of clinical presentations by sharing a common genetic predisposition and neuropathological mechanism in some cases. Nonetheless, this association is often unclear and underestimated. Since its first reports, research into FTD has constantly grown, with the identification of recent findings related to its neuropathology, genetic, clinical, and therapeutic issues. Literature is thriving on this topic, with numerous research articles published in recent years. In the present review, we aimed to provide an updated description of the clinical manifestations that link and potentially confound the diagnosis of FTD and psychiatric disorders in order to improve their differential diagnosis and early detection. In particular, we systematically reviewed the literature, considering articles specifically focused on the behavioral variant FTD, published after 2015 on the PubMed database.
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Affiliation(s)
- Matteo Vismara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Federica Giorgetti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Molteni
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Cremaschi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | | | - Claudio D'addario
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.,"Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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11
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Development of disease-modifying drugs for frontotemporal dementia spectrum disorders. Nat Rev Neurol 2020; 16:213-228. [PMID: 32203398 DOI: 10.1038/s41582-020-0330-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
Frontotemporal dementia (FTD) encompasses a spectrum of clinical syndromes characterized by progressive executive, behavioural and language dysfunction. The various FTD spectrum disorders are associated with brain accumulation of different proteins: tau, the transactive response DNA binding protein of 43 kDa (TDP43), or fused in sarcoma (FUS) protein, Ewing sarcoma protein and TATA-binding protein-associated factor 15 (TAF15) (collectively known as FET proteins). Approximately 60% of patients with FTD have autosomal dominant mutations in C9orf72, GRN or MAPT genes. Currently available treatments are symptomatic and provide limited benefit. However, the increased understanding of FTD pathogenesis is driving the development of potential disease-modifying therapies. Most of these drugs target pathological tau - this category includes tau phosphorylation inhibitors, tau aggregation inhibitors, active and passive anti-tau immunotherapies, and MAPT-targeted antisense oligonucleotides. Some of these therapeutic approaches are being tested in phase II clinical trials. Pharmacological approaches that target the effects of GRN and C9orf72 mutations are also in development. Key results of large clinical trials will be available in a few years. However, clinical trials in FTD pose several challenges, and the development of specific brain imaging and molecular biomarkers could facilitate the recruitment of clinically homogenous groups to improve the chances of positive clinical trial results.
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Effectiveness of Pharmacological Interventions for Symptoms of Behavioral Variant Frontotemporal Dementia. Cogn Behav Neurol 2020; 33:1-15. [DOI: 10.1097/wnn.0000000000000217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Panza F, Imbimbo BP, Lozupone M, Greco A, Seripa D, Logroscino G, Daniele A, Colosimo C. Disease-modifying therapies for tauopathies: agents in the pipeline. Expert Rev Neurother 2019; 19:397-408. [PMID: 30973276 DOI: 10.1080/14737175.2019.1606715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Tauopathies are heterogeneous clinicopathological entities characterized by abnormal neuronal and/or glial inclusions of the microtubule-binding protein tau. Primary tauopathies considered to be diseases correspond to a major class of frontotemporal lobar degeneration (FTLD) neuropathology (FTLD-Tau), including several forms of frontotemporal dementia (FTD) clinical syndromes. Little progress has been made in the past 20 years in developing effective disease-modifying drugs for primary tauopathies and available symptomatic treatments have limited efficacy. Areas covered: Potential disease-modifying drugs in clinical development to slow neuropathological progression of primary tauopathies. Expert opinion: Since the underlying pathology of primary tauopathies consists of abnormal tau protein aggregates, treatments are being developed to interfere with the aggregation process or to promote the clearance of this protein. Unfortunately, disease-modifying treatments remain years away as demonstrated by the recent negative Phase III findings of a tau aggregation inhibitor (LMTM) for treating the behavioral variant of FTD. Further evidence will come from ongoing Phase I/II trials on novel drugs and immunotherapeutics with various targets - prevention of deposition or removal of tau aggregates, inhibition of tau phosphorylation/acetylation, modulation of O-GlcNAcylation, activation of autophagy or ubiquitin-proteasome system pathways, and rescue of selected tau loss of function or suppression of tau gene expression.
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Affiliation(s)
- Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy.,c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Bruno P Imbimbo
- d Department of Research and Development , Chiesi Farmaceutici , Parma , Italy
| | - Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy
| | - Antonio Greco
- c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Davide Seripa
- c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Antonio Daniele
- e Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy.,f Institute of Neurology , Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Carlo Colosimo
- g Department of Neurological Sciences , Santa Maria University Hospital , Terni , Italy
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Logroscino G, Imbimbo BP, Lozupone M, Sardone R, Capozzo R, Battista P, Zecca C, Dibello V, Giannelli G, Bellomo A, Greco A, Daniele A, Seripa D, Panza F. Promising therapies for the treatment of frontotemporal dementia clinical phenotypes: from symptomatic to disease-modifying drugs. Expert Opin Pharmacother 2019; 20:1091-1107. [PMID: 31002267 DOI: 10.1080/14656566.2019.1598377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) is a heterogeneous clinical entity that includes several disorders characterized by different cellular mechanisms. Distinctive clinical features in FTD include behavioral, affective, and cognitive symptoms. Unfortunately, little progress has been made over the past 20 years in terms of the development of effective disease-modifying drugs with the currently available symptomatic treatments having limited clinical utility. AREAS COVERED This article reviews the principal pharmacological intervention studies for FTD. These are predominantly randomized clinical trials and include symptomatic treatments and potential disease-modifying drugs. EXPERT OPINION There is insufficient evidence on effective treatments for FTD and studies with better methodological backgrounds are needed. Most studies reporting therapeutic benefits were conducted with selective serotonin reuptake inhibitors, while anti-dementia drugs have been ineffective in FTD. Since the underlying pathology of FTD mostly consists of abnormal tau protein or TDP-43 aggregates, treatments are being developed to interfere with their aggregation process or with the clearance of these proteins. Furthermore, disease-modifying treatments remain years away as demonstrated by the recent negative Phase III findings of a tau aggregation inhibitor (LMTM) for treating the behavioral variant of FTD. The results from current ongoing Phase I/II trials will hopefully give light to future treatment options.
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Affiliation(s)
- Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Bruno P Imbimbo
- c Department of Research and Development , Chiesi Farmaceutici , Parma , Italy
| | - Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy
| | - Rodolfo Sardone
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy
| | - Rosa Capozzo
- b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Petronilla Battista
- e Istituti Clinici Scientifici Maugeri SPA SB, IRCCS , Institute of Cassano Murge , Bari , Italy
| | - Chiara Zecca
- b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Vittorio Dibello
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy.,f Interdisciplinary Department of Medicine (DIM), Section of Dentistry , University of Bari AldoMoro , Bari , Italy
| | - Gianluigi Giannelli
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy
| | - Antonello Bellomo
- g Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Antonio Greco
- h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Antonio Daniele
- i Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy.,j Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Davide Seripa
- h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy.,d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy.,h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
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Abstract
The growing elderly population is creating record numbers of individuals with Alzheimer's disease (AD) and other dementias. Nursing has an unprecedented opportunity to rethink how we care for adults with dementia, reduce the burden of caregivers, and preserve the personhood of patients. This article reviews AD and dementia pathophysiology, history, screening, stigma, treatments and interventions, and caregiver support. A nurse's journey with her mother with AD imparts the meaning of patient dignity.
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Chen Q, Ermann A, Shad MU. Effectiveness of Dextromethorphan/Quinidine in Frontotemporal Dementia. Am J Geriatr Psychiatry 2018; 26:506. [PMID: 29132987 DOI: 10.1016/j.jagp.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- QiLiang Chen
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Ashley Ermann
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Mujeeb U Shad
- School of Medicine, Oregon Health & Science University, Portland, OR; Department of Psychiatry, Oregon State Hospital, Salem, OR
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