Partners in FTD Care
Fall 2019

By Deborah Reed, MD, Guest Contributor

Currently there are no FDA-approved medications specifically for the treatment of FTD. However, other medications can address FTD’s behavioral and psychiatric symptoms.

Cognitive enhancing medications such as donepezil and memantine can be useful if the underlying disease process is Alzheimer’s pathology, despite a clinical presentation of FTD. But for persons diagnosed with FTD, other categories of medications are more useful: selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotic medications and anticonvulsants/mood stabilizers. Prescribers should take care to avoid any type of anticholinergic medication that can worsen cognition, and to carefully consider potential side effects. Benzodiazepines, for example, can contribute to confusion, drowsiness and poor coordination, leading to a fall risk.

Often, SSRIs—such as sertraline, fluoxetine and escitalopram—can address behaviors such as irritability, tearfulness, depression or anxiety early in the disease. They may also help with overeating and impulsive behavior. Nausea, headache and gastrointestinal side effects may occur. Sedating medications such as trazodone, meanwhile, can be helpful for sleep disturbances.

Antipsychotic medications such as quetiapine can treat significant aggression, agitation or severe compulsive behaviors. These medications have a “black box warning,” meaning they have on rare occurrences (less than five percent of the time) been shown to contribute to death from pneumonia or stroke in persons with dementia-related psychosis. Care partners should consult with the prescribing physician to determine if the risk of these medications outweighs their potential benefits. Sedation, dry mouth, decreased blood pressure and weight gain are common side effects of antipsychotics.

Anticonvulsant medications (divalproex or oxcarbazepine) that are often used in seizure disorders and bipolar disorder can help with disinhibited behaviors. Dizziness, headache, sedation and nausea can occur with these medications.

Persons diagnosed and/or their care partners should identify each problematic symptom or behavior, along with contributing medical conditions and environmental issues (temperature, noise level and social factors) before any medications are prescribed. Non-drug interventions such as redirection, music therapy, and structured activities can also help to reduce problematic behaviors, and should be considered first.

See also:

• Only Part of the Answer: Medications and FTD
• Preparing to Talk to the Doctor
• A Care Partner’s Perspective: The Importance of Advocacy
• What to Do About… Medications for FTD Symptoms
• Download the full issue (pdf)