Management

Management

There are currently no curative treatments for any of the FTD syndromes although clinical trials are now under way.

Drugs currently used in the clinic include:

  • Selective serotonin uptake inhibitors or SSRIs are often used in bvFTD to help with behavioural symptoms although their effect is relatively small. We would generally offer a trial to all people with bvFTD to see if there is a benefit.
  • Neuroleptic drugs should be avoided where possible, as patients with FTD are often sensitive to side effects.
  • The drugs used in Alzheimer’s disease such as the acetylcholinesterase inhibitors may make some behavioural symptoms worse and we do not prescribe these in the majority of people with FTD. However those with likely underlying Alzheimer’s disease, such as those with lvPPA may benefit.
  • Other drugs that are sometimes used for behavioural symptoms in FTD include mood stabilizers such as sodium valproate and topiramate.
  • Those with MND are usually prescribed riluzole, which has been shown to have some benefit.
  • For people who develop parkinsonism, including those with a PSP syndrome or CBS, dopamine therapies such as levodopa (Sinemet or Madopar) are often trialled, although the majority of people have a limited response. A review of drugs used in PSP and CBS by our team can be found here.

This is important but often overlooked in the management of people with FTD. It includes:

  • speech and language therapy with communication aids in PPA – read this paper from our team on different treatment methods used by speech and language therapists.
  • physiotherapy for those with movement disorders.
  • behavioural management strategies including:
    • for disinhibition, redirection or distraction with another activity.
    • for obsessive-compulsive behaviours, adjusting the daily routine to accommodate a person’s fixations.
    • for apathy, acceptance from the family of a more passive role taken by the person with FTD, with a change in family activities that take this into account.
    • for abnormal eating behaviour, keeping less food in the house, and if needed locking cupboards.
  • ‘business’-style cards stating that someone has behavioural problems or has aphasia, can be helpful in social settings – these are available usually from national support groups. For PSP and CBS, cards are available in the UK from the PSP association by emailing helpline@pspassociation.org.uk
  • advice regarding driving, and if needed a driving assessment. If a person with FTD continues to drive despite concerns from the family, removing the car keys or even disabling the engine may be needed.
  • psychological support and respite when needed for carers.
  • appropriate advice regarding benefits and financial help.
  • contact details of national and local support groups – see our Support page or visit the Rare Dementia Support website.