Zusammenfassung
Im Gegensatz zur Alzheimer-Demenz gibt es zur Pharmakotherapie frontotemporaler Demenzen
(FTD) bislang kaum systematische Untersuchungen. Neurochemisch wird bei der FTD ein
ausgeprägtes serotonerges Defizit angenommen. Dieses bildet die Grundlage für die
Behandlung, insbesondere von Verhaltensstörungen, mit serotonergen Antidepressiva.
Bislang sind jedoch nur Paroxetin und Trazodon in Studien der Evidenzklassen I und
II untersucht. Die Ergebnisse zu Paroxetin sind uneinheitlich, und bei Trazodon ist
ein relativ hohes Nebenwirkungsprofil zu berücksichtigen. Von den Substanzen mit primär
antidementivem Ansatzpunkt gibt es bislang lediglich Klasse II-Evidenz für den Einsatz
von Rivastigmin auch bei der FTD, wenngleich neurochemisch kein klarer Hinweis auf
ein cholinerges Defizit bei dieser Demenzform vorliegt. Zu Memantine gibt es bislang
keine publizierten Daten aus kontrollierten Studien für einen Einsatz bei der FTD.
Abstract
In contrast to Alzheimer's disease, there are only few systematic trials for drug
therapy of frontotemporal dementia (FTD). Neurochemically, a strong serotonergic deficit
is supposed in FTD. This is the rationale for treatment, especially of behavioral
abnormalities, with serotonergic antidepressants. However, only paroxetine and trazodone
have been studied in trials with class I and II evidence so far. The results of paroxetine
are inconsistent; and for trazodone a number of potential side-effects must be considered.
Moreover, there is class II evidence for rivastigmine in FTD, even though a cholinergic
deficit in this type of dementia is questionable. There are no published data from
controlled trials for the use of memantine in FTD so far.
Schlüsselwörter
frontotemperale Demenz - Pharmakotherapie - Trazodon - Paroxetin - Rivastigmin
Key words
frontotemporal dementia - pharmacotherapy - trazodone - paroxetine - rivastigmine
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Dr. med. Holger Kessler
Klinik für Psychiatrie und Psychotherapie Universitätsklinikum des Saarlandes
66421 Homburg/Saar
Email: holger.kessler@uniklinik-saarland.de
