Pharmakologische Behandlungsansätze bei der frontotemporalen Demenz

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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