Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)

Casper Wittebrood; Marina Boban; Annchiara Cagnin; Sabina Capellari; François Laurent De Winter; Atbin Djamshidian; Manuel Menéndez González; Lena E. Hjermind; Lenka Krajcovicova; Johanna Krüger; Johannes Levin; Kathrin Reetz; Eloy Rodriguez Rodriguez; Jonathan Rohrer; Tim Van Langenhove; Carola Reinhard; Holm Graessner; Robert Rusina; Dario Saracino; Marion Houot; Harro Seelar; Rik Vandenberghe

doi:10.1111/ene.16446

Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)

Casper Wittebrood^*
, Marina Boban
, Annchiara Cagnin
, Sabina Capellari
, François Laurent De Winter
, Atbin Djamshidian
, Manuel Menéndez González
, Lena E. Hjermind
, Lenka Krajcovicova
, Johanna Krüger
, Johannes Levin
, Kathrin Reetz
, Eloy Rodriguez Rodriguez
, Jonathan Rohrer
, Tim Van Langenhove
, Carola Reinhard
, Holm Graessner
, Robert Rusina
, Dario Saracino
, Marion Houot

Harro Seelar, Rik Vandenberghe

^*Corresponding author for this work

University Hospitals Leuven
University of Zagreb
University of Padua
University of Bologna
IRCCS Istituto delle Scienze Neurologiche di Bologna
Innsbruck Medical University
Hospital Universitario Central de Asturias
University of Oviedo
Instituto de INvestigación Biosanitaria Del Principado de Asturias (ISPA)
Rigshospitalet
Masaryk University
Oulu University Hospital
University of Oulu
Klinikum der Universität München
German Center for Neurodegenerative Diseases
Munich Cluster for Systems Neurology (SyNergy)
Universitätsklinikum Aachen
Hospital Universitario Marques de Valdecilla
Instituto de Salud Carlos III
Universidad de Cantabria
University College London
Ghent University Hospital
University Hospital Tübingen
University of Tübingen
Thomayer University Hospital
Sorbonne Université
Erasmus University Rotterdam

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Scopus)

85 Downloads (Pure)

Abstract

Background and Purpose:

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers.

Method:

The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND).

Results:

The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases.

Conclusions:

The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.

Original language	English
Article number	e16446
Journal	European Journal of Neurology
Volume	31
Issue number	12
DOIs	https://doi.org/10.1111/ene.16446
Publication status	Published - Dec 2024
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

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10.1111/ene.16446Licence: CC BY

Pharmacotherapy for behavioural manifestations in frontotemporal dementiaFinal published version, 2.81 MBLicence: CC BY

Cite this

Wittebrood, C., Boban, M., Cagnin, A., Capellari, S., De Winter, F. L., Djamshidian, A., González, M. M., Hjermind, L. E., Krajcovicova, L., Krüger, J., Levin, J., Reetz, K., Rodriguez, E. R., Rohrer, J., Van Langenhove, T., Reinhard, C., Graessner, H., Rusina, R., Saracino, D., ... Vandenberghe, R. (2024). Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND). European Journal of Neurology, 31(12), Article e16446. https://doi.org/10.1111/ene.16446

@article{519cdc6cbb2f426384b806297886cf22,

title = "Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)",

abstract = "Background and Purpose: Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. Method: The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). Results: The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases.Conclusions: The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.",

author = "Casper Wittebrood and Marina Boban and Annchiara Cagnin and Sabina Capellari and De Winter, \{Fran{\c c}ois Laurent\} and Atbin Djamshidian and Gonz{\'a}lez, \{Manuel Men{\'e}ndez\} and Hjermind, \{Lena E.\} and Lenka Krajcovicova and Johanna Kr{\"u}ger and Johannes Levin and Kathrin Reetz and Rodriguez, \{Eloy Rodriguez\} and Jonathan Rohrer and Tim Van Langenhove and Carola Reinhard and Holm Graessner and Robert Rusina and Dario Saracino and Marion Houot and Harro Seelar and Rik Vandenberghe",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). European Journal of Neurology published by John Wiley \& Sons Ltd on behalf of European Academy of Neurology.",

year = "2024",

month = dec,

doi = "10.1111/ene.16446",

language = "English",

volume = "31",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "John Wiley \& Sons Inc.",

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}

Wittebrood, C, Boban, M, Cagnin, A, Capellari, S, De Winter, FL, Djamshidian, A, González, MM, Hjermind, LE, Krajcovicova, L, Krüger, J, Levin, J, Reetz, K, Rodriguez, ER, Rohrer, J, Van Langenhove, T, Reinhard, C, Graessner, H, Rusina, R, Saracino, D, Houot, M, Seelar, H & Vandenberghe, R 2024, 'Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)', European Journal of Neurology, vol. 31, no. 12, e16446. https://doi.org/10.1111/ene.16446

Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND). / Wittebrood, Casper; Boban, Marina; Cagnin, Annchiara et al.
In: European Journal of Neurology, Vol. 31, No. 12, e16446, 12.2024.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Pharmacotherapy for behavioural manifestations in frontotemporal dementia

T2 - An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)

AU - Wittebrood, Casper

AU - Boban, Marina

AU - Cagnin, Annchiara

AU - Capellari, Sabina

AU - De Winter, François Laurent

AU - Djamshidian, Atbin

AU - González, Manuel Menéndez

AU - Hjermind, Lena E.

AU - Krajcovicova, Lenka

AU - Krüger, Johanna

AU - Levin, Johannes

AU - Reetz, Kathrin

AU - Rodriguez, Eloy Rodriguez

AU - Rohrer, Jonathan

AU - Van Langenhove, Tim

AU - Reinhard, Carola

AU - Graessner, Holm

AU - Rusina, Robert

AU - Saracino, Dario

AU - Houot, Marion

AU - Seelar, Harro

AU - Vandenberghe, Rik

PY - 2024/12

Y1 - 2024/12

N2 - Background and Purpose: Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. Method: The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). Results: The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases.Conclusions: The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.

AB - Background and Purpose: Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. Method: The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). Results: The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases.Conclusions: The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.

UR - https://www.scopus.com/pages/publications/85207517737

U2 - 10.1111/ene.16446

DO - 10.1111/ene.16446

M3 - Article

C2 - 39447217

AN - SCOPUS:85207517737

SN - 1351-5101

VL - 31

JO - European Journal of Neurology

JF - European Journal of Neurology

IS - 12

M1 - e16446

ER -

Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)

Abstract

Bibliographical note

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