Stimulant Treatment of Frontotemporal Dementia in 8 Patients

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Sir: Clinicians are often reluctant to use psychomotor stimulants in patients with disinhibition from frontal lobe dysfunction because of the concern that these medications will worsen behaviors or result in psychosis. We contrasted the effects of dextroamphetamine and quetiapine, an atypical antipsychotic often used to treat agitation in dementia patients with cognitive and behavioral symptoms, in 8 patients with behavioral-variant frontotemporal dementia (FTD) in a double-blind crossover trial. We were interested in testing a stimulant for several reasons: (1) there is autopsy, cerebrospinal fluid, and imaging evidence of dopaminergic deficiencies in FTD (reviewed in Huey et al.); (2) there is a clinical association between FTD and basal ganglia dopaminergic dysfunction (i.e., parkinsonism); and (3) executive dysfunction associated with psychiatric illness (e.g., attention-deficit/hyperactivity disorder) can improve with dopamine augmentation.​

J Clin Psychiatry 2008;69(12):1981-1982