From the Research
The best management approach for aggression and behavioral issues in frontotemporal dementia (FTD) involves a combination of non-pharmacological strategies and carefully selected medications, with a focus on personalized, evidence-based interventions, as recommended by the most recent study 1.
Key Considerations
- Non-pharmacological approaches should be tried first, including:
- Establishing consistent routines
- Creating a calm environment
- Identifying and avoiding triggers
- Using distraction techniques
- Providing caregiver education and support
- When medications are necessary, selective serotonin reuptake inhibitors (SSRIs) like citalopram (20-40mg daily) or sertraline (50-200mg daily) are typically first-line treatments for irritability and compulsive behaviors
- For more severe aggression, atypical antipsychotics may be considered at the lowest effective dose, such as quetiapine (25-200mg daily) or risperidone (0.25-2mg daily), though these carry black box warnings for increased mortality in elderly patients with dementia
- Trazodone (25-100mg) can help with agitation and sleep disturbances
- Medications should be started at low doses and titrated slowly while monitoring for side effects
Rationale
The underlying mechanism of behavioral symptoms in FTD relates to damage to the frontal and temporal lobes, which regulate behavior, impulse control, and social cognition 2. Regular reassessment of medication efficacy and side effects is essential, as is providing ongoing support to caregivers who often experience significant stress managing these challenging behaviors. A recent study 3 highlighted the importance of a nonpharmacological approach and early detection in managing aggression and agitation in patients with dementia. Another study 4 found that among mood stabilizers, carbamazepine has the most robust evidence of efficacy on behavioral and psychological symptoms of dementia. However, the most recent and highest quality study 1 recommends a personalized and evidence-based approach to behavioral interventions, which should be prioritized in clinical practice.