Subscribe to RSS
DOI: 10.1055/s-0028-1109403
© Georg Thieme Verlag KG Stuttgart · New York
Frontotemporale Demenz: Neurotransmitter und klinische Symptomatik im Fokus therapeutischer Überlegungen
Frontotemporal Dementia: Neurotransmitter and Clinical Symptoms with Focus on Therapeutic TargetsPublication History
Publication Date:
05 May 2009 (online)

Zusammenfassung
Die in den letzten Jahren immer häufiger diagnostizierte, frontotemporale Demenz ist aus klinischer Sicht eine Erkrankung, für die es mangels doppelblinder, placebokontrollierter Studien bisher keine Therapieempfehlungen nach Art der „Evidence Based Medicine” gibt. Post-mortem-Untersuchungen und funktionelle Bildgebung belegen Alterationen in der serotonergen und dopaminergen Signaltransduktion. Das cholinerge System scheint wenig betroffen zu sein. Fallberichte und Studien zum Einsatz von Antidepressiva, Neuroleptika und Stimmungsstabilisatoren zeigen Wirksamkeit. Doppelblinde, placebokontrollierte Studien existieren nur für Paroxetin, Trazodon und Rivastigmin. Während die Ergebnisse für Paroxetin unklar sind, zeigt Trazodon neben einer signifikanten Verbesserung von Verhaltensauffälligkeiten eine hohe Rate von unerwünschten Arzneimittelwirkungen. Mit dem Einsatz von Rivastigmin bessert sich der Punktwert im Neuropsychiatric Inventory. Darüber hinaus liefert die vorliegende Arbeit 2 Fallberichte zum Einsatz repetitiver transkranieller Magnetstimulation bei der frontotemporalen Demenz.
Abstract
Frontotemporal dementia is more frequently diagnosed because of revised diagnostic procedures. Due to the lack of pharmacological trials it is a disease that is difficult to manage in the way of evidence based medicine. Deficits in serotonergic and dopaminergic signaltransmission are well known. The cholinergic system does not seem to be affected. Case reports and clinical trials show a benefit by using antidepressants, neuroleptics and mood stabilizers. Nevertheless only paroxetine, trazodone and rivastigmine are tested by double-blind, placebo-controlled studies. While paroxetin shows inconsistent data, trazodone improves behavioural symptoms. Patients report a treatment-emergent adverse effect including fatigue, dizziness and hypotension. Rivastigmine leads to a significant decrease in the Neuropsychiatric Inventory Score. Finally, we present a two-cases-report that shows improve of disease symptoms under treatment with repetitive transcranial magnet stimulation.
Schlüsselwörter
frontotemporale Demenz - Pharmakotherapie - Trazodon - rTMS
Key words
frontotemporal dementia - pharmacotherapy - trazodone - rTMS
Literatur
- 1
Grossman M.
A multidisciplinary approach to Pick’s disease and frontotemporal dementia. Conference
proceedings. May 6 – 7, 1999. Philadelphia, Pennsylvania, USA.
Neurology.
2001;
56
S1-58
MissingFormLabel
- 2
Diehl-Schmid J, Pohl C, Perneczky R. et al .
Frühsymptome, Überlebenszeit und Todesursachen – Beobachtungen an 115 Patienten mit
Demenz auf der Grundlage frontotemporaler lobärer Degenerationen.
Fortschr Neurol Psychiatr.
2007;
75
708-713
MissingFormLabel
- 3
Friedland R P, Koss E, Lerner A. et al .
Functional imaging, the frontal lobes, and dementia.
Dementia.
1993;
4
192-203
MissingFormLabel
- 4
Freedman M.
Frontotemporal dementia: recommendations for therapeutic studies, designs, and approaches.
Can J Neurol Sci.
2007;
34 (Suppl 1)
S118-S124
MissingFormLabel
- 5
Kessler H, Supprian T, Falkai P.
Pharmakologische Behandlungsansätze bei der frontotemporalen Demenz.
Fortschr Neurol Psychiatr.
2007;
75
714-719
MissingFormLabel
- 6
Sparks D L, Markesbery W R.
Altered serotonergic and cholinergic synaptic markers in Pick’s disease.
Arch Neurol.
1991;
48
796-799
MissingFormLabel
- 7
Sparks D L, Danner F W, Davis D G. et al .
Neurochemical and histopathologic alterations characteristic of Pick’s disease in
a non-demented individual.
J Neuropathol Exp Neurol.
1994;
53
37-42
MissingFormLabel
- 8
Yang Y, Schmitt H P.
Frontotemporal dementia: evidence for impairment of ascending serotoninergic but not
noradrenergic innervation. Immunocytochemical and quantitative study using a graph
method.
Acta Neuropathol.
2001;
101
256-270
MissingFormLabel
- 9
Procter A W, Qurne M, Francis P T.
Neurochemical features of frontotemporal dementia.
Dement Geriatr Cogn Disord.
1999;
10 (Suppl 1)
80-84
MissingFormLabel
- 10
Francis P T, Holmes C, Webster M T. et al .
Preliminary neurochemical findings in non-Alzheimer dementia due to lobar atrophy.
Dementia.
1993;
4
172-177
MissingFormLabel
- 11
Engelborghs S, Vloeberghs E, Maertens K. et al .
Evidence for an association between the CSF HVA:5-HIAA ratio and aggressiveness in
frontotemporal dementia but not in Alzheimer’s disease.
J Neurol Neurosurg Psychiatry.
2004;
75
1080
MissingFormLabel
- 12
Franceschi M, Anchisi D, Pelati O. et al .
Glucose metabolism and serotonin receptors in the frontotemporal lobe degeneration.
Ann Neurol.
2005;
57
216-225
MissingFormLabel
- 13
Sjogren M, Minthon L, Passant U. et al .
Decreased monoamine metabolites in frontotemporal dementia and Alzheimer’s disease.
Neurobiol Aging.
1998;
19
379-384
MissingFormLabel
- 14
Sjogren M, Wikkelso C, Ostling S. et al .
Biological correlates of clinical subgroups of Alzheimer’s disease.
Dement Geriatr Cogn Disord.
2002;
14
191-197
MissingFormLabel
- 15
Asberg M.
Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies.
Ann N Y Acad Sci.
1997;
836
158-181
MissingFormLabel
- 16
Moore P, Landolt H P, Seifritz E. et al .
Clinical and physiological consequences of rapid tryptophan depletion.
Neuropsychopharmacology.
2000;
23
601-622
MissingFormLabel
- 17
Blier P, Ward N M.
Is there a role for 5-HT1A agonists in the treatment of depression?.
Biol Psychiatry.
2003;
53
193-203
MissingFormLabel
- 18
Kanazawa I, Kwak S, Sasaki H. et al .
Studies on neurotransmitter markers of the basal ganglia in Pick’s disease, with special
reference to dopamine reduction.
J Neurol Sci.
1988;
83
63-74
MissingFormLabel
- 19
Nagaoka S, Arai H, Iwamoto N. et al .
A juvenile case of frontotemporal dementia: neurochemical and neuropathological investigations.
Prog Neuropsychopharmacol Biol Psychiatry.
1995;
19
1251-1261
MissingFormLabel
- 20
Rinne J O, Laine M, Kaasinen V. et al .
Striatal dopamine transporter and extrapyramidal symptoms in frontotemporal dementia.
Neurology.
2002;
58
1489-1493
MissingFormLabel
- 21
Bowen D M, Benton J S, Spillane J A. et al .
Choline acetyltransferase activity and histopathology of frontal neocortex from biopsies
of demented patients.
J Neurol Sci.
1982;
57
191-202
MissingFormLabel
- 22
Meier-Ruge W, Iwangoff P, Reichlmeier K.
Neurochemical enzyme changes in Alzheimer’s and Pick’s disease.
Arch Gerontol Geriatr.
1984;
3
161-165
MissingFormLabel
- 23
Wood P L, Nair N P, Etienne P. et al .
Lack of cholinergic deficit in the neocortex in Pick’s disease.
Prog Neuropsychopharmacol Biol Psychiatry.
1983;
7
725-727
MissingFormLabel
- 24
White P, Hiley C R, Goodhardt M J. et al .
Neocortical cholinergic neurons in elderly people.
Lancet.
1977;
1
668-671
MissingFormLabel
- 25
Hansen L A, Deteresa R, Tobias H. et al .
Neocortical morphometry and cholinergic neurochemistry in Pick’s disease.
Am J Pathol.
1988;
131
507-518
MissingFormLabel
- 26
Odawara T, Shiozaki K, Iseki E. et al .
Alterations of muscarinic acetylcholine receptors in atypical Pick’s disease without
Pick bodies.
J Neurol Neurosurg Psychiatry.
2003;
74
965-967
MissingFormLabel
- 27
Swartz J R, Miller B L, Lesser I M. et al .
Frontotemporal dementia: treatment response to serotonin selective reuptake inhibitors.
J Clin Psychiatry.
1997;
58
212-216
MissingFormLabel
- 28
Ikeda M, Shigenobu K, Fukuhara R. et al .
Efficacy of fluvoxamine as a treatment for behavioral symptoms in frontotemporal lobar
degeneration patients.
Dement Geriatr Cogn Disord.
2004;
17
117-121
MissingFormLabel
- 29
Cummings J L, Mega M, Gray K. et al .
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.
Neurology.
1994;
44
2308-2314
MissingFormLabel
- 30
Mendez M F, Shapira J S, Miller B L.
Stereotypical movements and frontotemporal dementia.
Mov Disord.
2005;
20
742-745
MissingFormLabel
- 31
Moretti R, Torre P, Antonello R M. et al .
Frontotemporal dementia: paroxetine as a possible treatment of behavior symptoms.
A randomized, controlled, open 14-month study.
Eur Neurol.
2003;
49
13-19
MissingFormLabel
- 32
Chow T W, Mendez M F.
Goals in symptomatic pharmacologic management of frontotemporal lobar degeneration.
Am J Alzheimers Dis Other Demen.
2002;
17
267-272
MissingFormLabel
- 33
Deakin J B, Rahman S, Nestor P J. et al .
Paroxetine does not improve symptoms and impairs cognition in frontotemporal dementia:
a double-blind randomized controlled trial.
Psychopharmacology.
2004;
172
400-408
MissingFormLabel
- 34
Mendez M F.
Moria and Witzelsucht from frontotemporal dementia.
J Neuropsychiatry Clin Neurosci.
2005;
17
429-430
MissingFormLabel
- 35
Imamura T, Takanashi M, Hattori N. et al .
Bromocriptine treatment for perseveration in demented patients.
Alzheimer Dis Assoc Disord.
1998;
12
109-113
MissingFormLabel
- 36
McDowell S, Whyte J, D’Esposito M.
Differential effect of a dopaminergic agonist on prefrontal function in traumatic
brain injury patients.
Brain.
1998;
121 (Pt 6)
1155-1164
MissingFormLabel
- 37
Lebert F, Stekke W, Hasenbroekx C. et al .
Frontotemporal dementia: a randomised, controlled trial with trazodone.
Dement Geriatr Cogn Disord.
2004;
17
355-359
MissingFormLabel
- 38
Anderson I M, Scott K, Harborne G.
Serotonin and depression in frontal lobe dementia.
Am J Psychiatry.
1995;
152
645
MissingFormLabel
- 39
Moretti R, Torre P, Antonello R M. et al .
Effects of selegiline on fronto-temporal dementia: a neuropsychological evaluation.
Int J Geriatr Psychiatry.
2002;
17
391-392
MissingFormLabel
- 40
Adler G, Teufel M, Drach L M.
Pharmacological treatment of frontotemporal dementia: treatment response to the MAO-A
inhibitor moclobemide.
Int J Geriatr Psychiatry.
2003;
18
653-655
MissingFormLabel
- 41
Chow T W.
Treatment approaches to symptoms associated with frontotemporal degeneration.
Curr Psychiatry Rep.
2005;
7
376-380
MissingFormLabel
- 42
Figiel G, Sadowsky C.
A systematic review of the effectiveness of rivastigmine for the treatment of behavioral
disturbances in dementia and other neurological disorders.
Curr Med Res Opin.
2008;
24
157-166
MissingFormLabel
- 43
Curtis R C, Resch D S.
Case of pick’s central lobar atrophy with apparent stabilization of cognitive decline
after treatment with risperidone.
J Clin Psychopharmacol.
2000;
20
384-385
MissingFormLabel
- 44
Moretti R, Torre P, Antonello R M. et al .
Olanzapine as a treatment of neuropsychiatric disorders of Alzheimer’s disease and
other dementias: a 24-month follow-up of 68 patients.
Am J Alzheimers Dis Other Demen.
2003;
18
205-214
MissingFormLabel
- 45
Pijnenburg Y A, Sampson E L, Harvey R J. et al .
Vulnerability to neuroleptic side effects in frontotemporal lobar degeneration.
Int J Geriatr Psychiatry.
2003;
18
67-72
MissingFormLabel
- 46
Lindau M, Almkvist O, Kushi J. et al .
First symptoms – frontotemporal dementia versus Alzheimer’s disease.
Dement Geriatr Cogn Disord.
2000;
11
286-293
MissingFormLabel
- 47
Merrilees J J, Miller B L.
Long-term care of patients with frontotemporal dementia.
J Am Med Dir Assoc.
2003;
4
S162-164
MissingFormLabel
- 48
Moretti R, Torre P, Antonello R M. et al .
Rivastigmine in frontotemporal dementia: an open-label study.
Drugs Aging.
2004;
21
931-937
MissingFormLabel
- 49
Huey E D, Putnam K T, Grafman J.
A systematic review of neurotransmitter deficits and treatments in frontotemporal
dementia.
Neurology.
2006;
66
17-22
MissingFormLabel
- 50
Barker A T, Jalinous R, Freeston I L.
Non-invasive magnetic stimulation of human motor cortex.
Lancet.
1985;
1
1106-1107
MissingFormLabel
- 51
Zyss T.
Will electroconvulsive therapy induce seizures: magnetic brain stimulation as hypothesis
of a new psychiatric therapy.
Psychiatr Pol.
1992;
26
531-541
MissingFormLabel
- 52
Iyer M B, Mattu U, Grafman J. et al .
Safety and cognitive effect of frontal DC brain polarization in healthy individuals.
Neurology.
2005;
64
872-875
MissingFormLabel
Dr. med. Bernd Lenz
Psychiatrische und Psychotherapeutische Klinik Universitätsklinikum Erlangen
Schwabachanlage 6 – 10
91054 Erlangen
Email: bernd.lenz@uk-erlangen.de