Stimulant Treatment of Frontotemporal Dementia in 8 Patients

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Sir: Clinicians are often reluctant to use psychomotor stimulantsin patients with disinhibition from frontal lobe dysfunctionbecause of the concern that these medications will worsen behaviorsor result in psychosis. We contrasted the effects of dextroamphetamineand quetiapine, an atypical antipsychotic oftenused to treat agitation in dementia patients with cognitive andbehavioral symptoms, in 8 patients with behavioral-variantfrontotemporal dementia (FTD) in a double-blind crossovertrial. We were interested in testing a stimulant for several reasons:(1) there is autopsy, cerebrospinal fluid, and imaging evidenceof dopaminergic deficiencies in FTD (reviewed in Hueyet al.); (2) there is a clinical association between FTD and basalganglia dopaminergic dysfunction (i.e., parkinsonism); and (3)executive dysfunction associated with psychiatric illness (e.g.,attention-deficit/hyperactivity disorder) can improve with dopamineaugmentation.’ ‹