MEDICATION of Dementia in Motor Neuron Disease

No specific treatment is available for FTD/MND. Treatments for MND, such as riluzole and gabapentin, do not appear to affect the course of the dementia-inducing illness. Riluzole is currently the only licensed medication for MND. Available data from therapeutic trials in MND do not show beneficial cognitive effects, although there are no specific contraindications in this context. Gabapentin has been studied in trials as a disease-modifying agent in patients with MND but does not demonstrate specific cognitive-enhancing properties.

Acetylcholinesterase inhibitors (eg, donepezil, rivastigmine) are used to correct the cholinergic effect associated with Alzheimer disease. Although not studied specifically in FTD, anecdotal reports suggest they may increase irritability in patients with FTD.

FTD patients with profound presynaptic serotonergic deficits and behavioral disturbances may respond to selective serotonin reuptake inhibitors.

Selective dopamine-blockers, such as olanzapine, may be useful in agitated patients; monitor for side effects such as extrapyramidal syndromes. While plausible, it is not certain that treatment strategies for FTD apply to FTD/MND. Current treatments mainly are supportive and directed toward the features of MND.