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bvFTD – Symptomatic Management — SCE Neurology MCQ

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ModerateNeurodegenerative DiseasebvFTD – Symptomatic ManagementSCE Neurology

A 60-year-old man with a diagnosis of behavioural variant FTD is being discussed at the MDT. His family report he has become increasingly apathetic, disinhibited, and compulsive over 3 years. He eats excessively (hyperorality). MRI shows bilateral frontal and anterior temporal atrophy. His neurologist explains that no disease-modifying treatment currently exists for bvFTD. What is the pharmacological management approach?

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Correct answer: A — There is no disease-modifying treatment for bvFTD; management is symptomatic — SSRIs (e.g. sertraline) for behavioural symptoms (disinhibition, compulsive behaviours, irritability), trazodone for agitation/sleep disturbance, and avoidance of cholinesterase inhibitors (which may worsen behavioural symptoms)

There is no disease-modifying therapy for bvFTD. Pharmacological management is symptomatic: (1) SSRIs (sertraline, citalopram) for behavioural disturbance (disinhibition, compulsive behaviours, irritability, anxiety), (2) trazodone for agitation, sleep disturbance, and eating behaviours, (3) avoid cholinesterase inhibitors (donepezil, rivastigmine) — unlike AD, they can worsen behavioural symptoms in FTD and are not recommended. Antipsychotics should be used with extreme caution due to side effects and limited evidence. A: ChEIs may worsen bvFTD. C: Memantine has limited evidence in FTD. D: Antipsychotics should be last resort. E: Levodopa is for PD.

Reference: NICE NG97 Dementia; ABN FTD Guidelines