Frontotemporale Demenz: Neurotransmitter und klinische Symptomatik im Fokus therapeutischer Überlegungen

 

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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.

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Dr. med. Bernd Lenz

Psychiatrische und Psychotherapeutische Klinik Universitätsklinikum Erlangen

Schwabachanlage 6 – 10

91054 Erlangen

Email: bernd.lenz@uk-erlangen.de