Psychotropic medication usage in sporadic versus genetic behavioral-variant frontotemporal dementia

Juan-Camilo Vargas-Gonzalez; Nico Dimal; Kasey Cortez; Hilary Heuer; Leah K Forsberg; Brian S Appleby; Sami Barmada; Andrea Bozoki; David Clark; Yann Cobigo; R Ryan Darby; Bradford C Dickerson; Kimiko Domoto-Reilly; Douglas R Galasko; Daniel H Geschwind; Nupur Ghoshal; Neill R Graff-Radford; Ian M Grant; David Irwin; Ging-Yuek Robin Hsiung; Lawrence S Honig; Kejal Kantarci; Gabriel C Léger; Irene Litvan; Ian R Mackenzie; Joseph C Masdeu; Mario F Mendez; Chiadi U Onyike; Belen Pascual; Peter Pressman; Eliana Marisa Ramos; Erik D Roberson; Emily Rogalski; Brad F Boeve; Adam L Boxer; Howie J Rosen; Maria Carmela Tartaglia; ALLFTD Consortium Investigators

doi:10.1002/alz.14448

Psychotropic medication usage in sporadic versus genetic behavioral-variant frontotemporal dementia

Alzheimers Dement. 2024 Dec 23. doi: 10.1002/alz.14448. Online ahead of print.

Authors

Juan-Camilo Vargas-Gonzalez^{1

2}, Nico Dimal^{1

2}, Kasey Cortez², Hilary Heuer³, Leah K Forsberg⁴, Brian S Appleby⁵, Sami Barmada⁶, Andrea Bozoki⁷, David Clark⁸, Yann Cobigo³, R Ryan Darby⁹, Bradford C Dickerson¹⁰, Kimiko Domoto-Reilly¹¹, Douglas R Galasko¹², Daniel H Geschwind¹³, Nupur Ghoshal¹⁴, Neill R Graff-Radford¹⁵, Ian M Grant¹⁶, David Irwin¹⁷, Ging-Yuek Robin Hsiung¹⁸, Lawrence S Honig¹⁹, Kejal Kantarci⁴, Gabriel C Léger¹², Irene Litvan¹², Ian R Mackenzie¹⁸, Joseph C Masdeu²⁰, Mario F Mendez¹³, Chiadi U Onyike²¹, Belen Pascual²⁰, Peter Pressman²², Eliana Marisa Ramos¹³, Erik D Roberson²³, Emily Rogalski²⁴, Brad F Boeve⁴, Adam L Boxer³, Howie J Rosen³, Maria Carmela Tartaglia^{1

2

25}; ALLFTD Consortium Investigators

Affiliations

¹ Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
² Memory Clinic, University Health Network, Toronto, Ontario, Canada.
³ Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.
⁴ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Neurology, Case Western Reserve University, Beachwood, Ohio, USA.
⁶ University of Michigan, Ann Arbor, Michigan, USA.
⁷ Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸ Indiana University, Indianapolis, Indiana, USA.
⁹ Vanderbilt University, Nashville, Tennessee, USA.
¹⁰ Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Department of Neurology, University of Washington, Seattle, Washington, USA.
¹² University of California San Diego, San Diego, California, USA.
¹³ Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
¹⁴ Memory Diagnostic Center, Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
¹⁵ Mayo Clinic, Jacksonville, Florida, USA.
¹⁶ Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁷ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁸ University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Neurology Department and Taub Institute, Columbia University Irving Medical Center, New York, New York, USA.
²⁰ Nantz National Alzheimer Center, Houston Methodist, Houston, Texas, USA.
²¹ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²² University of Colorado Denver, Denver, Colorado, USA.
²³ Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁴ Healthy Aging & Alzheimer's Research Care (HAARC) Center, Department of Neurology, University of Chicago, Chicago, Illinois, USA.
²⁵ Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.

PMID: 39713899
DOI: 10.1002/alz.14448

Abstract

Introduction: Psychotropic medication (PM) use in behavioral-variant frontotemporal dementia (bvFTD) is higher than in other dementias. However, no information exists on whether PM use differs between sporadic and genetic bvFTD.

Methods: We analyzed data from sporadic and genetic bvFTD participants with PM prescriptions in the Advancing Research and Treatment in Frontotemporal Lobar Degeneration/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects study. We estimated ordinal odds ratio (OOR) of having more PM comparing sporadic and genetic bvFTD. Finally, we explored the neuropsychiatric symptom (NPS) combinations using classification and regression trees (CART).

Results: We included 263 with sporadic and 193 with genetic bvFTD. The OOR for sporadic bvFTD to be on PM was 1.75 (95% confidence interval: 1.21 to 2.53) for the fully adjusted model. CART revealed the most common NPS combination was apathy + personality changes in 18% of participants.

Discussion: Participants with sporadic bvFTD were twice as likely to be on PM compared to genetic bvFTD. The reason for increased PM usage in sporadic bvFTD participants should be further investigated.

Highlights: We report on patients with behavioral variant frontotemporal dementia (bvFTD). We evaluated the psychotropic medication (PM) prescription at baseline in the cohort. Patients with sporadic bvFTD had more prescriptions for PM than genetic patients. The frequency of symptoms combination was different in sporadic and genetic bvFTD.

Keywords: behavioral symptoms; frontotemporal dementia; frontotemporal lobar degeneration; medication usage; psychotropic drugs.

Abstract

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