title: Serotonergic function and treatment of behavioral and psychological symptoms of frontotemporal dementia.
abstract: OBJECTIVE
  The purposes of this study were first, to evaluate the effectiveness of citalopram in treating behavioral disturbances in frontotemporal dementia (FTD) subjects and second, to determine whether an association exists between serotonergic function, as determined by a neuroendocrine challenge, and treatment response.
  
  
  METHODS
  Single-dose citalopram (30 mg per os) challenge followed by a 6-week open-label study.
  
  
  METHODS
  Outpatients referred to memory clinics.
  
  
  METHODS
  Fifteen patients suffering from FTD with severe behavioral and psychological symptoms of dementia.
  
  
  METHODS
  Following citalopram challenge, all patients were treated with citalopram titrated to a target dose of 40 mg once daily.
  
  
  METHODS
  Behavioral disturbances, using the Neuropsychiatric Inventory (NPI) (primary outcome) and Frontal Behavioural Inventory (secondary outcome), were assessed. Change in prolactin concentration following citalopram challenge was used as an index of central serotonergic response.
  
  
  RESULTS
  Citalopram treatment was effective in treating behavioral symptoms, with significant decreases in NPI total score (F[2, 28] = 6.644, p = 0.004), disinhibition (F[2, 28] = 4.030, p = 0.029), irritability (F[2, 28] = 7.497, p = 0.003) and depression (F[2, 28] = 3.467, p = 0.045) scores over the 6 weeks. Significant improvement in Frontal Behavioural Inventory scores suggested that citalopram was also effective in the treatment ofbehaviors specific to FTD. A lower change score in concentration of prolactin was significantly positively correlated with greater improvement in the total NPI score from baseline to endpoint (r = 0.687, p = 0.005). A blunted response to a citalopram challenge, implying a dysfunctional serotonergic system, predicted a more positive treatment outcome.
  
  
  CONCLUSIONS
  The results suggest that despite the endogenous serotonin deficiency of FTD, citalopram treatment may be effective in targeting the behavioral disturbances characteristic of FTD.
authors: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Nathan
authors: N
authors: Herrmann
authors: Sandra E
authors: SE
authors: Black
authors: Tiffany
authors: T
authors: Chow
authors: Jaclyn
authors: J
authors: Cappell
authors: David F
authors: DF
authors: Tang-Wai
authors: Krista L
authors: KL
authors: Lanctôt
mesh_terms: D000368:Aged; D001526:Behavioral Symptoms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D057180:Frontotemporal Dementia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010901:Pituitary Function Tests / Q000379:methods / Q000523:psychology; D011237:Predictive Value of Tests; D011388:Prolactin / Q000187:drug effects / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D015283:Citalopram; D011388:Prolactin; D017367:Selective Serotonin Reuptake Inhibitors