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Alzheimer Dis Assoc Disord. 2014 Apr-Jun;28(2):182-9. doi: 10.1097/WAD.0b013e3182a7159d.

Demographic and neuropsychiatric factors associated with off-label medication use in frontotemporal dementia and Alzheimer's disease.

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*Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON †Department of Neurology, Memory and Aging Center §Department of Psychiatry, University of California, San Francisco ‡Stanford Geriatric Education Center, Stanford University School of Medicine, Palo Alto, CA.



Off-label medication use for treating cognitive impairments and neuropsychiatric symptoms occurs in frontotemporal dementia (FTD) and Alzheimer disease (AD). We compared the use of cognitive and psychiatric medications in FTD and AD and evaluated the relationship between neuropsychiatric symptoms and medication use.


Cognitive and psychiatric medication use, demographic variables, and Neuropsychiatric Inventory (NPI) subscale symptoms were obtained from the National Alzheimer's Coordinating Center Uniform Data Set (n=3958, 8.1% FTD). Bivariate statistics and logistic regressions were calculated to evaluate which demographic or NPI subscale symptoms predicted medication use.


Although cognitive medication was used more commonly in AD (78%), it was also commonly used off-label in FTD (56%). Psychiatric medications were in greater use in FTD than in AD (68% vs. 45%, respectively, P<0.001). In FTD, cognitive medication use was associated with elevated NPI elation scores and psychiatric medication use was associated with history of prior psychiatric disease. In AD, demographic variables (white, longer disease duration, higher education, more severe disease, or being male) were most predictive of cognitive medication use, whereas having psychiatric disease, being white, having longer disease duration, being younger, greater disease severity, and being disinhibited or anxious were associated with psychiatric medication use. Off-label antipsychotics were used by 4.7% of patients with AD and 10% of patients with FTD.


Our results revealed significant off-label medication use in both FTD and AD. A notable finding from this study was the lack of consistent relationships between medication use and neuropsychiatric symptoms across the 2 illnesses.

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