A study published in the journal The Lancet Neurology evaluates the efficacy of the hormone oxytocin as a treatment for apathy, a common symptom of FTD disorders.
Co-authors of the study include AFTD Medical Advisory Council (MAC) chair-elect Chiadi Onyike, MD; current MAC members Adam Boxer, MD, Howard Feldman, MD, and Carmela Tartaglia, MD; emeritus MAC chair Mario Mendez, MD, PhD; emeritus MAC member Edward Huey, MD; and AFTD grant recipient Simon Ducharme, MD.
No Treatments Exist for Apathy as a Symptom
Apathy is a common symptom of FTD disorders, especially behavioral variant FTD (bvFTD). Caused by degeneration of the region of the frontal lobe – the part of the brain associated with initiation, planning, and motivation – apathy can best be understood as a decline in goal-oriented behavior. Because it can cause people to uncharacteristically lose interest in relationships, hobbies, and interests, apathy is one of the more distressing symptoms of FTD for families and care partners.
“Symptomatic treatment in frontotemporal dementia is a field that needs more study,” lead author Kristy Coleman, MSc, told Education News Canada. “Unfortunately, there isn’t much out there in terms of evidence-based symptom management for any FTD symptoms, including apathy.”
Coleman’s team investigated if an artificially administered form of the hormone oxytocin could provide relief from apathy in FTD. Oxytocin plays an essential role in building relationships and is sometimes referred to as the “love hormone.” In pilot studies of people with FTD, a single dose or one-week course of oxytocin improved behavior and apathy-related symptoms.
The authors organized FOXY: A Phase 2 Clinical Trial of Intranasal Oxytocin for Frontotemporal Dementia to evaluate if oxytocin delivered through a nasal inhaler could provide safe and tolerable relief for apathy. The study involved 74 participants from 11 trial sites in the United States and Canada who took part in one of two stages; stage one was intended to determine a dosing schedule, while stage two allowed researchers to collect data to determine the efficacy of the treatment.
The measures used were the same in both stages, with researchers hoping the data would show an improvement in participants who took oxytocin compared to those who took a placebo. The authors used the apathy section of a behavioral screening tool called the Neuropsychiatric Inventory (NPI) to evaluate whether apathy improved. The NPI evaluates behavioral changes in people with dementia across several domains, including apathy, through a clinician interview with a care partner who spends a significant amount of time with a person with dementia. Care partners were asked to conduct dosing using nasal spray provided by the study’s authors.
Oxytocin Provides Small Improvement in Apathy
Participants in stage one were assigned to one of three cohorts, which were further divided into placebo and oxytocin groups; one cohort received a dose each day, another was dosed every other day, and the final cohort was dosed every third day. After receiving either a placebo or oxytocin dose, a cohort would receive the other option for the next round of dosing, before alternating back to the original option for the final round.
The scientists recorded a small but potentially clinically meaningful improvement in apathy, represented by a 1.32-point improvement in NPI scores (a score of 2 or above was required to qualify for the study). The authors underscore that this reflects an improvement in apathy noticed by care partners in their daily interactions with their loved one. Additionally, reductions in apathy were not associated with a worsening in other symptoms.
“It is a robust effect, but it is in the range of mild improvement. It’s not night and day, but enough that it was detectable by the care partners,” said co-author Elizabeth Finger, MD. “This is an exciting step forward in having specific treatments for neuropsychiatric symptoms of FTD.”
Certain subgroups within the study experienced more pronounced improvements. People with bvFTD, men, younger people, and those with certain genetic traits benefited more from oxytocin doses than others. Care partners reported little difficulty administering the oxytocin, and the treatment was safe and well tolerated by participants. While further research is needed to tackle new questions raised by the study and to address its limitations, the results identified a potential treatment for a troubling symptom of FTD that currently has none.
“Even small things like this make a huge difference,” said Coleman. “If you’re in a marriage with somebody who maybe doesn’t display interest in you or your well-being, to have those little glimmers is significant.”
To learn more about apathy, read the winter 2018 edition of AFTD’s Partners in FTD Care about apathy, or watch the apathy session from AFTD’s 2021 Education Conference on YouTube.
Do you need help addressing apathy for yourself or a loved one living with FTD? AFTD’s HelpLine understands what FTD is like and can provide the support you need; contact the HelpLine at 1-866-507-7222 or [email protected].