Novel approaches for the treatment of frontotemporal dementia: is there hope for the future?

Introduction: Frontotemporal dementia (FTD) refers to a group of neurodegenerative disorders characterized clinically by behavioral disturbances and pathologically by frontal and anterior temporal lobe neurodegeneration, resulting in brain atrophy. No disease-modifying therapy currently exists for FTD. Familial FTD is primarily caused by three major genetic mutations, extensively investigated during the preclinical phases. Compounds developed to date have been designed to target specific mutations. A shift to broader approaches targeting abnormal protein deposition must employ endpoints that are meaningful to genetic and sporadic FTD, despite the diversity of their symptoms. Areas covered: The authors review the most recent pharmacological and non-pharmacological randomized clinical trials (RCTs), focusing on the molecules involved, mechanisms of action, and pharmacological testing. The present review article is based on multiple database searches (MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar) on all the available literature up to the 1 May 2025. Expert opinion: Ongoing RCTs aimed to evaluate new disease-modifying or symptomatic treatment for FTD and to determine whether therapeutic strategies should target specific genetic mutations or focus on common protein deposits in the brain. These studies are laying the groundwork for future innovations. This shift could enable the transition from treating genetic FTD to tackling sporadic cases as well.