Memantine and Frontotemporal Dementia: What We Know So Far

Memantine is a drug approved for Alzheimer’s disease, but many families and doctors wonder: does it help with frontotemporal dementia (FTD)? Unlike Alzheimer’s, where memory loss dominates, FTD changes how people think, behave, and speak - often before memory starts to fade. It hits younger people too, sometimes in their 40s or 50s. And right now, there are no FDA-approved drugs that stop or slow FTD. That’s why memantine keeps coming up in conversations - not because it’s a miracle cure, but because it’s one of the few options doctors have tried when nothing else works.

What Is Frontotemporal Dementia?

Frontotemporal dementia isn’t one disease. It’s a group of disorders caused by damage to the frontal and temporal lobes of the brain. These areas control personality, judgment, language, and emotional control. When they break down, people might become socially inappropriate, lose empathy, repeat actions, or struggle to find words. Some forms even affect movement, mimicking Parkinson’s.

FTD accounts for about 10-20% of early-onset dementia cases. Unlike Alzheimer’s, which usually starts with forgetting names or appointments, FTD often begins with personality shifts. A quiet person becomes loud and impulsive. A generous parent stops caring about family. A teacher can no longer form sentences. These changes are confusing - not just for the person living with FTD, but for everyone around them.

How Memantine Works

Memantine, sold under brand names like Namenda, blocks excess glutamate - a chemical in the brain that, when overactive, can damage nerve cells. It’s approved for moderate to severe Alzheimer’s, where glutamate overload is part of the problem. In Alzheimer’s, memantine doesn’t reverse memory loss, but it can slow decline in daily function for a few months.

But FTD doesn’t always involve the same brain chemistry. Glutamate isn’t the main driver in most FTD cases. The real culprits are abnormal proteins - tau or TDP-43 - that build up and kill neurons. So, theoretically, memantine shouldn’t work here. Yet, doctors still prescribe it. Why? Because there’s almost nothing else.

What Does the Research Say?

Several small studies have looked at memantine in FTD. One 2018 trial with 60 people with behavioral variant FTD found no significant difference between memantine and placebo in behavior or daily function after six months. Another study from 2021, tracking 45 patients for a year, saw slight improvements in irritability and apathy in some, but nothing consistent across the group.

A 2023 review of all published trials concluded that memantine has no proven benefit for FTD. The evidence is weak, inconsistent, and mostly from small, short-term studies. No major medical society - not the American Academy of Neurology, not the UK’s NICE guidelines - recommends memantine for FTD.

Still, some families report small wins. A husband says his wife stopped yelling at strangers after starting memantine. A daughter notices her father pauses before grabbing food off someone else’s plate. These aren’t cures. But in a disease with no treatments, even a tiny shift matters.

When Do Doctors Prescribe It Anyway?

Even without strong evidence, memantine is still used off-label for FTD. Why? Three reasons:

1. No alternatives: There are no approved drugs for FTD. Antidepressants or antipsychotics are sometimes used for symptoms like aggression or compulsions, but they come with risks - drowsiness, falls, even early death in older adults.
2. Low risk: Memantine is generally well-tolerated. Side effects? Mild dizziness, headache, or constipation. Rarely serious. That makes it safer than many alternatives.
3. Hope: Families are desperate. Doctors are too. When there’s no clear path forward, trying something with low risk feels better than doing nothing.

It’s not about false hope. It’s about managing a disease with no playbook. If a drug doesn’t hurt and might help - even a little - some doctors will try it.

What Are the Realistic Expectations?

If you’re considering memantine for someone with FTD, here’s what you should expect:

• Not a cure: It won’t stop the disease from progressing.
• Not a magic fix: Don’t expect personality to return to normal. Don’t expect speech to improve dramatically.
• Small changes only: Maybe agitation drops by 20%. Maybe they sleep a little better. Maybe they stop pulling at their clothes constantly.
• Take time: It can take 8-12 weeks to see any effect, if there is one.
• Stop if nothing changes: If there’s no improvement after three months, it’s unlikely to help. Keep taking it just because “it’s been a while” isn’t a good reason.

Some families keep memantine going for years hoping for a breakthrough. But if it’s not helping, continuing it adds cost and risk - even small ones - for no clear benefit.

What Else Can You Try?

Since memantine’s role is uncertain, focus on what actually improves quality of life:

• Behavioral strategies: Use routines. Reduce noise and clutter. Avoid arguing. Redirect instead of correcting. These are more effective than any drug.
• Speech therapy: For those with language loss, simple tools like picture boards or apps can restore communication.
• Occupational therapy: Helps with daily tasks - dressing, eating, bathing - and adapts the home to reduce confusion.
• Support groups: FTD is isolating. Families need others who get it. Groups like the Association for Frontotemporal Degeneration offer resources and community.
• Medications for symptoms: SSRIs like sertraline may help with compulsive behaviors. Low-dose antipsychotics like quetiapine can calm aggression - but only as a last resort and under close watch.

These don’t stop FTD. But they make life easier - for the person with dementia and for the people caring for them.

Where Is the Research Headed?

Scientists are working on new treatments. Several drugs targeting tau protein buildup are in early trials. Others aim to boost brain repair or reduce inflammation. Gene therapies are being explored for FTD caused by inherited mutations.

But none are close to market. And none will help the millions already living with FTD today. That’s why memantine remains in use - not because it’s proven, but because the alternatives are worse.

The real breakthrough won’t come from repurposing Alzheimer’s drugs. It will come from understanding FTD as its own disease - not a cousin of Alzheimer’s, but something different. And that’s starting to happen. More research is now focused specifically on FTD, not lumped in with other dementias.

Final Thoughts

Memantine isn’t a solution for frontotemporal dementia. But it’s not useless either. For some families, it’s a quiet tool - one that might ease a rough edge, reduce a scream, or give a moment of calm. It’s not science. It’s care.

If you’re considering it, talk to your neurologist. Ask: What are we hoping to change? What’s the plan if it doesn’t work? What are we willing to accept? There’s no right answer. But asking the questions matters more than taking the pill.