Sodium selenate: A promising treatment for dementia
Twelve patients with bvFTD were treated with sodium selenate (15mg tds) for twelve months. Participants underwent a cognitive and behavioural battery, MRI, lumbar puncture and safety assessments at screening, baseline, and at regular intervals following treatment commencement. Adverse events were monitored via diary cards between clinic visits.

All 12 patients completed the study. Safety analysis found that sodium selenate was safe and well tolerated, with no study withdrawals. Commonly reported mild-moderate adverse events were nail changes (n=6), muscles aches (n=4), headache, fatigue, hair loss and fall (n=3). Five patients reduced their dose to 10mg tds due to adverse events. No treatment-related serious adverse events occurred. Analyses of efficacy data are ongoing. A mixed-effects analysis showed an overall small but significant decline on cognition and behaviour, including total NUCOG score (b=-0.18, 95% CI=-0.28–0.08) Cambridge Behavioural Index (b=0.32, 95% CI=0.18-0.46) and Carer Burden Scale score (b=0.1, 95% CI = 0.02-0.18). Percentage change in whole-brain volume from baseline to week 52 ranged from -0.26% to -6.51% (n=7 >-1.8%, n=4 <-1.8%). Plasma tau levels (n=6) did not change from baseline (3.73±0.26pg/mL) to week 52 (4.66±0.24pg/mL). CSF tau also showed no change from baseline (167.8±11.2pg/mL) to week 52 (156.1±2.49pg/mL). Although not significant, the directional changes are in line with the proposed mechanism of sodium selenate. Exploratory analyses of “responders” (brain volume change >-1.8%, n=7) found no change in NUCOG total score (b=-0.03, 95% CI -0.14-0.07) or CBS score (b=-0.05, 95% CI -0.04-0.13) over time.

Sodium selenate is safe and well tolerated in patients with bvFTD. Exploratory analyses indicate it may reduce atrophy and halt cognitive decline in a subset of bvFTD patients. Sodium selenate should be further investigated as a potential treatment for bvFTD, and biomarkers to identify the subset of “responder” patients explored.