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Haeger A, Muising J, Romanzetti S, Fimm B, Matz O, Schulz JB, Heim S, Reetz K. Communicative impairment and its neural correlates in Alzheimer's disease and frontotemporal dementia. Brain Behav 2024; 14:e3420. [PMID: 38494763 PMCID: PMC10945087 DOI: 10.1002/brb3.3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Communication skills can deteriorate in neurodegenerative diseases such as Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, their clinical assessment and treatment in patient care can be challenging. In the present study, we aimed to quantify the distinctive communication resources and barriers reported by patients and their relatives in AD and FTD and associated these communicative characteristics with clinical parameters, such as the degree of cognitive impairment and atrophy in language-associated brain areas. METHODS We assessed self-reported communication barriers and resources in 33 individuals with AD and FTD through an interview on daily-life communication, using the Aachener KOMPASS questionnaire. We correlated reported communication barriers and resources with atrophy from high-resolution 3T brain magnetic resonance imaging, neuropsychological assessment, and neurodegenerative markers from cerebrospinal fluid. RESULTS Communicative impairment was higher in FTD compared to AD. Increased reported communication barriers in our whole sample were associated with the atrophy rate in the left middle temporal lobe, a critical site within the neuronal language network, and with depressive symptoms as well as the semantic word fluency from neuropsychological assessment. The best model for prediction of communicative impairment included the diagnosis (AD or FTD), semantic word fluency, and depressive symptoms. CONCLUSIONS Our study demonstrates that communication barriers and resources can be successfully assessed via a structured interview based on self-report and report of patients' relatives in practice and are reflected in neuroimaging specific for AD and FTD as well as in further clinical parameters specific for these neurodegenerative diseases. This can potentially open new treatment options for clinical practice and patient care.
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Affiliation(s)
- Alexa Haeger
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Janka Muising
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Sandro Romanzetti
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Bruno Fimm
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Oliver Matz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Jörg B. Schulz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Stefan Heim
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- Institute of Neuroscience and Medicine (INM‐1)Research Centre JülichJülichGermany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Kathrin Reetz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
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Stam D, Rosseel S, De Winter FL, Van den Bossche MJA, Vandenbulcke M, Van den Stock J. Facial expression recognition deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic investigation of effects of phenotypic variant, task modality, geographical region and symptomatic specificity. J Neurol 2023; 270:5731-5755. [PMID: 37672106 DOI: 10.1007/s00415-023-11927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023]
Abstract
Deficits in social cognition may be present in frontotemporal dementia (FTD) and Alzheimer's disease (AD). Here, we conduct a qualitative synthesis and meta-analysis of facial expression recognition studies in which we compare the deficits between both disorders. Furthermore, we investigate the specificity of the deficit regarding phenotypic variant, domain-specificity, emotion category, task modality, and geographical region. The results reveal that both FTD and AD are associated with facial expression recognition deficits, that this deficit is more pronounced in FTD compared to AD and that this applies for the behavioral as well as for language FTD-variants, with no difference between the latter two. In both disorders, overall emotion recognition was most frequently impaired, followed by recognition of anger in FTD and by fear in AD. Verbal categorization was the most frequently used task, although matching or intensity rating tasks may be more specific. Studies from Oceania revealed larger deficits. On the other hand, non-emotional control tasks were more impacted by AD than by FTD. The present findings sharpen the social cognitive phenotype of FTD and AD, and support the use of social cognition assessment in late-life neuropsychiatric disorders.
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Affiliation(s)
- Daphne Stam
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
| | - Simon Rosseel
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
| | - François-Laurent De Winter
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Maarten J A Van den Bossche
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium.
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium.
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Chatzidimitriou E, Ioannidis P, Aretouli E, Papaliagkas V, Moraitou D. Correlates of Functional Impairment in Patients with the Behavioral Variant of Frontotemporal Dementia: A PRISMA-Compliant Systematic Review. Int J Mol Sci 2023; 24:13810. [PMID: 37762113 PMCID: PMC10531075 DOI: 10.3390/ijms241813810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The behavioral variant of frontotemporal dementia (bvFTD) has a devastating effect on multiple domains of daily living. The purpose of this PRISMA-compliant systematic review is to summarize the most important factors associated with functional impairment in this clinical group by critically analyzing the existing literature spanning the period from 2000 to 2023. To be included in the review, a study had to investigate any kind of correlates of functional status in bvFTD patients, using a previously validated instrument of functional assessment. Out of 40 articles assessed for eligibility, 18 met the inclusion criteria. The anatomical pattern of cerebral atrophy at baseline appeared to be the strongest predictor of the rate of functional decline over time, with the frontal-dominant anatomical subtype being associated with a faster rate of functional impairment. Additionally, executive dysfunction as well as apathy appeared to contribute significantly to functional disability in bvFTD patients. A comparative examination of bvFTD in relation to other clinical subtypes of FTD and other types of dementia in general suggests that it is the predominant atrophy of the frontal lobes along with the subsequent unique combination of cognitive and neuropsychiatric manifestations that account for the pronounced functional limitations observed in these individuals, even from the early stages of the disease.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece;
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI-AUTH), Balcan Center, Buildings A & B, 57001 Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B’ Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH), 54124 Thessaloniki, Greece
| | - Eleni Aretouli
- Department of Psychology, School of Social Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Alexandrion University Campus, 57400 Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece;
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI-AUTH), Balcan Center, Buildings A & B, 57001 Thessaloniki, Greece
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Cozza M, Boccardi V. A narrative review on mild behavioural impairment: an exploration into its scientific perspectives. Aging Clin Exp Res 2023; 35:1807-1821. [PMID: 37392350 DOI: 10.1007/s40520-023-02472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
In clinical practice, the admission of patients with late-onset psychological and behavioural symptoms is frequent, regardless of the presence or absence of cognitive decline. These symptoms commonly occur in the prodromal stage of dementia and can precede the onset of dementia. While the concept of Mild Cognitive Impairment (MCI) -which is defined as a level of cognitive impairment insufficient to impact daily functioning- is well established, the notion of Mild Behavioural Impairment (MBI) is not yet widely recognized. However, studies have demonstrated that the presence of MBI in both cognitively normal patients and individuals with MCI is associated with an increased risk of dementia progression. Thus, MBI may serve as a neurobehavioral indicator of pre-dementia risk states. This narrative review aims to discuss the evolution of the term, the relevant clinical aspects, and potential biomarkers that may contribute to the clinical definition of MBI. The objective is to assist clinicians in recognizing the diagnosis and differentiating it from psychiatric syndromes, as well as identifying possible etiologies of neurodegeneration.
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Affiliation(s)
- Mariagiovanna Cozza
- Department of Integration, Intermediate Care Programme, AUSL Bologna, Bologna, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Gambuli 1, 06132, Perugia, Italy.
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Chatzidimitriou E, Ioannidis P, Moraitou D, Konstantinopoulou E, Aretouli E. The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study. Front Hum Neurosci 2023; 17:1087765. [PMID: 36923586 PMCID: PMC10009888 DOI: 10.3389/fnhum.2023.1087765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Objective: Frontotemporal dementia (FTD) impinges significantly on cognition, behavior, and everyday functioning. Goal of the present study is the detailed description of behavioral disturbances and functional limitations, as well as the investigation of associations between cognition, behavior, and functional impairment among FTD patients. Given the importance of maintaining a satisfying functional status as long as possible, this study also aims to identify the cognitive correlates of compensatory strategy use in this clinical group. Methods: A total of 13 patients diagnosed with FTD (behavioral variant FTD = 9, non-fluent variant primary progressive aphasia = 3, semantic dementia = 1) were administrated a broad range of neuropsychological tests for the assessment of different cognitive abilities. Behavioral symptomatology and performance on everyday activities were rated with informant-based measures. Descriptive statistics were used for the delineation of behavioral and functional patterns, whereas stepwise multiple regression analyses were performed to identify associations between cognition, behavior, and functional status. Results: Negative symptoms, especially apathy, were found to predominate in the behavior of FTD patients. Instrumental tasks, such as housework and leisure activities, appeared to be the most impaired functional domains. Working memory was the strongest cognitive correlate of performance across various domains of everyday functioning, whereas working memory along with short-term verbal memory accounted for a great proportion of variance in compensatory strategy use. Behavioral disturbances and especially negative symptoms were also found to contribute significantly to functional impairment in FTD. Conclusions: Executive dysfunction, as well as behavioral disturbances contribute significantly to functional disability in FTD. Early interventions tailored at these domains may have the potential to improve functional outcomes and delay the rate of functional decline among FTD patients.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Konstantinopoulou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- School of Psychology, University of Ioannina, Ioannina, Greece
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Setién-Suero E, Murillo-García N, Sevilla-Ramos M, Abreu-Fernández G, Pozueta A, Ayesa-Arriola R. Exploring the Relationship Between Deficits in Social Cognition and Neurodegenerative Dementia: A Systematic Review. Front Aging Neurosci 2022; 14:778093. [PMID: 35572150 PMCID: PMC9093607 DOI: 10.3389/fnagi.2022.778093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNeurodegenerative diseases might affect social cognition in various ways depending on their components (theory of mind, emotional processing, attribution bias, and social perception) and the subtype of dementia they cause. This review aims to explore this difference in cognitive function among individuals with different aetiologies of dementia.MethodsThe following databases were explored: MEDLINE via PubMed, Cochrane Library, Lilacs, Web of Science, and PsycINFO. We selected studies examining social cognition in individuals with neurodegenerative diseases in which dementia was the primary symptom that was studied. The neurodegenerative diseases included Alzheimer's disease, Lewy body disease and frontotemporal lobar degeneration. The search yielded 2,803 articles.ResultsOne hundred twenty-two articles were included in the present review. The summarised results indicate that people with neurodegenerative diseases indeed have deficits in social cognitive performance. Both in populations with Alzheimer's disease and in populations with frontotemporal dementia, we found that emotional processing was strongly affected. However, although theory of mind impairment could also be observed in the initial stages of frontotemporal dementia, in Alzheimer's disease it was only appreciated when performing highly complex task or in advanced stages of the disease.ConclusionsEach type of dementia has a differential profile of social cognition deterioration. This review could provide a useful reference for clinicians to improve detection and diagnosis, which would undoubtedly guarantee better interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020152562, PROSPERO, identifier: CRD42020152562.
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Affiliation(s)
- Esther Setién-Suero
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
- *Correspondence: Esther Setién-Suero ; orcid.org/0000-0002-8027-6546
| | - Nancy Murillo-García
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | | | - Georgelina Abreu-Fernández
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Ana Pozueta
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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Kreilaus F, Przybyla M, Ittner L, Karl T. Cannabidiol (CBD) treatment improves spatial memory in 14-month-old female TAU58/2 transgenic mice. Behav Brain Res 2022; 425:113812. [PMID: 35202719 DOI: 10.1016/j.bbr.2022.113812] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 12/29/2022]
Abstract
Frontotemporal dementia (FTD) and Alzheimer's disease (AD) share the pathological hallmark of intracellular neurofibrillary tangles, which result from the hyperphosphorylation of microtubule associated protein tau. The P301S mutation in human tau carried by TAU58/2 transgenic mice results in brain pathology and behavioural deficits relevant to FTD and AD. The phytocannabinoid cannabidiol (CBD) exhibits properties beneficial for multiple pathological processes evident in dementia. Therefore, 14-month-old female TAU58/2 transgenic and wild type-like (WT) littermates were treated with 100mg/kg CBD or vehicle i.p. starting three weeks prior to conducting behavioural paradigms relevant to FTD and AD. TAU58/2 females exhibited impaired motor function, reduced bodyweight and less anxiety behaviour compared to WT. An impaired spatial reference memory of vehicle-treated transgenic mice were restored by chronic CBD treatment. Chronic CBD also reduced anxiety-like behaviors and decreased contextual fear-associated freezing in all mice. Chronic remedial CBD treatment ameliorated several disease-relevant phenotypes in 14-month-old TAU58/2 transgenic mice, suggesting potential for the treatment of tauopathy-related behavioural impairments including cognitive deficits.
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Affiliation(s)
- Fabian Kreilaus
- School of Medicine, Western Sydney University, NSW 2560, Australia
| | - Magdalena Przybyla
- Dementia Research Centre, Faculty of Medicine and Health Sciences, Macquarie University, NSW 2109, Australia
| | - Lars Ittner
- Dementia Research Centre, Faculty of Medicine and Health Sciences, Macquarie University, NSW 2109, Australia
| | - Tim Karl
- School of Medicine, Western Sydney University, NSW 2560, Australia; Neuroscience Research Australia (NeuRA), NSW 2031, Australia; School of Medical Sciences, University of New South Wales, NSW 2052, Australia.
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Musa Salech G, Lillo P, van der Hiele K, Méndez-Orellana C, Ibáñez A, Slachevsky A. Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia. Front Neurol 2022; 12:734251. [PMID: 35095710 PMCID: PMC8792989 DOI: 10.3389/fneur.2021.734251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD. Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology-Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables. Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = -0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001). Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.
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Affiliation(s)
- Gada Musa Salech
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Institute of Biomedical Sciences (ICBM), Neurosciences Department, East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Departamento de Neurología, Clínica Universidad de los Andes, Santiago, Chile
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Department of Neurology South, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - Karin van der Hiele
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | | | - Agustín Ibáñez
- Cognitive Neuroscience Center (CNC), National Scientific and Technical Research Council (CONICET), Universidad de San Andrés, Buenos Aires, Argentina
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Institute of Biomedical Sciences (ICBM), Neurosciences Department, East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Department of Neurology, Hospital del Salvador & University of Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Abstract
Dementia is a syndrome characterized by a gradually progressive course that spans a continuum from preclinical symptoms to major impairment in two or more cognitive domains with functional decline. In this review, the author examines some of the more common dementia syndromes from among dozens of different diseases. Findings show that as the U.S. population continues to age, the number of Americans with dementia is expected to rise drastically over the next several decades. This upsurge will contribute to increased health care costs and will have a significant public health impact. Neurodegenerative disorders such as Alzheimer's disease, frontotemporal degeneration, and alpha-synucleinopathies (e.g., Lewy body disease and Parkinson's disease) are some of the more prevalent causes for dementia. In recent years, advancements in neuroimaging, understanding of genetic contributions and pathological changes, and the development of novel biomarkers have fueled clinical understanding of these disorders. However, substantial disease-modifying therapies are still lagging. The advent of future interventions hinges on the ability to discern the distinct clinico-pathologic profiles of the various dementia syndromes and to identify reliable biomarkers for utilization in clinical trials.
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Affiliation(s)
- Kristin C Jones
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston
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11
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Mariano LI, Caramelli P, Guimarães HC, Gambogi LB, Moura MVB, Yassuda MS, Teixeira AL, de Souza LC. Can Social Cognition Measurements Differentiate Behavioral Variant Frontotemporal Dementia from Alzheimer's Disease Regardless of Apathy? J Alzheimers Dis 2021; 74:817-827. [PMID: 32116247 DOI: 10.3233/jad-190861] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) share cognitive and behavioral symptoms, such as apathy. Social cognition measurements are useful in distinguishing bvFTD from AD, but their accuracies may be affected by apathy. OBJECTIVE To investigate whether social cognition measurements can distinguish bvFTD from either apathetic or non-apathetic AD patients. METHODS Three groups of participants were enrolled in the present study: bvFTD (n = 22), AD (n = 20), and healthy controls (HC, n = 23). The AD group was divided into apathetic (n = 10) and non-apathetic (n = 10). All subjects underwent comprehensive neuropsychological examination, including the short version of the Social and Emotional Assessment (Mini-SEA), which comprises the facial emotion recognition test and the faux-pas recognition test (Faux-Pas Test). Apathy was assessed according to the Starkstein's Apathy (SA) Scale. RESULTS The bvFTD and AD groups did not differ on global cognitive efficiency and on executive functions. In comparison to the whole AD group, bvFTD displayed lower Faux-Pas Test and Mini-SEA scores. Both AD subgroups, apathetic or non-apathetic, exhibited similar performance on all social cognition measurements. In comparison to either apathetic AD or non-apathetic AD, bvFTD patients underperformed on the Faux-Pas Test and on the Mini-SEA. The area under the curve values for the Mini-SEA total score were 0.87 (bvFTD versus AD), 0.90 (bvFTD versus apathetic AD), and 0.83 (bvFTD versus non-apathetic AD). CONCLUSION Social cognition tests provide accurate distinction between bvFTD against either apathetic AD or non-apathetic AD. Social cognition measurements did not correlate with apathy severity.
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Affiliation(s)
- Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Pampulha, Belo Horizonte, Minas Gerais (MG), Brazil.,Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Pampulha, Belo Horizonte, Minas Gerais (MG), Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Henrique Cerqueira Guimarães
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Pampulha, Belo Horizonte, Minas Gerais (MG), Brazil
| | - Leandro Boson Gambogi
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Pampulha, Belo Horizonte, Minas Gerais (MG), Brazil
| | | | - Mônica Sanches Yassuda
- Grupo de Neurologia Cognitiva e do Comportamento (GNCC), Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo, SP, Brazil.,Programa de Pós-Graduação em Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antônio Lúcio Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Santa Casa BH Ensino e Pesquisa, Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Pampulha, Belo Horizonte, Minas Gerais (MG), Brazil.,Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
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12
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Russell LL, Greaves CV, Convery RS, Nicholas J, Warren JD, Kaski D, Rohrer JD. Novel instructionless eye tracking tasks identify emotion recognition deficits in frontotemporal dementia. ALZHEIMERS RESEARCH & THERAPY 2021; 13:39. [PMID: 33557926 PMCID: PMC7871635 DOI: 10.1186/s13195-021-00775-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022]
Abstract
Background Current tasks measuring social cognition are usually ‘pen and paper’ tasks, have ceiling effects and include complicated test instructions that may be difficult to understand for those with cognitive impairment. We therefore aimed to develop a set of simple, instructionless, quantitative, tasks of emotion recognition using the methodology of eye tracking, with the subsequent aim of assessing their utility in individuals with behavioural variant frontotemporal dementia (bvFTD). Methods Using the Eyelink 1000 Plus eye tracker, 18 bvFTD and 22 controls completed tasks of simple and complex emotion recognition that involved viewing four images (one target face (simple) or pair of eyes (complex) and the others non-target) followed by a target emotion word and lastly the original four images alongside the emotion word. A dwell time change score was then calculated as the main outcome measure by subtracting the percentage dwell time for the target image before the emotion word appeared away from the percentage dwell time for the target image after the emotion word appeared. All participants also underwent a standard cognitive battery and volumetric T1-weighted magnetic resonance imaging. Results Analysis using a mixed effects model showed that the average (standard deviation) mean dwell time change score in the target interest area was 35 (27)% for the control group compared with only 4 (18)% for the bvFTD group (p < 0.05) for the simple emotion recognition task, and 15 (26)% for the control group compared with only 2 (18)% for the bvFTD group (p < 0.05) for the complex emotion recognition task. Worse performance in the bvFTD group correlated with atrophy in the right ventromedial prefrontal and orbitofrontal cortices, brain regions previously implicated in social cognition. Conclusions In summary, eye tracking is a viable tool for assessing social cognition in individuals with bvFTD, being well-tolerated and able to overcome some of the problems associated with standard psychometric tasks. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00775-x.
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Affiliation(s)
- Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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13
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Malpetti M, Jones PS, Tsvetanov KA, Rittman T, van Swieten JC, Borroni B, Sanchez-Valle R, Moreno F, Laforce R, Graff C, Synofzik M, Galimberti D, Masellis M, Tartaglia MC, Finger E, Vandenberghe R, de Mendonça A, Tagliavini F, Santana I, Ducharme S, Butler CR, Gerhard A, Levin J, Danek A, Otto M, Frisoni GB, Ghidoni R, Sorbi S, Heller C, Todd EG, Bocchetta M, Cash DM, Convery RS, Peakman G, Moore KM, Rohrer JD, Kievit RA, Rowe JB, Genfi GFI. Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimers Dement 2020; 17:969-983. [PMID: 33316852 PMCID: PMC8247340 DOI: 10.1002/alz.12252] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022]
Abstract
Introduction Apathy adversely affects prognosis and survival of patients with frontotemporal dementia (FTD). We test whether apathy develops in presymptomatic genetic FTD, and is associated with cognitive decline and brain atrophy. Methods Presymptomatic carriers of MAPT, GRN or C9orf72 mutations (N = 304), and relatives without mutations (N = 296) underwent clinical assessments and MRI at baseline, and annually for 2 years. Longitudinal changes in apathy, cognition, gray matter volumes, and their relationships were analyzed with latent growth curve modeling. Results Apathy severity increased over time in presymptomatic carriers, but not in non‐carriers. In presymptomatic carriers, baseline apathy predicted cognitive decline over two years, but not vice versa. Apathy progression was associated with baseline low gray matter volume in frontal and cingulate regions. Discussion Apathy is an early marker of FTD‐related changes and predicts a subsequent subclinical deterioration of cognition before dementia onset. Apathy may be a modifiable factor in those at risk of FTD.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | | | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Raquel Sanchez-Valle
- Alzheimer's disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Fermin Moreno
- Department of Neurology, Cognitive Disorders Unit, Donostia Universitary Hospital, San Sebastian, Spain.,Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Caroline Graff
- Department of Neurobiology Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Bioclinicum, Karolinska Institutet, Solna, Sweden.,Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Galimberti
- Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy.,Centro Dino Ferrari, University of Milan, Milan, Italy
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Neurology Service, University Hospitals Leuven, Leuven, Belgium.,KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | | | | | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Québec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg- Essen, Duisburg, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sandro Sorbi
- Department of Neuroscience Psychology Drug Research and Child Health, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Carolin Heller
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Emily G Todd
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martina Bocchetta
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David M Cash
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rhian S Convery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Georgia Peakman
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Katrina M Moore
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rogier A Kievit
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Cognitive Neuroscience Department, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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14
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Su FT, Tai CH, Tan CH, Hwang WJ, Yu RL. The Development of the Social Functioning Scale for Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:1143-1151. [PMID: 32444559 DOI: 10.3233/jpd-201930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social functioning is crucial for the determinants of Parkinson's disease (PD) with dementia; however, there is no social functioning scale applicable to PD. OBJECTIVE This study aimed to develop a social functioning scale specific to PD (PDSFS) and provide a cut-off score to improve diagnosis accuracy. METHODS The items were developed through literature, interview patients, and PD expertise. After the pilot study, one hundred fifty-seven patients and 74 healthy participants were enrolled and completed the Mini-Mental State Examination, Clock Drawing Test, Activities of Daily Living, Neuropsychiatric Inventory, Adaptive Behavior Assessment System-Second Edition (ABAS-II) and part III of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The final PDSFS has 23 items. The exploratory factor analysis revealed three factors, including "Family Life, Hobbies and Self-Care", "Interpersonal Relationship and Recreational Leisure", and "Social Bond". The internal consistency coefficient was 0.883, and the test-retest reliability was 0.774, respectively. The total score of the PDSFS was significantly related to the total score of ABAS-II (r = 0.609, p < 0.001), and was not correlated with the third part of MDS-UPDRS (p = 0.736). A significant intergroup difference was found (p < 0.001), and the healthy controls had the highest PDSFS score, followed by non-demented PD and PD dementia. The optimal cut-off score for PD patients with dementia was 39 (sensitivity: 0.735; specificity: 0.857). CONCLUSIONS PDSFS is a practical and psychometrically sound tool to access the social functioning of the PD population.
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Affiliation(s)
- Fang-Te Su
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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15
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Abstract
Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person's ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.
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Affiliation(s)
- Gabriele Cipriani
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy.,MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
| | - Sabrina Danti
- PhD, Clinical and Health Psychology Unit, Hospital of Pontedera, Pontedera (PI), Italy
| | - Lucia Picchi
- PsyD, Clinical Psychology Unit, Hospital of Leghorn, Leghorn (LI), Italy
| | - Angelo Nuti
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy
| | - Mario Di Fiorino
- MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
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16
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Guarino A, Favieri F, Boncompagni I, Agostini F, Cantone M, Casagrande M. Executive Functions in Alzheimer Disease: A Systematic Review. Front Aging Neurosci 2019; 10:437. [PMID: 30697157 PMCID: PMC6341024 DOI: 10.3389/fnagi.2018.00437] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological aging.
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Affiliation(s)
- Angela Guarino
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | | | | | - Micaela Cantone
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Rome, Italy
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17
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Yassuda MS, Lima da Silva TB, O'Connor CM, Mekala S, Alladi S, Bahia VS, Amaral-Carvalho V, Guimaraes HC, Caramelli P, Balthazar MLF, Damasceno B, Brucki SMD, Nitrini R, Hodges JR, Piguet O, Mioshi E. Apathy and functional disability in behavioral variant frontotemporal dementia. Neurol Clin Pract 2018; 8:120-128. [PMID: 29708208 DOI: 10.1212/cpj.0000000000000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke's Cognitive Examination-revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.
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Affiliation(s)
- Mônica S Yassuda
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Thais B Lima da Silva
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Claire M O'Connor
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Shailaja Mekala
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Suvarna Alladi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Valeria S Bahia
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Viviane Amaral-Carvalho
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Henrique C Guimaraes
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Paulo Caramelli
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Marcio L F Balthazar
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Benito Damasceno
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Sonia M D Brucki
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Ricardo Nitrini
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - John R Hodges
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Olivier Piguet
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
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18
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Grimm OTR LA. Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-Related Quality of Life in a Case-Study. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ijcam.2017.08.00247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Abstract
Social cognition can be impaired in a range of neuro-degenerative conditions, yet the impact of these difficulties on behaviour and social relationships is not yet fully understood. This study assessed social cognition in 27 participants with Dementia of the Alzheimer Type (DAT) and their co-residing partners (N = 27) and explored the relationships between social cognition, cognitive ability, relationship continuity and behaviour following diagnosis. In line with previous research, participants with dementia scored lower on social cognition tasks compared to their partners. Behaviour changes such as apathy, disinhibition and agitation in participants with dementia were significantly related to relationship continuity; however, no significant associations were found with measures of social cognition. The results of this study are discussed within a therapeutic context and in line with current guidelines and policies.
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20
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Moheb N, Mendez MF, Kremen SA, Teng E. Executive Dysfunction and Behavioral Symptoms Are Associated with Deficits in Instrumental Activities of Daily Living in Frontotemporal Dementia. Dement Geriatr Cogn Disord 2017; 43:89-99. [PMID: 28103593 PMCID: PMC5300022 DOI: 10.1159/000455119] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deficits in instrumental activities of daily living (ADLs) may be more prominent in behavioral variant frontotemporal dementia (bvFTD) than in nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) or semantic variant primary progressive aphasia (svPPA). It is uncertain whether frontotemporal dementia (FTD) subgroups exhibit different patterns and/or predictors of functional impairment. METHODS We examined data from participants diagnosed with bvFTD (n = 607), svPPA (n = 132), and nfvPPA (n = 155) who were included in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) and assessed with the Functional Activities Questionnaire (FAQ). Stepwise multiple linear regression analyses were performed to identify associations between FAQ scores and cognitive/behavioral deficits using the NACC UDS neuropsychological testing battery and the Neuropsychiatric Inventory Questionnaire. RESULTS FAQ scores were higher in bvFTD than svPPA or nfvPPA. Functional deficits across FTD subtypes differed in severity, but not pattern, and were driven by executive dysfunction and behavioral symptoms. CONCLUSION Executive dysfunction and behavioral symptoms underlie instrumental ADL deficits in FTD, which are most prominent in bvFTD.
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Affiliation(s)
- Negar Moheb
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA,Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA,Veterans Affairs Greater Los Angeles Healthcare System
| | - Sarah A. Kremen
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Edmond Teng
- Department of Neurology, David Geffen School of Medicine at UCLA,Veterans Affairs Greater Los Angeles Healthcare System
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21
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Spreadbury JH, Kipps CM. Measuring younger onset dementia: A comprehensive literature search of the quantitative psychosocial research. DEMENTIA 2016; 18:135-156. [PMID: 27509918 DOI: 10.1177/1471301216661427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Research is beginning to demonstrate the unique psychosocial effects of young onset dementia. Theorising remains at an early stage and there has been little discussion about measurement and methodological issues. Our aim was to conduct a comprehensive literature search of the young onset dementia psychosocial research, and to identify the domains of experience measured with patients and caregivers. METHOD We conducted a search of five electronic databases (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) using equivalent database controlled vocabulary terms. We supplemented this search by using free text searches within electronic databases, searching reference sections of salient papers, and using online search engines. We defined psychosocial as referring to patient and caregiver psychological, behavioural, and social functioning in the context of living with young onset dementia. RESULTS We identified 72 published articles, 49 quantitative and 23 qualitative. The quantitative articles form the focus of the present review. We identified 10 domains of patient experience measured and 14 domains of caregiver experience. The patient domains measured most often were behaviour, cognition, functioning, and severity, and reflected a focus on symptoms and clinical features. Quality of Life (QoL) was the patient domain measured least often. The caregiver domains measured most often were mental health and burden, and reflected a focus on psychological well-being and coping. CONCLUSION The scope of measurement is broader in caregivers than patients. QoL although under-researched may be a useful domain to measure in future research. Risk factors, measurement and methodological issues are discussed.
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Affiliation(s)
- J H Spreadbury
- Faculty of Medicine, University of Southampton, Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, UK
| | - C M Kipps
- Faculty of Medicine, University of Southampton, Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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22
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Bora E, Velakoulis D, Walterfang M. Meta-Analysis of Facial Emotion Recognition in Behavioral Variant Frontotemporal Dementia: Comparison With Alzheimer Disease and Healthy Controls. J Geriatr Psychiatry Neurol 2016; 29:205-11. [PMID: 27056068 DOI: 10.1177/0891988716640375] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/02/2016] [Indexed: 12/24/2022]
Abstract
Behavioral disturbances and lack of empathy are distinctive clinical features of behavioral variant frontotemporal dementia (bvFTD) in comparison to Alzheimer disease (AD). The aim of this meta-analytic review was to compare facial emotion recognition performances of bvFTD with healthy controls and AD. The current meta-analysis included a total of 19 studies and involved comparisons of 288 individuals with bvFTD and 329 healthy controls and 162 bvFTD and 147 patients with AD. Facial emotion recognition was significantly impaired in bvFTD in comparison to the healthy controls (d = 1.81) and AD (d = 1.23). In bvFTD, recognition of negative emotions, especially anger (d = 1.48) and disgust (d = 1.41), were severely impaired. Emotion recognition was significantly impaired in bvFTD in comparison to AD in all emotions other than happiness. Impairment of emotion recognition is a relatively specific feature of bvFTD. Routine assessment of social-cognitive abilities including emotion recognition can be helpful in better differentiating between cortical dementias such as bvFTD and AD.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Dennis Velakoulis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia Neuropsychiatry Unit, ROYAL MELBOURNE Hospital, VIC, Australia
| | - Mark Walterfang
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia Neuropsychiatry Unit, ROYAL MELBOURNE Hospital, VIC, Australia
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23
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O'Connor CM, Clemson L, Hornberger M, Leyton CE, Hodges JR, Piguet O, Mioshi E. Longitudinal change in everyday function and behavioral symptoms in frontotemporal dementia. Neurol Clin Pract 2016; 6:419-428. [PMID: 27847684 PMCID: PMC5100706 DOI: 10.1212/cpj.0000000000000264] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The relationship between behavioral changes and functional decline in frontotemporal dementia (FTD) is not well understood. Methods: Thirty-nine patients (21 behavioral variant FTD [bvFTD], 18 semantic variant primary progressive aphasia [svPPA]) were followed up longitudinally (2–4 years follow-up). Functional (Disability Assessment for Dementia) and behavioral (Cambridge Behavioural Inventory Revised) assessments were included for between-group (pairwise comparisons, mixed model analysis) and within-group analyses (bivariate correlations). Results: Functionally, patients with bvFTD were more impaired than patients with svPPA at baseline and continued to be at follow-up, despite similar disease duration. By contrast, behavioral impairments differed between patient groups at baseline and at follow-up. At baseline, patients with bvFTD exhibited higher levels of apathy and changes in eating than patients with svPPA; disinhibited and stereotypical behaviors were similar. Over the years, patients with bvFTD showed reduction in disinhibition and stereotypical behavior while apathy and eating changes increased. By contrast, all measured behaviors increased in patients with svPPA over time. Finally, only apathy made longitudinal contributions to functional disability in patients with svPPA, whereas apathy and stereotypical behavior were associated with increased disability in patients with bvFTD. Conclusions: Despite shared overlapping baseline behavioral symptoms, patients with bvFTD are more functionally impaired than patients with svPPA. Apathy has a strong role in disability for both bvFTD and svPPA, but stereotypical behaviors only contributed to functional deficits in patients with bvFTD. Our findings suggest that rigid/compulsive behaviors may in fact support activity engagement in patients with svPPA. Taken together, our results indicate that interventions to reduce disability in the FTD spectrum require an alternative rationale in comparison to Alzheimer disease dementia, and should carefully weigh the interaction of behavioral symptoms and functional status.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Michael Hornberger
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Cristian E Leyton
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - John R Hodges
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Olivier Piguet
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Eneida Mioshi
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
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Panchal H, Paholpak P, Lee G, Carr A, Barsuglia JP, Mather M, Jimenez E, Mendez MF. Neuropsychological and Neuroanatomical Correlates of the Social Norms Questionnaire in Frontotemporal Dementia Versus Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2016; 31:326-32. [PMID: 26646114 PMCID: PMC10852706 DOI: 10.1177/1533317515617722] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditional neuropsychological batteries may not distinguish early behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's disease (AD) without the inclusion of a social behavioral measure. We compared 33 participants, 15 bvFTD, and 18 matched patients with early-onset AD (eAD), on the Social Norms Questionnaire (SNQ), neuropsychological tests and 3-dimensional T1-weighted magnetic resonance imaging (MRI). The analyses included correlations of SNQ results (total score, overendorsement or "overadhere" errors, and violations or "break" errors) with neuropsychological results and tensor-based morphometry regions of interest. Patients with BvFTD had significantly lower SNQ total scores and higher overadhere errors than patients with eAD. On neuropsychological measures, the SNQ total scores correlated significantly with semantic knowledge and the overadhere subscores with executive dysfunction. On MRI analysis, the break subscores significantly correlated with lower volume of lateral anterior temporal lobes (aTL). The results also suggest that endorsement of social norm violations corresponds to the role of the right aTL in social semantic knowledge.
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Affiliation(s)
- Hemali Panchal
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA Department of Psychiatry, Khon Kaen University, Khon Khaen, Thailand
| | - Grace Lee
- Department of Psychology, School of Behavioral Health, Loma Linda, CA, USA
| | - Andrew Carr
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Michelle Mather
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, Los Angeles, CA, USA Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, USA
| | - Mario F Mendez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, Los Angeles, CA, USA Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, USA
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25
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Klimkowicz-Mrowiec A, Krzywoszanski L, Szyper-Maciejewska A, Dziedzic T, Pera J, Slowik A. Emotional Decoding Abilities Do Not Influence Neuropsychiatric Disturbances in Patients With Frontotemporal Dementia. J Geriatr Psychiatry Neurol 2016; 29:108-12. [PMID: 26232407 DOI: 10.1177/0891988715598230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ability to accurately recognize emotional information belongs to very important interpersonal communication skills in humans. Disturbance of emotional processing is present in behavioral variant of frontotemporal dementia (bvFTD), and the severity of pathological behavior may be linked to misunderstanding of other people's emotions. In our study, we examined hypothesis that patients with worse ability to decode emotions have more behavioral and psychopathological disturbances--the most challenging manifestations of dementia--than those who decode emotions better. We were not able to prove this hypothesis. The ability to decode emotions in patients with bvFTD did not influenced their behavior.
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Affiliation(s)
| | | | | | - Tomasz Dziedzic
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Joanna Pera
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
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26
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Massimo L, Powers JP, Evans LK, McMillan CT, Rascovsky K, Eslinger P, Ersek M, Irwin DJ, Grossman M. Apathy in Frontotemporal Degeneration: Neuroanatomical Evidence of Impaired Goal-directed Behavior. Front Hum Neurosci 2015; 9:611. [PMID: 26617508 PMCID: PMC4639601 DOI: 10.3389/fnhum.2015.00611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Background: Apathy, the major manifestation of impaired goal-directed behavior (GDB), is the most common neuropsychiatric syndrome associated with behavioral variant frontotemporal degeneration (bvFTD). The behavioral and biological mechanisms of apathy, however, are not well understood. We hypothesized that GDB has multiple components—including at least initiation, planning and motivation—and that GDB is supported by a network of multiple frontal brain regions. In this study, we examined this hypothesis by evaluating the selective breakdown of GDB in bvFTD, and relating these deficits to gray matter (GM) atrophy and white matter (WM) integrity. Methods: Eighteen apathetic bvFTD participants and 17 healthy controls completed the Philadelphia Apathy Computerized Test (PACT). This test quantifies each of three components of GDB hypothesized to contribute to apathy. We then used regression analyses to relate PACT scores to GM atrophy and reduced white matter (WM) fractional anisotropy (FA) in bvFTD. Results: Compared to controls, bvFTD participants demonstrated significant impairments in each of the three hypothesized components of GDB that contribute to apathy. Regression analyses related each component to disease in specific GM structures and associated WM tracts. Poor initiation thus was related to GM atrophy in anterior cingulate and reduced FA in the cingulum. Planning impairment was related to GM atrophy in dorsolateral prefrontal cortex and reduced FA in superior longitudinal fasciculus. Poor motivation was related to GM atrophy in orbitofrontal cortex (OFC) and reduced FA in uncinate fasciculus (UNC). Conclusions: bvFTD patients have difficulty with initiation, planning and motivation components of GDB. These findings are consistent with the hypotheses that GDB encompasses at least three processes, that these are supported by a large-scale neural network within specific portions of the frontal lobe, and that degradation of any one of these prefrontal regions in bvFTD may contribute to apathy.
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Affiliation(s)
- Lauren Massimo
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA ; School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - John P Powers
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Lois K Evans
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - Corey T McMillan
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Paul Eslinger
- Department of Neurology, Penn State Hershey Milton S. Hershey Medical Center Hershey, PA, USA
| | - Mary Ersek
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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Cerami C, Dodich A, Iannaccone S, Marcone A, Lettieri G, Crespi C, Gianolli L, Cappa SF, Perani D. Right Limbic FDG-PET Hypometabolism Correlates with Emotion Recognition and Attribution in Probable Behavioral Variant of Frontotemporal Dementia Patients. PLoS One 2015; 10:e0141672. [PMID: 26513651 PMCID: PMC4626030 DOI: 10.1371/journal.pone.0141672] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/12/2015] [Indexed: 02/01/2023] Open
Abstract
The behavioural variant of frontotemporal dementia (bvFTD) is a rare disease mainly affecting the social brain. FDG-PET fronto-temporal hypometabolism is a supportive feature for the diagnosis. It may also provide specific functional metabolic signatures for altered socio-emotional processing. In this study, we evaluated the emotion recognition and attribution deficits and FDG-PET cerebral metabolic patterns at the group and individual levels in a sample of sporadic bvFTD patients, exploring the cognitive-functional correlations. Seventeen probable mild bvFTD patients (10 male and 7 female; age 67.8±9.9) were administered standardized and validated version of social cognition tasks assessing the recognition of basic emotions and the attribution of emotions and intentions (i.e., Ekman 60-Faces test-Ek60F and Story-based Empathy task-SET). FDG-PET was analysed using an optimized voxel-based SPM method at the single-subject and group levels. Severe deficits of emotion recognition and processing characterized the bvFTD condition. At the group level, metabolic dysfunction in the right amygdala, temporal pole, and middle cingulate cortex was highly correlated to the emotional recognition and attribution performances. At the single-subject level, however, heterogeneous impairments of social cognition tasks emerged, and different metabolic patterns, involving limbic structures and prefrontal cortices, were also observed. The derangement of a right limbic network is associated with altered socio-emotional processing in bvFTD patients, but different hypometabolic FDG-PET patterns and heterogeneous performances on social tasks at an individual level exist.
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Affiliation(s)
- Chiara Cerami
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
- * E-mail:
| | - Alessandra Dodich
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Iannaccone
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
| | - Alessandra Marcone
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
| | | | - Chiara Crespi
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, San Raffaele Hospital, Milan, Italy
| | - Stefano F. Cappa
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- NeTS Center, Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Nuclear Medicine Department, San Raffaele Hospital, Milan, Italy
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Kamminga J, Kumfor F, Burrell JR, Piguet O, Hodges JR, Irish M. Differentiating between right-lateralised semantic dementia and behavioural-variant frontotemporal dementia: an examination of clinical characteristics and emotion processing. J Neurol Neurosurg Psychiatry 2015; 86:1082-8. [PMID: 25511791 DOI: 10.1136/jnnp-2014-309120] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Right-lateralised semantic dementia (right SD) and behavioural-variant frontotemporal dementia (bvFTD) appear clinically similar, despite different patterns of underlying brain changes. This study aimed to elucidate distinguishing clinical and cognitive features in right SD versus bvFTD, emphasising emotion processing and its associated neural correlates. METHODS 12 patients with right SD and 19 patients with bvFTD were recruited. Clinical features were documented. All patients were assessed on standardised neuropsychological tests and a facial emotion processing battery. Performance was compared to 20 age-matched and education-matched controls. Grey matter intensity was related to emotion processing performance using whole-brain voxel-based morphometry analysis. RESULTS Patients with right SD exhibited disproportionate language dysfunction, prosopagnosia and a suggestion of increased obsessive personality/behavioural changes versus patients with bvFTD. In contrast, patients with bvFTD demonstrated pronounced deficits in attention/working memory, increased apathy and greater executive dysfunction, compared to patients with right SD. Decreased empathy, disinhibition and diet changes were common to both dementia subtypes. Emotion processing deficits were present in both FTD syndromes but were associated with divergent patterns of brain atrophy. In right SD, emotion processing dysfunction was associated with predominantly right medial and lateral temporal integrity, compared to mainly left temporal, inferior frontal and orbitofrontal and right frontal gyrus integrity in bvFTD. CONCLUSIONS This study demonstrates comparable deficits in facial emotion processing in right SD and bvFTD, in keeping with their similar clinical profiles. These deficits are attributable to divergent neural substrates in each patient group, namely, right lateralised regions in right SD, versus predominantly left lateralised regions in bvFTD.
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Affiliation(s)
- Jody Kamminga
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Kumfor
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Muireann Irish
- Neuroscience Research Australia, Sydney, New South Wales, Australia School of Psychology, University of New South Wales, Sydney, New South Wales, Australia Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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O'Connor CM, Clemson L, Brodaty H, Gitlin LN, Piguet O, Mioshi E. Enhancing caregivers' understanding of dementia and tailoring activities in frontotemporal dementia: two case studies. Disabil Rehabil 2015; 38:704-14. [PMID: 26056858 DOI: 10.3109/09638288.2015.1055375] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to describe the intervention process and results of the Tailored Activities Program (TAP) in two people diagnosed with Frontotemporal Dementia (FTD). METHOD TAP is an occupational therapy (OT) community-based intervention program that prescribes personalised activities to reduce difficult behaviours of dementia. The OT works with carers over a 4-month period (assessment, activity prescription and generalisation of strategies). Study measures were collected (blind researcher) pre- and post-intervention: cognition, functional disability, behavioural symptoms and Caregiver Confidence and Vigilance. RESULTS A 51-year-old woman with behavioural-variant FTD could consistently engage in more activities post-intervention, with scores indicating improvements to behaviour, function and caregiver confidence. A 63-year-old man with semantic variant FTD engaged well in the prescribed activities, with scores reflecting reduced carer distress regarding challenging behaviours and improved caregiver vigilance. CONCLUSIONS TAP is efficacious in FTD, allowing for differences in approach for FTD subtype, where behavioural symptoms are very severe and pervasive. IMPLICATIONS FOR REHABILITATION The Tailored Activities Program is an intervention which can be tailored to account for unique behavioural and language profiles inherent across frontotemporal dementia (FTD) subtypes. Maintaining a flexible approach when applying an intervention in FTD allows for tailoring to individual case variability within FTD subtypes.
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Affiliation(s)
- Claire M O'Connor
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney , Sydney , Australia
| | - Henry Brodaty
- b School of Psychiatry, University of New South Wales , Sydney , Australia
| | - Laura N Gitlin
- c Centre for Innovative Care in Aging, Johns Hopkins University , Baltimore , MD , USA
| | - Olivier Piguet
- d Neuroscience Research Australia , Sydney , Australia .,e School of Medical Science, University of New South Wales , Sydney , Australia , and
| | - Eneida Mioshi
- f Department of Psychiatry , University of Cambridge , UK
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Lima-Silva TB, Bahia VS, Carvalho VA, Guimarães HC, Caramelli P, Balthazar MLF, Damasceno B, Bottino CMDC, Brucki SMD, Nitrini R, Yassuda MS. Direct and indirect assessments of activities of daily living in behavioral variant frontotemporal dementia and Alzheimer disease. J Geriatr Psychiatry Neurol 2015; 28:19-26. [PMID: 25015849 DOI: 10.1177/0891988714541874] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is limited information about the functional profile of behavioral variant frontotemporal dementia (bvFTD). OBJECTIVE To compare direct and indirect assessments of activities of daily living (ADLs) in bvFTD and Alzheimer disease (AD) and their relationship with cognitive performance. METHODS In all, 20 patients with bvFTD, 30 patients with AD, and 34 normal controls (NCs), matched for age, education, and severity of dementia, completed the Direct Assessment of Functional Performance (DAFS-BR) and usual cognitive measures. The Disability Assessment for Dementia (DAD) was completed by caregivers. RESULTS In DAFS-BR, patients with bvFTD and AD had similar performance but lower than NCs. In DAD, there were no significant differences for effective performance, but patients with bvFTD had lower scores for initiation and planning/organization. Patients with bvFTD were less impaired than AD in cognition. CONCLUSION Functional changes in bvFTD seem to be better documented by indirect measures.
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Affiliation(s)
| | | | - Viviane Amaral Carvalho
- Department of Internal Medicine, Behavioral and Cognitive Neurology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Cerqueira Guimarães
- Department of Internal Medicine, Behavioral and Cognitive Neurology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Department of Internal Medicine, Behavioral and Cognitive Neurology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Benito Damasceno
- Department of Neurology, Neuropsychology and Dementia Unit, University of Campinas, São Paulo, Brazil
| | | | | | - Ricardo Nitrini
- Neurology Department, University of São Paulo, São Paulo, Brazil
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Life enhancing activities for family caregivers of people with frontotemporal dementia. Alzheimer Dis Assoc Disord 2015; 28:175-81. [PMID: 24113564 DOI: 10.1097/wad.0b013e3182a6b905] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aberrant psychological and behavioral symptoms are common in patients with dementia. These symptoms have negative consequences for family caregivers, causing stress and burden. Frontotemporal dementia (FTD) symptoms cause more pronounced stress and burden on caregivers than those associated with Alzheimer dementia. In this randomized, attention control pilot study, we delivered 5-weekly, one-on-one, positive affect intervention sessions to family caregivers of people with FTD. The program, Life Enhancing Activities for Family Caregivers: LEAF was conducted in-person or by videoconference with caregivers across the United States. Measures of affect, caregiver mood, stress, distress, and caregiver burden were assessed at baseline, end of sessions, and 1 month after completion. Twenty-four caregivers (12 intervention and 12 attention control) participated. At the end of the intervention, scores on positive affect, negative affect, burden, and stress all improved in the intervention compared with the control group. These scores continued to show improvement at the assessment done 1 month after intervention. Subjects were receptive to the skills and the delivery methods. The positive emotion skill-building intervention proved feasible especially in the internet videoconference delivery format. The intervention promoted positive affect and improved psychological outcomes for family caregivers of people with FTD.
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Parsing cognitive and emotional empathy deficits for negative and positive stimuli in frontotemporal dementia. Neuropsychologia 2015; 67:14-26. [DOI: 10.1016/j.neuropsychologia.2014.11.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/03/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
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Barsuglia JP, Kaiser NC, Wilkins SS, Karve SJ, Barrows RJ, Paholpak P, Panchal HV, Jimenez EE, Mather MJ, Mendez MF. A scale of socioemotional dysfunction in frontotemporal dementia. Arch Clin Neuropsychol 2014; 29:793-805. [PMID: 25331776 PMCID: PMC4296158 DOI: 10.1093/arclin/acu050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/13/2022] Open
Abstract
Early social dysfunction is a hallmark symptom of behavioral variant frontotemporal dementia (bvFTD); however, validated measures for assessing social deficits in dementia are needed. The purpose of the current study was to examine the utility of a novel informant-based measure of social impairment, the Socioemotional Dysfunction Scale (SDS) in early-onset dementia. Sixteen bvFTD and 18 early-onset Alzheimer's disease (EOAD) participants received standard clinical neuropsychological measures and neuroimaging. Caregiver informants were administered the SDS. Individuals with bvFTD exhibited greater social dysfunction on the SDS compared with the EOAD group; t(32) = 6.32, p < .001. The scale demonstrated preliminary evidence for discriminating these frequently misdiagnosed groups (area under the curve = 0.920, p = <.001) and internal consistency α = 0.977. The SDS demonstrated initial evidence as an effective measure for detecting abnormal social behavior and discriminating bvFTD from EOAD. Future validation is recommended in larger and more diverse patient groups.
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Affiliation(s)
- Joseph P Barsuglia
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Natalie C Kaiser
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Stacy Schantz Wilkins
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Simantini J Karve
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robin J Barrows
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Elvira E Jimenez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michelle J Mather
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mario F Mendez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA Department of Psychiatry & Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
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Fernández-Matarrubia M, Matías-Guiu J, Moreno-Ramos T, Matías-Guiu J. Demencia frontotemporal variante conductual: aproximación clínica y terapéutica. Neurologia 2014; 29:464-72. [DOI: 10.1016/j.nrl.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022] Open
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Fernández-Matarrubia M, Matías-Guiu J, Moreno-Ramos T, Matías-Guiu J. Behavioural variant frontotemporal dementia: Clinical and therapeutic approaches. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bickart KC, Dickerson BC, Barrett LF. The amygdala as a hub in brain networks that support social life. Neuropsychologia 2014; 63:235-48. [PMID: 25152530 DOI: 10.1016/j.neuropsychologia.2014.08.013] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 01/13/2023]
Abstract
A growing body of evidence suggests that the amygdala is central to handling the demands of complex social life in primates. In this paper, we synthesize extant anatomical and functional data from rodents, monkeys, and humans to describe the topography of three partially distinct large-scale brain networks anchored in the amygdala that each support unique functions for effectively managing social interactions and maintaining social relationships. These findings provide a powerful componential framework for parsing social behavior into partially distinct neural underpinnings that differ among healthy people and disintegrate or fail to develop in neuropsychiatric populations marked by social impairment, such as autism, antisocial personality disorder, and frontotemporal dementia.
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Affiliation(s)
- Kevin C Bickart
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Northeastern University, United States
| | - Bradford C Dickerson
- Psychiatric Neuroimaging Research Program and Martinos Center for Biomedical Imaging, Northeastern University, United States; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, United States
| | - Lisa Feldman Barrett
- Psychiatric Neuroimaging Research Program and Martinos Center for Biomedical Imaging, Northeastern University, United States; Department of Psychology, Northeastern University, United States.
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Is the emotion recognition deficit associated with frontotemporal dementia caused by selective inattention to diagnostic facial features? Neuropsychologia 2014; 60:84-92. [DOI: 10.1016/j.neuropsychologia.2014.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 11/24/2022]
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Holwerda TJ, Deeg DJH, Beekman ATF, van Tilburg TG, Stek ML, Jonker C, Schoevers RA. Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL). J Neurol Neurosurg Psychiatry 2014; 85:135-42. [PMID: 23232034 DOI: 10.1136/jnnp-2012-302755] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. METHODS We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. RESULTS After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. CONCLUSIONS Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.
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Functional status in behavioral variant frontotemporal dementia: a systematic review. BIOMED RESEARCH INTERNATIONAL 2013; 2013:837120. [PMID: 24308008 PMCID: PMC3838822 DOI: 10.1155/2013/837120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
Abstract
The aim was to conduct a systematic review of studies that described the functional profile of patients with behavioral variant frontotemporal dementia (bvFTD), published between 2000 and 2013. The bibliographic search was conducted using the terms “frontotemporal dementia” and “frontotemporal lobar degeneration” in combination with “independence,” “functionality,” “basic activities of daily living,” “disability,” and scales that measure functional performance: “Disability Assessment for Dementia-DAD,” “Functional Activities Questionnaire (FAQ),” “Direct Assessment of Functional Status (DAFS).” To be included in the review, the study had to mention the characterization of the functional status of patients with bvFTD in the objectives of the study, using a previously validated instrument of functional assessment. Fourteen studies met this criterion. The reviewed studies suggested that individuals with bvFTD have greater functional impairment when compared to those with other subtypes of frontotemporal lobar degeneration or Alzheimer's disease. The studies documented a significant association between cognitive impairment and measures of functionality in these patients. The cognitive profile of patients may predict faster functional decline.
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40
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McCade D, Savage G, Guastella A, Hickie IB, Lewis SJG, Naismith SL. Emotion recognition in mild cognitive impairment: relationship to psychosocial disability and caregiver burden. J Geriatr Psychiatry Neurol 2013; 26:165-73. [PMID: 23752253 DOI: 10.1177/0891988713491832] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Impaired emotion recognition in dementia is associated with increased patient agitation, behavior management difficulties, and caregiver burden. Emerging evidence supports the presence of very early emotion recognition difficulties in mild cognitive impairment (MCI); however, the relationship between these impairments and psychosocial measures is not yet explored. METHODS Emotion recognition abilities of 27 patients with nonamnestic MCI (naMCI), 29 patients with amnestic MCI (aMCI), and 22 control participants were assessed. Self-report measures assessed patient functional disability, while informants rated the degree of burden they experienced. RESULTS Difficulties in recognizing anger was evident in the amnestic subtype. Although both the patient groups reported greater social functioning disability, compared with the controls, a relationship between social dysfunction and anger recognition was evident only for patients with naMCI. A significant association was found between burden and anger recognition in patients with aMCI. CONCLUSIONS Impaired emotion recognition abilities impact MCI subtypes differentially. Interventions targeted at patients with MCI, and caregivers are warranted.
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Affiliation(s)
- Donna McCade
- Ageing Brain Centre, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia.
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41
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O'Connor CM, Clemson L, da Silva TBL, Piguet O, Hodges JR, Mioshi E. Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia (FTD): A call for randomised controlled studies. Dement Neuropsychol 2013; 7:143-150. [PMID: 29213832 PMCID: PMC5619510 DOI: 10.1590/s1980-57642013dn70200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
FTD is a unique condition which manifests with a range of behavioural symptoms,
marked dysfunction in activities of daily living (ADL) and increased levels of
carer burden as compared to carers of other dementias. No efficacious
pharmacological interventions to treat FTD currently exist, and research on
pharmacological symptom management is variable. The few studies on
non-pharmacological interventions in FTD focus on either the carer or the
patients' symptoms, and lack methodological rigour. This paper reviews and
discusses current studies utilising non-pharmacological approaches, exposing the
clear need for more rigorous methodologies to be applied in this field. Finally,
a successful randomised controlled trial helped reduce behaviours of concern in
dementia, and through implementing participation in tailored activities, the
FTD-specific Tailored Activities Program (TAP) is presented. Crucially, this
protocol has scope to target both the person with FTD and their carer. This
paper highlights that studies in this area would help to elucidate the potential
for using activities to reduce characteristic behaviours in FTD, improving
quality of life and the caregiving experience in FTD.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney.,Neuroscience Research Australia, Sydney, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney
| | - Thaís Bento Lima da Silva
- Behavioural and Cognitive Neurology Unit, Neurology Department, University of São Paulo, São Paulo SP, Brazil
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
| | - Eneida Mioshi
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
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42
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Kumfor F, Piguet O. Emotion recognition in the dementias: brain correlates and patient implications. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.16] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Changes in behavior, personality and the ability to interact in social situations have been reported to varying extents across dementia syndromes. Deficits in the ability to recognize emotion in others probably contribute to these socioemotional changes. This article reviews the patterns of emotion recognition impairments and their underlying brain correlates in four dementia syndromes: Alzheimer’s disease; frontotemporal dementia; Huntington’s disease; and progressive supranuclear palsy. Despite emotion recognition deficits being observed in all these patient groups, a limited understanding exists on how these deficits translate into everyday behavior. The adoption of ecologically valid tasks is likely to improve our understanding of these deficits in everyday settings, and will help to provide guidance for management strategies for patients and their carers.
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Affiliation(s)
- Fiona Kumfor
- Neuroscience Research Australia, PO Box 1165, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Australian Research Council Centre of Excellence in Cognition & its Disorders, University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Australian Research Council Centre of Excellence in Cognition & its Disorders, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, PO Box 1165, Randwick, New South Wales, Australia.
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Harciarek M, Cosentino S. Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. Int Rev Psychiatry 2013; 25:178-96. [PMID: 23611348 PMCID: PMC4481322 DOI: 10.3109/09540261.2013.763340] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer's disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.
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Affiliation(s)
- Michał Harciarek
- Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Poland.
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Rascovsky K, Grossman M. Clinical diagnostic criteria and classification controversies in frontotemporal lobar degeneration. Int Rev Psychiatry 2013; 25:145-58. [PMID: 23611345 PMCID: PMC3906583 DOI: 10.3109/09540261.2013.763341] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) can manifest as a spectrum of clinical syndromes, ranging from behavioural impairment to language or motor dysfunction. Recently, revised diagnostic criteria have been proposed for the behavioural and progressive aphasia syndromes associated with frontotemporal degeneration. The present review will summarize these diagnostic guidelines and highlight some lingering controversies in the classification of FTLD clinical syndromes. We will discuss common tools and methods used to identify the insidious changes of behavioural variant frontotemporal dementia (bvFTD), the value of new, patient-based tasks of orbitofrontal function, and the issue of a benign or 'phenocopy' variant of bvFTD. With regard to primary progressive aphasia (PPA), we will discuss the scope of the semantic disorder in semantic-variant PPA, the nature of the speech disorder in non-fluent, agrammatic PPA, and the preliminary utility of a logopenic PPA classification.
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Affiliation(s)
- Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Kortte KB, Rogalski EJ. Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia. Int Rev Psychiatry 2013; 25:237-45. [PMID: 23611353 PMCID: PMC3659798 DOI: 10.3109/09540261.2012.751017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary progressive aphasia (PPA) and behavioural-variant frontotemporal dementia (bvFTD) are clinical syndromes under the umbrella term 'frontotemporal dementia' (FTD) and are caused by a neurodegenerative disease with an onset most typically in the productive years of adulthood. The cognitive and behavioural impairments associated with FTD interfere with successful engagement in typical life roles, such as parenting, working, and maintenance of interpersonal relationships. There are currently no treatments to stop or slow the degenerative process and there are only very limited medication options for the management of the cognitive-behavioural symptoms. However, alternative, non-pharmacological interventions may offer significant benefit to the quality of life of the diagnosed individual. The goal of this paper is to provide an overview of the approaches available through neurorehabilitation and community-based services that facilitate successful engagement in life activities and promote optimal quality of life for the individuals and families living with FTD. It is hoped that as medical providers become more familiar with behavioural interventions, referrals for services will increase thereby allowing individuals with FTD and their caregivers to learn ways to adapt, adjust, and participate in life to the fullest despite the impairments from this progressive disease.
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Affiliation(s)
- Kathleen B. Kortte
- Department of Physical Medicine and Rehabilitation The Johns Hopkins University School of Medicine
| | - Emily J. Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine
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Ruckmann J, Rief W. Empathie: neurowissenschaftliche Grundlagen, klinische Implikationen und offene Fragestellungen. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000346611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cerami C, Cappa SF. The behavioral variant of frontotemporal dementia: linking neuropathology to social cognition. Neurol Sci 2013; 34:1267-74. [PMID: 23377232 DOI: 10.1007/s10072-013-1317-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/19/2013] [Indexed: 12/12/2022]
Abstract
The behavioral variant of frontotemporal dementia (bvFTD) is one of the most frequent neurodegenerative disorders with a presenile onset. It is characterized by a long phase of subclinical behavioral changes and social conduct disorders, associated with a progressive modification of personality. Recently, an international consortium of experts developed revised guidelines for its clinical diagnosis, which highlight the supportive role of biomarkers in the diagnostic process. According to new criteria, bvFTD can be classified in "possible" (requiring three of six specific clinical features), "probable" (in the presence of functional disability and typical neuroimaging features), and "with definite frontotemporal lobar degeneration" (requiring the presence of a known causal mutation or a histopathological confirmation). Familial aggregation is frequently reported in bvFTD and frontotemporal lobar degeneration in general, with an autosomal dominant transmission in about 10 % cases. The aim of this paper is to review and discuss recent advances in the knowledge of clinical, neuropsychological, and imaging features of bvFTD. We also briefly summarize the available genetic information about the frontotemporal lobar degeneration spectrum.
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Affiliation(s)
- Chiara Cerami
- Neurorehabilitation Unit, Department of Clinical Neurosciences, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Dara C, Kirsch-Darrow L, Ochfeld E, Slenz J, Agranovich A, Vasconcellos-Faria A, Ross E, Hillis AE, Kortte KB. Impaired emotion processing from vocal and facial cues in frontotemporal dementia compared to right hemisphere stroke. Neurocase 2013; 19:521-9. [PMID: 22827701 PMCID: PMC3485448 DOI: 10.1080/13554794.2012.701641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To advance our understanding about the emotional and cognitive deficits of patients with frontotemporal dementia with behavioral variant (bvFTD), the current study examined comprehension and expression of emotions from prosodic and facial cues in a 66-year-old woman. The patient diagnosed with bvFTD is compared to six patients with acute right hemisphere stroke. Recognition of emotion from prosodic cues was assessed using an identification task in four conditions with decreasing verbal demands (neutral sentences, language-like pseudo sentences, monosyllables, and asyllabic vowel sounds). Repetition of utterances with emotional connotations and self-generated conversations were analyzed to measure relative changes in mean fundamental frequency (f0), f0 variance, speech rate, and intensity along with the facial musculature pattern. The patient showed a marked deficit in identifying emotions in all four prosody conditions; and she did not show much variation in modulating mean f0, f0 variance, speech rate and intensity for all emotion categories when compared to neutral utterances. In addition, this patient demonstrated little to no facial expressions during emotionally provoking tasks, but demonstrated no difficulty recognizing emotions from facial expressions or verbal scenarios. Results show that the patient seems to have selective impairment in recognition of emotions from prosody and expression of emotions using both prosodic and facial features. Impaired processing of emotional prosody and facial expressions could be important for detecting bvFTD with greater right hemisphere atrophy.
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Affiliation(s)
- Chinar Dara
- a Department of Neurology , The Johns Hopkins University , Baltimore , MD , USA
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Lima-Silva TB, Bahia VS, Carvalho VA, Guimarães HC, Caramelli P, Balthazar M, Damasceno B, Bottino CMDC, Brucki SMD, Nitrini R, Yassuda MS. Functional profile of patients with behavioral variant frontotemporal dementia (bvFTD) compared to patients with Alzheimer's disease and normal controls. Dement Neuropsychol 2013; 7:96-103. [PMID: 29213825 PMCID: PMC5619551 DOI: 10.1590/s1980-57642013dn70100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There are few studies describing the functional changes in behavioral variant
frontotemporal dementia (bvFTD) and it is not clear which aspects of
functionality are affected by the disease.
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Affiliation(s)
| | | | - Viviane Amaral Carvalho
- Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Henrique Cerqueira Guimarães
- Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Márcio Balthazar
- Department of Neurology, University of Campinas, Campinas SP, Brazil
| | - Benito Damasceno
- Department of Neurology, University of Campinas, Campinas SP, Brazil
| | | | | | - Ricardo Nitrini
- Neurology Department, University of São Paulo, São Paulo SP, Brazil
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Piguet O, Hodges JR. Behavioural-variant frontotemporal dementia: an update. Dement Neuropsychol 2013; 7:10-18. [PMID: 29213814 PMCID: PMC5619539 DOI: 10.1590/s1980-57642013dn70100003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/28/2013] [Indexed: 12/12/2022] Open
Abstract
Behavioural-variant frontotemporal dementia (bvFTD) is characterised by insidious changes in personality and interpersonal conduct that reflect progressive disintegration of the neural circuits involved in social cognition, emotion regulation, motivation and decision making. The underlying pathology is heterogeneous and classified according to the presence of intraneuronal inclusions of tau, TDP-43 or occasionally FUS. Biomarkers to detect these histopathological changes in life are increasingly important with the development of disease-modifying drugs. Gene mutations have been found which collectively account for around 10-20% of cases including a novel hexanucleotide repeat on chromosome 9 (C9orf72). The recently reviewed International Consensus Criteria for bvFTD propose three levels of diagnostic certainly: possible, probable and definite. Detailed history taking from family members to elicit behavioural features underpins the diagnostic process with support from neuropsychological testing designed to detect impairment in decision-making, emotion processing and social cognition. Brain imaging is important for increasing the level of diagnosis certainty. Carer education and support remain of paramount importance.
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Affiliation(s)
- Olivier Piguet
- Neuroscience Research Australia, Barker St, Randwick NSW
2031, Australia. School of Medical Sciences, the University of New South Wales,
Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, the
University of New South Wales, Sydney, Australia
| | - John R. Hodges
- Neuroscience Research Australia, Barker St, Randwick NSW
2031, Australia. School of Medical Sciences, the University of New South Wales,
Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, the
University of New South Wales, Sydney, Australia
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