1
|
Dilcher R, Malpas CB, O'Brien TJ, Vivash L. Social Cognition in Behavioral Variant Frontotemporal Dementia and Pathological Subtypes: A Narrative Review. J Alzheimers Dis 2023; 94:19-38. [PMID: 37212100 DOI: 10.3233/jad-221171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Behavioral variant frontotemporal dementia (bvFTD) belongs to the spectrum of frontotemporal lobar degeneration (FTLD) and is characterized by frontal dysfunction with executive deficits and prominent socioemotional impairments. Social cognition, such as emotion processing, theory of mind, and empathy may significantly impact daily behavior in bvFTD. Abnormal protein accumulation of tau or TDP-43 are the main causes of neurodegeneration and cognitive decline. Differential diagnosis is difficult due to the heterogeneous pathology in bvFTD and the high clinicopathological overlap with other FTLD syndromes, especially in late disease stages. Despite recent advances, social cognition in bvFTD has not yet received sufficient attention, nor has its association with underlying pathology. This narrative review evaluates social behavior and social cognition in bvFTD, by relating these symptoms to neural correlates and underlying molecular pathology or genetic subtypes. Negative and positive behavioral symptoms, such as apathy and disinhibition, share similar brain atrophy and reflect social cognition. More complex social cognitive impairments are probably caused by the interference of executive impairments due to increasing neurodegeneration. Evidence suggests that underlying TDP-43 is associated with neuropsychiatric and early social cognitive dysfunction, while patients with underlying tau pathology are marked by strong cognitive dysfunction with increasing social impairments in later stages. Despite many current research gaps and controversies, finding distinct social cognitive markers in association to underlying pathology in bvFTD is essential for validating biomarkers, for clinical trials of novel therapies, and for clinical practice.
Collapse
Affiliation(s)
- Roxane Dilcher
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Charles B Malpas
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
| |
Collapse
|
2
|
Holtmann O, Schloßmacher I, Franz M, Moenig C, Tenberge JG, Preul C, Schwindt W, Bruchmann M, Melzer N, Miltner WHR, Straube T. Effects of emotional valence and intensity on cognitive and affective empathy after insula lesions. Cereb Cortex 2022; 33:4562-4573. [PMID: 36124830 DOI: 10.1093/cercor/bhac362] [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: 03/21/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
The insula plays a central role in empathy. However, the complex structure of cognitive (CE) and affective empathy (AE) deficits following insular damage is not fully understood. In the present study, patients with insular lesions (n = 20) and demographically matched healthy controls (n = 24) viewed ecologically valid videos that varied in terms of valence and emotional intensity. The videos showed a person (target) narrating a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions, they continuously rated their own affect. Mean squared error (MSE) assessed deviations between subject and target ratings. Patients differed from controls only in negative, low-intensity AE, rating their own affective state less negative than the target. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty pointing to a threshold role of the insula in online ratings of AE.
Collapse
Affiliation(s)
- Olga Holtmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Straße 52, Muenster 48149, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Fliednerstraße 21, Muenster 48149, Germany
| | - Insa Schloßmacher
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Straße 52, Muenster 48149, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Fliednerstraße 21, Muenster 48149, Germany
| | - Marcel Franz
- Department of Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3, Jena 07743, Germany
| | - Constanze Moenig
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Jan-Gerd Tenberge
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Christoph Preul
- Department of Neurology, University Hospital Jena, Am Klinikum 1, Jena 07747, Germany
| | - Wolfram Schwindt
- Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Straße 52, Muenster 48149, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Fliednerstraße 21, Muenster 48149, Germany
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany.,Department of Neurology, Heinrich-Heine University of Düsseldorf, Moorenstraße 5, Düsseldorf 40225, Germany
| | - Wolfgang H R Miltner
- Department of Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3, Jena 07743, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Straße 52, Muenster 48149, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Fliednerstraße 21, Muenster 48149, Germany
| |
Collapse
|
3
|
Affiliation(s)
- Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Departments of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
- Department of Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Elvira E. Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Department of Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA
| |
Collapse
|