A predictive coding framework of allostatic interoceptive overload to comprehend frontotemporal dementia

Abstract

AbstractBackgroundRecent allostatic‐interoceptive predictive coding theories propose that efficient regulation of the internal milieu is necessary to correctly anticipate the needs required to overcome environmental challenges before they arise. These theories are based on neurocognitive models of allostatic load and interoceptive processes, dimensions convergently affected in behavioral variant frontotemporal dementia. Nevertheless, this neurodegenerative disease has not been previously framed within such framework.MethodWe propose the hypothesis that behavioral variant frontotemporal dementia may be characterized by an imbalance of the predictive allostatic‐interoceptive system, with manifestations across psychological, cerebral, cardiocerebral and peripheral dimensions. Further, we propose a set of theory‐driven predictions in behavioral variant frontotemporal dementia, which could be subsumed into a dimensional framework integrating neurocognitive and physiological markers into a multimodal assessment of allostatic interoceptive priors.ResultUnder such framework, cognitive and behavioral impairments of behavioral variant frontotemporal dementia would be predicted by structural and connectivity deficits among critical allostatic interoceptive brain’ hubs, altered electrophysiological activity, and allostatic overload, jointly yielding meaningful associations with clinical manifestations.ConclusionSuch framework could help to further understand the hallmarks behavioral and physiopathological dysregulations of behavioral variant frontotemporal dementia within a predictive coding account, strengthening clinical models integrating its neurological and psychiatric manifestations.