Abstract
We investigated the occurrence of goal-directed motivational change in the form of apathy in patients with frontotemporal dementia (FTD), particularly those with behavioral variant social and executive deficits (bvFTD). Standardized behavioral inventory was employed to survey and compare apathy ratings from patients and caregivers. In cases of bvFTD, apathy ratings were further related to measures of social cognition, executive function, and atrophy on brain MRI. Results indicated that caregivers rated bvFTD patients as having significantly elevated apathy scores though patient self-ratings were normal. Caregiver and self-ratings of FTD samples with progressive nonfluent aphasia and semantic dementia did not differ from healthy controls and their informants. In the bvFTD sample, caregiver apathy scores were not correlated with general cognitive screening or depression scores, but were significantly correlated with social cognition and executive function measures. Voxel-based morphometry revealed that apathy ratings in bvFTD were related to prominent atrophy in the right caudate (including the ventral striatum), the right temporo-parietal junction, right posterior inferior and middle temporal gyri, and left frontal operculum- anterior insula region. Findings suggest that bvFTD is associated with a significant breakdown in goal-directed motivated behavior involving disruption of cortical-basal ganglia circuits that is also related to social and executive function deficits.
Highlights
Recent investigations have begun to identify underlying deficits and correlates of the clinically problematic social and executive function impairments in frontotemporal dementia, in those patients who present with significant behavioral deficits [i.e., behavioral variant FTD [13,30,42,44]]
AES caregiver ratings identified a marked increase in apathy scores for the behavioral variant FTD (bvFTD) sample (AES total score = 58.25) which were significantly higher than the progressive nonfluent aphasia (PNFA), semantic dementia (SD), and healthy control samples (AES total scores = 30.44–38.40, p < 0.0001)
Results support the hypothesis that an identifiable association exists between behavioral assessment of apathy in bvFTD patients and their social cognitive as well as executive function capabilities
Summary
Recent investigations have begun to identify underlying deficits and correlates of the clinically problematic social and executive function impairments in frontotemporal dementia, in those patients who present with significant behavioral deficits [i.e., behavioral variant FTD (bvFTD) [13,30,42,44]]. One of the more enigmatic features concerns insidious decline in motivation and typical goal-directed actions. As these behavioral symptoms progress, flattened, blunted, and poorly-regulated affect can be readily observed along with decreasing interest in usual social, recreational, occupational and creative pursuits, usually described as clinical apathy [25,38]. Within the FTD clinical spectrum, apathy and related symptoms appear to be most apparent and problematic in bvFTD cases (15, 35, 51), which is the focus of this investigation
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