Hyperorality in Frontotemporal dementia: Cognitive, Behavioral, and Neuroanatomic Profiles in Early‐Stage Disease

Abstract

AbstractBackgroundHyperorality represents a key feature observed in the behavioral variant of frontotemporal dementia (bvFTD). While hyperorality is common in advanced cases of bvFTD, less is known about its frequency in early‐stage disease. The cognitive, behavioral, and neuroanatomic patterns of patients with early stage bvFTD and hyperorality have also not been well established. The primary aim of this study is to describe the frequency of hyperorality in a sample of patients with early stage bvFTD while also exploring patterns of cognitive, behavioral, and neuroanatomic change.MethodData are from subjects enrolled in the ALLFTD study, an established US consortium with an ongoing cohort study of FTD. Cognitive profiles were assessed using validated neuropsychological batteries, and social behavior was measured using validated scales. Psychiatric states were coded as binary variables. Differences in baseline characteristics and clinical outcomes were compared using t‐tests for continuous variables and Pearson χ2 tests for categorical variables. Statistical significance was based on p values <0.05.ResultWe enrolled 1,694 subjects, comprising 145 with a CDR® plus NACC FTLD global score less than or equal to 1 at the first visit who were used in our analysis. 50% of subjects exhibited hyperorality. There were no demographic differences between groups other than CDR global scores which were higher in the hyperorality group (0.8 versus 0.7, p = 0.003). Cognitive profiles encompassing domains of processing speed, language, executive functioning, memory, and attention did not differ between groups. Subjects with hyperorality had lower scores on scales of self‐monitoring, empathetic concern, and perspective taking. Subjects with hyperorality had higher rates of motor disturbance, and ritualistic/compulsive behaviors. There were no volumetric differences in neuroanatomic regions of interest.ConclusionOur findings indicate that hyperorality is common in early stage bvFTD, arising prior to cognitive and neuroanatomic changes. Hyperorality travels with motor disturbances and ritualistic/compulsive behaviors alongside eroding social behavioral functioning. Hyperorality may serve as an early signal of disease, providing an opportunity for intervention prior to significant neurodegeneration using novel therapeutics and non‐invasive brain stimulation.