Initiation Difficulty and Apathy in Behavioral Variant Frontotemporal Degeneration (PD7.001)

Abstract

Objective: To investigate initiation difficulty in apathetic patients with behavioral variant Frontotemporal Degeneration (bvFTD). Background The syndrome of apathy, defined as a reduction in self-generated or voluntary behavior, is caused in part by disruption of a frontal-striatal initiation system. Apathy is prevalent in bvFTD and is the most disturbing behavioral feature for caregivers. Previous approaches measuring apathy have depended on caregiver surveys, but are confounded by caregiver stress. Here we describe an objective, quantitative assessment of apathy. Design/Methods: We assessed patients with mild bvFTD (mean MMSE=26.42; n=12) and demographically-matched controls (NC; n=10). We surveyed apathy with Neuropsychiatric Inventory (NPI) apathy severity (FxS, worst possible score =12) and caregiver distress (worst possible score =5) scales. To quantify apathy objectively, we measured reaction time (RT) to hit a target key in response to a simple visual stimulus presented on a computer screen (24 trials). A trial began with the patient depressing a key on the computer keyboard. We examined both the RT to lift the finger from the start key in response to visual stimulus onset (initiation time), and to press a target key to complete a trial (overall time). Initiation RT was related to grey matter atrophy using voxel-based morphometry. Results: Mean NPI apathy FxS was 5.91; mean caregiver stress was 2.5. Apathy severity was correlated with caregiver distress (p=.054). Initiation RT and overall RT were significantly slower in bvFTD than NC (both p Conclusions: Patients with bvFTD have difficulty with initiation that contributes to apathy. This is related to atrophy in frontal regions important for goal-directed behavior. Apathy severity rating scales are confounded by caregiver stress and here we quantified apathy in bvFTD with an objective measure that is not confounded by proxy report. Supported by: The John A. Hartford Foundation9s Building Academic Geriatric Nursing Capacity Award Program, US Public Health Service (AG17586, AG15116, AG10124, NS53488 and NS44266) and the Wyncote Foundation. Disclosure: Dr. Massimo has nothing to disclose. Dr. Morgan has nothing to disclose. Dr. Chandrasekaren has nothing to disclose. Dr. Boller has nothing to disclose. Dr. Camp has nothing to disclose. Dr. Rascovsky has nothing to disclose. Dr. Grossman has nothing to disclose.