Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia

Abstract

Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD.Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology–Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables.Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = −0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001).Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.

The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study

“…More specifically, apathy was found to be the most robust behavioral correlate of functional impairment in both bvFTD and SemD (Kipps et al, 2009;O'Connor et al, 2016a;Musa Salech et al, 2022). Stereotypical behavior and disinhibition has also been associated with poor functional outcomes, but only in bvFTD (O'Connor et al, 2016b;Musa Salech et al, 2022). With respect to other behavioral symptoms that correlate with the functional status in FTD, literature suggests that hallucinations and anxiety are associated with decreased functional capacity in bvFTD, whereas delusions and eating disorders seem to contribute to functional decline in nfvPPA (Moheb et al, 2017).…”

“…Approximately 5 years after symptom onset, the vast majority of bvFTD patients tend to develop severe functional impairment (Mioshi et al, 2007). However, information on the functional status of patients with FTD is relatively sparse and focuses mainly on the behavioral-variant of FTD (Josephs et al, 2011;Lima-Silva et al, 2013, 2015aMusa Salech et al, 2022). Research has shown that, as happens in AD, FTD initially affects instrumental activities of daily living (IADLs), while decline in basic activities of daily living (BADLs) develops later in the course of the disease (Mioshi et al, 2010;Musa Salech et al, 2022).…”

“…However, information on the functional status of patients with FTD is relatively sparse and focuses mainly on the behavioral-variant of FTD (Josephs et al, 2011;Lima-Silva et al, 2013, 2015aMusa Salech et al, 2022). Research has shown that, as happens in AD, FTD initially affects instrumental activities of daily living (IADLs), while decline in basic activities of daily living (BADLs) develops later in the course of the disease (Mioshi et al, 2010;Musa Salech et al, 2022). In comparison to other types of dementia, such as AD, bvFTD has been associated with more profound functional impairments (Roberson et al, 2005;Borroni and Padovani, 2007;Mioshi et al, 2007).…”

“…As mentioned above, the literature examining cognitive correlates of functional status specifically in FTD patients is, to date, very limited (Josephs et al, 2011;Moheb et al, 2017;Musa Salech et al, 2022). In all three FTD subtypes, decreased performance on measures of executive functions is correlated with poorer IADL performance.…”

“…In addition to cognitive deficits, behavioral disturbances have also been reported to predict functional status in FTD, as more severe behavioral symptoms are correlated with increased functional disability (Moheb et al, 2017;Musa Salech et al, 2022). More specifically, apathy was found to be the most robust behavioral correlate of functional impairment in both bvFTD and SemD (Kipps et al, 2009;O'Connor et al, 2016a;Musa Salech et al, 2022). Stereotypical behavior and disinhibition has also been associated with poor functional outcomes, but only in bvFTD (O'Connor et al, 2016b;Musa Salech et al, 2022).…”