Different Apathy Profile in Behavioral Variant of Frontotemporal Dementia and Alzheimer's Disease: A Preliminary Investigation

Abstract

Apathy is one of the most common behavioral symptoms of dementia; it is one of the salient features of behavioral variant of frontotemporal dementia (bvFTD) but is also very frequent in Alzheimer's disease. This preliminary investigation was aimed at assessing the type of apathy-related symptoms in a population of bvFTD and AD subjects showing comparable apathy severity. Each patient underwent a comprehensive neuropsychological assessment; behavioral changes were investigated by the neuropsychiatric inventory (NPI), using the NPI-apathy subscale to detect apathetic symptoms. At univariate analysis, bvFTD subjects showed lack of initiation (χ 2 = 4.602, p = 0.032), reduced emotional output (χ 2 = 6.493, p = 0.008), and reduced interest toward friends and family members (χ 2 = 4.898, p = 0.027), more frequently than AD subjects. BvFTD displayed higher scores than AD on NPI total score (p = 0.005) and on subscales assessing agitation (p = 0.004), disinhibition (p = 0.007) and sleep disturbances (p = 0.025); conversely, AD subjects were more impaired on memory, constructional abilities, and attention. On multivariate logistic regression, reduced emotional output was highly predictive of bvFTD (OR = 18.266; p = 0.008). Our preliminary findings support the hypothesis that apathy is a complex phenomenon, whose clinical expression is conditioned by the site of anatomical damage. Furthermore, apathy profile may help in differentiating bvFTD from AD.

Efficacy of memantine on neuropsychiatric symptoms associated with the severity of behavioral variant frontotemporal dementia: A six-month, open-label, self-controlled clinical trial

“…Notably, each enrolled subject in the present study had significant neuropsychiatric disturbances, as assessed by NPI-Q and NPI-D scores. The high prevalence of neuropsychiatric symptoms in patients with bvFTD has been previously reported in other community-based studies (33,34). Patients with moderate-to-severe bvFTD had a higher NPI-Q total score than patients with mild bvFTD.…”

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

“…2,3 Apathy has been described in association with focal lesions of the prefrontal cortex, 72 caudate nucleus, internal globus pallidus, and medial-dorsal thalamic nuclei, 73,74 and is also a common clinical feature reported in association with several neurodegenerative diseases, including Parkinson's disease, 75 Alzheimer's disease, frontotemporal dementia, 76 Huntington's disease, 77 and progressive supranuclear palsy. 78 Classically, apathy is the result of a disruption of emotional-aff ective mechanisms linked to the ventromedial prefrontal cortex, amygdala, and ventral striatum 3 (fi gure 3) and frequently reported in patients with the behavioural variant of frontotemporal dementia.…”

“…78 Classically, apathy is the result of a disruption of emotional-aff ective mechanisms linked to the ventromedial prefrontal cortex, amygdala, and ventral striatum 3 (fi gure 3) and frequently reported in patients with the behavioural variant of frontotemporal dementia. 76 In these patients, imaging studies 76 have shown that severity of apathy is related to orbitofrontal cortex abnormalities with grey matter atrophy in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex. In Alzheimer's disease, the degree of apathy severity has been linked to neurofi brillary tangles and volume loss in the medial prefrontal cortex, including the anterior cingulate cortex.…”

“…In Alzheimer's disease, the degree of apathy severity has been linked to neurofi brillary tangles and volume loss in the medial prefrontal cortex, including the anterior cingulate cortex. 76 Accordingly, other functional imaging studies [79][80][81][82] have shown an association between apathy and hypometabolism in the medial orbitofrontal cortex and anterior cingulate cortex.…”

A Novel Assessment and Profiling of Multidimensional Apathy in Alzheimer’s Disease

“…An example of this is that people with dementia who endorse more emotionally apathetic statements were more apathetic overall, and specifically showed more extreme and variable behavioral problems such as insensitivity and uncooperativeness [17]. A further study by Quaranta et al [18] using the NPI found there to be differing apathy characteristics between AD and frontotemporal dementia, where the latter were reported to more frequently endorse statements relating to a lack of initiation, decreased emotional output and diminished interest towards friends or family. However, the NPI is a tool designed to assess apathy amongst other behavioral impairments and does not examine apathy multidimensionally.…”