Executive and social-cognitive determinants of environmental dependency syndrome in behavioral frontotemporal dementia.

Flanagan, Emma; Lagarde, Julien; Hahn, Valérie; Guichart-Gomez, E.; Sarazin, Marie; Hornberger, Michael; Bertoux, Maxime

doi:10.1037/neu0000433

Cited by 7 publications

(4 citation statements)

References 49 publications

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“…Eslinger et al (2007), for example, reported that performance on the visual-verbal test was predictive of social dilemma judgments in patients with bvFTD. Previous studies have also found similar results using alternative tasks, including the Wisconsin card sorting test (Torralva et al, 2009, 2015; Flanagan et al, 2018).…”

Section: Discussionsupporting

confidence: 69%

Cognitive and Neuroanatomic Accounts of Referential Communication in Focal Dementia

Healey

Spotorno

Olm

et al. 2019

eNeuro

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The primary function of language is to communicate—that is, to make individuals reach a state of mutual understanding about a particular thought or idea. Accordingly, daily communication is truly a task of social coordination. Indeed, successful interactions require individuals to (1) track and adopt a partner’s perspective and (2) continuously shift between the numerous elements relevant to the exchange. Here, we use a referential communication task to study the contributions of perspective taking and executive function to effective communication in nonaphasic human patients with behavioral variant frontotemporal dementia (bvFTD). Similar to previous work, the task was to identify a target object, embedded among an array of competitors, for an interlocutor. Results indicate that bvFTD patients are impaired relative to control subjects in selecting the optimal, precise response. Neuropsychological testing related this performance to mental set shifting, but not to working memory or inhibition. Follow-up analyses indicated that some bvFTD patients perform equally well as control subjects, while a second, clinically matched patient group performs significantly worse. Importantly, the neuropsychological profiles of these subgroups differed only in set shifting. Finally, structural MRI analyses related patient impairment to gray matter disease in orbitofrontal, medial prefrontal, and dorsolateral prefrontal cortex, all regions previously implicated in social cognition and overlapping those related to set shifting. Complementary white matter analyses implicated uncinate fasciculus, which carries projections between orbitofrontal and temporal cortices. Together, these findings demonstrate that impaired referential communication in bvFTD is cognitively related to set shifting, and anatomically related to a social-executive network including prefrontal cortices and uncinate fasciculus.

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Section: Discussionsupporting

confidence: 69%

Cognitive and Neuroanatomic Accounts of Referential Communication in Focal Dementia

Healey

Spotorno

Olm

et al. 2019

eNeuro

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“…Socially inappropriate behaviors like inappropriate familiarity or a lack of distance (e.g., staring at or touching the clinician, making inappropriate comments or jokes, being inappropriately jovial) during the anamnesis or during the cognitive assessment (e.g., walking out of the room, smiling, shrugging of shoulders) are often subtle signs of early behavioral disinhibition in bvFTD. Difficulties to inhibit irrelevant stimuli from the environment is often considered as a key feature of bvFTD and patients often struggle to focus on a task because of distractors [e.g., (67)], a symptom that has been linked to “environmental dependency” (68) and to increased stimulus-bound thought and behavior (69). Pathological gambling and personal neglect or reduced self-care (Diogenes syndrome) have been well-described (70, 71), as well as utilization or imitation behaviors (43, 72).…”

Section: The Clinical Diagnostic Criteria For Bvftdmentioning

confidence: 99%

“…Another commonly used test, the Trail-Making-Test part B (TMT-B) may even be more impaired in patients with AD compared to bvFTD (144) although bvFTD patients may be more insensitive to errors in this task (145). Environmental dependency symptoms such as imitation or utilization behavior have been described as more frequently observed in bvFTD than in AD (43, 72) but the variability of their assessment procedures and the probable multidimensionality of these symptoms (68) may have limited the investigations about their clinical relevancy and applicability. Even though saccade or anti-saccade abnormalities are sometimes reported as typical of bvFTD (46, 146), executive-related oculomotor function have been found to be impaired in AD as well (147), although they may be preserved in early disease stages (148).…”

Section: Cognitive Dysfunctions In Bvftdmentioning

confidence: 99%

Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia–A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond

Johnen

Bertoux

2019

Front. Neurol.

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Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.

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“…The majority of ToM-studies in bvFTD did not control for cognitive abilities and there is evidence that ToM correlates with executive functioning in bvFTD (Baez et al, 2014; Gregory et al, 2002; Torralva et al, 2015). On the other hand, there is indirect evidence that ToM deficits can not be explained by global cognitive or executive dysfunction (Bertoux et al, 2016; Flanagan et al, 2018). A possible approach to reducing the impact of other cognitive processes on TOM function is the use of an implicit task.…”

Section: Introductionmentioning

confidence: 99%

Reduced tendency to attribute mental states to abstract shapes in behavioral variant frontotemporal dementia links with cerebellar structural integrity

Stock

Winter

Stam

et al. 2019

NeuroImage: Clinical

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Theory of mind (ToM) refers to the ability to attribute mental states to others. Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by profound deficits in social cognition, including ToM. We investigate whether bvFTD affects intention attribution tendency while viewing abstract animations and whether this might represent a primary deficit. A sample of 15 bvFTD patients and 19 matched controls were assessed on cognition and performed an implicit ToM task. They were instructed to describe what they observed in movement patterns displayed by geometrical shapes (triangles). These movement patterns either represented animacy, goal-directed actions or manipulation of mental state (ToM). The responses were scored for both accuracy and intentionality attribution. Using Voxel-Based Morphometry, we investigated the structural neuroanatomy associated with intention attribution tendency. The behavioral results revealed deficits in the bvFTD group on intentionality attribution that were specific for the ToM condition after controlling for global cognitive functioning (MMSE-score), visual attention (TMT B-score), fluid intelligence (RCPMT-score) and confrontation naming (BNT-score). In the bvFTD sample, the intention attribution tendency on the ToM-condition was associated with grey matter volume of a cluster in the cerebellum, spanning the right Crus I, Crus II, VIIIb, IX, left VIIb, IX and vermal IX and X. The results reveal a specific, primary, implicit domain-general ToM deficit in bvFTD that cannot be explained by cognitive dysfunction. Furthermore, the findings point to a contribution of the cerebellum in the social-cognitive phenotype of bvFTD.

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Executive and social-cognitive determinants of environmental dependency syndrome in behavioral frontotemporal dementia.

Abstract: These findings reveal a complex interaction between executive dysfunction and mental attribution deficits influencing the prevalence of EDS in bvFTD. Further investigation is required to improve our understanding of the mechanisms underlying these behaviors. (PsycINFO Database Record

Cited by 7 publications

References 49 publications

Cognitive and Neuroanatomic Accounts of Referential Communication in Focal Dementia

Cognitive and Neuroanatomic Accounts of Referential Communication in Focal Dementia

Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia–A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond

Reduced tendency to attribute mental states to abstract shapes in behavioral variant frontotemporal dementia links with cerebellar structural integrity

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