Neural correlates of altered insight in frontotemporal dementia: a systematic review

Muñoz-Neira, Carlos; Tedde, Andrea; Coulthard, Elizabeth; Thai, Ngoc Jade; Pennington, Catherine

doi:10.1016/j.nicl.2019.102066

Cited by 16 publications

(14 citation statements)

References 105 publications

(277 reference statements)

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“…There are differing conceptual models of awareness. Some models predominantly view lack of awareness as a symptom of brain disease and neurocognitive deficits that can be mapped radiologically [ 6 ]. This may be termed anosognosia, meaning lack of knowledge of a deficit, typically neurological.…”

Section: Introductionmentioning

confidence: 99%

Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme

et al. 2021

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Background People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. Methods This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. Results There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Conclusions Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care.

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Section: Introductionmentioning

confidence: 99%

Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme

et al. 2021

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“…We anticipated loss of synaptic density in the frontal and temporal poles and we searched for precise regional loss of synaptic projections. We have a particular interest in anosognosia as an early marker of neurocognitive disorders 17 , and we anticipated that decreased awareness for clinical symptoms, a frequent behavioral disorder observed in about 85% of bvFTD patients 18 would be related to frontal and/or temporal synaptopathy 19 .…”

Section: Introductionmentioning

confidence: 99%

In vivo exploration of synaptic projections in frontotemporal dementia

Salmon

Bahri

Plenevaux

et al. 2021

Sci Rep

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The purpose of this exploratory research is to provide data on synaptopathy in the behavioral variant of frontotemporal dementia (bvFTD). Twelve patients with probable bvFTD were compared to 12 control participants and 12 patients with Alzheimer’s disease (AD). Loss of synaptic projections was assessed with [18F]UCBH-PET. Total distribution volume was obtained with Logan method using carotid artery derived input function. Neuroimages were analyzed with SPM12. Verbal fluency, episodic memory and awareness of cognitive impairment were equally impaired in patients groups. Compared to controls, [18F]UCBH uptake tended to decrease in the right anterior parahippocampal gyrus of bvFTD patients. Loss of synaptic projections was observed in the right hippocampus of AD participants, but there was no significant difference in [18F]UCBH brain uptake between patients groups. Anosognosia for clinical disorder was correlated with synaptic density in the caudate nucleus and the anteromedial prefrontal cortex. This study suggests that synaptopathy in bvFTD targets the temporal social brain and self-referential processes.

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“…In the same way, there has been reported a high gender variability in patients with FTD (3,68,69), which also accounts as a limitation for the generalization of our results. Moreover, further studies should include other factors such as lack of insight and judgment problems, given that these are clinical characteristics of bvFTD (70)(71)(72) and may influence functional impairment of both IADLs and a-ADLs. Another limitation is related to the use of informant-based questionnaires for the assessment of functional impairment and neuropsychiatric symptoms, and the way it was conducted (at home), which could be susceptible to reporter bias.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Neural correlates of altered insight in frontotemporal dementia: a systematic review

Cited by 16 publications

References 105 publications

Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme

Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme

In vivo exploration of synaptic projections in frontotemporal dementia

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

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