Primary empathy deficits in frontotemporal dementia

Abstract

Loss of empathy is an early central symptom and diagnostic criterion of the behavioral variant frontotemporal dementia (bvFTD). Although changes in empathy are evident and strongly affect the social functioning of bvFTD patients, few studies have directly investigated this issue by means of experimental paradigms. The current study assessed multiple components of empathy (affective, cognitive and moral) in bvFTD patients. We also explored whether the loss of empathy constitutes a primary deficit of bvFTD or whether it is explained by impairments in executive functions (EF) or other social cognition domains. Thirty-seven bvFTD patients with early/mild stages of the disease and 30 healthy control participants were assessed with a task that involves the perception of intentional and accidental harm. Participants were also evaluated on emotion recognition, theory of mind (ToM), social norms knowledge and several EF domains. BvFTD patients presented deficits in affective, cognitive and moral aspects of empathy. However, empathic concern was the only aspect primarily affected in bvFTD that was neither related nor explained by deficits in EF or other social cognition domains. Deficits in the cognitive and moral aspects of empathy seem to depend on EF, emotion recognition and ToM. Our findings highlight the importance of using tasks depicting real-life social scenarios because of their greater sensitivity in the assessment of bvFTD. Moreover, our results contribute to the understanding of primary and intrinsic empathy deficits of bvFTD and have important theoretical and clinical implications.

Integration of Intention and Outcome for Moral Judgment in Frontotemporal Dementia: Brain Structural Signatures

“…This finding suggests that although our sample features both executive and moral judgment impairments, these two domains are independent. In line with this result, previous studies have shown that some social cognition domains, such as empathic concern of intentional harms [29], are primarily affected in bvFTD, independently from executive dysfunction. In controls, we found a significant association between the verbal inhibitory control subtest and the global moral score.…”

“…As in previous reports by our group [29,30,31,32], diagnosis was initially made by a group of experts in bvFTD. Each case was individually reviewed in a multidisciplinary clinical meeting involving cognitive neurologists, psychiatrists, and neuropsychologists.…”

“…Each case was individually reviewed in a multidisciplinary clinical meeting involving cognitive neurologists, psychiatrists, and neuropsychologists. bvFTD patients were recruited as part of a broader ongoing study on frontotemporal dementia [23,29,33,34]. Patients presented with functional impairment and prominent changes in personality and social behavior as verified by a caregiver during initial assessment.…”

Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke

“…For instance, according to the social context network model [37,75], damage to interoceptive hubs in bvFTD may affect salience attribution during social cognition deficits (e.g. [57,[76][77][78]). Moreover, interoceptive tasks and the HEP have been linked to emotion and social cognition [5,79].…”

Prosocial deficits in behavioral variant frontotemporal dementia relate to reward network atrophy

“…Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disease that is characterized by a gradual deterioration of social behavior and empathy (Baez et al., 2014; Clark et al., 2015; Gleichgerrcht, Torralva, Roca, Pose, & Manes, 2011; Hsieh, Hornberger, Piguet, & Hodges, 2012). In bvFTD, atrophy in emotion‐ and reward‐relevant neural systems may alter patients’ responsivity to affective cues, thereby impairing their ability to share, intuit, and respond to the needs of others (Henry, Phillips, & von Hippel, 2014; Rankin et al., 2006; Snowden et al., 2008).…”