Screening for Emotional Expression in Frontotemporal Dementia: A Pilot Study

Abstract

Objective Although emotional blunting is a core feature of behavioral variant frontotemporal dementia (bvFTD), there are no practical clinical measures of emotional expression for the early diagnosis of bvFTD. Method Three age-matched groups (bvFTD, Alzheimer's disease (AD), and healthy controls (HC)) of eight participants each were presented with real-life vignettes varying in emotional intensity (high versus low) with either negative or positive outcomes. This study evaluated verbal (self-reports of distress) and visual (presence or absence of facial affect) measures of emotional expression during the vignettes. Results The bvFTD patients did not differ from the AD and HC groups in reported distress or in the amount of facial affect during vignettes with high emotional intensity or type of outcome. However, the bvFTD patients reported significantly less distress and had correspondingly few facial affective expressions when compared on vignettes of low intensity. Conclusions Patients with bvFTD require a high intensity of emotional stimulus and are significantly hyporesponsive to low-intensity stimuli. Simple screening or observations of verbal and facial responsiveness to mildly arousing stimuli may aid in differentiating bvFTD from normal subjects and patients with other dementias. Future studies can investigate whether delivering information with high emotional intensity can facilitate communication with patients with bvFTD.

Exploring the Relationship Between Deficits in Social Cognition and Neurodegenerative Dementia: A Systematic Review

“…Fourteen studies explored emotional processing and empathy. Eleven studies (79%) reported a greater deficit in individuals with bvFTD compared with patients with AD (Kipps et al, 2009a ; Buhl et al, 2013 ; Bertoux et al, 2015 ; Chiu et al, 2016 ; Dermody et al, 2016 ; Carr et al, 2017 , 2018 ; Fong et al, 2017a ; Sturm et al, 2017 , 2018 ; Dodich et al, 2018 ), and the other three studies specifically observed reduced levels of empathy indicators in patients with bvFTD. The remaining studies did not report significant differences between the two groups of patients (Fernandez-Duque et al, 2010 ; Reul et al, 2017 ; Synn et al, 2018 ).…”

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

“…Emotion responding is also disturbed, with patients showing a diminished self-conscious emotional behavior (embarrassment and amusement) as well as a diminished associated physiological response, particularly toward negative emotional stimuli (239, 240). Similarly, blunted expressiveness in response to emotional stimuli, especially in low-intensity context and decreased autonomic responses such as skin conductance have been observed in bvFTD (241–244). Finally, recent investigations have showed that patients with bvFTD could have difficulties to imitate facial emotion expressions (245).…”

Behavioral changes to frontotemporal dementia diagnosis

“…Patients with FTD may have apathy, which is one of the most common and disabling dementia syndromes (Fernández-Matarrubia et al, 2018). These patients now require greater intensity of emotional stimuli to provoke suffering and emotional expression when compared to healthy people (Carr et al, 2018). However, in the early phase of the disease, other manifestations may be present, such as disinhibition, which will determine the course of the disease and the anatomical changes developed (Santamaria-Garcia et al, 2016).…”

“…While sexual hypofunction is related to atrophy of the right supramarginal gyrus, middle frontal gyrus, and thalamus, sexual hyperfunction is associated with cerebellar atrophy (Ahmed et al, 2018). One of the differences between the apathy of AD with FTD is that in the former there are no anatomical changes, while in the latter there is atrophy of the anterior cingulate cortex, ventromedial prefrontal cortex and anterior temporal lobes (Carr et al, 2018). .…”