Social Cognition Deficits: The Key to Discriminate Behavioral Variant Frontotemporal Dementia from Alzheimer’s Disease Regardless of Amnesia?

Abstract

Relative sparing of episodic memory is a diagnostic criterion of behavioural variant frontotemporal dementia (bvFTD). However, increasing evidences suggest that bvFTD patients can show episodic memory deficits at a similar level as Alzheimer's disease (AD). Social cognition tasks have been proposed to distinguish bvFTD, but no study to date has explored the utility of such tasks for the diagnosis of amnestic bvFTD. Here, we contrasted social cognition performance of amnestic and nonamnestic bvFTD from AD, with a subgroup having confirmed in vivo pathology markers.Ninety-six participants (38 bvFTD and 28 AD patients as well as 30 controls) performed the short Social-cognition and Emotional Assessment (mini-SEA). BvFTD patients were divided into amnestic versus non-amnestic presentation using the validated Free and Cued Selective Reminding Test (FCSRT) assessing episodic memory.As expected, the accuracy of the FCSRT to distinguish the overall bvFTD group from AD was low (69.7%) with ~50% of bvFTD patients being amnestic. By contrast, the diagnostic accuracy of the mini-SEA was high (87.9%). When bvFTD patients were split on the level of amnesia, mini-SEA diagnostic accuracy remained high (85.1%) for amnestic bvFTD vs. AD and increased to very high (93.9%) for non-amnestic bvFTD vs. AD.Social cognition deficits can distinguish bvFTD and AD regardless of amnesia to a high degree and provide a simple way to distinguish both diseases at presentation. These findings have clear implications for the diagnostic criteria of bvFTD. They suggest that the emphasis should be on social cognition deficits with episodic memory deficits not being a helpful diagnostic criterion in bvFTD.

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

“…By contrast, in this study, we aim to investigate the relationship between EDS and executive/attentional impairment as well as mental attribution ability on a test of social faux pas in a group of patients with behavioural variant of frontotemporal dementia (bvFTD). The behavioural variant of frontotemporal dementia (bvFTD) provides an ideal population to evaluate these two hypotheses due to these patients' characteristic marked executive (Rascovsky et al, 2011) and social cognition deficits (Bertoux, et al, 2016a;Elamin, Pender, Hardiman, & Abrahams, 2012), including pronounced ToM impairment (Bertoux et al, 2012;Torralva et al, 2007). No study to our knowledge has directly investigated and contrasted the Supervisory Attentional System model and the social hypothesis in the same sample by applying a measure of mental attribution dependent on social interaction knowledge.…”

Measurement of Social Cognition in Amyotrophic Lateral Sclerosis: A Population Based Study

“…ALS-related executive dysfunction has been reported to be the main predictor of social cognition performance when compared with demographic variables, behaviour, mood and personality [10]. Social cognitive deficits are also a well-recognised feature of Frontotemporal dementia [11] (FTD). ALS with a comorbid FTD is known to occur in 10–15% of patients [12], with a strong clinical and pathological overlap between these conditions [13].…”

Determinants of theory of mind performance in Alzheimer's disease: A data-mining study

“…Such findings would have implications towards designing the next generation of ToM tests with low executive or memory demands so as to gauge true ToM deficits in AD. This is also of critical importance considering that social cognition assessment is currently one of the best cognitive domain to discriminate AD from bvFTD clinically, even when either condition presents with severe amnesia (Bertoux et al, 2015).…”