Behavioural neurologyApathy in Alzheimer's disease and frontotemporal dementia: Distinct clinical profiles and neural correlates
Section snippets
Background
Apathy is the most prevalent and disabling non-cognitive symptom of dementia (Pagonabarraga et al., 2015, Savva et al., 2009), affecting up to 90% of individuals with dementia over the disease course (Steinberg et al., 2008, van Reekum et al., 2005). This loss of motivation severely limits the ability to function independently and to carry out activities such as basic hygiene, cooking, and maintaining social relationships. Moreover, presence of apathy in dementia is associated with functional
Participants
In total, 122 dementia patients were recruited – 69 bvFTD and 53 AD – from FRONTIER, the younger onset dementia research clinic in Sydney. All patients were assessed by an experienced behavioural neurologist and underwent neuropsychological assessment, structural brain magnetic resonance imaging (MRI) and had a reliable informant available. Diagnosis was determined according to current international consensus criteria (McKhann et al., 2011, Rascovsky et al., 2011). Exclusion criteria were:
Results
No significant differences in age, education or sex were observed across groups (all p values > .05; Table 1) and patient groups were matched for disease duration (p = .471). In line with previous findings, functional impairment (clinical disease stage on the FRS) was greater in bvFTD than AD (p < .001), with bvFTD patients rated as severe whereas AD patients were rated as moderate (Mioshi et al., 2010). Both patient groups showed significant cognitive impairment relative to controls on the ACE
Discussion
We have revealed here, that both the severity and nature of apathy is significantly different in AD and bvFTD. Although a relatively similar proportion of patients with AD and bvFTD show apathy on the NPI, in AD, the apathy was less frequent and less severe than in bvFTD. When we examined the different aspects of apathy applying the ABC model (Levy and Dubois, 2006, Marin, 1991), divergent profiles emerged: severe cognitive apathy in AD; severe affective and cognitive apathy in bvFTD; and
Funding sources
This work was supported in part by funding to ForeFront, a collaborative research group dedicated to the study of frontotemporal dementia and motor neuron disease, from the National Health and Medical Research Council (NHMRC) (APP1037746) and the Australian Research Council (ARC) Centre of Excellence in Cognition and its Disorders Memory Program (CE11000102). In addition, this study was supported by NHMRC Project Grant (APP1121791). FK is supported by an NHMRC-ARC Dementia Research Development
Conflict of interest
The authors have no conflicts of interest to declare.
Acknowledgements
The authors are grateful to all the patients and their families for supporting our research.
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2022, Parkinsonism and Related DisordersCitation Excerpt :Third, those with higher emotional apathy displayed reduced GMV in ventral and middle limbic regions. Previously, emotional apathy comparably correlated with lower GMV in the left insula across neurodegenerative disorders [6], while insular lesions related with reduced reward sensitivity [29]. Limbic temporomesial cortex lesions have also been linked to emotional apathy, disrupting the flow of emotional valence information from the amygdala and nucleus accumbens to the OFC [30].
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2022, NeuropsychologiaCitation Excerpt :By comparison, the two patients with combined initiation and executive apathy had contrasting lesion sites, one of which was a discrete left cerebellar lesion (P10) and the second was the right superior temporal region and insula (P11). As noted earlier (1.4), cerebellar GM intensity has been associated with initiation apathy in frontotemporal dementia and Alzheimer's disease (Kumfor et al., 2018), while the insula has previously been identified as an important region in apathy in progressive supranuclear palsy and Alzheimer's disease (Stanton et al., 2013; Kos et al., 2016), primary progressive aphasia (Quang et al., 2021) and stroke (e.g., Rochat et al., 2013). Importantly, the discrepancies between these two patients' lesions highlight that the same pattern of apathy symptoms can arise as a result of very different pathology.