Primary empathy deficits in frontotemporal dementia.

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.

The INECO Frontal Screening tool differentiates behavioral variant - frontotemporal dementia (bv-FTD) from major depression / Rastreio frontal INECO diferencia a variante comportamental da demência frontotemporal de depressão maior

Executive dysfunction may result from prefrontal circuitry involvement occurring in both neurodegenerativediseases and psychiatric disorders. Moreover, multiple neuropsychiatric conditions, may present with overlapping behavioraland cognitive symptoms, making differential diagnosis challenging, especially during earlier stages. In this sense, cognitiveassessment may contribute to the differential diagnosis by providing an objective and quantifiable set of measures that hasthe potential to distinguish clinical conditions otherwise perceived in everyday clinical settings as quite similar. Objective:The goal of this study was to investigate the utility of the INECO Frontal Screening (IFS) for differentiating bv-FTD patientsfrom patients with Major Depression. Methods: We studied 49 patients with bv-FTD diagnosis and 30 patients diagnosedwith unipolar depression compared to a control group of 26 healthy controls using the INECO Frontal Screening (IFS), the MiniMental State Examination (MMSE) and the Addenbrooke?s Cognitive Examination-Revised (ACE-R). Results: Patient groupsdiffered significantly on the motor inhibitory control (U=437.0, p<0.01), verbal working memory (U=298.0, p<0.001), spatialworking memory (U=300.5, p<0.001), proverbs (U=341.5, p<0.001) and verbal inhibitory control (U=316.0, p<0.001)subtests, with bv-FTD patients scoring significantly lower than patients with depression. Conclusion: Our results suggestthe IFS can be considered a useful tool for detecting executive dysfunction in both depression and bv-FTD patients and,perhaps more importantly, that it has the potential to help differentiate these two conditions.

A disfunção executiva pode resultar de envolvimento do circuito pré-frontal que ocorre em doençasneurodegenerativas e distúrbios psiquiátricos. Além disso, várias condições neuropsiquiátricas, podem apresentarsobreposição de sintomas comportamentais e cognitivos, tornando o diagnóstico diferencial um desafio, especialmentedurante as fases iniciais. Neste sentido, a avaliação cognitiva pode contribuir para o diagnóstico diferencial, fornecendoum conjunto de medidas objetivas e quantificáveis com potencial para distinguir as condições clínicas percebidas emambientes clínicos comuns como bastante similar. Objetivo: O objetivo deste estudo foi o de investigar a utilidade do RastreioFrontal INECO (IFS) em diferenciar pacientes bv-FTD de pacientes com depressão maior. Métodos: Foram estudados 49pacientes com diagnóstico de bv-FTD e 30 pacientes com diagnóstico de depressão unipolar, que foram comparados comum grupo controle de 26 controles saudáveis usando o IFS, o Mini Exame do Estado Mental (MMSE) e Exame Cognitivode Addenbrooke-revisado (ACE-I). Resultados: Os grupos de pacientes diferiram significativamente no controle inibitóriomotor (U=437,0, p<0,01), memória de trabalho verbal (U=298,0, p<0,001), a memória de trabalho espacial (U=300,5,p<0,001), provérbios (U=341,5, p<0,001) e no controle inibitório verbal (U=316,0, p<0,001), com pacientes com bv-FTDtendo pontuação significativamente menor do que os pacientes com depressão. Conclusão: Nossos resultados sugeremque o IFS pode ser considerado uma ferramenta útil para detectar a disfunção executiva em depressão e pacientes bv-FTDe, talvez mais importante, que tem o potencial de ajudar na diferenciação dessas duas condições.

The INECO Frontal Screening tool differentiates behavioral variant - frontotemporal dementia (bv-FTD) from major depression.

Executive dysfunction may result from prefrontal circuitry involvement occurring in both neurodegenerative diseases and psychiatric disorders. Moreover, multiple neuropsychiatric conditions, may present with overlapping behavioral and cognitive symptoms, making differential diagnosis challenging, especially during earlier stages. In this sense, cognitive assessment may contribute to the differential diagnosis by providing an objective and quantifiable set of measures that has the potential to distinguish clinical conditions otherwise perceived in everyday clinical settings as quite similar. OBJECTIVE: The goal of this study was to investigate the utility of the INECO Frontal Screening (IFS) for differentiating bv-FTD patients from patients with Major Depression. METHODS: We studied 49 patients with bv-FTD diagnosis and 30 patients diagnosed with unipolar depression compared to a control group of 26 healthy controls using the INECO Frontal Screening (IFS), the Mini Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R). RESULTS: Patient groups differed significantly on the motor inhibitory control (U=437.0, p<0.01), verbal working memory (U=298.0, p<0.001), spatial working memory (U=300.5, p<0.001), proverbs (U=341.5, p<0.001) and verbal inhibitory control (U=316.0, p<0.001) subtests, with bv-FTD patients scoring significantly lower than patients with depression. CONCLUSION: Our results suggest the IFS can be considered a useful tool for detecting executive dysfunction in both depression and bv-FTD patients and, perhaps more importantly, that it has the potential to help differentiate these two conditions.

A disfunção executiva pode resultar de envolvimento do circuito pré-frontal que ocorre em doenças neurodegenerativas e distúrbios psiquiátricos. Além disso, várias condições neuropsiquiátricas, podem apresentar sobreposição de sintomas comportamentais e cognitivos, tornando o diagnóstico diferencial um desafio, especialmente durante as fases iniciais. Neste sentido, a avaliação cognitiva pode contribuir para o diagnóstico diferencial, fornecendo um conjunto de medidas objetivas e quantificáveis com potencial para distinguir as condições clínicas percebidas em ambientes clínicos comuns como bastante similar. OBJETIVO: O objetivo deste estudo foi o de investigar a utilidade do Rastreio Frontal INECO (IFS) em diferenciar pacientes bv-FTD de pacientes com depressão maior. MÉTODOS: Foram estudados 49 pacientes com diagnóstico de bv-FTD e 30 pacientes com diagnóstico de depressão unipolar, que foram comparados com um grupo controle de 26 controles saudáveis usando o IFS, o Mini Exame do Estado Mental (MMSE) e Exame Cognitivo de Addenbrooke-revisado (ACE-I). RESULTADOS: Os grupos de pacientes diferiram significativamente no controle inibitório motor (U=437,0, p<0,01), memória de trabalho verbal (U=298,0, p<0,001), a memória de trabalho espacial (U=300,5, p<0,001), provérbios (U=341,5, p<0,001) e no controle inibitório verbal (U=316,0, p<0,001), com pacientes com bv-FTD tendo pontuação significativamente menor do que os pacientes com depressão. CONCLUSÃO: Nossos resultados sugerem que o IFS pode ser considerado uma ferramenta útil para detectar a disfunção executiva em depressão e pacientes bv-FTD e, talvez mais importante, que tem o potencial de ajudar na diferenciação dessas duas condições.