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Tondelli M, Ballotta D, Maramotti R, Carbone C, Gallingani C, MacKay C, Pagnoni G, Chiari A, Zamboni G. Resting-state networks and anosognosia in Alzheimer's disease. Front Aging Neurosci 2024; 16:1415994. [PMID: 38903902 PMCID: PMC11188402 DOI: 10.3389/fnagi.2024.1415994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Recent evidence suggests that anosognosia or unawareness of cognitive impairment in Alzheimer's Disease (AD) may be explained by a disconnection between brain regions involved in accessing and monitoring information regarding self and others. It has been demonstrated that AD patients with anosognosia have reduced connectivity within the default mode network (DMN) and that anosognosia in people with prodromal AD is positively associated with bilateral anterior cingulate cortex (ACC), suggesting a possible role of this region in mechanisms of awareness in the early phase of disease. We hypothesized that anosognosia in AD is associated with an imbalance between the activity of large-scale resting-state functional magnetic resonance imaging (fMRI) networks, in particular the DMN, the salience network (SN), and the frontoparietal network (FPN). Methods Sixty patients with MCI and AD dementia underwent fMRI and neuropsychological assessment including the Anosognosia Questionnaire Dementia (AQ-D), a measure of anosognosia based on a discrepancy score between patient's and carer's judgments. After having applied Independent Component Analysis (ICA) to resting fMRI data we performed: (i) correlations between the AQ-D score and functional connectivity in the DMN, SN, and FPN, and (ii) comparisons between aware and unaware patients of the DMN, SN, and FPN functional connectivity. Results We found that anosognosia was associated with (i) weak functional connectivity within the DMN, in posterior and middle cingulate cortex particularly, (ii) strong functional connectivity within the SN in ACC, and between the SN and basal ganglia, and (iii) a heterogenous effect concerning the functional connectivity of the FPN, with a weak connectivity between the FPN and PCC, and a strong connectivity between the FPN and ACC. The observed effects were controlled for differences in severity of cognitive impairment and age. Conclusion Anosognosia in the AD continuum is associated with a dysregulation of the functional connectivity of three large-scale networks, namely the DMN, SN, and FPN.
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Affiliation(s)
- Manuela Tondelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Oxford Project to Investigate Memory and Ageing (OPTIMA), Experimental Medicine Division of Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniela Ballotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Maramotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Chiara Carbone
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Gallingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Clare MacKay
- Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pagnoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiari
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Giovanna Zamboni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Oxford Project to Investigate Memory and Ageing (OPTIMA), Experimental Medicine Division of Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Rhodes E, Mechanic-Hamilton D, Phillips JS, Bahena A, Vitali N, Hlava Q, Cook P, Gee J, Grossman M, McMillan C, Massimo L. Discrepancies in Patient and Caregiver Ratings of Personality Change in Alzheimer's Disease and Related Dementias. Arch Clin Neuropsychol 2024; 39:399-408. [PMID: 37867324 PMCID: PMC11110615 DOI: 10.1093/arclin/acad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Personality change in Alzheimer's disease and related dementias (ADRD) is complicated by the patient and informant factors that confound accurate reporting of personality traits. We assessed the impact of caregiver burden on informant report of Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) and investigated the regional cortical volumes associated with larger discrepancies in the patient and informant report of the Big Five personality traits. METHOD Sixty-four ADRD participants with heterogeneous neurodegenerative clinical phenotypes and their informants completed the Big Five Inventory (BFI). Caregiver burden was measured using the Zarit Burden Interview. Discrepancy scores were computed as the difference between patient and informant ratings for the BFI. Regional gray matter volumes from T1-weighted 3T MRI were normalized to intracranial volume and related to global Big Five discrepancy scores using linear regression. RESULTS Higher levels of caregiver burden were associated with higher informant ratings of patient neuroticism (ß = 0.08, p = .012) and with lower informant ratings of patient agreeableness (ß = 0.11, p = .021) and conscientiousness (ß = 0.04, p = .034) independent of disease severity. Patients with greater Big Five discrepancy scores showed smaller cortical volumes in the right medial prefrontal cortex (β = -5.24, p = .045) and right superior temporal gyrus (β = -7.91, p = .028). CONCLUSIONS Informant ratings of personality traits in ADRD can be confounded by the caregiver burden, highlighting the need for more objective measures of personality and behavior in dementia samples. Discrepancies between informant and patient ratings of personality may additionally reflect loss of insight secondary to cortical atrophy in the frontal and temporal structures.
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Affiliation(s)
- Emma Rhodes
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dawn Mechanic-Hamilton
- Alzheimer’s Disease Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S Phillips
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alejandra Bahena
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nykko Vitali
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Quinn Hlava
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Philip Cook
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James Gee
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Murray Grossman
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Corey McMillan
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lauren Massimo
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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Salmon E, Meyer F, Genon S, Collette F, Bastin C. Neural correlates of impaired cognitive processes underlying self-unawareness in Alzheimer's disease. Cortex 2024; 171:1-12. [PMID: 37977109 DOI: 10.1016/j.cortex.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
Self-unawareness concerning current symptoms remains a clinical challenge in Alzheimer's disease. Reduced self-awareness likely depends on complex biopsychosocial mechanisms that comprise multiple cognitive processes, regulated by personal goals and values. We specifically reviewed the cognitive processes impaired in unaware participants with AD by emphasizing the related impaired brain activity observed during task-based fMRI. Unawareness can be explained by a failure in functioning of or in connection between brain regions that intervene in access, retrieval and updating of (present or extended) self-information (posterior midline, medial temporal, inferior parietal cortices), or in its monitoring, evaluation, or control (medial and lateral prefrontal cortices). Although one must be cautious when relating function to brain regions, impaired processes were tentatively related to the Cognitive Awareness Model. Although brain function depends on neural networks, impaired brain activity during cognitive processes was discussed according to previous studies reporting correlations between brain regions and scores of anosognosia. The review provides a framework to help clinicians considering processes that can explain unawareness in dementia. In patients at early stages of AD, different levels of awareness of cognitive or social clinical changes might be described as impairment in the interaction between specific cognitive processes and contents.
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Affiliation(s)
- Eric Salmon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - François Meyer
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Sarah Genon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium; Institute of Systems Neuroscience, Heinrich Heine University Duesseldorf, Duesseldorf, Germany; Institute of Neuroscience and Medicine (INM-7), Research Centre Juelich, Juelich, Germany.
| | - Fabienne Collette
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Christine Bastin
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
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Jellinger KA. Pathomechanisms of cognitive and behavioral impairment in corticobasal degeneration. J Neural Transm (Vienna) 2023; 130:1509-1522. [PMID: 37659990 DOI: 10.1007/s00702-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Corticobasal degeneration (CBD) is a rare, sporadic, late-onset progressive neurodegenerative disorder of unknown etiology, clinically characterized by an akinetic-rigid syndrome, behavior and personality disorders, language problems (aphasias), apraxia, executive and cognitive abnormalities and limb dystonia. The syndrome is not specific, as clinical features of pathologically proven CBD include several phenotypes. This 4-repeat (4R) tauopathy is morphologically featured by often asymmetric frontoparietal atrophy, ballooned/achromatic neurons containing filamentous 4R-tau aggregates in cortex and striatum, thread-like processes that are more widespread than in progressive supranuclear palsy (PSP), pathognomonic "astroglial plaques", and numerous inclusions in both astrocytes and oligodendroglia ("coiled bodies") in the white matter. Cognitive deficits in CBD are frequent initial presentations before onset of motor symptoms, depending on the phenotypic variant. They predominantly include executive and visuospatial dysfunction, sleep disorders and language deficits with usually preserved memory domains. Neuroimaging studies showed heterogenous locations of brain atrophy, particularly contralateral to the dominant symptoms, with disruption of striatal connections to prefrontal cortex and basal ganglia circuitry. Asymmetric hypometabolism, mainly involving frontal and parietal regions, is associated with brain cholinergic deficits, and dopaminergic nigrostriatal degeneration. Widespread alteration of cortical and subcortical structures causing heterogenous changes in various brain functional networks support the concept that CBD, similar to PSP, is a brain network disruption disorder. Putative pathogenic factors are hyperphosphorylated tau-pathology, neuroinflammation and oxidative injury, but the basic mechanisms of cognitive impairment in CBD, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for early diagnosis and adequate treatment of this fatal disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Rhodes E, Mechanic-Hamilton D, Phillips JS, McMillan C, Bahena A, Vitali N, Hlava Q, Cook P, Gee J, Grossman M, Massimo L. Discrepancies in patient and caregiver ratings of personality change in Alzheimer's disease and related dementias. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.09.23287003. [PMID: 36993170 PMCID: PMC10055470 DOI: 10.1101/2023.03.09.23287003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Assessment of personality change in Alzheimer's disease and related dementias (ADRD) is clinically meaningful but complicated by patient (i.e., reduced insight) and informant (i.e., caregiver burden) factors that confound accurate reporting of personality traits. This study assessed the impact of caregiver burden on informant report of Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness) and investigated regional cortical volumes associated with larger discrepancies in patient and informant report of Big Five personality traits. Methods Sixty-four ADRD participants with heterogeneous neurodegenerative clinical phenotypes and their informants completed the Big Five Inventory (BFI). Caregiver burden was measured using the Zarit Burden Interview (ZBI). Discrepancy scores were computed as the absolute value of the difference between patient and informant ratings for all BFI trait scores and summed to create a global score. Regional grey matter volumes from T1-weighted 3T MRI were normalized to intracranial volume and related to global Big Five discrepancy scores using linear regression. Results Higher levels of caregiver burden were associated with higher informant ratings of patient Neuroticism (ß =0.27, p =.016) and lower informant ratings of patient Agreeableness (ß =-0.32, p =.002), Conscientiousness (ß =-0.3, p =.002), and Openness (ß =-0.34, p =.003) independent of disease severity. Patients with greater Big Five discrepancy scores showed smaller cortical volumes in right medial PFC (β = -0.00015, p = .002), right superior temporal gyrus (β = -0.00028, p = .025), and left inferior frontal gyrus (β = -0.00006 p = .013). Conclusions Informant ratings of personality traits in ADRD can be confounded by caregiver burden, highlighting the need for more objective measures of personality and behavior in dementia samples. Discrepancies between informant and patient ratings of personality may additionally reflect loss of insight secondary to cortical atrophy in frontal and temporal structures.
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Beadle JN, Heller A, Rosenbaum RS, Davidson PSR, Tranel D, Duff M. Amygdala but not hippocampal damage associated with smaller social network size. Neuropsychologia 2022; 174:108311. [PMID: 35810880 PMCID: PMC9887793 DOI: 10.1016/j.neuropsychologia.2022.108311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Social network size has been associated with complex socio-cognitive processes (e.g., memory, perspective taking). Supporting this idea, recent neuroimaging studies in healthy adults have reported a relationship between social network size and brain volumes in regions related to memory and social cognition (e.g., hippocampus, amygdala). Lesion-deficit studies in neurological patients are rare and have been inconclusive due to differences in participant sampling and measurement. The present study uses a multiple case study approach. We investigated patients with focal damage to the hippocampus and/or amygdala (two neural structures thought to be critical for social networks), and examined the patients' social network size, loneliness, and life satisfaction relative to a non-injured comparison group. Patients with amygdalar damage had smaller social networks and reported higher levels of loneliness and lower life satisfaction, on average, than comparison participants. Patients with damage to the hippocampus reported more friends than the comparison participants, but did not differ in their ratings of loneliness or life satisfaction. This lesion study offers new evidence that the amygdala is critical for social networks, life satisfaction, and reduced loneliness.
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Affiliation(s)
- Janelle N Beadle
- Department of Gerontology, University of Nebraska at Omaha, USA.
| | - Abi Heller
- Department of Gerontology, University of Nebraska at Omaha, USA
| | - R Shayna Rosenbaum
- Department of Psychology and Vision: Science to Applications (VISTA) Program, York University, Canada
| | | | - Daniel Tranel
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, USA
| | - Melissa Duff
- Department of Hearing and Speech Sciences, Vanderbilt University, USA
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The sense of agency for brain disorders: A comprehensive review and proposed framework. Neurosci Biobehav Rev 2022; 139:104759. [PMID: 35780975 DOI: 10.1016/j.neubiorev.2022.104759] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
Abstract
Sense of Agency (SoA) refers to the feeling of control over voluntary actions and the outcomes of those actions. Several brain disorders are characterized by an abnormal SoA. To date, there is no robust treatment for aberrant agency across disorders; this is, in large part, due to gaps in our understanding of the cognitive mechanisms and neural correlates of the SoA. This apparent gap stems from a lack of synthesis in established findings. As such, the current review reconciles previously established findings into a novel neurocognitive framework for future investigations of the SoA in brain disorders, which we term the Agency in Brain Disorders Framework (ABDF). In doing so, we highlight key top-down and bottom-up cues that contribute to agency prospectively (i.e., prior to action execution) and retrospectively (i.e., after action execution). We then examine brain disorders, including schizophrenia, autism spectrum disorders (ASD), obsessive-compulsive disorders (OCD), and cortico-basal syndrome (CBS), within the ABDF, to demonstrate its potential utility in investigating neurocognitive mechanisms underlying phenotypically variable presentations of the SoA in brain disorders.
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Masina F, Pezzetta R, Lago S, Mantini D, Scarpazza C, Arcara G. Disconnection from prediction: A systematic review on the role of right temporoparietal junction in aberrant predictive processing. Neurosci Biobehav Rev 2022; 138:104713. [PMID: 35636560 DOI: 10.1016/j.neubiorev.2022.104713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
The right temporoparietal junction (rTPJ) is a brain area that plays a critical role in a variety of cognitive functions. Although different theoretical proposals tried to explain the ubiquitous role of rTPJ, recent evidence suggests that rTPJ may be a fundamental cortical region involved in different kinds of predictions. This systematic review aims to better investigate the potential role of rTPJ under a predictive processing perspective, providing an overview of cognitive impairments in neurological patients as the consequence of structural or functional disconnections or damage of rTPJ. Results confirm the involvement of rTPJ across several tasks and neurological pathologies. RTPJ, via its connections with other brain networks, would integrate diverse information and update internal models of the world. Against traditional views, which tend to focus on distinct domains, we argue that the role of rTPJ can be parsimoniously interpreted as a key hub involved in domain-general predictions. This alternative account of rTPJ role in aberrant predictive processing opens different perspectives, stimulating new hypotheses in basic research and clinical contexts.
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Affiliation(s)
| | | | - Sara Lago
- IRCCS San Camillo Hospital, Venice, Italy.
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven 3001, Belgium.
| | - Cristina Scarpazza
- IRCCS San Camillo Hospital, Venice, Italy; Department of General Psychology, University of Padua, Padua, Italy.
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Cacciamani F, Godefroy V, Brambati SM, Migliaccio R, Epelbaum S, Montembeault M. Differential Patterns of Domain-Specific Cognitive Complaints and Awareness Across the Alzheimer's Disease Spectrum. Front Aging Neurosci 2022; 14:811739. [PMID: 35813963 PMCID: PMC9261482 DOI: 10.3389/fnagi.2022.811739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Characterizing self- and informant-reported cognitive complaints, as well as awareness of cognitive decline (ACD), is useful for an early diagnosis of Alzheimer's disease (AD). However, complaints and ACD related to cognitive functions other than memory are poorly studied. Furthermore, it remains unclear which source of information is the most useful to distinguish various groups on the AD spectrum. Methods: Self- and informant-reported complaints were measured with the Everyday Cognition questionnaire (ECog-Subject and ECog-StudyPartner) in four domains (memory, language, visuospatial, and executive). ACD was measured as the subject-informant discrepancy in the four ECog scores. We compared the ECog and ACD scores across cognitive domains between four groups: 71 amyloid-positive individuals with amnestic AD, 191 amnestic mild cognitive impairment (MCI), or 118 cognitively normal (CN), and 211 amyloid-negative CN controls, selected from the ADNI database. Receiver operating characteristic curves analysis was performed to evaluate the accuracy of the ECog and ACD scores in discriminating clinical groups. Results: Self- and informant-reported complaints were generally distributed as follows: memory, language, executive, and visuospatial (from the most severe to the least severe). Both groups of CN participants presented on average more memory and language complaints than their informant. MCI participants showed good agreement with their informants. AD participants presented anosognosia in all domains, but especially for the executive domain. The four ECog-StudyPartner sub-scores allowed excellent discrimination between groups in almost all classifications and performed significantly better than the other two classifiers considered. The ACD was excellent in distinguishing the participants with AD from the two groups of CN participants. The ECog-Subject was the least accurate in discriminating groups in four of the six classifications performed. Conclusion: In research, the study of complaint and anosognosia should not be reduced solely to the memory domain. In clinical practice, non-amnestic complaints could also be linked to Alzheimer's disease. The presence of an informant also seems necessary given its accuracy as a source of information.
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Affiliation(s)
- Federica Cacciamani
- ARAMISLab, Inserm, CNRS, Sorbonne Université, Inria, Paris Brain Institute (ICM), Pitié-Salpêtrière Hospital, Paris, France
- PHARes Team, Bordeaux Population Health, University of Bordeaux, Inserm, Bordeaux, France
| | - Valérie Godefroy
- FrontLab, Paris Brain Institute (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - Simona M. Brambati
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Raffaella Migliaccio
- FrontLab, Paris Brain Institute (ICM), Pitié-Salpêtrière Hospital, Paris, France
- Institute of Memory and Alzheimer’s disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphane Epelbaum
- ARAMISLab, Inserm, CNRS, Sorbonne Université, Inria, Paris Brain Institute (ICM), Pitié-Salpêtrière Hospital, Paris, France
- Institute of Memory and Alzheimer’s disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Maxime Montembeault
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Theodorou E, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Anosognosia in Dementia: Evaluation of Perfusion Correlates Using 99mTc-HMPAO SPECT and Automated Brodmann Areas Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051136. [PMID: 35626292 PMCID: PMC9140080 DOI: 10.3390/diagnostics12051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Considerable inconsistency exists regarding the neural substrates of anosognosia in dementia in previous neuroimaging studies. The purpose of this study was the evaluation of anosognosia perfusion correlates across various types of dementia using automated Brodmann areas (BAs) analysis and comparison with a database of normal subjects. (2) Methods: We studied 72 patients: 32 with Alzheimer’s disease, 26 with frontotemporal dementia—FTD (12 behavioral FTD, 9 semantic FTD, 5 Progressive Non-Fluent Aphasia), 11 with corticobasal syndrome, and 3 with progressive supranuclear palsy. Addenbrook’s Cognitive Examination—Revised (ACE-R) mean(±SD) was 55.6(±22.8). For anosognosia measurement, the Anosognosia Questionnaire—Dementia was used. Total anosognosia score mean(±SD) was 22.1(±17.9), cognitive anosognosia score mean(±SD) was 18.1(±15.1) and behavioral–mood anosognosia score mean(±SD) was 3.3(±4.7). (3) Results: Higher anosognosia total score was associated with hypoperfusion in the inferior temporal, anterior cingulate, and inferior frontal cortices of the right hemisphere (BAs 20R, 24R, 32R, 45R). Higher anosognosia cognitive score was correlated with hypoperfusion in the left middle and anterior temporal cortices, and right dorsal anterior cingulate cortex (BAs 21L, 22L, 32R). No association was found with behavioral–mood anosognosia. (4) Conclusions: Automated analysis of brain perfusion Single Photon Emission Computed Tomography could be useful for the investigation of anosognosia neural correlates in dementia.
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Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
- Correspondence: or ; Tel.: +30-2413502916; Fax: +302413501851
| | - Nikolaos Sifakis
- Nuclear Medicine Department, “Alexandra” General Hospital, 11528 Athens, Greece;
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, 11528 Athens, Greece;
| | - Vasiliki Kamtsadeli
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Dimitra Sali
- Neurology Department, Evrokliniki, 11521 Athens, Greece;
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Eudoxia Theodorou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Ioannis Tsougos
- Medical Physics Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece;
| | | | - Panagiotis Georgoulias
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
| | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
- Memory Disorders Clinic, Medical Center, 15125 Athens, Greece
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Fremont R, Dworkin J, Manoochehri M, Krueger F, Huey E, Grafman J. Damage to the dorsolateral prefrontal cortex is associated with repetitive compulsive behaviors in patients with penetrating brain injury. BMJ Neurol Open 2022; 4:e000229. [PMID: 35519903 PMCID: PMC9020295 DOI: 10.1136/bmjno-2021-000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/18/2022] [Indexed: 11/03/2022] Open
Abstract
Background Damage to cortico-striato-thalamo-cortical (CSTC) circuits is associated with the development of repetitive behaviours in animals and humans. However, the types of repetitive behaviours that are developed after injury to these structures are poorly defined. This study examines the effect of damage to separate elements of CSTC circuits sustained by veterans of the Vietnam War on obsessions, compulsions, and tics. Methods We performed partial correlations (correcting for cognition, age, education, and global brain damage) between volume loss from traumatic brain injury in specific elements of CSTC circuits (lateral and medial orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate cortex, thalamus, and basal ganglia) and scores on a modified version of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and the Yale Global Tic Severity Scale in 83 Vietnam war veterans with penetrating brain injuries at different sites throughout the brain. Results We found that volume loss in the left dorsolateral prefrontal cortex was associated with the development of compulsive behaviours (r=0.32, padj<0.05) whereas volume loss in the basal ganglia was associated with the development of tics (r=0.33, padj<0.05). Conclusion Our findings indicate that damage to specific CSTC elements can be associated with the development of compulsive behaviours and tics that are not necessarily accompanied by obsessions.
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Affiliation(s)
- Rachel Fremont
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Jordan Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Masood Manoochehri
- Taub Insitute, Columbia University Medical Center, New York, New York, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, Virginia, USA
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Edward Huey
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Neurology, Columbia University, New York, New York, USA
| | - Jordan Grafman
- Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
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12
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Le C, Finger E. Pharmacotherapy for Neuropsychiatric Symptoms in Frontotemporal Dementia. CNS Drugs 2021; 35:1081-1096. [PMID: 34426949 DOI: 10.1007/s40263-021-00854-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Despite significant progress in the understanding of the frontotemporal dementias (FTDs), there remains no disease-modifying treatment for these conditions, and limited effective symptomatic treatment. Behavioural variant frontotemporal dementia (bvFTD) is the most common FTD syndrome, and is characterized by severe impairments in behaviour, personality and cognition. Neuropsychiatric symptoms are common features of bvFTD but are present in the other FTD syndromes. Current treatment strategies therefore focus on ameliorating the neuropsychiatric features. Here we review the rationale for current treatments related to each of the main neuropsychiatric symptoms forming the diagnostic criteria for bvFTD relevant to all FTD subtypes, and two additional symptoms not currently part of the diagnostic criteria: lack of insight and psychosis. Given the paucity of effective treatments for these symptoms, we highlight how contributing mechanisms delineated in cognitive neuroscience may inform future approaches to clinical trials and more precise symptomatic treatments for FTDs.
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Affiliation(s)
- Christine Le
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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13
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Silverman HE, Gazes Y, Barker MS, Manoochehri M, Goldman JS, Wassermann EM, Tierney MC, Cosentino S, Grafman J, Huey ED. Frontal Pole Hypometabolism Linked to Reduced Prosocial Sexual Behaviors in Frontotemporal Dementia and Corticobasal Syndrome. J Alzheimers Dis 2021; 77:821-830. [PMID: 32741826 DOI: 10.3233/jad-200346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Changes in sexual behaviors in frontotemporal dementia (FTD) are common and multifaceted, but not well characterized. OBJECTIVE To characterize changes in sexual behaviors and intimacy in FTD compared to corticobasal syndrome (CBS) and normal controls (NC), and to evaluate the neuroanatomical associations of these changes. METHODS Spouses of 30 FTD patients, 20 CBS patients, and 35 NC completed the Sexual Symptoms in Neurological Illness and Injury Questionnaire (SNIQ), which captures changes in sexual interest, inappropriate sexual behaviors, and prosocial sexual behaviors. 25 patients with FTD and 14 patients with CBS also received 18-flouorodeoxyglucose positron-emission topography (18FDG-PET) scans to determine the metabolic changes associated with these symptoms. RESULTS FTD patients showed a greater increase in inappropriate sexual behaviors than CBS patients [p = 0.009] and NC [p < 0.001] and a greater decrease in prosocial sexual behaviors than CBS patients [p = 0.026] and NC [p < 0.001]. Groups did not differ in change in sexual interest. Among both patient groups, the most common change was decreased prosocial sexual behaviors p < 0.01. Hypometabolism in Brodmann's Area 10 (BA10), within the right frontal pole, correlated with decreased prosocial sexual behaviors [p(FWE-corr) <0.05, k = 44]. No anatomical associations were found with other sexual changes. CONCLUSION Decreased prosocial sexual behavior was associated with hypometabolism in BA 10, an area tied to social knowledge and theory of mind, supporting the idea that changes reflect social-cognitive deficits due to frontal dysfunction.
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Affiliation(s)
- Hannah E Silverman
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yunglin Gazes
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan S Barker
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Masood Manoochehri
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jill S Goldman
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Michael C Tierney
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie Cosentino
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan Grafman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Brain Injury Research Program, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Edward D Huey
- The Gertrude H. Sergievsky Center & Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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14
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Salmon E, Bahri MA, Plenevaux A, Becker G, Seret A, Delhaye E, Degueldre C, Balteau E, Lemaire C, Luxen A, Bastin C. In vivo exploration of synaptic projections in frontotemporal dementia. Sci Rep 2021; 11:16092. [PMID: 34373529 PMCID: PMC8352914 DOI: 10.1038/s41598-021-95499-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022] Open
Abstract
The purpose of this exploratory research is to provide data on synaptopathy in the behavioral variant of frontotemporal dementia (bvFTD). Twelve patients with probable bvFTD were compared to 12 control participants and 12 patients with Alzheimer’s disease (AD). Loss of synaptic projections was assessed with [18F]UCBH-PET. Total distribution volume was obtained with Logan method using carotid artery derived input function. Neuroimages were analyzed with SPM12. Verbal fluency, episodic memory and awareness of cognitive impairment were equally impaired in patients groups. Compared to controls, [18F]UCBH uptake tended to decrease in the right anterior parahippocampal gyrus of bvFTD patients. Loss of synaptic projections was observed in the right hippocampus of AD participants, but there was no significant difference in [18F]UCBH brain uptake between patients groups. Anosognosia for clinical disorder was correlated with synaptic density in the caudate nucleus and the anteromedial prefrontal cortex. This study suggests that synaptopathy in bvFTD targets the temporal social brain and self-referential processes.
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Affiliation(s)
- Eric Salmon
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium.
| | - Mohamed Ali Bahri
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Alain Plenevaux
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Guillaume Becker
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Alain Seret
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Emma Delhaye
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Christian Degueldre
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Evelyne Balteau
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Christian Lemaire
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - André Luxen
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
| | - Christine Bastin
- GIGA Cyclotron Research Centre, University of Liège, B30 Sart Tilman, 4000, Liège, Belgium
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15
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Muñoz-Neira C, Tedde A, Coulthard E, Thai NJ, Pennington C. Neural correlates of altered insight in frontotemporal dementia: a systematic review. Neuroimage Clin 2019; 24:102066. [PMID: 31795052 PMCID: PMC6889795 DOI: 10.1016/j.nicl.2019.102066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022]
Abstract
Altered insight into disease or specific symptoms is a prominent clinical feature of frontotemporal dementia (FTD). Understanding the neural bases of insight is crucial to help improve FTD diagnosis, classification and management. A systematic review to explore the neural correlates of altered insight in FTD and associated syndromes was conducted. Insight was fractionated to examine whether altered insight into different neuropsychological/behavioural objects is underpinned by different or compatible neural correlates. 6 databases (Medline, Embase, PsycINFO, Web of Science, BIOSIS and ProQuest Dissertations & Theses Global) were interrogated between 1980 and August 2019. 15 relevant papers were found out of 660 titles screened. The studies included suggest that different objects of altered insight are associated with distinctive brain areas in FTD. For example, disease unawareness appears to predominantly correlate with right frontal involvement. In contrast, altered insight into social cognition potentially involves, in addition to frontal areas, the temporal gyrus, insula, parahippocampus and amygdala. Impaired insight into memory problems appears to be related to the frontal lobes, postcentral gyrus, parietal cortex and posterior cingulate. These results reflect to a certain extent those observed in other neurodegenerative conditions like Alzheimer's disease (AD) and also other brain disorders. Nevertheless, they should be cautiously interpreted due to variability in the methodological aspects used to reach those conclusions. Future work should triangulate different insight assessment approaches and brain imaging techniques to increase the understanding of this highly relevant clinical phenomenon in dementia.
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Affiliation(s)
- Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK.
| | - Andrea Tedde
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Sassari, Italy
| | - Elizabeth Coulthard
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - N Jade Thai
- Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - Catherine Pennington
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Centre for Dementia Prevention, University of Edinburgh, UK
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16
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Gut Microbiota Disorder, Gut Epithelial and Blood-Brain Barrier Dysfunctions in Etiopathogenesis of Dementia: Molecular Mechanisms and Signaling Pathways. Neuromolecular Med 2019; 21:205-226. [PMID: 31115795 DOI: 10.1007/s12017-019-08547-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
Emerging evidences indicate a critical role of the gut microbiota in etiopathogenesis of dementia, a debilitating multifactorial disorder characterized by progressive deterioration of cognition and behavior that interferes with the social and professional functions of the sufferer. Available data suggest that gut microbiota disorder that triggers development of dementia is characterized by substantial reduction in specific species belonging to the Firmicutes and Bacteroidetes phyla and presence of pathogenic species, predominantly, pro-inflammatory bacteria of the Proteobacteria phylum. These changes in gut microbiota microecology promote the production of toxic metabolites and pro-inflammatory cytokines, and reduction in beneficial substances such as short chain fatty acids and other anti-inflammatory factors, thereby, enhancing destruction of the gut epithelial barrier with concomitant activation of local and distant immune cells as well as dysregulation of enteric neurons and glia. This subsequently leads to blood-brain barrier dysfunctions that trigger neuroinflammatory reactions and predisposes to apoptotic neuronal and glial cell death, particularly in the hippocampus and cerebral cortex, which underlie the development of dementia. However, the molecular switches that control these processes in the histo-hematic barriers of the gut and brain are not exactly known. This review integrates very recent data on the molecular mechanisms that link gut microbiota disorder to gut epithelial and blood-brain barrier dysfunctions, underlying the development of dementia. The signaling pathways that link gut microbiota disorder with impairment in cognition and behavior are also discussed. The review also highlights potential therapeutic options for dementia.
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17
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Gainotti G. Anosognosia in degenerative brain diseases: The role of the right hemisphere and of its dominance for emotions. Brain Cogn 2018; 127:13-22. [DOI: 10.1016/j.bandc.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/12/2022]
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18
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Levy S, Gansler D, Huey E, Wassermann E, Grafman J. Assessment of Patient Self-awareness and Related Neural Correlates in Frontotemporal Dementia and Corticobasal Syndrome. Arch Clin Neuropsychol 2018; 33:519-529. [PMID: 29088311 PMCID: PMC6116784 DOI: 10.1093/arclin/acx105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE We compared two different methods of assessing self-awareness (clinician-rated vs. self- and caregiver report) in participants with neurodegenerative conditions. Additionally, we examined the contribution of memory dysfunction to assessment of self-awareness. METHOD Sixty-seven participants with various neurodegenerative disorders participated in this study. Data were collected on brain volume, neurocognitive function, demographic characteristics, and two measures of patient self-awareness, defined as (1) the discrepancy between patient and caregiver ratings of dysexecutive syndrome and (2) clinician-observed rating of patient insight. Penalized regression with best subset variable selection and 10-fold cross-validation was used to evaluate three neurocognitive frameworks: self-regulation, language, and perspective-taking, each predicting the results from the two methods of self-awareness measurement. RESULTS The self-regulation framework was more robustly predictive for both the clinician rating and discrepancy method than language or perspective-taking. Frameworks in which the clinician rating was the criterion were more robust than those with the discrepancy method as criterion. When a measure of memory functioning was added to the framework, there was no appreciable improvement in the prediction of self-awareness. CONCLUSIONS A self-regulation neurocognitive framework, consisting of regions of interest and neuropsychological test scores, was more effective in understanding patient self-awareness than perspective-taking or language frameworks. Compared to the discrepancy method, a clinician rating of self-awareness was more robustly associated with relevant clinical variables of regional brain volume and neuropsychological performance, suggesting it may be a useful measure to aid clinical diagnosis.
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Affiliation(s)
- Sarah Levy
- Department of Psychology, Suffolk University College of Arts and Sciences, Boston, MA, USA
| | - David Gansler
- Department of Psychology, Suffolk University College of Arts and Sciences, Boston, MA, USA
| | - Edward Huey
- Departments of Psychiatry and Neurology, Columbia University, NY, USA
| | - Eric Wassermann
- Department of Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jordan Grafman
- Department of Physical Medicine and Rehabilitation, Neurology; Shirley Ryan Ability Lab., Northwestern University, Chicago, IL, USA
- Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Northwestern University, Weinberg College of Arts and Sciences, Chicago, IL, USA
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19
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Fieo RA, Silverman H, O'Shea D, Manoochehri M, Grafman J, Huey ED. Establishing dimensionality of sexual behaviours in patients with regional brain dysfunction. Brain Inj 2018; 32:1455-1464. [PMID: 30010443 DOI: 10.1080/02699052.2018.1497202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To develop a validated, caregiver-based measurement scale to assess sexual changes across several domains in a sample of 86 patients with penetrating traumatic brain injury (TBI) and 65 patients with neurodegeneration due to frontotemporal dementia and corticobasal syndrome. METHODS A new measure, the Sexual Symptoms in Neurological Illness and Injury Questionnaire (SNIQ), was constructed. Dimensionality, monotonicity, item discrimination power, and scalability were evaluated using nonparametric Mokken item response theory (IRT) methodology. RESULTS Three primary domains were established. The domains presented with sufficient reliability (rho .70 to .80), while meeting the Mokken IRT criteria of medium scalability. The domains were labeled 'Prosocial sexual behaviour' (H = .42), 'Sexual interest' (H = .50), and 'Inappropriate sexual behaviour' (H = .41). A fourth dimension emerged, 'Detachment' (H = .47), but with very few items. CONCLUSIONS Construct validity was established for groups of items pertaining to three unique aspects of sexuality. These findings support further use of the SNIQ in assessing and researching sexual behaviours in patients with dementia and brain injury.
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Affiliation(s)
- Robert A Fieo
- b Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,g Department of Aging and Geriatric Research, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Hannah Silverman
- a Gertrude H. Sergievsky Center and Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Deirdre O'Shea
- b Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,f Department of Clinical and Health Psychology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
| | - Masood Manoochehri
- a Gertrude H. Sergievsky Center and Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Jordan Grafman
- d Brain Injury Research Program , Shirley Ryan AbilityLab , Chicago , IL , USA.,e Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Edward D Huey
- a Gertrude H. Sergievsky Center and Taub Institute for Research in Alzheimer's Disease and The Aging Brain, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,c Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons , Columbia University , New York , NY , USA
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20
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Roberts S, Henry JD, Molenberghs P. Immoral behaviour following brain damage: A review. J Neuropsychol 2018; 13:564-588. [DOI: 10.1111/jnp.12155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/21/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Stefanie Roberts
- School of Psychological Sciences Monash Institute of Cognitive and Clinical Neurosciences Monash University Clayton Victoria Australia
| | - Julie D. Henry
- School of Psychology University of Queensland St Lucia Queensland Australia
| | - Pascal Molenberghs
- School of Psychological Sciences The University of Melbourne Parkville Victoria Australia
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21
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Santamaría-García H, Baez S, Reyes P, Santamaría-García JA, Santacruz-Escudero JM, Matallana D, Arévalo A, Sigman M, García AM, Ibáñez A. A lesion model of envy and Schadenfreude: legal, deservingness and moral dimensions as revealed by neurodegeneration. Brain 2017; 140:3357-3377. [PMID: 29112719 PMCID: PMC5841144 DOI: 10.1093/brain/awx269] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022] Open
Abstract
The study of moral emotions (i.e. Schadenfreude and envy) is critical to understand the ecological complexity of everyday interactions between cognitive, affective, and social cognition processes. Most previous studies in this area have used correlational imaging techniques and framed Schadenfreude and envy as unified and monolithic emotional domains. Here, we profit from a relevant neurodegeneration model to disentangle the brain regions engaged in three dimensions of Schadenfreude and envy: deservingness, morality, and legality. We tested a group of patients with behavioural variant frontotemporal dementia (bvFTD), patients with Alzheimer’s disease, as a contrastive neurodegeneration model, and healthy controls on a novel task highlighting each of these dimensions in scenarios eliciting Schadenfreude and envy. Compared with the Alzheimer’s disease and control groups, patients with bvFTD obtained significantly higher scores on all dimensions for both emotions. Correlational analyses revealed an association between envy and Schadenfreude scores and greater deficits in social cognition, inhibitory control, and behaviour disturbances in bvFTD patients. Brain anatomy findings (restricted to bvFTD and controls) confirmed the partially dissociable nature of the moral emotions’ experiences and highlighted the importance of socio-moral brain areas in processing those emotions. In all subjects, an association emerged between Schadenfreude and the ventral striatum, and between envy and the anterior cingulate cortex. In addition, the results supported an association between scores for moral and legal transgression and the morphology of areas implicated in emotional appraisal, including the amygdala and the parahippocampus. By contrast, bvFTD patients exhibited a negative association between increased Schadenfreude and envy across dimensions and critical regions supporting social-value rewards and social-moral processes (dorsolateral prefrontal cortex, angular gyrus and precuneus). Together, this study provides lesion-based evidence for the multidimensional nature of the emotional experiences of envy and Schadenfreude. Our results offer new insights into the mechanisms subsuming complex emotions and moral cognition in neurodegeneration. Moreover, this study presents the exacerbation of envy and Schadenfreude as a new potential hallmark of bvFTD that could impact in diagnosis and progression.
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Affiliation(s)
- Hernando Santamaría-García
- Centro de Memoria y Cognición. Intellectus-Hospital Universitario San Ignacio, Bogotá Colombia.,Pontificia Universidad Javeriana, Departments of Physiology, Psychiatry and Aging Institute Bogotá, Colombia.,Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Grupo de Investigación en Cerebro y Cognición Social, Bogotá, Colombia
| | - Sandra Baez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Grupo de Investigación en Cerebro y Cognición Social, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia
| | - Pablo Reyes
- Centro de Memoria y Cognición. Intellectus-Hospital Universitario San Ignacio, Bogotá Colombia.,Pontificia Universidad Javeriana, Departments of Physiology, Psychiatry and Aging Institute Bogotá, Colombia
| | | | - José M Santacruz-Escudero
- Centro de Memoria y Cognición. Intellectus-Hospital Universitario San Ignacio, Bogotá Colombia.,Pontificia Universidad Javeriana, Departments of Physiology, Psychiatry and Aging Institute Bogotá, Colombia.,Departament de Psiquiatria i Medicina Legal, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Diana Matallana
- Centro de Memoria y Cognición. Intellectus-Hospital Universitario San Ignacio, Bogotá Colombia.,Pontificia Universidad Javeriana, Departments of Physiology, Psychiatry and Aging Institute Bogotá, Colombia
| | - Analía Arévalo
- Departamento de Neurologia, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Mariano Sigman
- Universidad Torcuato di Tella, Laboratorio de Neurociencias, Buenos Aires, Argentina
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia
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22
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Sunderaraman P, Cosentino S. Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia. Curr Neurol Neurosci Rep 2017; 17:27. [PMID: 28283961 DOI: 10.1007/s11910-017-0734-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness and summarize both traditional and emerging approaches to assessing awareness from clinical and meta-cognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and meta-cognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying meta-cognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA.,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA. .,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA. .,Department of Neurology, Columbia University Medical Center, New York, NY, USA. .,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA.
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Juskenaite A, Quinette P, Laisney M, Eustache ML, Desgranges B, Viader F, Eustache F. Preserved Self-Evaluation in Amnesia Supports Access to the Self through Introspective Computation. Front Hum Neurosci 2016; 10:462. [PMID: 27695407 PMCID: PMC5025446 DOI: 10.3389/fnhum.2016.00462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2022] Open
Abstract
Encounters with new people result in the extraction and storage in memory of both their external features, allowing us to recognize them later, and their internal traits, allowing us to better control our current interactions with them and anticipate our future ones. Just as we extract, encode, store, retrieve and update the representations of others so, too, do we process representations of ourselves. These representations, which rely on declarative memory, may be altered or cease to be accessible in amnesia. Nonetheless, studies of amnesic patients have yielded the surprising observation that memory impairments alone do not prevent patients from making accurate trait self-judgments. In this review article, we discuss prevailing explanations for preserved self-evaluation in amnesia and propose an alternative one, based on the concept of introspective computation. We also consider molecular and anatomical aspects of brain functioning that potentially support introspective computation.
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Affiliation(s)
- Aurelija Juskenaite
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
| | - Peggy Quinette
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
| | - Mickaël Laisney
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
| | - Marie-Loup Eustache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
| | - Béatrice Desgranges
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
| | - Fausto Viader
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- Service de Neurologie, Centre Hospitalier Universitaire de CaenCaen, France
| | - Francis Eustache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1077Caen, France
- UMR-S1077, Université de Caen-NormandieCaen, France
- UMR-S1077, École Pratique des Hautes Études (EPHE)Caen, France
- U1077, Centre Hospitalier Universitaire de CaenCaen, France
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Berlingeri M, Ravasio A, Cranna S, Basilico S, Sberna M, Bottini G, Paulesu E. Unrealistic representations of “the self”: A cognitive neuroscience assessment of anosognosia for memory deficit. Conscious Cogn 2015; 37:160-77. [DOI: 10.1016/j.concog.2015.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 06/09/2015] [Accepted: 08/24/2015] [Indexed: 12/12/2022]
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Arroyo-Anlló EM, Bouston AT, Fargeau MN, Orgaz Baz B, Gil R. Self-Consciousness in Patients with Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis 2015; 49:1021-9. [PMID: 26599058 DOI: 10.3233/jad-150821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Self-consciousness (SC) is multifaceted and considered to be the consciousness of one's own mental states. The medial prefrontal cortex may play a critical role in SC. The main aim of this paper was to examine SC in patients with behavioral variant frontotemporal dementia, who are characterized more by changes in personal, social, and emotional conduct and loss of insight than by cognitive disturbances. Control and patient groups of 21 subjects each, matched by age, educational level, gender, and nationality were assessed using a SC questionnaire. It measures several aspects: Personal identity, Anosognosia, Affective state, Body representation, Prospective memory, Introspection, and Moral judgments. The most disturbed ones in patients were Anosognosia, Affective state, and Moral judgments, and the least disturbed aspects were awareness of identity and of body representation. No significant correlations were found between the SC score and any clinical or demographical characteristics. The core deficiency of SC in patients was related to behavioral SC aspects, which are more dependent on orbito-frontal functioning.
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Affiliation(s)
- Eva M Arroyo-Anlló
- University of Salamanca, Department of Psychobiology, Neuroscience Institute of Castilla-León, Salamanca, Spain
| | - Adèle Turpin Bouston
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
| | - Marie-Noëlle Fargeau
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
| | - Begõna Orgaz Baz
- University of Salamanca, Department of Methodology of Behavior Sciences, Salamanca, Spain
| | - Roger Gil
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
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De Carolis A, Cipollini V, Corigliano V, Comparelli A, Sepe-Monti M, Orzi F, Ferracuti S, Giubilei F. Anosognosia in people with cognitive impairment: association with cognitive deficits and behavioral disturbances. Dement Geriatr Cogn Dis Extra 2015; 5:42-50. [PMID: 25852731 PMCID: PMC4361910 DOI: 10.1159/000367987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS To investigate, in a group of subjects at an early stage of cognitive impairment, the relationship between anosognosia and both cognitive and behavioral symptoms by exploring the various domains of insight. METHODS One hundred and eight subjects affected by cognitive impairment were consecutively enrolled. The level of awareness was evaluated by means of the Clinical Insight Rating Scale (CIRS). Psychiatric symptoms were evaluated using the Italian version of the Neuropsychiatric Inventory (NPI), whereas memory (memory index, MI) and executive (executive index, EI) functions were explored using a battery of neuropsychological tests and qualified by means of a single composite cognitive index score for each function. RESULTS A significant positive correlation between the total NPI score and global anosognosia score was found. Furthermore, both the MI and EI scores were lower in subjects with anosognosia than in those without anosognosia (p < 0.001 and p < 0.007, respectively). When the single domains of the CIRS were considered, anosognosia of reason of visit correlated with the EI score (r = -0.327, p = 0.01) and night-time behavioral disturbances (r = 0.225; p = 0.021); anosognosia of cognitive deficit correlated with depression (r = -0.193; p = 0.049) and the MI score (r = -0.201; p = 0.040); anosognosia of functional deficit correlated with the MI score (r = -0.257; p = 0.008), delusions (r = 0.232; p = 0.015) and aberrant motor behavior (r = 0.289; p = 0.003); anosognosia of disease progression correlated with the MI score (r = -0.236; p = 0.015), agitation (r = 0.247; p = 0.011), aberrant motor behavior (r = 0.351; p = 0.001) and night-time behavioral disturbances (r = 0.216; p = 0.027). CONCLUSIONS Our study suggests that, in the early stage of cognitive impairment, anosognosia is associated with both cognitive deficits and behavioral disorders according to the specific functional anatomy of the symptoms.
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Affiliation(s)
- Antonella De Carolis
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Virginia Cipollini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Corigliano
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Comparelli
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Micaela Sepe-Monti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Orzi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Ferracuti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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McCusker E, Loy CT. The many facets of unawareness in huntington disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:257. [PMID: 25411649 PMCID: PMC4231168 DOI: 10.7916/d8fj2fd3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Abstract
Background Unawareness or diminished awareness is present when a patient's perception of obvious disease manifestations and impact differ from that of observers such as clinicians or family members. Methods We examined studies that specifically investigate unawareness in Huntington disease (HD). Results Unawareness of motor, cognitive, behavioral, and functional aspects of HD has been documented throughout the disease course. This can occur at motor and cognitive onset but is more pronounced as the disease progresses. Discussion We discuss the implications for diagnosis, symptom report at presentation, timing of diagnosis, acceptance of symptomatic care strategies, and reporting in clinical trials. Assessments of work place competency, discrimination, driving, and the particular challenges of isolated patients without caregivers are described. Engaging with a person who is unaware of their disease or its impact presents a number of conflicts, including maintaining the right to autonomy, privacy, confidentiality, and independence while recognizing concerns for the wellbeing of the vulnerable person with HD and their caregiver when the unaware person refuses assistance. Unawareness is seen increasingly as neurologically based due to the impairment of functional networks, predominantly in nondominant frontostriatal pathways.
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Affiliation(s)
- Elizabeth McCusker
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
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Shany-Ur T, Lin N, Rosen HJ, Sollberger M, Miller BL, Rankin KP. Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention. ACTA ACUST UNITED AC 2014; 137:2368-81. [PMID: 24951639 DOI: 10.1093/brain/awu161] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accurate self-awareness is essential for adapting one's tasks and goals to one's actual abilities. Patients with neurodegenerative diseases, particularly those with right frontal involvement, often present with poor self-awareness of their functional limitations that may exacerbate their already jeopardized decision-making and behaviour. We studied the structural neuroanatomical basis for impaired self-awareness among patients with neurodegenerative disease and healthy older adults. One hundred and twenty-four participants (78 patients with neurodegenerative diseases including Alzheimer's disease, behavioural variant frontotemporal dementia, right-temporal frontotemporal dementia, semantic variant and non-fluent variant primary progressive aphasia, and 46 healthy controls) described themselves on the Patient Competency Rating Scale, rating observable functioning across four domains (daily living activities, cognitive, emotional control, interpersonal). All participants underwent structural magnetic resonance imaging. Informants also described subjects' functioning on the same scale. Self-awareness was measured by comparing self and informant ratings. Group differences in discrepancy scores were analysed using general linear models, controlling for age, sex and disease severity. Compared with controls, patients with behavioural variant frontotemporal dementia overestimated their functioning in all domains, patients with Alzheimer's disease overestimated cognitive and emotional functioning, patients with right-temporal frontotemporal dementia overestimated interpersonal functioning, and patients with non-fluent aphasia overestimated emotional and interpersonal functioning. Patients with semantic variant aphasia did not overestimate functioning on any domain. To examine the neuroanatomic correlates of impaired self-awareness, discrepancy scores were correlated with brain volume using voxel-based morphometry. To identify the unique neural correlates of overlooking versus exaggerating deficits, overestimation and underestimation scores were analysed separately, controlling for age, sex, total intracranial volume and extent of actual functional decline. Atrophy related to overestimating one's functioning included bilateral, right greater than left frontal and subcortical regions, including dorsal superior and middle frontal gyri, lateral and medial orbitofrontal gyri, right anterior insula, putamen, thalamus, and caudate, and midbrain and pons. Thus, our patients' tendency to under-represent their functional decline was related to degeneration of domain-general dorsal frontal regions involved in attention, as well as orbitofrontal and subcortical regions likely involved in assigning a reward value to self-related processing and maintaining accurate self-knowledge. The anatomic correlates of underestimation (right rostral anterior cingulate cortex, uncorrected significance level) were distinct from overestimation and had a substantially smaller effect size. This suggests that underestimation or 'tarnishing' may be influenced by non-structural neurobiological and sociocultural factors, and should not be considered to be on a continuum with overestimation or 'polishing' of functional capacity, which appears to be more directly mediated by neural circuit dysfunction.
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Affiliation(s)
- Tal Shany-Ur
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA2 The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
| | - Nancy Lin
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Howard J Rosen
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Marc Sollberger
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA3 Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Bruce L Miller
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Katherine P Rankin
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
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Armstrong N, Schupf N, Grafman J, Huey ED. Caregiver burden in frontotemporal degeneration and corticobasal syndrome. Dement Geriatr Cogn Disord 2014; 36:310-8. [PMID: 24022248 PMCID: PMC4484601 DOI: 10.1159/000351670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Caregiver stress is often a serious problem when caring for a patient with frontal lobe dysfunction. METHODS A total of 102 caregivers of both patients with frontotemporal degeneration and corticobasal syndrome completed the Frontal Systems Behavior Scale (FrSBe) and the Zarit Burden Interview (ZBI). To analyze the association between apathy or disinhibition (or both) and caregiver burden, the effects of the total FrSBe and the apathy and disinhibition subscales of the FrSBE on the total ZBI score were assessed with logistic regressions and t tests. RESULTS Total FrSBE score and the apathy FrSBE subscore predicted caregiver burden. Apathy occurred without disinhibition, and the two occurred together, but disinhibition without apathy was very rare. CONCLUSIONS Disinhibition without apathy occurred very rarely. Apathy was more associated with caregiver burden than disinhibition.
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Affiliation(s)
- Nicole Armstrong
- Department of Epidemiology, Mailman School of Public Health, New York, N.Y., USA
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Sollberger M, Rosen HJ, Shany-Ur T, Ullah J, Stanley CM, Laluz V, Weiner MW, Wilson SM, Miller BL, Rankin KP. Neural substrates of socioemotional self-awareness in neurodegenerative disease. Brain Behav 2014; 4:201-14. [PMID: 24683513 PMCID: PMC3967536 DOI: 10.1002/brb3.211] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/30/2013] [Accepted: 12/15/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neuroimaging studies examining neural substrates of impaired self-awareness in patients with neurodegenerative diseases have shown divergent results depending on the modality (cognitive, emotional, behavioral) of awareness. Evidence is accumulating to suggest that self-awareness arises from a combination of modality-specific and large-scale supramodal neural networks. METHODS We investigated the structural substrates of patients' tendency to overestimate or underestimate their own capacity to demonstrate empathic concern for others. Subjects' level of empathic concern was measured using the Interpersonal Reactivity Index, and subject-informant discrepancy scores were used to predict regional atrophy pattern, using voxel-based morphometry analysis. Of the 102 subjects, 83 were patients with neurodegenerative diseases such as behavioral variant frontotemporal dementia (bvFTD) or semantic variant primary progressive aphasia (svPPA); the other 19 were healthy older adults. RESULTS bvFTD and svPPA patients typically overestimated their level of empathic concern compared to controls, and overestimating one's empathic concern predicted damage to predominantly right-hemispheric anterior infero-lateral temporal regions, whereas underestimating one's empathic concern showed no neuroanatomical basis. CONCLUSIONS These findings suggest that overestimation and underestimation of one's capacity for empathic concern cannot be interpreted as varying degrees of the same phenomenon, but may arise from different pathophysiological processes. Damage to anterior infero-lateral temporal regions has been associated with semantic self-knowledge, emotion processing, and social perspective taking; neuropsychological functions partly associated with empathic concern itself. These findings support the hypothesis that-at least in the socioemotional domain-neural substrates of self-awareness are partly modality-specific.
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Affiliation(s)
- Marc Sollberger
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California ; Department of Neurology, University Hospital Basel, Switzerland ; Memory Clinic, University Center for Medicine of Aging, Felix-Platter Hospital Basel, Switzerland
| | - Howard J Rosen
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Tal Shany-Ur
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Jerin Ullah
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Christine M Stanley
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Victor Laluz
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Michael W Weiner
- Department of Radiology, University of California San Francisco, California ; Magnetic Resonance Imaging Unit, San Francisco Veterans Affairs Hospital San Francisco, California
| | - Stephen M Wilson
- Department of Speech, Language and Hearing Sciences Tucson, Arizona
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Katherine P Rankin
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
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Poletti M, Sambataro F. The development of delusion revisited: a transdiagnostic framework. Psychiatry Res 2013; 210:1245-59. [PMID: 23978732 DOI: 10.1016/j.psychres.2013.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 07/15/2013] [Accepted: 07/20/2013] [Indexed: 01/07/2023]
Abstract
This study proposes a transdiagnostic framework for delusion development, analysing psychiatric (schizophrenia, bipolar disorder, major depressive disorder) and neurological disorders (stroke, and neurodegenerative diseases) in which delusions are predominant. Our aim is to identify a transdiagnostic core of neural and cognitive alterations associated with delusions across distinct clinical disorders. Reviewed empirical evidence suggests delusions are associated: on the neural level with changes in the ventromedial prefrontal cortex (vmPFC) networks, and on the neuropsychological level with dysfunction in the processes (generation of affective value, the construction of internal models of the world, and the reflection about Self and/or Other's mental states) that these network mediate. The concurrent aberration of all these processes could be critical for the clinical transition to a psychotic delusional state. In particular, delusions could become clinically manifest when (1) stimuli are attributed an aberrant affective salience, that (2) is explained by the patient within distorted explanatory internal models that (3) are poorly inhibited by cognitive control systems. This framework extends the two-factor account of delusion model and suggests that common neural mechanisms for the delusions in psychiatric and in neurological disorders.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL of Reggio Emilia, Reggio Emilia, Italy.
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DeCarolis A, Corigliano V, Comparelli A, Sepe-Monti M, Cipollini V, Orzi F, Ferracuti S, Giubilei F. Neuropsychological patterns underlying anosognosia in people with cognitive impairment. Dement Geriatr Cogn Disord 2013; 34:216-23. [PMID: 23128165 DOI: 10.1159/000343488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 12/12/2022] Open
Abstract
AIMS To investigate, in a group of subjects with cognitive impairment, the relationship between anosognosia, in each dimension of insight, and neuropsychological domains. METHODS Two hundred and seventy-one subjects affected by cognitive impairment were consecutively enrolled. Anosognosia was evaluated by means of the Clinical Insight Rating Scale (CIRS). The general level of cognitive impairment was evaluated by means of the Mini-Mental State Examination, while 8 cognitive domains were examined by means of neuropsychological tests. RESULTS The number of subjects with anosognosia evaluated by means of the CIRS total score as well as those with anosognosia divided according to the reason for visit was higher in moderately cognitively impaired subjects than in mildly cognitively impaired subjects (p < 0.001). A relationship between anosognosia and neuropsychological scores was only found in mild cognitive impairment, with subjects with anosognosia displaying significantly lower Raven's Colored Progressive Matrices Test and Rey Auditory Verbal Learning Test-delayed recall scores than subjects without anosognosia. CONCLUSIONS Our study suggests that the relationship between the severity of cognitive deficits and anosognosia in subjects with cognitive impairment is partial and depends on the specific domain of unawareness. Furthermore, in the early phase of cognitive impairment, the presence of specific cognitive deficits suggests that the nature of anosognosia is domain-specific.
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Affiliation(s)
- A DeCarolis
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Kalenzaga S, Clarys D. Self-referential processing in Alzheimer's disease: two different ways of processing self-knowledge? J Clin Exp Neuropsychol 2013; 35:455-71. [PMID: 23631426 DOI: 10.1080/13803395.2013.789485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Two previous studies showed that self-reference encoding had no effect on Alzheimer's disease (AD) patients' recollective experience when it was compared to other-reference encoding, whereas it did have an effect when it was compared to semantic processing, but only for emotional trait adjectives. In the present study, the performance of 22 AD patients was compared with that of 21 normal controls on a task involving recognition of emotional versus neutral adjective traits following self-reference versus other-reference encoding, using the remember/know/guess paradigm. Results showed that although AD patients had a positive explicit view of themselves, their self became salient for negative adjective traits only. We concluded that there might exist two ways of processing self-referential knowledge in human cognition: one explicit and the other more implicit.
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Affiliation(s)
- Sandrine Kalenzaga
- UMR-CNRS 6234 Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, Poitiers, France.
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Zamboni G, Drazich E, McCulloch E, Filippini N, Mackay CE, Jenkinson M, Tracey I, Wilcock GK. Neuroanatomy of impaired self-awareness in Alzheimer's disease and mild cognitive impairment. Cortex 2013; 49:668-78. [DOI: 10.1016/j.cortex.2012.04.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/07/2012] [Accepted: 04/20/2012] [Indexed: 12/12/2022]
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Ichikawa H, Ohno H, Murakami H, Ishigaki S, Ohnaka Y, Kawamura M. Self-rated anosognosia score may be a sensitive and predictive indicator for progressive brain atrophy in amyotrophic lateral sclerosis: an X-ray computed tomographic study. Eur Neurol 2012; 69:158-65. [PMID: 23257903 DOI: 10.1159/000345371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 10/07/2012] [Indexed: 11/19/2022]
Abstract
We investigated whether a self-rated anosognosia score can be an indicator for progression of brain atrophy in patients with amyotrophic lateral sclerosis (ALS). Scores for 16 patients were compared with the ventricular areas of the bilateral anterior and inferior horns measured on x-ray computed tomography. Longitudinal enlargement was expressed as a monthly increase in size: (ventricular size at the initial scan - ventricular size at the follow-up scan)/scan interval (months). The anosognosia scores ranged from -4 to 3 and 3-18 in patients with and without frontotemporal lobar degeneration (FTLD), respectively (p = 0.0011). Anosognosia scores were significantly correlated with sizes of anterior (r = 0.704, p = 0.0016) and inferior (r = 0.898, p < 0.0001) horns. In non-demented patients for whom follow-up CT scans were available (n = 7), the scores were significantly correlated with the longitudinal increase in inferior horn size (r = 0.754, p = 0.0496), but not with that of anterior horn size (r = -0.166, p = 0.7111). In conclusion, anosognosia in ALS is associated with greater anterior and inferior horn sizes, reflecting frontotemporal lobar atrophy. Moreover, mild anosognosia in ALS patients without FTLD may predict impending inferior horn enlargement, reflecting medial temporal atrophy.
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Affiliation(s)
- Hiroo Ichikawa
- Department of Neurology, Brain Nerve Center, Showa University Fujigaoka Hospital, Tokyo, Japan.
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Poletti M, Enrici I, Adenzato M. Cognitive and affective Theory of Mind in neurodegenerative diseases: Neuropsychological, neuroanatomical and neurochemical levels. Neurosci Biobehav Rev 2012; 36:2147-64. [DOI: 10.1016/j.neubiorev.2012.07.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/25/2012] [Accepted: 07/11/2012] [Indexed: 12/14/2022]
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Duval C, Bejanin A, Piolino P, Laisney M, de La Sayette V, Belliard S, Eustache F, Desgranges B. Theory of mind impairments in patients with semantic dementia. Brain 2012; 135:228-41. [PMID: 22232593 DOI: 10.1093/brain/awr309] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Semantic dementia is characterized by semantic deficits and behavioural abnormalities that occur in the wake of bilateral inferolateral and predominantly left-sided anterior temporal lobe atrophy. The temporal poles have been shown to be involved in theory of mind, namely the ability to ascribe cognitive and affective mental states to others that regulates social interactions by predicting and interpreting human behaviour. However, very few studies have examined theory of mind in semantic dementia. In this study, we investigated both cognitive and affective theory of mind in a group of patients with semantic dementia, using separate objective and subjective assessment tasks. Results provided objective evidence of an impact of semantic dementia on cognitive and affective theory of mind, consistent with the patients' atrophy in the left temporal lobe and hypometabolism in the temporal lobes and the medial frontal cortex. However, the subjective assessment of theory of mind suggested that awareness of the affective but not cognitive theory of mind deficit persists into the moderate stage of the disease.
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Affiliation(s)
- Céline Duval
- Inserm – EPHE – University of Caen/Basse-Normandie, Unit U923, GIP Cyceron, CHU Côte de Nacre, Caen, France
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Mendez MF, Shapira JS. Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria". Conscious Cogn 2011; 20:1690-6. [PMID: 21959203 DOI: 10.1016/j.concog.2011.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 11/25/2022]
Abstract
Loss of insight is a prominent clinical manifestation of behavioral variant frontotemporal dementia (bvFTD), but its characteristics are poorly understood. Twelve bvFTD patients were compared with 12 Alzheimer's disease (AD) patients on a structured insight interview of cognitive insight (awareness of having a disorder) and emotional insight (concern over having a disorder). Compared to the AD patients, the bvFTD patients were less aware and less concerned about their disorder, and they had less appreciation of its effects on themselves and on others. After corrective feedback ("updating"), the bvFTD patients were just as aware of their disorder as the AD patients but remained unconcerned and unappreciative of its effects. These findings suggest that lack of insight in bvFTD is not due to "anosognosia," or impaired cognitive and executive awareness of disease, but to "frontal anosodiaphoria," or lack of emotional concern over having bvFTD and its impact on themselves and others.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, The University of California at Los Angeles, USA.
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Zamboni G, Wilcock G. Lack of awareness of symptoms in people with dementia: the structural and functional basis. Int J Geriatr Psychiatry 2011; 26:783-92. [PMID: 21744382 DOI: 10.1002/gps.2620] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/20/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review studies investigating the brain correlates of unawareness of cognitive and behavioural symptoms in people with dementia. DESIGN A detailed search of the literature was conducted to include all the peer-reviewed studies published in English aimed at identifying the structural or functional brain correspondents of unawareness in dementia patients. Their results were interpreted in relation to the methodological differences in terms of type of dementia studied, the protocol adopted to measure lack of awareness, the imaging techniques employed, the experimental designs and statistical analyses performed. RESULTS Eighteen studies undertaken to explore the functional and structural correlates of unawareness of cognitive symptoms in dementia were identified. Although their results showed a disparate range of brain correlates, they were mainly localized in frontal and temporo-parietal regions. CONCLUSIONS Although the anatomical correlates of unawareness of disease in dementia have not yet been exhaustively explored, understanding the correlates of unawareness may also contribute to understand the brain correlates of self-awareness and self-reflection. We discuss the current knowledge base and consider potential future directions for research.
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Affiliation(s)
- G Zamboni
- OPTIMA Project, Nuffield Department of Clinical Medicine, University of Oxford, UK; FMRIB Centre, University of Oxford, UK.
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Poletti M, Borelli P, Bonuccelli U. The neuropsychological correlates of pathological lying: evidence from behavioral variant frontotemporal dementia. J Neurol 2011; 258:2009-13. [DOI: 10.1007/s00415-011-6058-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/08/2011] [Accepted: 04/12/2011] [Indexed: 11/24/2022]
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