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Neuroanatomy of Apathy and Disinhibition in Frontotemporal Lobar Degeneration
Open accessAbstract
OBJECTIVE: To investigate the neural basis for the behavioral symptoms of frontotemporal lobar degeneration (FTLD) that cause the greatest caregiver distress. BACKGROUND: FTLD is a progressive neurodegenerative disease associated with behavioral disturbances. Group studies have related these behaviors to volume loss on MRI. METHODS: Forty caregivers of patients with the clinical diagnosis of FTLD completed the Neuropsychiatric Inventory. Twelve neuropsychiatric symptoms and the associated caregiver distress were assessed. Optimized voxel-based morphometry identified significant atrophy in subgroups of FTLD patients with isolated behavioral symptoms corresponding to the most distressing behaviors, and we correlated cortical atrophy directly with these distressing behavioral disorders in an unbiased group analysis. RESULTS: The greatest stressors for caregivers were apathy and disinhibition (p < 0.005 for both contrasts). Partially distinct areas of cortical atrophy were associated with these behaviors in both individual patients with these symptoms and group-wide analyses, including the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex in apathetic patients, and the medial orbital frontal cortex in disinhibited patients. CONCLUSIONS: Caregiver stress in families of FTLD patients is due in large part to apathy and disinhibition. The anatomic distribution of cortical loss corresponding to these distressing social behaviors includes partially distinct areas within the frontal lobe.
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“People with frontotemporal dementia are more likely to experience frequent and serious BPSD, e.g., agitation, disinhibition, apathy and eating abnormalities [125,126,127,128].”
From Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia (2023) · cites this paper as [126]
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Metadata
- Authors
- Massimo, L., Powers, C., Moore, P., Vesely, L., Avants, B., Gee, J., Libon, D. J., & Grossman, M.
- Affiliations
- University of Pennsylvania (US)
- Drexel University (US)
- Venue
- Dementia and Geriatric Cognitive Disorders
- Publisher
- S. Karger AG
- Published
- 2009
- Volume
- 27
- Issue
- 1
- Pages
- 96-104
- ISSN
- 1420-8008 (ISSN-L)
- 1421-9824
- PMC
- PMC2820577
- OpenAlex
- W2169733225
- Cited by
- 156
- References
- 46
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 8 · 2021: 10 · 2020: 9 · 2019: 12 · 2018: 11 · 2017: 10 · 2016: 12 · 2015: 10 · 2014: 10 · 2013: 13 · 2012: 11
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Dementia and Geriatric Cognitive Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (NS53488, AG 17586, AG15116)
- National Institute on Aging (AG15116, R01AG015116, P01AG017586, AG17586)
- National Institute of Neurological Disorders and Stroke (NS53488, NS-44266, P50NS053488, R01NS044266)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Clinical Neurology › Amyotrophic Lateral Sclerosis Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- frontotemporal lobar degeneration, apathy, disinhibition, caregiver distress, neuropsychiatric symptoms, cortical atrophy, voxel-based morphometry, dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, frontal lobe, behavioral symptoms
- MeSH terms
- Aged, Behavior, Brain, Dementia, Female, Humans, Image Processing, Computer-Assisted, Inhibition, Psychological, Magnetic Resonance Imaging, Male, Middle Aged, Stress, Psychological, Caregivers
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