 |
|
Apathy Symptom Profile and Behavioral Associations in Frontotemporal Dementia vs Dementia of Alzheimer Type
Tiffany W. Chow, MD;
Malcolm A. Binns, PhD;
Jeffrey L. Cummings, MD;
Isabel Lam, BSc;
Sandra E. Black, MD, FRCPC;
Bruce L. Miller, MD;
Morris Freedman, MD, FRCPC;
Donald T. Stuss, PhD;
Robert van Reekum, MD, FRCPC
Arch Neurol. 2009;66(7):888-893.
Background Apathy is a common and significant problem in patients with dementia, regardless of its cause. Observations about frontosubcortical circuit syndromes indicate that apathy may have affective, behavioral, or cognitive manifestations.
Objectives To explore whether the apathy manifested in frontotemporal dementia (FTD), with its predominantly anterior brain neuropathologic features, differs from the apathy in dementia of Alzheimer type (DAT), with its predominantly hippocampal- and temporoparietal-based neuropathologic features, and to determine whether other behavioral disturbances reported in frontosubcortical circuit syndromes correlate with apathy.
Design Analyses included individual items within Neuropsychiatric Inventory subscale items. Items of the apathy/indifference subscale were designated by consensus as affective (lacking in emotions), behavioral (inactive, chores abandoned), or cognitive (no interest in the activities of others). Proportions of correlated nonapathy Neuropsychiatric Inventory items were calculated.
Setting Several neurology specialty clinics contributed to our data set.
Participants A total of 92 participants with FTD and 457 with DAT.
Main Outcome Measures The Neuropsychiatric Inventory was analyzed.
Results Apathy was more prevalent in patients with FTD than in those with DAT, but when present, the specific apathy symptoms associated with both types of dementia were rarely restricted to 1 of the 3 domains of apathy. Dysphoria concurrent with apathy was unique to the DAT group and negatively correlated in the FTD group. Participants with affective apathy more frequently copresented with an orbital frontosubcortical syndrome in FTD (impulsivity and compulsions). Affective apathy also copresented with uncooperative agitation, anger, and physical agitation in both types of dementia.
Conclusions Apathy is common in patients with FTD and DAT, although it is more common in those with FTD. When present, it usually involves changes in affect, behavior, and cognition. It is associated with behaviors that have previously been shown to affect patient safety, independence, and quality of life.
Author Affiliations: Rotman Research Institute (Drs Chow, Binns, Black, Freedman, and Stuss) and Kunin-Lunenfeld Applied Research Unit (Dr van Reekum), Division of Neurology, Department of Medicine, Baycrest (Drs Chow, Black, Freedman, and Stuss); Division of Geriatric Psychiatry, Department of Psychiatry (Drs Chow and van Reekum), Division of Neurology (Drs Chow, Freedman, and Black), and School of Public Health (Dr Binns), University of Toronto; LC Campbell Cognitive Neurology Research Unit, Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre (Ms Lam and Dr Black), Toronto, Ontario, Canada; UCLA Alzheimer's Disease Center, Los Angeles, California (Dr Cummings); UCSF Memory and Aging Center, San Francisco, California (Dr Miller).
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
This Month in Archives of Neurology
Arch Neurol. 2009;66(7):817-818.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Social Cognition and Emotional Assessment differentiates frontotemporal dementia from depression
Bertoux et al.
J. Neurol. Neurosurg. Psychiatry 2012;0:jnnp-2011-301849v1-jnnp-2011-301849.
ABSTRACT
| FULL TEXT
Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia
Rascovsky et al.
Brain 2011;134:2456-2477.
ABSTRACT
| FULL TEXT
Clinical, genetic and pathological heterogeneity of frontotemporal dementia: a review
Seelaar et al.
J. Neurol. Neurosurg. Psychiatry 2011;82:476-486.
ABSTRACT
| FULL TEXT
|
