Affiliations: Departments of Neurology, Neural and Behavioral
Sciences, and Radiology College of Medicine, Penn State Hershey Medical Center,
Hershey, PA, USA | Department of Neurology, University of Pennsylvania
School of Medicine, Philadelphia, PA, USA
Note: [] Correspondence author: Paul J. Eslinger, Ph.D., Penn State
Hershey Medical Center, Department of Neurology – EC037, 30 Hope Drive,
PO Box 859, Hershey, PA 17033-0859, USA. Tel.: +717 531 1804; Fax: +717 531
4694; E-mail: peslinger@hmc.psu.edu
Abstract: We investigated the occurrence of goal-directed motivational change
in the form of apathy in patients with frontotemporal dementia (FTD),
particularly those with behavioral variant social and executive deficits
(bvFTD). Standardized behavioral inventory was employed to survey and compare
apathy ratings from patients and caregivers. In cases of bvFTD, apathy ratings
were further related to measures of social cognition, executive function, and
atrophy on brain MRI. Results indicated that caregivers rated bvFTD patients as
having significantly elevated apathy scores though patient self-ratings were
normal. Caregiver and self-ratings of FTD samples with progressive nonfluent
aphasia and semantic dementia did not differ from healthy controls and their
informants. In the bvFTD sample, caregiver apathy scores were not correlated
with general cognitive screening or depression scores, but were significantly
correlated with social cognition and executive function measures. Voxel-based
morphometry revealed that apathy ratings in bvFTD were related to prominent
atrophy in the right caudate (including the ventral striatum), the right
temporo-parietal junction, right posterior inferior and middle temporal gyri,
and left frontal operculum- anterior insula region. Findings suggest that bvFTD
is associated with a significant breakdown in goal-directed motivated behavior
involving disruption of cortical-basal ganglia circuits that is also related to
social and executive function deficits.
