Affiliations: [a] Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| [b] Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| [c] Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| [d] Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| [e] Department of Neurology, Alfred Hospital, Melbourne, Australia
Correspondence:
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Correspondence to: Dr Lucy Vivash, Department of Neurosciences, Monash University, Level 6 The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia. Tel.:+61 3 9903 0860; E-mail: lucy.vivash@monash.edu.
Abstract: Behavioral variant frontotemporal dementia (bvFTD) belongs to the spectrum of frontotemporal lobar degeneration (FTLD) and is characterized by frontal dysfunction with executive deficits and prominent socioemotional impairments. Social cognition, such as emotion processing, theory of mind, and empathy may significantly impact daily behavior in bvFTD. Abnormal protein accumulation of tau or TDP-43 are the main causes of neurodegeneration and cognitive decline. Differential diagnosis is difficult due to the heterogeneous pathology in bvFTD and the high clinicopathological overlap with other FTLD syndromes, especially in late disease stages. Despite recent advances, social cognition in bvFTD has not yet received sufficient attention, nor has its association with underlying pathology. This narrative review evaluates social behavior and social cognition in bvFTD, by relating these symptoms to neural correlates and underlying molecular pathology or genetic subtypes. Negative and positive behavioral symptoms, such as apathy and disinhibition, share similar brain atrophy and reflect social cognition. More complex social cognitive impairments are probably caused by the interference of executive impairments due to increasing neurodegeneration. Evidence suggests that underlying TDP-43 is associated with neuropsychiatric and early social cognitive dysfunction, while patients with underlying tau pathology are marked by strong cognitive dysfunction with increasing social impairments in later stages. Despite many current research gaps and controversies, finding distinct social cognitive markers in association to underlying pathology in bvFTD is essential for validating biomarkers, for clinical trials of novel therapies, and for clinical practice.
Keywords: Alzheimer’s disease, behavior, frontotemporal dementia, pathology, social cognition
