title: Metacognitive deficits in frontotemporal dementia.
abstract: OBJECTIVE
  To investigate whether metacognitive impairments in self-awareness and self-monitoring occur in patients with frontotemporal dementia (FTD), particularly among those with prominent social and dysexecutive impairments.
  
  
  METHODS
  Patients diagnosed with FTD were divided by clinical subtype (social-dysexecutive (n = 12) aphasic (n = 15), and constituent subgroups of progressive non-fluent aphasia and semantic dementia) and compared with subjects with probable Alzheimer's disease (AD, n = 11) and age-matched healthy controls (n = 11). All subjects completed comprehensive behavioural ratings scales, which were compared with caregiver ratings. Subjects also rated their test performances in verbal associative fluency, word list learning, and memory task with comparisons made between actual and judged performance levels.
  
  
  RESULTS
  The FTD sample as a whole showed significantly less behavioural self-awareness and self-knowledge than the AD and healthy control samples. FTD patients with prominent social and dysexecutive impairments demonstrated the most extensive loss of self-awareness and self-knowledge, significantly overrating themselves in multiple social, emotional, and cognitive domains, and failing to acknowledge that any behavioural change had occurred in most areas. The remaining clinical samples showed select and minimal discrepancies. All clinical groups were significantly unaware of their apathy levels. Most FTD patients judged episodic cognitive test performance adequately, with partial difficulties observed in the socially impaired and progressive non-fluent aphasia subgroups.
  
  
  CONCLUSIONS
  FTD patients, particularly those with prominent social and dysexecutive impairments, exhibit profound metacognitive anosognosia that may represent a loss of self-awareness, self-monitoring, and self-knowledge, likely related to significant prefrontal pathophysiology. Other FTD clinical groups and AD patients showed less pervasive and more select metacognitive deficiencies.
authors.affiliation: Department of Neurology-H037, Penn State Milton S Hershey Medical Center, PO Box 850, Hershey, PA 17033-0850, USA. peslinger@psu.edu
authors.forename: P J
authors.initials: PJ
authors.lastname: Eslinger
authors.forename: K
authors.initials: K
authors.lastname: Dennis
authors.forename: P
authors.initials: P
authors.lastname: Moore
authors.forename: S
authors.initials: S
authors.lastname: Antani
authors.forename: R
authors.initials: R
authors.lastname: Hauck
authors.forename: M
authors.initials: M
authors.lastname: Grossman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D003704:Dementia / Q000150:complications* / Q000523:psychology*; D018450:Disease Progression; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012649:Self Concept; D012919:Social Behavior