Neuroanatomy of apathy and disinhibition in frontotemporal lobar degeneration.
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.
Massimo
Lauren
L
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pa., USA.
Powers
Chivon
C
Moore
Peachie
P
Vesely
Luisa
L
Avants
Brian
B
Gee
James
J
Libon
David J
DJ
Grossman
Murray
M
D000368:Aged; D001519:Behavior; D001921:Brain / Q000473:pathology*; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000473:pathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007266:Inhibition, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000523:psychology