title: Regional brain atrophy and impaired decision making on the balloon analog risk task in behavioral variant frontotemporal dementia.
abstract: OBJECTIVE
  The goal of this study was 2-fold, first, to compare decision making in behavioral variant frontotemporal dementia (bvFTD) patients and healthy adults using the Balloon Analog Risk Task (BART), and, second, to identify the regions of gray matter atrophy associated with bvFTD patients' BART performance.
  
  
  BACKGROUND
  Stimulus-reinforcement learning is required to evaluate the results of previously chosen actions to improve future decisions. Although there is a well established literature suggesting altered decision making in FTD patients and data from lesion studies suggest orbitofrontal cortex (OFC) involvement in decision making, there is very little research looking at the brain correlates of decision making in FTD populations specifically.
  
  
  METHODS
  Twenty-seven bvFTD patients and 19 age-matched and education-matched normal controls completed the BART. Voxel-based morphometry analysis was performed on the magnetic resonance imaging scans of a subset of patients.
  
  
  RESULTS
  Compared with healthy controls, the bvFTD patients did not learn and pumped less to inflate a balloon to receive a reward, indicating altered stimulus-reinforcement learning. The voxel-based morphometry analysis indicated that bvFTD patients' impaired BART performance was related to atrophy in the right lateral OFC.
  
  
  CONCLUSIONS
  The right lateral OFC is crucial for stimulus-reinforcement learning required for the adjustment of behavior under changing reward contingencies.
authors.affiliation: Catholic University of America, Washington, DC, USA.
authors.forename: Maren
authors.initials: M
authors.lastname: Strenziok
authors.forename: Sarah
authors.initials: S
authors.lastname: Pulaski
authors.forename: Frank
authors.initials: F
authors.lastname: Krueger
authors.forename: Giovanna
authors.initials: G
authors.lastname: Zamboni
authors.forename: Deborah
authors.initials: D
authors.lastname: Clawson
authors.forename: Jordan
authors.initials: J
authors.lastname: Grafman
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D003657:Decision Making / Q000502:physiology*; D005260:Female; D057180:Frontotemporal Dementia / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012054:Reinforcement, Psychology