title: Understanding Emotions in Frontotemporal Dementia: The Explicit and Implicit Emotional Cue Mismatch.
abstract: BACKGROUND
  Previous studies have reported significant deficits in emotion recognition among individuals along the frontotemporal dementia (FTD) spectrum. The basis of emotional impairment is still poorly understood and explicit (emotion appraisal) and implicit (autonomic system activity) responses have not been carefully evaluated.
  
  
  OBJECTIVE
  We investigated explicit evaluation of emotions by testing valence and arousal using self-report measures and we also assessed automatic responses to emotional cues, using autonomic measures (skin conductance response and heart rate).
  
  
  METHODS
  16 behavioral variant FTD and 12 agrammatic variants of primary progressive aphasia patients were included. The performance of these patients was compared to a group of 14 patients with Alzheimer's disease and 20 healthy controls. Each subject was required to observe and evaluate affective pictures while autonomic parameters were recorded.
  
  
  RESULTS
  FTD patients preserved a functional general competency in terms of valence (correct positive versus negative attribution) and arousal (correct dichotomy between high versus low arousal category) distinction. These patients showed significant changes in autonomic implicit response compared to the other groups. The mismatch between explicit and implicit responsiveness to emotional cues was found both in behavioral variant FTD and in agrammatic variants of primary progressive aphasia. Emotional responsiveness was related to the severity of behavioral abnormalities as measured by the Frontal Behavioral Inventory and associated with atrophy of the left putamen.
  
  
  CONCLUSIONS
  The present findings indicate that FTD patients are able to explicitly "appraise" the emotion, but they cannot implicitly "feel" the emotion. This mismatch between the two levels may help explain the general emotional behavior impairment found in these patients.
authors.affiliation: Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University, Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Balconi
authors.affiliation: Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cotelli
authors.affiliation: Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Brambilla
authors.affiliation: Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Manenti
authors.affiliation: Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Cosseddu
authors.affiliation: Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Premi
authors.affiliation: Neuroradiology Unit, University of Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparotti
authors.affiliation: Alzheimer Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Zanetti
authors.affiliation: Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.affiliation: Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Borroni
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001037:Aphasia / Q000150:complications; D003463:Cues; D003936:Diagnosis, Computer-Assisted; D005260:Female; D057180:Frontotemporal Dementia / Q000150:complications*; D005712:Galvanic Skin Response / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010775:Photic Stimulation; D011569:Psychiatric Status Rating Scales; D011601:Psychophysics; D013223:Statistics as Topic
keywords: Basal ganglia; dementia; emotional disturbances; putamen