title: Neural basis of motivational approach and withdrawal behaviors in neurodegenerative disease.
abstract: BACKGROUND
  The Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS) have been theorized as neural systems that regulate approach/withdrawal behaviors. Behavioral activation/inhibition balance may change in neurodegenerative disease based on underlying alterations in systems supporting motivation and approach/withdrawal behaviors, which may in turn be reflected in neuropsychiatric symptoms.
  
  
  METHODS
  A total of 187 participants (31 patients diagnosed with behavioral variant of FTD [bvFTD], 13 semantic variant of primary progressive aphasia [svPPA], 14 right temporal variant FTD [rtFTD], 54 Alzheimer's disease [AD], and 75 older healthy controls [NCs]) were included in this study. Changes in behavioral inhibition/activation were measured using the BIS/BAS scale. We analyzed the correlation between regional atrophy pattern and BIS/BAS score, using voxel-based morphometry (VBM).
  
  
  RESULTS
  ADs had significantly higher BIS scores than bvFTDs and NCs. bvFTDs activation-reward response (BAS-RR) was significantly lower than ADs and NCs, though their activation-drive (BAS-D) was significantly higher than in ADs. Both AD and rtFTD patients had abnormally low activation fun-seeking (BAS-FS) scores. BIS score correlated positively with right anterior cingulate and middle frontal gyrus volume, as well as volume in the right precentral gyrus and left insula/operculum.
  
  
  CONCLUSIONS
  AD, bvFTD, and rtFTD patients show divergent patterns of change in approach/withdrawal reactivity. High BIS scores correlated with preservation of right-predominant structures involved in task control and self-protective avoidance of potentially negative reinforcers. Damage to these regions in bvFTD may create a punishment insensitivity that underlies patients' lack of self-consciousness in social contexts.
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California ; Department of Psychiatry, Jikei University School of Medicine Tokyo, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Shinagawa
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Adhimoolam
authors.initials: A
authors.lastname: Babu
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Virginia
authors.initials: V
authors.lastname: Sturm
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Tal
authors.initials: T
authors.lastname: Shany-Ur
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Parnian
authors.initials: P
authors.lastname: Toofanian Ross
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Diana
authors.initials: D
authors.lastname: Zackey
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Pardis
authors.initials: P
authors.lastname: Poorzand
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Grossman
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Miller
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California San Francisco, California.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Rankin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D004644:Emotions / Q000502:physiology; D005260:Female; D057180:Frontotemporal Dementia / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D011678:Punishment; D012201:Reward; D012919:Social Behavior
keywords: Alzheimer’s disease; behavior inhibition; dementia; frontotemporal dementia; neurodegeneration; social concern; voxel-based morphometry