title: Neural correlates of reduced awareness in instrumental activities of daily living in frontotemporal dementia.
abstract: A decline in instrumental activities of daily living has been described as the earliest functional deficit in patients with neurodegenerative disease. It embraces specific competencies such as: "recalling the date and telephone calls, orienting to new places, remembering the location of objects at home, understanding conversation and the plot of a movie, keeping belongings in order, doing mental calculations and handling money, remembering appointments and shopping lists and performing clerical work". Since changes in instrumental daily living activities are one of the descriptors of behavioural-variant frontotemporal dementia, we decided to investigate the neural correlates of a reduced awareness in this specific domain in twenty-three consecutive behavioural-variant frontotemporal dementia patients. Gray matter volume changes associated with a reduced awareness for the instrumental domain, assessed using a validated caregiver-patient discrepancy questionnaire, were examined. Interestingly, we found disabilities in instrumental daily living activities and a reduced awareness of these to be related to medial prefrontal cortex atrophy, where the mid-cingulate cortices, dorsal anterior insula and cuneous play an important role. Importantly, if the executive system does not function correctly, the comparator mechanism of action self-monitoring does not detect mismatches between the current and previous performance states stored in the personal database, and produces a reduced awareness for the instrumental domain.
authors.affiliation: Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy; Centro Interdipartimentale di Studi Avanzati in Neuroscienze, National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy. Electronic address: martina.amanzio@unito.it.
authors.forename: Martina
authors.initials: M
authors.lastname: Amanzio
authors.affiliation: Neuroradiology, Department of Neuroscience, Neuroradiology, Via Cherasco 15, 10126, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: D'Agata
authors.affiliation: Neurology II, Department of Neuroscience, Neurology II, Via Cherasco 15, 10126 Turin, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Palermo
authors.affiliation: Neurology I and Alzheimer Evaluation Unit, Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rubino
authors.affiliation: Neurology I and Alzheimer Evaluation Unit, Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Zucca
authors.affiliation: Nuclear Medicine, AOU Cittá della Salute e della Scienza, C.so Bramante 88, 10126, Turin, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Galati
authors.affiliation: Neurology I and Alzheimer Evaluation Unit, Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pinessi
authors.affiliation: Nuclear Medicine, AOU Cittá della Salute e della Scienza, C.so Bramante 88, 10126, Turin, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Castellano
authors.affiliation: Centro Interdipartimentale di Studi Avanzati in Neuroscienze, National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy; Neurology I and Alzheimer Evaluation Unit, Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors.forename: Innocenzo
authors.initials: I
authors.lastname: Rainero
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001284:Atrophy; D001364:Awareness; D005260:Female; D057180:Frontotemporal Dementia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007558:Italy; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009929:Organ Size
keywords: awareness of deficit questionnaire - dementia scale; behavioural variant frontotemporal dementia; instrumental activities of daily living; magnetic resonance imaging; voxel-based morphometry