Fronto-striatal atrophy correlates of neuropsychiatric dysfunction in frontotemporal dementia (FTD) and Alzheimer's disease (AD)

Abstract

Behavioural disturbances in frontotemporal dementia (FTD) are thought to reflect mainly atrophy of cortical regions. Recent studies suggest that subcortical brain regions, in particular the striatum, are also significantly affected and this pathology might play a role in the generation of behavioural symptoms.OBJECTIVETo investigate prefrontal cortical and striatal atrophy contributions to behavioural symptoms in FTD.METHODSOne hundred and eighty-two participants (87 FTD patients, 39 AD patients and 56 controls) were included. Behavioural profiles were established using the Cambridge Behavioural Inventory Revised (CBI-R) and Frontal System Behaviour Scale (FrSBe). Atrophy in prefrontal (VMPFC, DLPFC) and striatal (caudate, putamen) regions was established via a 5-point visual rating scale of the MRI scans. Behavioural scores were correlated with atrophy rating scores.RESULTSBehavioural and atrophy ratings demonstrated that patients were significantly impaired compared to controls, with bvFTD being most severely affected. Behavioural-anatomical correlations revealed that VMPFC atrophy was closely related to abnormal behaviour and motivation disturbances. Stereotypical behaviours were associated with both VMPFC and striatal atrophy. By contrast, disturbance of eating was found to be related to striatal atrophy only.CONCLUSIONFrontal and striatal atrophy contributed to the behavioural disturbances seen in FTD, with some behaviours related to frontal, striatal or combined fronto-striatal pathology. Consideration of striatal contributions to the generation of behavioural disturbances should be taken into account when assessing patients with potential FTD.

Fronto-Striatal Atrophy in Behavioral Variant Frontotemporal Dementia and Alzheimer’s Disease

“…Given the importance of the connections between VMPFC and ventral striatum ( 23 , 45 ) and the role of this ventral circuit in reward-guided choice behavior ( 54 ), the conjunctive and respective investigations of the VMPFC and ventral striatum could represent promising ways to enhance the diagnosis of bvFTD. This dovetails nicely with previous findings, such as the association between disinhibition and fronto-striatal atrophy in bvFTD ( 17 , 55 ), as well as other behavioral features, such as apathy, reduced empathy, and aberrant motor behavior ( 56 , 57 ). Finally, some studies have also reported that atrophy of the striatum directly predicts executive, language, and psychomotor dysfunctions and poorer general cognition ( 10 , 13 ).…”

An investigation of care-based vs. rule-based morality in frontotemporal dementia, Alzheimer's disease, and healthy controls

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Immoral behaviour following brain damage: A review

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