Self-appraisal in behavioural variant frontotemporal degeneration

Abstract

Objective Previous work investigating deficits in self-appraisal in behavioural-variant frontotemporal degeneration (bvFTD) has focused on a single domain: social/behavioural processes. We examined whether a domain-specific versus multi-domain model best explains degraded self-appraisal in bvFTD. Methods 49 patients with bvFTD and 73 patients with Alzheimer’s disease (AD) were administered quantitative assessments of episodic memory, naming and grammatical comprehension. Self-appraisal of cognitive test performance was assessed by asking patients to rate their performance immediately after completing each neuropsychological test. A discrepancy score was created to reflect the difference between patient performance on neuropsychological tests and self-appraisal of their test performance. Self-appraisal for each neuropsychological measure was related to grey matter (GM) density in each group using voxel-based morphometry. Results bvFTD patients were poor at evaluating their own performance on all cognitive tests, with no significant correlations between self-appraisal and actual performance. By contrast, poor self-appraisal in AD was restricted to episodic memory performance. Poor self-appraisal on each task in bvFTD and AD was related to reduced GM density in several ventral and rostral medial prefrontal regions. Crucially, poor self-appraisal for all domains in bvFTD was related to a specific area of reduced GM density in the subgenual cingulate (BA 25). Conclusion Poor self-appraisal in bvFTD affects multiple domains, and this multi-domain impairment pattern is associated with frontal disease in the subgenual cingulate.

A Systematic Review of Metacognitive Differences Between Alzheimer’s Disease and Frontotemporal Dementia

“…Rather than measuring test performance, the focus is placed on the accuracy of these test judgments as an indicator of monitoring awareness. The objectivity of 2 of these 3 primary techniques has become a concern 16 (for a recent review, see Cosentino 17 ). For example, as noted by Massimo et al, 16 informants (typically caregivers or family members) may not be completely unbiased when providing an estimate of an individual's awareness.…”

“…Unfortunately, although FDA-approved medications exist for AD, no FDA-approved medications currently exist for FTD, frequently resulting in the use of AD medications-including anticholinesterase-by individuals with FTD. 14 Although some research suggests an ability to differentiate between AD and FTD on a neural basis, such as through structural imaging, 16 these methods are expensive and time consuming. Such difficulties may be addressed through metacognitive assessment, a low-cost means of identifying cognitive deficits.…”

Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review

“…Self-awareness referred to the capacity to reflect upon and identify with one's own abilities, attitudes and behavior 33 . Self-appraisal was related to impaired awareness of one's own abilities 35 . Cognitive insight was defined as a PwD current capacity to evaluate his or her anomalous experiences and atypical interpretations of events 38 .…”

“…Different concepts were used to define the construct of awareness [12][13][14][15][16][17][18][19][20] , anosognosia [21][22][23][24][25][26][27][28][29][30][31][32] , self-awareness 33,34 , self -appraisal 35 , insight 36,37 , cognitive insight 38 , metacognition [39][40][41] , unawareness of deficits 42 , awareness of deficit 43,44 , awareness of disease 1,45 , awareness of functioning 46 , awareness of cognitive deficits 47 , awareness of disabilities 48 , awareness of performance 49 , unawareness of memory 42,[50][51][52] , anosognosia of memory 53 , awareness of memory deficits 54,55 , awareness of memory function and functional abilities 56 , unawareness of psychosis or behavioral problems …”

“…Among them, 13 evaluated only this domain 20,23,27,38,39,41,44,47,[50][51][52][53]55 . Ten studies evaluated awareness of cognitive and functional deficits domains 1,18,20,[33][34][35]40,45,46,54 , nine assessed cognitive and social-emotional functioning domains 12,13,17,24,28,30,36,37,49 , and three focused on cognitive and behavioral impairment domains 14,16,42 . Three researches compared awareness of cognitive, functional and behavioral impairment domains 22,25,32 and four studied the recognition of cognitive, functional, and social-emotional 15,19,29,43 .…”