Metacognitive deficits in frontotemporal dementia.

Area of Science:

• Neuroscience
• Cognitive Psychology
• Neurology

Background:

• Frontotemporal dementia (FTD) is a neurodegenerative disease affecting behavior, personality, and language.
• Metacognitive functions, including self-awareness and self-monitoring, are crucial for social interaction and daily functioning.
• Impairments in self-awareness have been anecdotally reported in FTD but require systematic investigation.

Purpose of the Study:

• To investigate metacognitive impairments in self-awareness and self-monitoring in patients with FTD.
• To determine if these impairments are more pronounced in FTD subtypes with social and dysexecutive deficits.
• To compare metacognitive abilities in FTD patients with those in Alzheimer's disease (AD) and healthy controls.

Main Methods:

• Patients with FTD (categorized by subtype: social-dysexecutive, aphasic) and probable AD were compared with healthy controls.
• Behavioral self-ratings were compared with caregiver ratings.
• Self-ratings of performance on cognitive tasks (verbal fluency, memory) were compared with actual performance.

Main Results:

• FTD patients exhibited significantly reduced behavioral self-awareness and self-knowledge compared to AD and control groups.
• FTD patients with social and dysexecutive impairments showed the most severe self-awareness deficits, overrating themselves and failing to recognize behavioral changes.
• All clinical groups were unaware of their apathy levels; most FTD patients adequately judged cognitive task performance, with some exceptions.

Conclusions:

• FTD patients, particularly those with social and dysexecutive impairments, display profound metacognitive anosognosia (lack of self-awareness).
• This anosognosia is likely linked to prefrontal cortex dysfunction.
• Other FTD subtypes and AD patients showed less widespread metacognitive deficits.