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Person-Based Versus Generalized Impulsivity Disinhibition in Frontotemporal Dementia and Alzheimer Disease

Pongsatorn Paholpak^1,2, Andrew R Carr^1,3, Joseph P Barsuglia³

¹1 Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.

Journal of Geriatric Psychiatry and Neurology

|September 21, 2016

Abstract

Background:

While much disinhibition in dementia results from generalized impulsivity, in behavioral variant frontotemporal dementia (bvFTD) disinhibition may also result from impaired social cognition.

Objective:

To deconstruct disinhibition and its neural correlates in bvFTD vs. early-onset Alzheimer's disease (eAD).

Methods:

Caregivers of 16 bvFTD and 21 matched-eAD patients completed the Frontal Systems Behavior Scale disinhibition items. The disinhibition items were further categorized into (1) "person-based" subscale which predominantly associated with violating social propriety and personal boundary and (2) "generalized-impulsivity" subscale which included nonspecific impulsive acts. Subscale scores were correlated with grey matter volumes from tensor-based morphometry on magnetic resonance images.

Results:

In comparison to the eAD patients, the bvFTD patients developed greater person-based disinhibition ( P < 0.001) but comparable generalized impulsivity. Severity of person-based disinhibition significantly correlated with the left anterior superior temporal sulcus (STS), and generalized-impulsivity correlated with the right orbitofrontal cortex (OFC) and the left anterior temporal lobe (aTL).

Conclusions:

Person-based disinhibition was predominant in bvFTD and correlated with the left STS. In both dementia, violations of social propriety and personal boundaries involved fronto-parieto-temporal network of Theory of Mind, whereas nonspecific disinhibition involved the OFC and aTL.

Keywords:

Alzheimer disease Frontal System Behavior Scale disinhibition frontotemporal dementia

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