Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations
Eric Mitchell1, Tamara P Tavares1, Lena Palaniyappan2
1Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada.
Insights
Hoarding and obsessive-compulsive behaviors in frontotemporal dementia (FTD) are distinct. Left temporal lobe degeneration is linked to hoarding, while OCB involves different brain regions, suggesting partial dissociation.
Area of Science:
- Neuroscience
- Neurology
- Psychiatry
Background:
- Hoarding and obsessive-compulsive behaviors (OCB) are recognized symptoms in frontotemporal dementia (FTD).
- Existing models differentiate hoarding and OCB, but their separate examination and neuroanatomical correlates in FTD patients remain underexplored.
- This study investigates the distinct neuroanatomical underpinnings of hoarding and OCB in FTD.
Purpose of the Study:
- To examine the neuroanatomical correlates of hoarding and OCB in patients with frontotemporal dementia (FTD).
- To determine if hoarding and OCB are clinically and anatomically dissociable in FTD.
- To contribute to understanding the neural basis of hoarding and OCB in the general population.
Main Methods:
- Quantitative MRI volumetric analysis of cortical thickness and subcortical volumes was performed on 49 FTD patients.
- FreeSurfer software was used for neuroanatomical analyses.
- Patients were evaluated between 2004 and 2018.
Main Results:
- New hoarding behaviors were observed in 29% of FTD patients, more common in the semantic variant.
- New or increased OCB were present in 49% of patients.
- Hoarding was associated with reduced left temporal, insular, and anterior cingulate cortical thickness; OCB with reduced anterior cingulate and bilateral amygdala/hippocampal volumes, and greater right temporal cortical thickness.
Conclusions:
- Degeneration of the left temporal lobe is implicated in hoarding emergence in FTD, particularly the semantic variant.
- Hoarding and OCB appear to be clinically and anatomically partially dissociable in FTD.
- Findings may inform understanding of hoarding and OCB in individuals without dementia.
Background:
Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010).
Methods:
Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer.
Results:
Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding.
Discussion:
The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.
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