Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

Few studies have reported neuropsychiatric symptoms (NPS) in Primary Progressive Aphasia (PPA), a neurodegenerative disorder that primarily affects the left hemisphere. Depression is associated with left-sided stroke, but it remains unclear if depression and other NPS are also associated with PPA. The authors compared the frequency of NPS in 55 cases of PPA with 110 cognitively normal persons matched for age, sex and education. Depression, apathy, agitation, anxiety, appetite change, and irritability are associated with PPA. Hallucinations, delusion and night time behavior were not associated with PPA.

RESUMOEste estudo avaliou as associações e dissociações encontradas entre déficits de memória episódica em relação aos de funções executivas e verificou se estes déficits encontrados eram primários ou secundários. Os 81 pacientes pós-Traumatismo Cranioencefálico (TCE) foram avaliados por meio do Teste de Aprendizagem Auditivo-Verbal de Rey e do Teste Hayling. Os resultados sugerem que prejuízo na velocidade de controle inibitório pode contribuir para déficit na memória episódica e que as velocidades de iniciação e inibição parecem ser complementares, mas a primeira precede a segunda. Nossos achados ressaltam que os prejuízos executivos provavelmente sejam primários em nossa amostra de pacientes pós-TCE e que estes prejuízos podem causar déficits na memória episódica.Palavras-chave: traumatismo cranioencefálico; memória episódica; funções executivas; iniciação; inibição. ABSTRACT Primary and Secondary Executive Function Deficits Following TBI: analysis of dissociationsThe present study evaluated the presence of associations and dissociations between impairments in episodic memory and executive functions in patients with traumatic brain injury (TBI), and verified whether these deficits were primary or secondary. Eighty-one patients with TBI were assessed using the Rey Auditory Verbal Learning Test and the Hayling Test. The results suggest that impairments in inhibition speed may contribute to deficits in episodic memory, and that initiation and inhibition abilities may be complementary and the first precedes the second. Our findings highlighted that primary executive impairment following TBI may lead to episodic memory deficits.

Background Neuropsychiatric symptoms (NPS) are common in neurodegenerative disorders such as Alzheimer’s disease/Mild Cognitive Impairment (AD/MCI), Parkinson’s disease (PD), Frontotemporal Dementia (FTD), Amyotrophic Lateral Sclerosis (ALS) and in those with Cerebrovascular disease (CVD). The relationship between symptoms, cognition, and function in these cohorts is unclear. Method Data was obtained from the Ontario Neurodegenerative Disease Research Initiative study. We used the Neuropsychiatric Inventory Questionnaire‐ severity scale (NPIQ) to measure NPS, Montreal Cognitive Assessment (MoCA) for cognition, and Lawton’s informant based questionnaires to measure basic and instrumental activities of daily living (ADLs/iADLs). Linear regression was performed to investigate the effects of NPS on ADL and iADL function while controlling for age, education and cognition. Results were bootstrapped by resampling residuals (n=1,000) to control for non‐normal sample distribution. Result 520 participants were enrolled: AD/MCI (n=126), VCD (n=161), PD (n=140), FTD (n=53), and ALS (n=40). There were significant differences between these cohorts on NPIQ scores (AD/MCI=16.77±0.18, VCD=16.94±0.12, PD=16.34±0.17, FTD=21.44±0.15, ALS=14.19±0.22, p < .001). Across combined cohorts, NPIQ was inversely correlated with MoCA (rs=‐0.15, p=.001), iADLs (rs=‐0.32, p<.001), and ADLs (rs=‐0.34, p<.001). NPIQ (alone) predicted iADLs in FTD, and (together with MoCA) in MCI/AD and PD (Corrected p values < .05) but not in CVD or ALS. Further, NPIQ alone predicted ADLs in AD/MCI, FTD and PD (Corrected p values < .05) but not in VCD or ALS. Conclusion NPS burden was different across neurodegenerative disease cohorts. NPS were the main determinants of function in FTD, and in AD/MCI and PD when combined with cognition. However, NPS did not determine function in VCD or ALS. These findings indicate the need for further research into biomarkers of NPS and function, and targets of clinical interventions in neurodegenerative disorders.