期刊
JOURNAL OF ALZHEIMERS DISEASE
卷 53, 期 3, 页码 801-816出版社
IOS PRESS
DOI: 10.3233/JAD-160175
关键词
Neurodegenerative diseases; orbitofrontal cortex; right hemisphere; social cognition; theory of mind
资金
- Australian Research Council Centre of Excellence in Cognition and its Disorders [CE110001021]
- ForeFront
- National Health and Medical Research Council of Australia Program Grant [1037746]
- ARC Discovery Researcher Early Career Award [DE130100463]
- NHMRC Senior Research Fellowship [APP1103258]
Loss of empathy is a core presenting feature of the behavioral-variant of frontotemporal dementia (bvFTD), resulting in socioemotional difficulties and behavioral transgressions. In contrast, interpersonal functioning remains relatively intact in Alzheimer's disease (AD), despite marked cognitive decline. The neural substrates mediating these patterns of loss and sparing in social functioning remain unclear, yet are relevant for our understanding of the social brain. We investigated cognitive versus affective aspects of empathy using the Interpersonal Reactivity Index (IRI) in 25 AD and 24 bvFTD patients and contrasted their performance with 22 age-and education-matched controls. Cognitive empathywas comparably compromised inADand bvFTD, whereas affective empathy was impaired exclusively in bvFTD. While controlling for overall cognitive dysfunction ameliorated perspective-taking deficits in AD, empathy loss persisted across cognitive and affective domains in bvFTD. Voxelbased morphometry analyses revealed divergent neural substrates of empathy loss in each patient group. Perspective-taking deficits correlated with predominantly left-sided temporoparietal atrophy in AD, whereas widespread bilateral frontoinsular, temporal, parietal, and occipital atrophy was implicated in bvFTD. Reduced empathic concern in bvFTD was associated with atrophy in the left orbitofrontal, inferior frontal, and insular cortices, and the bilateral mid-cingulate gyrus. Our findings suggest that social cognitive deficits in AD arise largely as a consequence of global cognitive dysfunction, rather than a loss of empathy per se. In contrast, loss of empathy in bvFTD reflects the deterioration of a distributed network of frontoinsular and temporal structures that appear crucial for monitoring and processing social information.
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