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Research paper
Differentiating between right-lateralised semantic dementia and behavioural-variant frontotemporal dementia: an examination of clinical characteristics and emotion processing
  1. Jody Kamminga1,2,
  2. Fiona Kumfor1,3,4,
  3. James R Burrell1,3,4,
  4. Olivier Piguet1,3,4,
  5. John R Hodges1,3,4,
  6. Muireann Irish1,2,4
  1. 1Neuroscience Research Australia, Sydney, New South Wales, Australia
  2. 2School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
  3. 3School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
  4. 4Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
  1. Correspondence to Dr Muireann Irish, Neuroscience Research Australia, Barker Street, Randwick, Sydney, NSW 2031, Australia; m.irish{at}neura.edu.au

Abstract

Background and purpose Right-lateralised semantic dementia (right SD) and behavioural-variant frontotemporal dementia (bvFTD) appear clinically similar, despite different patterns of underlying brain changes. This study aimed to elucidate distinguishing clinical and cognitive features in right SD versus bvFTD, emphasising emotion processing and its associated neural correlates.

Methods 12 patients with right SD and 19 patients with bvFTD were recruited. Clinical features were documented. All patients were assessed on standardised neuropsychological tests and a facial emotion processing battery. Performance was compared to 20 age-matched and education-matched controls. Grey matter intensity was related to emotion processing performance using whole-brain voxel-based morphometry analysis.

Results Patients with right SD exhibited disproportionate language dysfunction, prosopagnosia and a suggestion of increased obsessive personality/behavioural changes versus patients with bvFTD. In contrast, patients with bvFTD demonstrated pronounced deficits in attention/working memory, increased apathy and greater executive dysfunction, compared to patients with right SD. Decreased empathy, disinhibition and diet changes were common to both dementia subtypes. Emotion processing deficits were present in both FTD syndromes but were associated with divergent patterns of brain atrophy. In right SD, emotion processing dysfunction was associated with predominantly right medial and lateral temporal integrity, compared to mainly left temporal, inferior frontal and orbitofrontal and right frontal gyrus integrity in bvFTD.

Conclusions This study demonstrates comparable deficits in facial emotion processing in right SD and bvFTD, in keeping with their similar clinical profiles. These deficits are attributable to divergent neural substrates in each patient group, namely, right lateralised regions in right SD, versus predominantly left lateralised regions in bvFTD.

  • FRONTAL LOBE
  • DEMENTIA
  • MRI
  • NEUROPSYCHOLOGY
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