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Research paper
Tracking the progression of social cognition in neurodegenerative disorders
  1. Fiona Kumfor1,2,3,
  2. Muireann Irish1,3,4,
  3. Cristian Leyton1,3,
  4. Laurie Miller3,5,6,
  5. Suncica Lah3,6,
  6. Emma Devenney1,2,3,
  7. John R Hodges1,2,3,
  8. Olivier Piguet1,2,3
  1. 1Neuroscience Research Australia, Sydney, New South Wales, Australia
  2. 2School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
  3. 3ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
  4. 4School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
  5. 5Neuropsychology Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  6. 6School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Fiona Kumfor, Neuroscience Research Australia, PO Box 1165, Randwick, NSW 2031, Australia; f.kumfor{at}


Background and purpose Behavioural-variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) patients experience behavioural and emotion recognition alterations, yet understanding of how socioemotional processing is affected with disease progression is minimal. Additionally, evidence suggests that bvFTD patients with limited brain atrophy on neuroimaging at presentation (bvFTD-la) have a more benign course than those with marked atrophy (bvFTD-ma). Longitudinal investigation of these patients, however, is lacking.

Methods We investigated general cognition, emotion recognition and sarcasm detection in 20 bvFTD (8 with limited brain atrophy) and 17 AD patients longitudinally and used mixed models analyses to determine the level and rates of decline across groups over time.

Results At baseline, all patient groups performed worse than controls on general cognition and emotion recognition measures. The bvFTD-ma group showed significant impairment on the sarcasm detection task compared with controls. Longitudinally, an overall effect of time was present for general cognition (p<0.001); however, the rate of decline did not differ across groups. Trends for interactions between time and diagnosis were observed for both emotion recognition tasks (p=0.055; p=0.062), with the bvFTD-ma group declining more rapidly than AD or bvFTD-la groups. On the sarcasm detection task, the bvFTD-ma and AD patients declined, whereas bvFTD-la patients remained stable over time (p=0.002).

Conclusions Tasks of sarcasm detection represent a clinically useful tool to differentiate between bvFTD and AD at baseline. Furthermore, tasks of socioemotional functioning can track progression within bvFTD and identify bvFTD patients more likely to show a faster rate of decline.

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