Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina. fmanes @ ineco.org.ar
Dement Geriatr Cogn Disord. 2011;32(1):11-7. doi: 10.1159/000329912. Epub 2011 Aug 4.
The behavioral variant of frontotemporal dementia (bvFTD) is characterized by progressive changes in personality and social interaction, loss of empathy, disinhibition and impulsivity, most of which generally precede the onset of cognitive deficits. In this study, we investigated decision-making cognition in a group of patients with an early bvFTD diagnosis whose standard neuropsychological performance was within normal range for all variables.
The Iowa Gambling Task was administered to this group of early bvFTD patients, to a group of early bvFTD patients who had shown impaired performance on the classical neuropsychological battery and to healthy controls.
Decision-making was impaired in both bvFTD patient groups, whether they had shown impaired or normal performance in the classical neuropsychological evaluation.
Patients with early bvFTD may perform normally on standard cognitive tests, and yet develop severe deficits in judgment and decision-making. In many current legal systems, early bvFTD patients showing preserved cognitive functioning who commit unlawful acts run the risk of not being able to plead insane or not guilty on the grounds of diminished responsibility beyond reasonable doubt. This represents a unique legal and ethical dilemma. Our findings have important implications for medicolegal decisions relating to capacity and culpability, and regarding the philosophical concept of 'free will'.
行为变异额颞叶痴呆（bvFTD）的特征是人格和社会交往的逐渐改变，同理心、抑制和冲动的丧失，其中大多数通常在认知缺陷出现之前就已经出现。在这项研究中，我们研究了一组早期 bvFTD 诊断患者的决策认知能力，这些患者的标准神经心理学表现为所有变量均在正常范围内。
我们对这组早期 bvFTD 患者以及另一组在经典神经心理学测试中表现出受损的早期 bvFTD 患者进行了爱荷华赌博任务测试，同时对健康对照组进行了该测试。
无论在经典神经心理学评估中表现出受损或正常，两组 bvFTD 患者的决策能力都受损。
早期 bvFTD 患者可能在标准认知测试中表现正常，但在判断和决策方面会出现严重缺陷。在许多现行法律体系中，表现出认知功能正常的早期 bvFTD 患者如果实施违法行为，他们可能无法以合理怀疑为依据，以减轻责任或精神失常为由提出无罪或无罪抗辩。这代表了一个独特的法律和伦理困境。我们的发现对与能力和罪责有关的医学法律决策以及关于“自由意志”的哲学概念具有重要意义。
