Neuroscience Research Australia, Sydney, NSW 2031, Australia.
Brain. 2012 Mar;135(Pt 3):678-92. doi: 10.1093/brain/aws011.
This review offers a critical appraisal of the literature on episodic memory performance in frontotemporal dementia. Historically, description of patients diagnosed with what was then known as Pick's disease included the presence of memory deficits and an underlying amnestic syndrome was noted in some of these patients. Over the last 20 years, however, the clinical view has been that episodic memory processing is relatively intact in the frontotemporal dementia syndrome. In particular, patients with the subtypes of behavioural variant frontotemporal dementia and progressive non-fluent aphasia are reported to perform within normal limits on standard memory tests. In the third clinical presentation of frontotemporal dementia, semantic dementia, relatively intact episodic memory against a significantly impaired semantic memory was regarded as the hallmark. This position was instrumental in the development of clinical diagnostic criteria for frontotemporal dementia in which amnesia was explicitly listed as an exclusion criterion for the disease. The relative intactness of episodic memory, therefore, appeared to be a useful diagnostic marker to distinguish early frontotemporal dementia from Alzheimer's disease, in which early episodic memory disturbance remains the most common clinical feature. We argue that recent evidence questions the validity of preserved episodic memory in frontotemporal dementia, particularly in behavioural variant frontotemporal dementia. In semantic dementia, a complex picture emerges with preservation of some components of episodic memory, notably recognition-based visual memory and recall of recent autobiographical events. We propose a critical synthesis of recent neuropsychological evidence on retrograde and anterograde memory in light of neuroimaging and neuropathological findings, demonstrating involvement of medial temporal structures in frontotemporal dementia, structures known to be critical for episodic memory processing. We further argue that the multifactorial nature of most memory tests commonly used clinically fail to capture the memory deficits in frontotemporal dementia and that sensitive assessment tools of memory are needed. Together, recent clinical and experimental findings and the historical evidence represent a strong case for a re-evaluation of the importance of memory disturbance in the clinical diagnosis of frontotemporal dementia.
这篇综述对额颞叶痴呆患者情景记忆表现的文献进行了批判性评估。历史上，对被诊断为当时所谓的皮克病的患者的描述包括存在记忆缺陷，并且在其中一些患者中注意到潜在的遗忘综合征。然而，在过去的 20 年中，临床观点一直认为额颞叶痴呆综合征中的情景记忆处理相对完整。特别是，行为变异额颞叶痴呆和进行性非流利性失语症的亚型患者在标准记忆测试中表现正常。在额颞叶痴呆的第三种临床表现语义性痴呆中，相对完整的情景记忆伴随着明显受损的语义记忆被认为是其标志。这种观点对额颞叶痴呆临床诊断标准的制定起到了重要作用，其中明确将遗忘列为该疾病的排除标准。因此，情景记忆的相对完整性似乎是区分早期额颞叶痴呆和阿尔茨海默病的有用诊断标志物，因为早期情景记忆障碍仍然是最常见的临床特征。我们认为，最近的证据质疑额颞叶痴呆中情景记忆保存的有效性，特别是在行为变异额颞叶痴呆中。在语义性痴呆中，出现了一个复杂的情况，即情景记忆的某些成分得到了保留，特别是基于识别的视觉记忆和最近自传事件的回忆。我们根据神经影像学和神经病理学发现，对逆行和顺行记忆的最近神经心理学证据进行了批判性综合，证明内侧颞叶结构参与了额颞叶痴呆，这些结构对于情景记忆处理至关重要。我们进一步认为，临床上常用的大多数记忆测试的多因素性质未能捕捉到额颞叶痴呆中的记忆缺陷，需要使用敏感的记忆评估工具。综上所述，最近的临床和实验发现以及历史证据有力地证明了需要重新评估记忆障碍在额颞叶痴呆临床诊断中的重要性。
