Bertoux Maxime, de Souza Leonardo Cruz, O'Callaghan Claire, Greve Andrea, Sarazin Marie, Dubois Bruno, Hornberger Michael
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Institut de la Mémoire et de la Maladie d'Alzheimer, Pitié-Salpêtrière Hospital, Paris, France.
J Alzheimers Dis. 2016;49(4):1065-74. doi: 10.3233/JAD-150686.
Relative sparing of episodic memory is a diagnostic criterion of behavioral variant frontotemporal dementia (bvFTD). However, increasing evidence suggests that bvFTD patients can show episodic memory deficits at a similar level as Alzheimer's disease (AD). Social cognition tasks have been proposed to distinguish bvFTD, but no study to date has explored the utility of such tasks for the diagnosis of amnestic bvFTD. Here, we contrasted social cognition performance of amnestic and non-amnestic bvFTD from AD, with a subgroup having confirmed in vivo pathology markers. Ninety-six participants (38 bvFTD and 28 AD patients as well as 30 controls) performed the short Social-cognition and Emotional Assessment (mini-SEA). BvFTD patients were divided into amnestic versus non-amnestic presentation using the validated Free and Cued Selective Reminding Test (FCSRT) assessing episodic memory. As expected, the accuracy of the FCSRT to distinguish the overall bvFTD group from AD was low (69.7% ) with ∼50% of bvFTD patients being amnestic. By contrast, the diagnostic accuracy of the mini-SEA was high (87.9% ). When bvFTD patients were split on the level of amnesia, mini-SEA diagnostic accuracy remained high (85.1% ) for amnestic bvFTD versus AD and increased to very high (93.9% ) for non-amnestic bvFTD versus AD. Social cognition deficits can distinguish bvFTD and AD regardless of amnesia to a high degree and provide a simple way to distinguish both diseases at presentation. These findings have clear implications for the diagnostic criteria of bvFTD. They suggest that the emphasis should be on social cognition deficits with episodic memory deficits not being a helpful diagnostic criterion in bvFTD.
情景记忆相对保留是行为变异型额颞叶痴呆（bvFTD）的一项诊断标准。然而，越来越多的证据表明，bvFTD患者的情景记忆缺陷程度可与阿尔茨海默病（AD）患者相似。社会认知任务已被提出用于鉴别bvFTD，但迄今为止尚无研究探讨此类任务在遗忘型bvFTD诊断中的效用。在此，我们对比了遗忘型和非遗忘型bvFTD与AD患者的社会认知表现，其中一个亚组有已证实的活体病理标志物。96名参与者（38名bvFTD患者、28名AD患者以及30名对照）进行了简短的社会认知与情感评估（mini-SEA）。使用经过验证的评估情景记忆的自由和线索选择性回忆测试（FCSRT），将bvFTD患者分为遗忘型和非遗忘型表现。正如预期的那样，FCSRT区分整体bvFTD组与AD组的准确性较低（69.7%），约50%的bvFTD患者为遗忘型。相比之下，mini-SEA的诊断准确性较高（87.9%）。当根据遗忘程度对bvFTD患者进行划分时，mini-SEA对遗忘型bvFTD与AD的诊断准确性仍然很高（85.1%），而对非遗忘型bvFTD与AD的诊断准确性则提高到非常高（93.9%）。无论是否存在遗忘，社会认知缺陷都能在很大程度上区分bvFTD和AD，并提供了一种在初诊时区分这两种疾病的简单方法。这些发现对bvFTD的诊断标准具有明确的意义。它们表明，应强调社会认知缺陷，而情景记忆缺陷在bvFTD中并非有用的诊断标准。
