Scherling Carole S, Zakrzewski Jessica, Datta Samir, Levenson Robert W, Shimamura Arthur P, Sturm Virginia E, Miller Bruce L, Rosen Howard J
Department of Neurology, UCSF Memory and Aging Center San Francisco, University of California, San Francisco, San Francisco, CA, United States.
Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.
Front Behav Neurosci. 2017 Oct 17;11:189. doi: 10.3389/fnbeh.2017.00189. eCollection 2017.
Anosognosia, or lack of awareness of one's deficits, is a core feature of the behavioral variant of frontotemporal dementia (bvFTD). We hypothesized that this deficit has its origins in failed emotional processing of errors. We studied autonomic and facial emotional reactivity to errors in patients with bvFTD ( = 17), Alzheimer's disease (AD, = 20), and healthy controls (HC, = 35) during performance of a timed two-alternative-choice button press task. Performance-related behavioral responses to errors were quantified using rates of error correction and post-error slowing of reaction times. Facial emotional responses were measured by monitoring facial reactivity via video and subsequently coding the type, duration and intensity of all emotional reactions. Skin conductance response (SCR) was measured via noninvasive sensors. SCR and total score for each facial emotion expression were quantified for each trial. Facial emotions were grouped into self-conscious (amusement, embarrassment) and negative (fear, sadness, anger, disgust, contempt) emotions. HCs corrected 99.4% of their errors. BvFTD patients corrected 94% (not statistically different compared with HC) and AD corrected 74.8% of their errors ( < 0.05 compared with HC and bvFTD). All groups showed similar post-error slowing. Errors in HCs were associated with greater facial reactivity and SCRs compared with non-error trials, including both negative and self-conscious emotions. BvFTD patients failed to produce self-conscious emotions or an increase in SCR for errors, although they did produce negative emotional responses to a similar degree as HCs. AD showed no deficit in facial reactivity to errors. Although, SCR was generally reduced in AD during error trials, they showed a preserved increase in SCR for errors relative to correct trials. These results demonstrate a specific deficit in emotional responses to errors in bvFTD, encompassing both physiological response and a specific deficit in self-conscious emotions, despite intact awareness and correction of errors. The findings provide a potential mechanism for anosognosia and possibly other behavioral abnormalities in bvFTD and highlight the importance of studying multiple channels of reactivity to errors, including performance related responses and emotional responses, in order to understand how impaired error processing could influence behavior.
疾病失认症，即对自身缺陷缺乏认知，是额颞叶痴呆行为变异型（bvFTD）的核心特征。我们推测这种缺陷源于对错误的情感处理失败。我们研究了bvFTD患者（n = 17）、阿尔茨海默病（AD，n = 20）患者及健康对照者（HC，n = 35）在执行限时二选一按键任务时对错误的自主神经和面部情绪反应。使用错误纠正率和错误后反应时减慢来量化与表现相关的对错误的行为反应。通过视频监测面部反应，随后对所有情绪反应的类型、持续时间和强度进行编码，以此测量面部情绪反应。通过无创传感器测量皮肤电反应（SCR）。对每个试验的SCR和每种面部情绪表达的总分进行量化。面部情绪分为自我意识情绪（娱乐、尴尬）和负面情绪（恐惧、悲伤、愤怒、厌恶、轻蔑）。HC组纠正了99.4%的错误。bvFTD患者纠正了94%（与HC组相比无统计学差异），AD患者纠正了74.8%的错误（与HC组和bvFTD组相比，P < 0.05）。所有组在错误后反应时减慢方面表现相似。与无错误试验相比，HC组的错误与更强的面部反应性和SCR相关，包括负面情绪和自我意识情绪。bvFTD患者对错误未能产生自我意识情绪或SCR增加，尽管他们产生负面情绪反应的程度与HC组相似。AD患者在对错误的面部反应性方面没有缺陷。虽然在错误试验期间AD患者的SCR总体降低，但相对于正确试验，他们在错误时SCR仍有保留的增加。这些结果表明，bvFTD患者在对错误的情绪反应方面存在特定缺陷，包括生理反应和自我意识情绪方面的特定缺陷，尽管对错误有完整的认知和纠正。这些发现为bvFTD中的疾病失认症及可能的其他行为异常提供了一种潜在机制，并强调了研究对错误的多种反应通道（包括与表现相关的反应和情绪反应）的重要性，以便理解错误处理受损如何影响行为。
