额颞叶痴呆患者同理心受损与普遍低情绪之间的差异。

Impaired Empathy Versus General Hypoemotionality in Frontotemporal Dementia.

机构信息

The Departments of Neurology, Psychiatry and Biobehavioral Sciences, and Medicine, Statistic Core, David Geffen School of Medicine, University of California at Los Angeles (Mendez, Jimenez); the VA Greater Los Angeles Healthcare System (Mendez, Carr, Jimenez); the Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles (Riedel, Thompson); and the Departments of Engineering, Neurology, Ophthalmology, Pediatrics, Psychiatry, and Radiology, University of Southern California, Los Angeles (Thompson).

出版信息

J Neuropsychiatry Clin Neurosci. 2019 Fall;31(4):378-385. doi: 10.1176/appi.neuropsych.18090202. Epub 2019 May 3.

DOI:10.1176/appi.neuropsych.18090202

PMID:31046591

Abstract

OBJECTIVE

Impaired empathy is a diagnostic feature of behavioral variant frontotemporal dementia (bvFTD), but it is not clear whether it is caused by a primary impairment in empathy or by general emotional blunting.

METHODS

Patients with bvFTD who met criteria for loss of empathy (N=10) and patients with Alzheimer's disease (N=15) were assessed with a measure for empathy (Socioemotional Dysfunction Scale [SDS]) and a measure for general emotion (Scale for Emotional Blunting [SEB]). All patients underwent neuroimaging. Both patient groups and a healthy control group (N=18) were evaluated by using autonomic responses (skin conductance responses [SCR]) to pictures from the Internal Affective Picture System (IAPS) (presence or absence of empathy stimuli and high versus low emotion).

RESULTS

All participants reported understanding the content and others' perspectives on the empathy pictures; however, only patients with bvFTD showed impaired empathic behavior on the SDS, which persisted after adjusting for measures from the emotion scale (SEB). Patients with bvFTD had significantly lower SCR for all the IAPS stimuli, including for empathy pictures, which also persisted after adjusting for emotional content. On MRI analysis, SCR across groups significantly correlated with the volume of the dorsal anterior cingulate gyrus (dACC).

CONCLUSIONS

These results indicate that patients with bvFTD have decreased empathic behavior with or without emotional blunting, and they exhibit decreased psychophysiological responses to empathy stimuli, independent of general emotion. These preliminary findings suggest a specific impairment in emotional empathy, possibly related to impairment of the emotional appraisal role of the dACC.

摘要

目的

同理心受损是行为变异额颞叶痴呆（bvFTD）的一个诊断特征，但尚不清楚同理心受损是原发性的，还是一般情绪迟钝导致的。

方法

符合同理心丧失标准的 bvFTD 患者（N=10）和阿尔茨海默病患者（N=15）接受同理心量表（社会情感功能障碍量表[SDS]）和一般情绪量表（情绪迟钝量表[SEB]）评估。所有患者均接受神经影像学检查。使用自主反应（皮肤电反应[SCR]）对来自内部情感图片系统（IAPS）的图片进行评估，对患者组和健康对照组（N=18）进行评估（有无同理心刺激以及高与低情绪）。

结果

所有参与者均报告理解同理心图片的内容和他人的观点；然而，只有 bvFTD 患者在 SDS 上表现出同理心行为受损，且在调整情绪量表（SEB）的测量值后仍持续存在。所有 IAPS 刺激（包括同理心图片）的 bvFTD 患者的 SCR 均显著降低，在调整情绪内容后仍持续存在。在 MRI 分析中，各组的 SCR 与背侧前扣带皮层（dACC）体积显著相关。