Saini Dinesh, Mukherjee Adreesh, Roy Arijit, Biswas Atanu
Department of Neurology, Bangur Institute of Neurosciences, and Institute of Post Graduate Medical Education and Research, Kolkata, India.
Dement Geriatr Cogn Dis Extra. 2020 Dec 15;10(3):182-194. doi: 10.1159/000512042. eCollection 2020 Sep-Dec.
Executive dysfunction is the common thread between pure cortical dementia like the behavioral variant of frontotemporal dementia (bvFTD) and subcortical dementia like Parkinson's disease dementia (PDD). Although there are clinical and cognitive features to differentiate cortical and subcortical dementia, the behavioral symptoms differentiating these 2 conditions are still not well known.
To evaluate the behavioral profile of bvFTD and PDD and compare them to find out which behavioral symptoms can differentiate between the two.
Twenty consecutive patients with bvFTD (>1 year after diagnosis) and 20 PDD patients were recruited according to standard diagnostic criteria. Behavioral symptoms were collected from the reliable caregiver by means of a set of questionnaires and then compared between the 2 groups.
bvFTD patients had more severe disease and more behavioral symptoms than PDD. bvFTD patients were different from PDD patients due to their significantly greater: loss of basic emotion ( < 0.001, odds ratio [OR] 44.33), loss of awareness of pain ( < 0.001, OR 44.33), disinhibition ( < 0.001, OR 35.29), utilization phenomenon ( = 0.008, OR 22.78), loss of taste discrimination ( < 0.001, OR 17), neglect of hygiene ( = 0.001, OR 13.22), loss of embarrassment ( = 0.003, OR 10.52), wandering ( = 0.004, OR 9.33), pacing ( = 0.014, OR 9), selfishness ( = 0.014, OR 9), increased smoking ( = 0.014, OR 9), increased alcohol consumption ( = 0.031, OR 7.36), social avoidance ( = 0.012, OR 6.93), mutism ( = 0.041, OR 5.67), and failure to recognize objects ( = 0.027, OR 4.33). The bvFTD patients were also significantly less suspicious ( = 0.001, OR 0.0295), less inclined to have a false belief that people were in their home ( = 0.014, OR 0.11) and had fewer visual illusions/hallucinations ( = 0.004, OR 0.107) than PDD patients.
Behavioral symptoms are helpful to distinguish bvFTD from PDD, and thus also cortical dementia with frontal-lobe dysfunction from subcortical dementia.
执行功能障碍是诸如额颞叶痴呆行为变异型（bvFTD）等纯皮质性痴呆与诸如帕金森病痴呆（PDD）等皮质下痴呆之间的共同特征。尽管存在区分皮质性和皮质下痴呆的临床和认知特征，但区分这两种情况的行为症状仍未完全明确。
评估bvFTD和PDD的行为特征并进行比较，以找出哪些行为症状可区分两者。
根据标准诊断标准招募了20例连续的bvFTD患者（诊断后超过1年）和20例PDD患者。通过一组问卷从可靠的照料者处收集行为症状，然后在两组之间进行比较。
bvFTD患者比PDD患者病情更严重，行为症状更多。bvFTD患者与PDD患者不同，因为他们在以下方面明显更严重：基本情感丧失（<0.001，优势比[OR]44.33）、痛觉丧失（<0.001，OR 44.33）、脱抑制（<0.001，OR 35.29）、利用现象（=0.008，OR 22.78）、味觉辨别丧失（<0.001，OR 17）、忽视卫生（=0.001，OR 13.22）、尴尬感丧失（=0.003，OR 10.52）、徘徊（=0.004，OR 9.33）、踱步（=0.014，OR 9）、自私（=0.014，OR 9）、吸烟增加（=0.014，OR 9）、饮酒增加（=0.031，OR 7.36）、社交回避（=0.012，OR 6.93）、缄默（=0.041，OR 5.67）以及物体识别障碍（=0.027，OR 4.33）。与PDD患者相比，bvFTD患者的怀疑程度也显著更低（=0.001，OR 0.0295），较少倾向于错误地认为有人在家中（=0.014，OR 0.11），并且视幻觉/幻视较少（=0.004，OR 0.107）。
行为症状有助于区分bvFTD与PDD，从而也有助于区分额叶功能障碍的皮质性痴呆与皮质下痴呆。
